Correction: Prospective mental imagery as its link with anxiety and depression in prisoners.

[This corrects the article DOI: 10.1371/journal.pone.0191551.].

Prospective mental imagery and its link with anxiety and depression in prisoners.

Mental imagery is known to play a key role in the development and maintenance of depression and anxiety. Prisoners commonly experience psychological distress, but interventions to address this are currently lacking. We aimed to examine the link between prospective mental imagery and anxiety and depression among prisoners. One hundred twenty-three male prisoners from a Category C prison in southwest England participated in the study. They completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the General Anxiety Disorder Scale (GAD-7) to measure whether they experience depression and/or anxiety symptoms. Furthermore, they completed additional questionnaires to evaluate their prospective mental imagery. Results showed that 67.5% of prisoners presented with more depression symptoms and 27.7% with more anxiety symptoms. Supporting earlier findings, our data revealed that some dimensions of prospective mental imagery were significantly related with increased anxiety and depression symptoms in prisoners. Namely, intrusive negative personally relevant imagery was a positive predictor and likelihood of positive events a negative predictor of both anxiety and depression symptoms. The perceived likelihood of negative events was a positive predictor of depression. Intrusive verbal thought was a positive predictor of anxiety. The obtained results suggest the need to develop interventions not only targeting the reduction of prospective negative imagery but also the enhancement of positive mental imagery.

A comparison of immersive virtual reality with traditional neuropsychological measures in the assessment of executive functions.

OBJECTIVE: This study investigated immersive virtual reality (IVR), as a novel technique to test executive function of healthy younger and older adults. We predicted IVR tasks to have greater predictive power than traditional measures when assessing age-related cognitive functioning due to the real-world validity of the tasks. METHODS: Participants (n=40) completed the Stroop colour-word test and the trail-making test (TMT) as traditional and commonly used assessments of executive functioning. Participants then completed three IVR tasks; a seating arrangement task, an item location task (both set in a virtual chemistry lab), and a virtual parking simulator. RESULTS: Younger adults completed significantly more parking simulator levels (p<0.001), placed significantly more objects (p<0.001), and located significantly more items than older adults (p<0.01), demonstrating higher levels of performance. Significant correlations were found between performance on traditional neuropsychological measures and IVR measures. For example, Stroop CW performance significantly correlated with the number of parking simulator levels completed (τ=0.43, p<0.01). This suggests that IVR measures assess the same underlying cognitive constructs as traditional tasks. In addition, IVR measures contributed a significant percentage of the explained variance in age. CONCLUSION: IVR measures (i.e. number of parking simulator levels completed and number of objects placed in the seating arrangement task) were found to be stronger contributors than existing traditional neuropsychological tasks in predicting age-related cognitive decline. Future research should investigate the implementation of these real-world-based tasks in clinical groups given this promising initial work.

Voluntary and Involuntary Imagery in Social Anxiety.

BACKGROUND: Negative mental imagery is ubiquitous in cognitive models of social anxiety and in the social anxiety literature. Previous research has shown that it is causal of increased anxiety, lower social performance ratings and lower implicit self-esteem. Despite its prevalence, few studies have investigated this imagery directly. AIMS: This study aimed to provide an in-depth analysis of the phenomenology of negative imagery experienced by socially anxious individuals, and to compare recurrent and intrusive images with images deliberately generated by participants during the study. METHOD: Thirty-eight undergraduate students screened to be above average in social anxiety scores completed a computerized imagery questionnaire adapted from previous qualitative work. RESULTS: Thematic analyses revealed four major image themes for intrusive images and three for deliberately generated images including interacting with others and anxiety symptoms. Most intrusive images were based on negative episodic memories and were experienced at least fortnightly. Images were primarily visual, auditory and somatic but could involve any sensory modality. Depression anxiety stress scale (DASS-21) scores were higher in participants who experienced intrusive imagery and increased with the frequency of intrusions. Emotionality was generally higher in intrusive images than generated images. CONCLUSIONS: The phenomenology of negative imagery experienced by socially anxious individuals is idiosyncratic and may be inherently different from images generated for use in experimental research. Theoretical and clinical implications are discussed.

Undoing the past in order to lie in the present: Counterfactual thinking and deceptive communication.

