Imagery rescripting of early memories in health anxiety disorder: A feasibility and non-randomized pilot study.

BACKGROUND AND OBJECTIVES: Health anxiety is a common problem and is associated with frequent primary care visits, increased health care costs, and poor prognosis and low recovery rates. Previous research shows that imagery rescripting (IR) is a promising treatment technique for various disorders. To date, IR has not been examined as a viable treatment for health anxiety. The purpose of the present feasibility and pilot study was to test one session of IR of early anxiety-laden health-related memories in a small sample of patients suffering from HA. METHODS: A within-groups design was used with a sample of 18 patients suffering from HA, who first underwent a control condition (reading about CBT), and then one week later a session of IR. After another week, the effects were measured on self-reported health anxiety and early anxiety provoking health-related mental images (memories). RESULTS: After the IR intervention, significant reductions of health anxiety and health worry, as well as image and memory distress, vividness and frequency were observed. LIMITATIONS: Among the most important limitations are the absence of an active control group, the small size of the sample, the absence of a longer follow-up, and the use of only self-report measures. CONCLUSIONS: The results suggest that IR is a feasible technique in the treatment of health anxiety, and that more controlled research along these lines may be worthwhile.

Audio Feedback with Reduced Self-focus as an Intervention for Social Anxiety: An Experimental Study.

BACKGROUND AND OBJECTIVES: Socially anxious individuals tend to underestimate their performance largely due to attentional bias. Video and audio feedback (AF) with cognitive preparation (CP) have shown to improve socially anxious individuals' evaluation of their performance in previous studies. In the present study, it was hypothesized that one of the three steps in CP, reduced self-focus (RS), is sufficient to cause an improved voice evaluation after AF. This was tested in a single-session randomized controlled experiment. METHOD: Forty-one socially anxious participants were asked to give a speech, then to listen to and evaluate a taped recording of their performance. Half of the sample were instructed to reduce their self-focus prior to AF, the rest received AF only. RS involved asking participants to listen to the audio recording as though they were listening to a stranger. Generalization effects were assessed by a second speech. RESULTS: AF with RS led to more improved voice evaluations than AF-only after the first speech, and the effects remained in the evaluation of the second speech. More positive speech evaluations were associated with corresponding reductions of performance anxiety. LIMITATIONS: small sample, analogue study. CONCLUSION: One component of cognitive preparation-(RS)-appears to be sufficient to cause significant effects on voice evaluation in socially anxious individuals. If the results are replicated in clinical samples, AF with RS may be a promising intervention in the treatment of social anxiety.

Legionella micdadei brain abscess.

We describe an immunocompromised patient who developed a large frontal brain abscess caused by Legionella micdadei. This is, to our knowledge, a rare case of culture-proven Legionella central nervous system infection.

Effects of analytical and experiential self-focus on rumination after a stress induction in patients with social anxiety disorder: a pilot study.

According to cognitive models, negative post-event processing rumination is a key maintaining factor in social anxiety disorder (SAD). Analogue research has supported the differentiation of self-focus into different modes of self-focused attention with distinct effects on rumination in depression and social anxiety. The purpose of this study was to replicate these effects with a sample of clients with SAD (N = 12) using (a) an experimental, cross-over design and (b) an evaluation situation (impromptu speech) prior to manipulation. Processing an identical list of symptoms, half of a sample was asked to successively adopt an analytic (abstract, evaluative) and an experiential (concrete, process-focused) self-focus; the other half employed the modes in the reversed order. Effects were assessed with a thought-listing (TL) procedure. As predicted, the two modes of self-focused attention affected cognitions differently; participants in the experiential condition showed a tendency for a decreased proportion of negative thoughts, whereas those in the analytical condition reported a decreased proportion of neutral thoughts. No difference was shown on positive cognitions. Furthermore, the participants' self-evaluation following the speech predicted their degree of subsequent negative thinking. After self-focus inductions, however, this effect was only seen in those participants who started by receiving the analytical self-focus induction. The results support previous findings that the analytical and the experiential self-focus modes affect cognitions differently, and that experiential processing may have beneficial effects on rumination in SAD. However, results need to be replicated in a larger sample.

Imagery rescripting of early memories in social anxiety disorder: an experimental study.

INTRODUCTION: Evidence suggests that negative self imagery plays an important role in social anxiety disorder (SAD) as a maintaining factor, and that early memories of traumatic experiences are linked to recurrent catastrophic images. Previous research has showed that cognitive restructuring combined with imagery rescripting of these memories may affect recurrent images resulting in less imagery distress and less anxiety in social situations. The present study replicated these effects using (a) a modified treatment with imagery rescripting without cognitive restructuring, and (b) an experimental between-groups design. METHOD: Patients with SAD (N = 14) were randomised either to imagery rescripting of early memories, or to a reading task. RESULTS: Follow-up after 1 week showed that the intervention led to significant improvements in memory and image distress, and reduced fears of negative evaluation and social interaction. DISCUSSION: The results indicate that imagery rescripting is effective even without cognitive restructuring and question the importance of the latter. However, the small sample limits the strength of the conclusions. CONCLUSION: Imagery rescripting of early distressful memories may be a powerful intervention in the treatment of SAD.

The enhancement of beneficial effects following audio feedback by cognitive preparation in the treatment of social anxiety: a single-session experiment.

BACKGROUND AND OBJECTIVES: According to cognitive models, negatively biased processing of the publicly observable self is an important aspect of social phobia; if this is true, effective methods for producing corrective feedback concerning the public self should be strived for. Video feedback is proven effective, but since one's voice represents another aspect of the self, audio feedback should produce equivalent results. This is the first study to assess the enhancement of audio feedback by cognitive preparation in a single-session randomized controlled experiment. METHOD: Forty socially anxious participants were asked to give a speech, then to listen to and evaluate a taped recording of their performance. Half of the sample was given cognitive preparation prior to the audio feedback and the remainder received audio feedback only. Cognitive preparation involved asking participants to (1) predict in detail what they would hear on the audiotape, (2) form an image of themselves giving the speech and (3) listen to the audio recording as though they were listening to a stranger. To assess generalization effects all participants were asked to give a second speech. RESULTS: Audio feedback with cognitive preparation was shown to produce less negative ratings after the first speech, and effects generalized to the evaluation of the second speech. More positive speech evaluations were associated with corresponding reductions of state anxiety. Social anxiety as indexed by the Implicit Association Test was reduced in participants given cognitive preparation. LIMITATIONS: Small sample size; analogue study. CONCLUSION: Audio feedback with cognitive preparation may be utilized as a treatment intervention for social phobia.