The Nature of Mental Imagery and Its Relationship With Amotivational Psychopathology in People With Schizophrenia Spectrum Disorders.

Many people with schizophrenia spectrum disorders (SSDs) experience profound amotivation, which is strongly related to anticipatory anhedonia. Yet, the neuropsychological fundamentals of anticipatory anhedonia and amotivation are barely understood, resulting in a lack of effective treatments for these patients. Aberrancies in positive mental imagery may interfere with the anticipation of pleasure and could thus explain anticipatory anhedonia and amotivation. However, the nature of mental imagery and its relationship with amotivational psychopathology in SSD is largely unknown. In this preregistered study, we therefore examined mental imagery characteristics and their relation to anticipatory anhedonia, amotivation, and daily life activity in SSD. TheN = 86 participants included individuals with SSD (n = 43) and demographically matched healthy controls (n = 43). Mental imagery, anticipatory pleasure, amotivation, and activity engagement were assessed with structured interviews and self-report questionnaires. Ecological momentary assessment was used to measure state anticipatory pleasure and activity engagement in daily life (n = 81). Compared to the control group, the SSD group showed comparable quantity, but less vividness of mental imagery. Reduced vividness of mental imagery in SSD was significantly associated with higher anticipatory anhedonia, amotivation, and low activity engagement in cross-sectional and prospective analyses. Reduced mental imagery vividness may cause a lack of internal incentive to seek pleasurable experiences and could explain amotivation. Interventions aiming to improve mental imagery vividness and related anticipatory pleasure responses in SSD may be effective in targeting amotivation.

The Perceived Functions and Phenomenological Characteristics of Future Thinking and Clinically Significant Generalized Anxiety Disorder Symptoms.

Current research indicates that anxiety disorders and elevated levels of trait anxiety are associated with biases and impairments when thinking of personally relevant future events, that is, future thinking. However, to date, little research has been conducted into how people with symptoms of clinical anxiety perceive the functions of future thinking. The current study presents a cross-sectional survey comparing individuals with elevated symptoms of generalized anxiety disorder (GAD) and related functional impact (N = 51, 43.1% female, Mage = 33.1, SD = 10.2) matched on age and gender with individuals with no clinically significant symptoms of GAD (N = 51, 43.1% female, Mage = 33.3, SD = 10.1) on self-reported functions of future thinking and a battery of items assessing the phenomenological characteristics. The results indicated various significant differences in the perceived functions of future thinking and its phenomenological characteristics in those with elevated GAD symptoms. Broadly, they indicate more frequent future thinking and more commonly for self-distraction or processing negatively valenced future events, and generally less adaptive mental representations that support current thinking on the psychopathological process of increased worry, anxious arousal and maladaptive cognition in clinical anxiety symptoms.

The potential of Future Event Specificity Training (FEST) to decrease anhedonia and dampening of positive emotions: A randomised controlled trial.

Impaired episodic future thinking (EFT), as reflected in reduced specificity, low levels of detail and less use of mental imagery, has been associated with depressive symptomatology. The beneficial impact of Future Event Specificity Training (FEST) on impaired EFT has recently been demonstrated, as well as on anhedonia, the core symptom of depression reflecting low positive affect. The current study aimed to replicate these previous findings. In addition, this study is the first to examine the potential of FEST to reduce engagement in dampening, a maladaptive response style characterised by reducing the intensity and/or frequency of positive emotional states, which is linked to depressive symptoms and anhedonia. An RCT (FEST vs. waitlist control) was conducted in a large sample of Dutch-speaking undergraduate students (N = 155). In line with prior research, FEST resulted in significant improvements in EFT features. However, likely related to limited room for change detection, no significant changes were found in anhedonia and dampening. In the light of the positive impact of FEST on several EFT features, future studies should address methodological issues to create optimal conditions for potential change detection. Finally, further examination of the proposed theoretical change mechanisms aimed to reduce anhedonia and dampening is warranted.

Future thinking and anticipatory pleasure in adolescents with major depression: Association with depression symptoms and executive functions.