This paper explores the proposal that there is a close link between counterfactual thinking and lying. Both require the imagination of alternatives to reality and we describe four studies which explore this link. In Study 1 we measured individual differences in both abilities and found that individuals with a tendency to generate counterfactual thoughts were also more likely to generate potential lies. Studies 2 and 3 showed that counterfactual availability influences people's ability to come up with lies and the extent to which they expect others to lie. Study 4 used a behavioural measure of deception to show that people tend to lie more in situations also known to elicit counterfactual thoughts. Overall, the results show that the imagination of alternatives to the past plays an important role in the generation of lies. We discuss the implications for the fields of counterfactual thinking and deception.

Negative mental imagery in public speaking anxiety: Forming cognitive resistance by taxing visuospatial working memory.

BACKGROUND AND OBJECTIVES: This study sought to reconcile two lines of research. Previous studies have identified a prevalent and causal role of negative imagery in social phobia and public speaking anxiety; others have demonstrated that lateral eye movements during visualisation of imagery reduce its vividness, most likely by loading the visuospatial sketchpad of working memory. It was hypothesised that using eye movements to reduce the intensity of negative imagery associated with public speaking may reduce anxiety resulting from imagining a public speaking scenario compared to an auditory control task. METHODS: Forty undergraduate students scoring high in anxiety on the Personal Report of Confidence as a Speaker scale took part. A semi-structured interview established an image that represented the participant's public speaking anxiety, which was then visualised during an eye movement task or a matched auditory task. Reactions to imagining a hypothetical but realistic public speaking scenario were measured. RESULTS: As hypothesised, representative imagery was established and reduced in vividness more effectively by the eye movement task than the auditory task. The public speaking scenario was then visualised less vividly and generated less anxiety when imagined after performing the eye movement task than after the auditory task. LIMITATIONS: Self-report measures and a hypothetical scenario rather than actual public speaking were used. Replication is required in larger as well as clinical samples. CONCLUSIONS: Visuospatial working memory tasks may preferentially reduce anxiety associated with personal images of feared events, and thus provide cognitive resistance which reduces emotional reactions to imagined, and potentially real-life future stressful experiences.

Assessing vividness of mental imagery: The Plymouth Sensory Imagery Questionnaire.

Mental imagery may occur in any sensory modality, although visual imagery has been most studied. A sensitive measure of the vividness of imagery across a range of modalities is needed: the shorter version of Bett's Questionnaire upon Mental Imagery (Sheehan, , J. Clin. Psychology, 23, 386) uses outdated items and has an unreliable factor structure. We report the development and initial validation of the Plymouth Sensory Imagery Questionnaire (Psi-Q) comprising items for each of the following modalities: Vision, Sound, Smell, Taste, Touch, Bodily Sensation, and Emotional Feeling. An exploratory factor analysis on a 35-item form indicated that these modalities formed separate factors, rather than a single imagery factor, and this was replicated by confirmatory factor analysis. The Psi-Q was validated against the Spontaneous Use of Imagery Scale (Reisberg et al., , Appl. Cogn. Psychology, 17, 147) and Marks' (, J. Mental Imagery, 19, 153) Vividness of Visual Imagery Questionnaire-2 (VVIQ-2). A short 21-item form comprising the best three items from the seven factors correlated with the total score and subscales of the full form, and with the VVIQ-2. Inspection of the data shows that while visual and sound imagery is most often rated as vivid, individuals who rate one modality as strong and the other as weak are not uncommon. Findings are interpreted within a working memory framework and point to the need for further research to identify the specific cognitive processes underlying the vividness of imagery across sensory modalities.

Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework.

Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of studies across experimental psychology and clinical psychology in order to highlight the key domains and measures most likely to be of relevance. This includes a consideration of methods for experimentally assessing the generation, maintenance, inspection and transformation of mental images; as well as subjective measures of characteristics such as image vividness and clarity. We present a guiding framework in which we propose that cognitive, subjective and clinical aspects of imagery should be explored in future research. The guiding framework aims to assist researchers in the selection of measures for assessing those aspects of mental imagery that are of most relevance to clinical psychology. We propose that a greater understanding of the role of mental imagery in clinical disorders will help drive forward advances in both theory and treatment.

Imagery in the aftermath of viewing a traumatic film: using cognitive tasks to modulate the development of involuntary memory.

