Positive Imagery-Based Cognitive Bias Modification as a Web-Based Treatment Tool for Depressed Adults: A Randomized Controlled Trial.

Depression is a global health problem requiring treatment innovation. Targeting neglected cognitive aspects may provide a useful route. We tested a cognitive-training paradigm using positive mental imagery (imagery cognitive bias modification, imagery CBM), developed via experimental psychopathology studies, in a randomized controlled trial. Training was delivered via the Internet to 150 individuals with current major depression. Unexpectedly, there was no significant advantage for imagery CBM compared with a closely matched control for depression symptoms as a whole in the full sample. In exploratory analyses, compared with the control, imagery CBM significantly improved anhedonia over the intervention and improved depression symptoms as a whole for those participants with fewer than five episodes of depression and those who engaged to a threshold level of imagery. Results suggest avenues for improving imagery CBM to inform low-intensity treatment tools for depression. Anhedonia may be a useful treatment target for future work

Modulating cognitive bias in the context of depression: mental imagery, emotion and behaviour

The overarching aim of this thesis was to contribute towards the translation of a laboratory paradigm into a clinical intervention: that is, to develop a positive Cognitive Bias Modification (CBM) technique using mental imagery into an internet-based computerized intervention for people with clinical depression. Preliminary studies using an imagery-based CBM to modify interpretation bias in depression have shown significant effects of the CBM in alleviating depressive symptoms. We know very little, however, about the mechanisms underlying the beneficial effect of imagery-based CBM in depression. A particular focus of the current thesis was to explore the effects of imagery-based CBM on variables that were thought to contribute to symptom improvement: mental imagery, emotion and behaviour. Experiment 1 explored these effects in a sample of mildly depressed individuals, using a CBM paradigm in which participants were required to generate mental imagery in response to positive, negative or mixed (control) combinations of picture and word cues. Participants assigned to the positive imagery condition showed mood improvements as well as enhanced behavioural performance (fishing game task) and reduced cognitive bias compared to participants in the two other conditions. Further, positive imagery was rated as increasingly vivid as they went along with the training. Study 2 explored the possibility that the behavioural task (i.e. a fishing game) used in mildly depressed individuals to detect CBM-induced differences in behaviour could be associated with behavioural differences between individuals with various and clinical levels of depressive symptoms. The hypothesis was tested that in a sample of individuals with minimal to severe symptoms of depression, behavioural performance on the fishing game would be inversely related to the severity of their depressive symptoms. As predicted, participants with higher depression scores performed less well on the fishing game task than those with lower scores, and this association remained when controlling for other variables such as state mood. Experiment 3a and 3b constituted the first two pilot studies exploring the feasibility of delivering imagery-based CBM over the internet to individuals with clinical depression. In Experiment 3a, the imagery-based CBM was developed into an internet-based intervention involving 6 sessions of CBM that participants completed in their own home over a week. The Oxford Imagery Generation (OxIGen) program was piloted in a small sample (N = 6) of clinically depressed individuals, and qualitative data were collected to assess experience of the intervention. As a result, refinements were made to improve the intervention and enhance engagement. In Experiment 3b, the finalised version of the OxIGen program, which involved 12 sessions of online CBM completed over a month, was piloted in a small sample (N = 8) of individuals with clinical depression. Results showed high levels of acceptability and adherence. Three of the four participants allocated to the positive imagery version of OxIGen showed reliable levels of symptom improvement. The exploration of the effects of OxIGen on mental imagery, bias and behaviour provided a mixed picture. For example, the predicted change in vividness for positive future imagery and negative interpretative bias was only found in two of the four participants from the positive imagery group. Finally in Experiment 4, the effects of OxIGen on positive future imagery and behaviour were examined as part of a wider clinical trial involving a large sample (N = 150) of individuals with clinical depression. The larger scale of this study allowed a sufficiently powered test of the prediction that the intervention would lead to changes in specific features of imagery (i.e. vividness and likelihood of positive future imagery) and increases in behavioural activation. Further, the hypothesised link between positive future imagery and optimism was tested. The results examined whether the OxIGen intervention can induce changes at different levels of psychological functioning (i.e. emotional, cognitive and behavioural). It is discussed that the combined action of these changes may reinstate a positive feedback cycle that ultimately leads to symptom improvements. Existing resources are largely insufficient to combat the major health problem of depression. The development of a promising laboratory paradigm towards a clinical intervention is an important step towards the development of short and inexpensive forms of treatment that can be delivered to the hands of the many people who need help.</p

Efficacité clinique d'une intervention comportementale de groupe chez deux patients atteints d'un trouble dépressif récurrent

Notre étude clinique portait sur l'instauration et l'évaluation de l'efficacité clinique d'une intervention comportementale brève destinée à un groupe de patients présentant un état dépressif d'intensité modérée à sévère. Les résultats indiquent que l'intervention n'a pas eu les effets attendus sur la sévérité de la symptomatologie dépressive, le niveau d'activation comportementale et d'évitement et les stratégies de régulation de l'humeur des 2 patients que nous avons sélectionnés dans cette étude. Les raisons de ces résultats sont mises en lien avec le fonctionnement psychopathologique des 2 patients et avec le contenu et la structure de l'intervention comportementale. Finalement, nous formulons quelques propositions relatives à d'autres formes de prise en charge de leurs difficultés

Looking on the bright side in social anxiety: the potential benefit of promoting positive mental imagery