OBJECTIVE: Impairments in episodic future thinking and anticipatory pleasure were noted to explain the depressive symptoms in adults however similar studies are not there in adolescents. This study examined whether there are impairments in episodic future thinking and anticipatory pleasure in clinically-depressed adolescents as compared to non-depressed adolescents, and their association with depression when controlled for executive functions and anxiety symptoms among the depressed adolescents. METHODS: The study included 29 adolescents with major depression and 29 adolescents from local schools through convenient sampling technique. All the participants were assessed with standardized measures of depression and anxiety, episodic future thinking, anticipatory pleasure and executive functioning. RESULTS: Depressed adolescents significantly differed from the non-depressed adolescents in autobiographical memory specificity, anticipatory pleasure, and specific dimensions of executive functions. The ANCOVAs indicated executive function slightly attenuated group differences on future specificity which were still non-significant (all p's > .05). For memory specificity and for anticipatory pleasure, group differences were still significant at p < .05 level. CONCLUSION: Adolescents with major depressive episode may display similar, but less pronounced, impairments in future thinking than what is previously reported in adults. Though, autobiographical specificity is prominent. The deficits are attributable to depression than executive functioning deficits.

The association between trichotillomania symptoms and emotion regulation difficulties: A systematic review and meta-analysis.

BACKGROUND: Emotion regulation is postulated to play an important role in Trichotillomania (TTM). Whilst a growing number of studies have examined the relationship between emotion regulation difficulties and TTM symptoms, there have been no attempts to evaluate the overall strength of this association or the quality of the evidence base. METHOD: This systematic review and meta-analysis aimed to synthesise findings from studies that have examined the relationship between emotion regulation difficulties and TTM symptoms, to inform future TTM treatment targets. We identified 17 studies that met inclusion criteria. From these studies, 32 correlation coefficients were extracted for meta-analysis. The Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies was used to assess risk of bias amongst the included studies. RESULTS: There was a moderately sized association between TTM symptoms and ER difficulties, (r adjusted = 0.32, 95 % CI [0.28, 0.37], t = 15.58 (df = 11.86), p < 0.0001) that was moderated by sample size (F(df1 = 1, df2 = 30) = 4.597, b = -0.0001, SE = 0.0001, 95 % CI [-0.0002; 0.0000], p = 0.040) and differences between types of emotion regulation measures (Q(df = 1) = 4.06, p = 0.044). LIMITATIONS: The data analysed was correlational, therefore causality was unable to be determined. Comorbidities were not able to be examined as a moderator. CONCLUSION: This study provided a preliminary integration of the evidence and demonstrated that individuals with higher levels of TTM severity appear to exhibit decreased overall emotion regulation abilities and strategies.

Mindfulness, psychological flexibility and their relationship with psychopathology in persons with schizophrenia-spectrum-disorders and healthy controls - A multicenter cross-sectional study.

The precise nature of the relationship between mindfulness, psychological flexibility (PF) and psychopathology in schizophrenia spectrum disorders (SSD) remains largely unclear and warrants further investigation. We recruited 43 persons with SSD and 43 controls. Our findings revealed that SSD showed lower mindfulness and PF than controls. Mindfulness was associated with higher PS, anticipatory pleasure, behavioral activation, and lower depressive and negative symptoms. PS was associated with lower depressive and negative symptoms and higher anticipatory pleasure and behavioral activation. The outcomes imply that targeting mindfulness and PF may prove beneficial in alleviating the amotivational psychopathology exhibited in SSD.

Cognitive dependencies and psychological health correlates of coherence in autobiographical reasoning.

Autobiographical reasoning is a process by which an individual creates a coherent life account. The degree of coherence in autobiographical reasoning has been related to psychological health correlates such as depression and self-esteem in previous studies, but with inconsistent findings. Similarly, the basic psychological processes required to achieve coherence have been previously studied with regard to intelligence, but infrequently, and also with mixed findings. In the present study, we first developed and evaluated a German version of the Awareness of Narrative Identity Questionnaire (ANIQ) as an established measure of self-reported coherence. Second, we tested for cognitive dependencies on intelligence and memory indices. Third, we analysed its associations with psychological health correlates. We assessed a sample of 272 participants and thereof 189 participants again two-weeks later. Results supported the assumptions of the German ANIQ's psychometric qualities (factor structure, test-retest reliability, invariance) and validity (with regard to self-consciousness, self-concept clarity, and written accounts of personal turning points). We found coherence to be independent of intelligence and verbal memory, but partially dependent on figural memory. Coherence was related to depression, positivity, self-esteem, and self-esteem stability, but not to anxiety, substantiating its salutogenic effects.