BACKGROUND AND OBJECTIVES: Involuntary autobiographical memories that spring unbidden into conscious awareness form part of everyday experience. In psychopathology, involuntary memories can be associated with significant distress. However, the cognitive mechanisms associated with the development of involuntary memories require further investigation and understanding. Since involuntary autobiographical memories are image-based, we tested predictions that visuospatial (but not other) established cognitive tasks could disrupt their consolidation when completed post-encoding. METHODS: In Experiment 1, participants watched a stressful film then immediately completed a visuospatial task (complex pattern tapping), a control-task (verbal task) or no-task. Involuntary memories of the film were recorded for 1-week. In Experiment 2, the cognitive tasks were administered 30-min post-film. RESULTS: Compared to both control and no-task conditions, completing a visuospatial task post-film reduced the frequency of later involuntary memories (Expts 1 and 2) but did not affect voluntary memory performance on a recognition task (Expt 2). LIMITATIONS: Voluntary memory was assessed using a verbal recognition task and a broader range of memory tasks could be used. The relative difficulty of the cognitive tasks used was not directly established. CONCLUSIONS: An established visuospatial task after encoding of a stressful experience selectively interferes with sensory-perceptual information processing and may therefore prevent the development of involuntary autobiographical memories.

Cognitions in bipolar affective disorder and unipolar depression: imagining suicide.

OBJECTIVE: Bipolar disorder has the highest rate of suicide of all the psychiatric disorders. In unipolar depression, individuals report vivid, affect-laden images of suicide or the aftermath of death (flashforwards to suicide) during suicidal ideation but this phenomenon has not been explored in bipolar disorder. Therefore the authors investigated and compared imagery and verbal thoughts related to past suicidality in individuals with bipolar disorder (n = 20) and unipolar depression (n = 20). METHODS: The study used a quasi-experimental comparative design. The Structured Clinical Interview for DSM-IV was used to confirm diagnoses. Quantitative and qualitative data were gathered through questionnaire measures (e.g., mood and trait imagery use). Individual interviews assessed suicidal cognitions in the form of (i) mental images and (ii) verbal thoughts. RESULTS: All participants reported imagining flashforwards to suicide. Both groups reported greater preoccupation with these suicide-related images than with verbal thoughts about suicide. However, compared to the unipolar group, the bipolar group were significantly more preoccupied with flashforward imagery, rated this imagery as more compelling, and were more than twice as likely to report that the images made them want to take action to complete suicide. In addition, the bipolar group reported a greater trait propensity to use mental imagery in general. CONCLUSIONS: Suicidal ideation needs to be better characterized, and mental imagery of suicide has been a neglected but potentially critical feature of suicidal ideation, particularly in bipolar disorder. Our findings suggest that flashforward imagery warrants further investigation for formal universal clinical assessment procedures.

Mood stability versus mood instability in bipolar disorder: a possible role for emotional mental imagery.

A cognitive model of bipolar disorder suggests that mental imagery acts as an emotional amplifier of mood and may be heightened in bipolar disorder. First, we tested whether patients with bipolar disorder would score higher on mental imagery measures than a matched healthy control group. Second, we examined differences in imagery between patients divided into groups according to their level of mood stability. Mood ratings over approximately 6-months, made using a mobile phone messaging system, were used to divide patients into stable or unstable groups. Clinician decisions of mood stability were corroborated with statistical analysis. Results showed (I) compared to healthy controls, patients with bipolar disorder had significantly higher scores for general mental imagery use, more vivid imagery of future events, higher levels of intrusive prospective imagery, and more extreme imagery-based interpretation bias; (II) compared to patients with stable mood, patients with unstable mood had higher levels of intrusive prospective imagery, and this correlated highly with their current levels of anxiety and depression. The findings were consistent with predictions. Further investigation of imagery in bipolar disorder appears warranted as it may highlight processes that contribute to mood instability with relevance for cognitive behaviour therapy.

Prospective mental imagery in patients with major depressive disorder or anxiety disorders.

Prospective negative cognitions are suggested to play an important role in maintaining anxiety disorders and major depressive disorder (MDD). However, little is known about positive prospective mental imagery. This study investigated differences in prospective mental imagery among 27 patients with anxiety disorders, 24 patients with MDD, and 32 control participants. Measures of both deliberately generated and intrusive imagery were completed. Results indicated that both patients with anxiety disorders and those with MDD provided poorer vividness ratings for deliberately generated prospective positive scenarios compared to the control group. Patients with anxiety disorders showed a greater ability to vividly generate imagery for prospective negative scenarios than both patients with MDD and control participants. Finally, both clinical groups reported greater levels of intrusive prospective imagery of personally-relevant events as compared to the control group. The current findings underline the necessity to target prospective positive mental imagery in treating MDD and anxiety disorders.

Measuring Intrusive Prospective Imagery using the Impact of Future Events Scale (IFES): Psychometric properties and relation to risk for Bipolar Disorder.

We define intrusive prospective imagery as the experience of mental imagery of events that may happen in the future and which come to mind involuntarily. This everyday phenomenon may be exacerbated in psychological disorders such as bipolar disorder (Holmes, Geddes, Colom, & Goodwin, 2008) although specific measures to assess this have been lacking. We recently developed the Impact of Future Events Scale (IFES; Deeprose & Holmes, 2010), which is further examined in the current paper. In Study 1, adults volunteers (N=50) completed the IFES on two occasions, with 1-week between measurements. This revealed acceptable test-rest reliability. In Study 2, (N=90) IFES showed good internal consistency and confirmed two predictions. First, in the total sample risk for bipolar disorder (MDQ; Hirschfield et al., 2000) and IFES Total Score correlated positively. Second, when the sample was split into high (MDQ ≥ 7) and low (MDQ ≤ 6) bipolarity risk groups, higher IFES Total Scores were observed in the high risk group. We conclude that 1) IFES presents a useful measure for assessing intrusive prospective imagery with acceptable test-retest reliability and good internal consistency and 2) risk for bipolar disorder is associated with elevated IFES Total Scores with potentially important clinical implications.

Key steps in developing a cognitive vaccine against traumatic flashbacks: visuospatial Tetris versus verbal Pub Quiz.

BACKGROUND: Flashbacks (intrusive memories of a traumatic event) are the hallmark feature of Post Traumatic Stress Disorder, however preventative interventions are lacking. Tetris may offer a 'cognitive vaccine' [1] against flashback development after trauma exposure. We previously reported that playing the computer game Tetris soon after viewing traumatic material reduced flashbacks compared to no-task [1]. However, two criticisms need to be addressed for clinical translation: (1) Would all games have this effect via distraction/enjoyment, or might some games even be harmful? (2) Would effects be found if administered several hours post-trauma? Accordingly, we tested Tetris versus an alternative computer game--Pub Quiz--which we hypothesized not to be helpful (Experiments 1 and 2), and extended the intervention interval to 4 hours (Experiment 2). METHODOLOGY/PRINCIPAL FINDINGS: The trauma film paradigm was used as an experimental analog for flashback development in healthy volunteers. In both experiments, participants viewed traumatic film footage of death and injury before completing one of the following: (1) no-task control condition (2) Tetris or (3) Pub Quiz. Flashbacks were monitored for 1 week. Experiment 1: 30 min after the traumatic film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz led to a significant increase in flashbacks. Experiment 2: 4 hours post-film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz did not. CONCLUSIONS/SIGNIFICANCE: First, computer games can have differential effects post-trauma, as predicted by a cognitive science formulation of trauma memory. In both Experiments, playing Tetris post-trauma film reduced flashbacks. Pub Quiz did not have this effect, even increasing flashbacks in Experiment 1. Thus not all computer games are beneficial or merely distracting post-trauma - some may be harmful. Second, the beneficial effects of Tetris are retained at 4 hours post-trauma. Clinically, this delivers a feasible time-window to administer a post-trauma "cognitive vaccine".

An exploration of prospective imagery: the impact of future events scale.

BACKGROUND: Mental imagery of the future has clear clinical importance, although little is known about intrusive, prospective imagery of personally-relevant events. Currently, no measure is available to assess this. AIMS: The Impact of Future Events Scale (IFES) was created to assess the impact of intrusive, prospective, personally-relevant imagery. It was examined in relation to predictions about dysphoria. METHOD: To form the IFES, the IES-R (a measure of the impact of a past traumatic event on posttraumatic stress disorder symptomatology such as intrusive re-experiencing) was adapted item-by-item to assess intrusive "pre-experiencing" and imagery of specific, future events. Participants (N = 75) completed the IFES and assessments of depression, anxiety and general imagery use. RESULTS: As predicted, the IFES significantly and positively correlated with depression scores. Analyses using subgroups of non-dysphoric and mild-dysphoric participants confirmed that the mild-dysphoric group reported significantly higher IFES scores, indicating higher levels of pre-experiencing of the future and related hyperarousal and avoidance. CONCLUSIONS: IFES provides a measure of the impact of "pre-experiencing" in the form of intrusive prospective, personally-relevant imagery, with sensitivity to group differences on the basis of depression scores. Further research is required to extend these finding into clinical depression and other psychopathological conditions.