Autobiographical memory and psychopathology: Is memory specificity as important as we make it seem?

Several decades of research have established reduced autobiographical memory specificity, or overgeneral memory, as an important cognitive factor associated with the risk for and maintenance of a range of psychiatric diagnoses. In measuring this construct, experimenters code autobiographical memories for the presence or absence of a single temporal detail that indicates that the remembered event took place on a single, specific, day (Last Thursday when I rode bikes with my son), or multiple days (When I rode bikes with my son). Studies indicate that the specificity of memories and the amount of other episodic detail that they include (e.g., who, what, and where) are related and may rely on the same neural processes to elicit their retrieval. However, specificity and detailedness are nonetheless separable constructs: imperfectly correlated and differentially associated with current and future depressive symptoms and other associated intrapersonal (e.g., rumination) and interpersonal (e.g., social support) outcomes. The ways in which the details of our memories align with narrative themes (i.e., agency, communion, identity) and the coherence with which these details are presented, are also emerging as important factors associated with psychopathology. The temporal specificity of autobiographical memories may be important, but other memory constructs warrant further attention in research and theory, especially given the associations, and dependencies, between each of these constructs. Researchers in this area must consider carefully whether their research questions necessitate a focus on autobiographical memory specificity or whether a more inclusive analysis of other autobiographical memory features is necessary and more fruitful. This article is categorized under: Psychology > Memory.

Structured data vs. unstructured data in machine learning prediction models for suicidal behaviors: A systematic review and meta-analysis.

Suicide remains a leading cause of preventable death worldwide, despite advances in research and decreases in mental health stigma through government health campaigns. Machine learning (ML), a type of artificial intelligence (AI), is the use of algorithms to simulate and imitate human cognition. Given the lack of improvement in clinician-based suicide prediction over time, advancements in technology have allowed for novel approaches to predicting suicide risk. This systematic review and meta-analysis aimed to synthesize current research regarding data sources in ML prediction of suicide risk, incorporating and comparing outcomes between structured data (human interpretable such as psychometric instruments) and unstructured data (only machine interpretable such as electronic health records). Online databases and gray literature were searched for studies relating to ML and suicide risk prediction. There were 31 eligible studies. The outcome for all studies combined was AUC = 0.860, structured data showed AUC = 0.873, and unstructured data was calculated at AUC = 0.866. There was substantial heterogeneity between the studies, the sources of which were unable to be defined. The studies showed good accuracy levels in the prediction of suicide risk behavior overall. Structured data and unstructured data also showed similar outcome accuracy according to meta-analysis, despite different volumes and types of input data.

Autobiographical memory impairments as a transdiagnostic feature of mental illness: A meta-analytic review of investigations into autobiographical memory specificity and overgenerality among people with psychiatric diagnoses.

Decades of research has examined the difficulty that people with psychiatric diagnoses have in recalling specific autobiographical memories of events that lasted less than a day. Instead, they seem to retrieve general events that have occurred many times or which occurred over longer periods of time, termed overgeneral memory. We present the first transdiagnostic meta-analysis of memory specificity/overgenerality and the first meta-regression of proposed causal mechanisms. A keyword search of Embase, PsycARTICLES, and PsycINFO databases yielded 74 studies that compared people with and without psychiatric diagnoses on the retrieval of specific (k = 85) or general memories (k = 56). The majority of studies included participants with Major Depressive Disorder (∼49%), Schizophrenia (∼19%), and Posttraumatic Stress Disorder (∼17%) with few studies involving other groups of participants, for example, Anxiety Disorders (∼5%). Multilevel meta-analysis confirmed that people with psychiatric diagnoses typically recall fewer specific, g = -0.864, 95% CI [-1.030, -0.698], and more general, g = 712, 95% CI [0.524, 0.900], memories than diagnoses-free people. The size of these effects did not differ between diagnostic groups. There were no consistent moderators of effect size heterogeneity; effect sizes were not explained by methodological factors such as cue valence or demographic variables such as participants' age or between-group differences in process variables (e.g., rumination). Deficits in autobiographical memory retrieval may be a transdiagnostic factor, but further research in underrepresented diagnostic groups, and with novel experimental manipulations of encoding and retrieval processes, is warranted before full transdiagnosticity and the processes underlying reduced specificity/overgenerality can be established. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sext Dissemination: Differences across Nations in Motivations and Associations.

Sext dissemination presents policy and legislative challenges given its potential psychological, social, and legal harms. We report on a cross-national comparison of sext-image dissemination in a large sample of 1148 young adults aged 18-29 years (M = 22.54, SD = 2.50, 53.0% women, 47.0% men), either U.S. (53.8%) or Australian (46.2%) residents. The results indicate that 14% of young adults disseminated sexts, with no difference by gender or country. Over 50% of respondents indicated that the last time they received a disseminated sext, it was unexpected or unwelcome, with women twice as likely as men to receive unwelcome sexts. The most frequent motivations for sext dissemination were similar cross-nationally, relating to the attractiveness of the person depicted, as a joke, to gossip, because it was not a big deal, bragging, roasting or teasing, and to increase social status. Motivations of attractiveness, bragging, or social status were more commonly endorsed by men, while women endorsed reasons around gossip or roasting/teasing. Unique predictors of sext dissemination included U.S. residence, requesting sexts, receiving disseminated sexts, having one's own images disseminated, and more positive subjective norms to dissemination, and there was a country-gender interaction, where Australian women and U.S. men were more likely to disseminate sexts than then U.S. women or Australian men. The findings have implications for prevention programs seeking to address harmful online sexual interactions, including addressing respect, consent, and subjective norms supporting non-consensual dissemination.

The current state of memory Specificity Training (MeST) for emotional disorders.

Memory Specificity Training (MeST) is an intervention developed from basic science that has found clinical utility. MeST uses cued recall exercises to target the difficulty that some people with emotional disorders have in recalling personally experienced events. MeST is simple enough to be delivered alongside traditional interventions or online by artificial intelligence. Currently, research indicates MeST's effects are immediate but short-lived, and there is limited research indicating its superiority over established interventions. Future investigations must establish the dosage and specific components of MeST that are necessary for clinically significant effects. Further, it must establish the secondary processes (e.g., problem-solving) that mediate between MeST-driven improvements in memory and symptoms. Similar interventions that build upon the idea of training autobiographical memory specificity are also emerging and warrant further investigation.

Cannabis use among early adolescents and transdiagnostic mental health risk factors.

INTRODUCTION: Cannabis is the most widely used psychoactive substance among adolescents worldwide, and the age at which consumption begins to decrease. Cannabis use in adolescents is associated with a wide range of adverse consequences in adulthood including increased vulnerability to psychosis and other mental disorders, as well as suicidal ideation and attempt. The aim of this study is to extend understanding of the link between cannabis use and mental illness by examining whether cannabis use at early ages predicts transdiagnostic variables that are precursors to severe clinical diagnoses. METHODS: A descriptive cross-sectional study was conducted. The sample was made up of 605 adolescents from 7th to 9th grades, with a mean age of 13.2 years (SD = 1.0, 47% girls). The variables evaluated were: anomalous perception of reality, intolerance of uncertainty, rumination, suicide attempt, hopelessness, and symptoms of depression and anxiety. The administration of the questionnaires was carried out in groups of 20 participants under the supervision of a researcher in a unique session of 1 hour. RESULTS: Adolescent cannabis users scored higher on all variables assessed: anomalous perception of reality (Cohen's d = .60), rumination (d = .48), intolerance of uncertainty (d = .11), suicidal attempt (affirmative answer: 25.9% of users vs 7.7% of non-users), hopelessness (d = .85), symptoms of depression (d = .80), and anxiety (d = .39). A binary logistic regression showed that the only variable uniquely related to cannabis use was hopelessness (Wald = 4.560, OR: 1.159, p = .033). CONCLUSIONS: Among some mental health risk factors, hopelessness appears uniquely related to cannabis use. Adolescents may use cannabis as a coping strategy for negative thoughts and emotions, or it may be a consequence of cannabis use. Future prevention programs should focus on preventing/treating modifiable factors such as hopelessness, and delaying cannabis use in specific subgroups of adolescents who experience pathologies such as depression or suicide attempts.

Specificity and detail in autobiographical memory retrieval: a multi-site (re)investigation.