Mental imagery and emotion in treatment across disorders: using the example of depression.

Abnormalities in mental imagery have been implicated in a range of mental health conditions. Imagery has a particularly powerful effect on emotion and as such plays a particularly important role in emotional disorders. In depression, not only is the occurrence of intrusive negative imagery problematic, but also the lack of positive (in particular, future-directed) imagery is important. The authors suggest that, in depression, imagery can exacerbate the effects of interpretation bias. This article outlines an experimental psychopathology subcomponents model of depression that focuses specifically on the role of imagery and interpretation bias in the maintenance of the disorder. The authors propose that negative intrusive imagery, a lack of positive imagery, and negative interpretation bias serve both independently and interactively to maintain depressed mood. Finally, the authors consider the implications of this imagery-based approach for the development of new cognitive treatments in this area.

Can playing the computer game "Tetris" reduce the build-up of flashbacks for trauma? A proposal from cognitive science.

BACKGROUND: Flashbacks are the hallmark symptom of Posttraumatic Stress Disorder (PTSD). Although we have successful treatments for full-blown PTSD, early interventions are lacking. We propose the utility of developing a 'cognitive vaccine' to prevent PTSD flashback development following exposure to trauma. Our theory is based on two key findings: 1) Cognitive science suggests that the brain has selective resources with limited capacity; 2) The neurobiology of memory suggests a 6-hr window to disrupt memory consolidation. The rationale for a 'cognitive vaccine' approach is as follows: Trauma flashbacks are sensory-perceptual, visuospatial mental images. Visuospatial cognitive tasks selectively compete for resources required to generate mental images. Thus, a visuospatial computer game (e.g. "Tetris") will interfere with flashbacks. Visuospatial tasks post-trauma, performed within the time window for memory consolidation, will reduce subsequent flashbacks. We predicted that playing "Tetris" half an hour after viewing trauma would reduce flashback frequency over 1-week. METHODOLOGY/PRINCIPAL FINDINGS: The Trauma Film paradigm was used as a well-established experimental analog for Post-traumatic Stress. All participants viewed a traumatic film consisting of scenes of real injury and death followed by a 30-min structured break. Participants were then randomly allocated to either a no-task or visuospatial ("Tetris") condition which they undertook for 10-min. Flashbacks were monitored for 1-week. Results indicated that compared to the no-task condition, the "Tetris" condition produced a significant reduction in flashback frequency over 1-week. Convergent results were found on a clinical measure of PTSD symptomatology at 1-week. Recognition memory between groups did not differ significantly. CONCLUSIONS/SIGNIFICANCE: Playing "Tetris" after viewing traumatic material reduces unwanted, involuntary memory flashbacks to that traumatic film, leaving deliberate memory recall of the event intact. Pathological aspects of human memory in the aftermath of trauma may be malleable using non-invasive, cognitive interventions. This has implications for a novel avenue of preventative treatment development, much-needed as a crisis intervention for the aftermath of traumatic events.

Unconscious memory formation during anaesthesia.

Do patients form memories of intra-operative events when they are adequately anaesthetized? Studies of memory priming during anaesthesia with depth or awareness monitoring provide some evidence that they do, although only the most basic form of memory function, perceptual priming, persists when patients are unconscious. The probability of memory encoding increases as depth of anaesthesia decreases. There is a theoretical possibility that patients can be adversely affected, through memory priming, by comments made in the operating theatre, and some evidence that positive intra-operative suggestions can benefit patients.

Is priming during anesthesia unconscious?

General anesthesia provides an alternative to typical laboratory paradigms for investigating implicit learning. We assess the evidence that a simple type of learning--priming--can occur without consciousness. Although priming has been shown to be a small but persistent phenomenon in surgical patients (Merikle & Daneman, 1996) there is reason to question whether it occurs implicitly due to problems in detecting awareness using typical clinical signs. This paper reviews the published studies on priming during anesthesia that have included a measure of awareness or of anesthetic depth. We conclude that perceptual priming, but not conceptual priming, takes place in the absence of conscious awareness.