This investigation examined conflicting suggestions regarding the association between problems retrieving specific autobiographical memories and the tendency to retrieve the details of these memories. We also examined whether these tendencies are differentially related to depression symptoms. U.S., Belgian, Hong Kong and Japanese participants retrieved memories related to cue words. Responses were coded for if they referred to a specific event (i.e., an event lasting less than 24 h) and their details (What? Where? Who?). Across sites, and in meta-analyses, the retrieval of more specific memories was associated with retrieval of more details. Memories that were specific included more detail than non-specific memories. Across sites, retrieval of more specific memories and more detail was associated with less severe depression symptoms. Episodic specificity and detailedness are related but separable constructs. Future investigations of autobiographical memory specificity, and methods for alleviating problematic specificity, should consider measures of episodic detailedness.

An Initial Examination of Post-Traumatic Stress Disorder in Mothers of Children with Autism Spectrum Disorder: Challenging Child Behaviors as Criterion A Traumatic Stressors.

Parenting a child with autism spectrum disorder (ASD) is associated with high levels of stress. Several studies have conceptualized this as a traumatic stress response to challenging child behaviors such as self-harm, suicidal ideation, and physical aggression toward caregivers. In the present study, we explored the relevance of a trauma-based diagnostic framework to a sample of 30 mothers (M age = 42.97, SD = 5.82) of children with ASD (M age = 12.43, SD = 3.15). Participants were interviewed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for post-traumatic stress disorder (PTSD) and an abbreviated Mini International Neuropsychiatric Interview to assess for comorbidity. Three participants were excluded as they met criteria for PTSD from a traumatic event unrelated to their parenting experience. Of the remaining 27 participants, 6 (22.2%) met criteria for PTSD in the context of traumatic parenting experiences. Descriptions of traumatic events experienced are summarized. Results suggest that, for some parents, challenging child behaviors such as physical violence toward the caregiver from the child, self-injurious behaviors, and suicidal behaviors function as traumatic stressors as per Criterion A of PTSD (American Psychiatric Association [2013]. Diagnostic and statistical manual of mental disorders [DSM-5]. Arlington, VA). This has implications for health professionals engaged with parents of children with ASD, who should consider the possibility of PTSD when challenging behaviors of a potentially traumatic nature are present. Autism Res 2020. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study found that some challenging behaviors exhibited by children with autism spectrum disorder can be traumatic for parents and lead to the development of post-traumatic stress disorder. Some of these behaviors included self-harming behaviors like head banging, expressing suicidal urges, and becoming physically aggressive toward parents during meltdowns. Autism Res 2020, 13: 1527-1536. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence.

Parents of children with autism spectrum disorder appear to experience high levels of psychological distress, yet little is known about the prevalence of psychological disorders in this population. The aim of this systematic review and meta-analysis was to estimate the proportion of these parents who experience clinically significant psychopathology. Articles reporting proportions of psychological disorders in a sample of parents of children with autism spectrum disorder were located. The initial search returned 25,988 articles. Thirty-one studies with a total sample of 9208 parents were included in the final review. The median meta-analytic proportions were 31% (95% confidence interval = [24%, 38%]) for depressive disorders, 33% (95% confidence interval = [20%, 48%]) for anxiety disorders, 10% (95% confidence interval = [1%, 41%]) for obsessive-compulsive disorder, 4% (95% confidence interval = [0%, 22%]) for personality disorders, 2% (95% confidence interval = [1%, 4%]) for alcohol and substance use disorders and 1% (95% confidence interval = [0%, 5%]) for schizophrenia spectrum disorders. Significant heterogeneity was detected in these categories. Further research is needed to gain more insight into variables that may moderate parental psychopathology. This review and meta-analysis is the first to provide prevalence estimates of psychological disorders in parents of children with autism spectrum disorder.

Sleep-competing behaviours among Australian school-attending youth: Associations with sleep, mental health and daytime functioning.

Sleep problems are highly prevalent among school-attending youth, and impact on school performance and outcomes. Sleep-competing behaviours are likely factors in the inadequate sleep time and related functional outcomes observed in this population. We examined a range of sleep-competing behaviours and their associations with sleep variables in Australian school-attending youth. We also assessed whether these behaviours indirectly affected mental health and daytime functioning through poorer sleep quality. A total of 353 school-attending youth (mean age = 14.6 years, 53% female) were recruited from high schools in Australia, and completed a range of self-report measures. Approximately 50% of the youth obtained sub-optimal levels of sleep and reported having a problematically long sleep onset latency. Sleep competing behaviours, related and unrelated to electronic media use, were reported as occurring frequently, and were associated with a range of sleep variables. These behaviours were also related to poorer mental health and daytime sleepiness, with this association explained by indirect effects through sleep quality. Sleep-competing behaviours are prevalent on school nights in Australian youth, and may have adverse associations with mental health and functioning. Prevention and intervention programs might address the risk factors identified in the current study.

Differential associations between impaired autobiographical memory recall and future thinking in people with and without schizophrenia.

OBJECTIVES: The ability to think about future events serves a range of important functions. People with schizophrenia show impairments in future thinking. However, whether these impairments are specific to positive or negative events and to what extent they are associated with impairments in verbal fluency and autobiographical memory remains poorly understood. METHODS: People with schizophrenia (n = 93) and people without psychiatric diagnoses (n = 111) were asked to generate future events and retrieve past autobiographical events and they also completed a test of verbal fluency. Participants also completed questionnaire measures of the positive and negative dimensions of schizophrenia and depression symptoms. RESULTS: People with schizophrenia generated significantly fewer positive and negative future events than controls. In a linear regression, the interaction between diagnosis and autobiographical memory retrieval explained a significant amount of variance in the number of future events that participants generated even when accounting for symptoms and verbal fluency. Past and future thinking abilities were correlated in controls but not in people with schizophrenia. CONCLUSIONS: People with schizophrenia may not rely on autobiographical content to imagine the future and may rely instead on semantic processes. Interventions that improve past and future thinking amongst people with schizophrenia are warranted. PRACTITIONER POINTS: Compared to control participants, people with schizophrenia have marked difficulty generating possible, positive and negative, future events. Unlike controls, for people with schizophrenia there is no relation between their ability to remember past events and their ability to think about the future. People with schizophrenia may have difficulty using their memories for their past to imagine and simulate possible future events.

Sexting and Psychological Distress: The Role of Unwanted and Coerced Sexts.

Sexting (e.g., conveying nude electronic images) is now common among young adults. Despite leading to negative consequences for some (e.g., harassment and unwanted dissemination), findings regarding sexting behaviors and mental health variables have been mixed. We recruited a convenience sample of young adults (N = 444, M age = 20, SD = 1) to test the hypothesis that sexting might be associated with poorer mental health. Our results showed no association between receiving or sending sexts overall. However, receiving unwanted sexts, or sexting under coercion, was associated with higher depression, anxiety, and stress symptoms, and lower self-esteem, and these two sexting experiences were independent predictors of psychological distress. The relationship between these sexting behaviors with poor mental health was moderated by gender, with poorer outcomes for males receiving unwanted sexts. These findings indicate a possible moderating factor in sexting and mental health.

Computerised memory specificity training (c-MeST) for the treatment of major depression: a study protocol for a randomised controlled trial.

INTRODUCTION: Major depression is a prevalent and debilitating disorder, but many sufferers do not receive support or respond to current treatments. The development of easily accessible and low-intensity treatments that have clear cognitive mechanisms of change is indicated. Memory specificity training (MeST) is an intervention for depression that targets deficits in recalling detailed memories of past experiences through repeated practice of autobiographical memory retrieval. This randomised controlled trial will assess the efficacy of an online, computerised version of MeST (c-MeST). METHODS AND ANALYSIS: Adults aged 18 and over with a current major depressive episode (MDE) will be recruited and randomised to have access to the seven session, online c-MeST programme for 2 weeks, or to a wait-list control group. The primary outcomes will be diagnostic status of MDE and self-reported depressive symptoms at postintervention. One-month and three-month follow-ups will be collected. Increases in autobiographical memory specificity will be assessed as a mediator of change, as well as other variables thought to contribute to reduced memory specificity, such as rumination and cognitive avoidance. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Deakin University Human Research Ethics Committee to conduct the study (ID: 2017_168). The findings will be disseminated through scholarly publications and workshops and will inform future trials, such as with an active comparator or as an adjunct treatment. TRIAL REGISTRATION NUMBER: ACTRN12618000257268; Pre-results.