Current cognitive models of social phobia converge on the view that negative imagery is a key factor in the development and maintenance of the disorder. Research to date has predominantly focussed on the detrimental impact of negative imagery on cognitive bias and anxiety symptoms, while the potential benefit of promoting positive imagery has been relatively unexplored. Emerging evidence suggests however that positive imagery could have multiple benefits such as improving positive affect, self-esteem and positive interpretation bias, and enhancing social performance. The present article defends the view that combining bias induction with a repeated practice in generating positive imagery in a cognitive bias modification procedure could represent a promising area for future research and clinical innovation in social anxiety disorder

Modulating cognitive bias in the context of depression: mental imagery, emotion and behaviour

The overarching aim of this thesis was to contribute towards the translation of a laboratory paradigm into a clinical intervention: that is, to develop a positive Cognitive Bias Modification (CBM) technique using mental imagery into an internet-based computerized intervention for people with clinical depression. Preliminary studies using an imagery-based CBM to modify interpretation bias in depression have shown significant effects of the CBM in alleviating depressive symptoms. We know very little, however, about the mechanisms underlying the beneficial effect of imagery-based CBM in depression. A particular focus of the current thesis was to explore the effects of imagery-based CBM on variables that were thought to contribute to symptom improvement: mental imagery, emotion and behaviour. Experiment 1 explored these effects in a sample of mildly depressed individuals, using a CBM paradigm in which participants were required to generate mental imagery in response to positive, negative or mixed (control) combinations of picture and word cues. Participants assigned to the positive imagery condition showed mood improvements as well as enhanced behavioural performance (fishing game task) and reduced cognitive bias compared to participants in the two other conditions. Further, positive imagery was rated as increasingly vivid as they went along with the training. Study 2 explored the possibility that the behavioural task (i.e. a fishing game) used in mildly depressed individuals to detect CBM-induced differences in behaviour could be associated with behavioural differences between individuals with various and clinical levels of depressive symptoms. The hypothesis was tested that in a sample of individuals with minimal to severe symptoms of depression, behavioural performance on the fishing game would be inversely related to the severity of their depressive symptoms. As predicted, participants with higher depression scores performed less well on the fishing game task than those with lower scores, and this association remained when controlling for other variables such as state mood. Experiment 3a and 3b constituted the first two pilot studies exploring the feasibility of delivering imagery-based CBM over the internet to individuals with clinical depression. In Experiment 3a, the imagery-based CBM was developed into an internet-based intervention involving 6 sessions of CBM that participants completed in their own home over a week. The Oxford Imagery Generation (OxIGen) program was piloted in a small sample (N = 6) of clinically depressed individuals, and qualitative data were collected to assess experience of the intervention. As a result, refinements were made to improve the intervention and enhance engagement. In Experiment 3b, the finalised version of the OxIGen program, which involved 12 sessions of online CBM completed over a month, was piloted in a small sample (N = 8) of individuals with clinical depression. Results showed high levels of acceptability and adherence. Three of the four participants allocated to the positive imagery version of OxIGen showed reliable levels of symptom improvement. The exploration of the effects of OxIGen on mental imagery, bias and behaviour provided a mixed picture. For example, the predicted change in vividness for positive future imagery and negative interpretative bias was only found in two of the four participants from the positive imagery group. Finally in Experiment 4, the effects of OxIGen on positive future imagery and behaviour were examined as part of a wider clinical trial involving a large sample (N = 150) of individuals with clinical depression. The larger scale of this study allowed a sufficiently powered test of the prediction that the intervention would lead to changes in specific features of imagery (i.e. vividness and likelihood of positive future imagery) and increases in behavioural activation. Further, the hypothesised link between positive future imagery and optimism was tested. The results examined whether the OxIGen intervention can induce changes at different levels of psychological functioning (i.e. emotional, cognitive and behavioural). It is discussed that the combined action of these changes may reinstate a positive feedback cycle that ultimately leads to symptom improvements. Existing resources are largely insufficient to combat the major health problem of depression. The development of a promising laboratory paradigm towards a clinical intervention is an important step towards the development of short and inexpensive forms of treatment that can be delivered to the hands of the many people who need help.This thesis is not currently available in ORA

Pulmonary Arterial Hypertension among HIV-Infected Children: Results of a National Survey and Review of the Literature

Since the advent of highly active anti-retroviral therapy, HIV-related mortality has decreased dramatically. As a consequence, patients are living longer, and HIV infection is becoming a chronic disease. Patients and caretakers have to deal with chronic complications of infection and treatment, such as cardiovascular diseases, which now represent an important health issue, even in the pediatric population. Prevalence of pulmonary arterial hypertension (PAH) in the adult HIV population is around 0.4-0.6%, which is around 1000- to 2500-fold more prevalent than in the general population. In recent adult PAH registries, HIV has been identified as the fourth cause of PAH, accounting for approximately 6-7% of cases. Therefore, regular screening is recommended in HIV-infected adults by many experts. If HIV-associated PAH is mainly reported in HIV-infected adults, pediatric cases have also been, albeit rarely, described. This scarcity may be due to a very low PAH prevalence, or due to the lack of systematic cardiovascular screening in pediatric patients. As PAH may manifest only years or decades after infection, a systematic screening should perhaps also be recommended to HIV-infected children. In this context, we retrospectively looked for PAH screening in children included in our national Swiss Mother and Child HIV cohort study. A questionnaire was sent to all pediatric infectious disease specialists taking care of HIV-infected children in the cohort. The questions tried to identify symptoms suggestive of cardiovascular risk factors and asked which screening test was performed. In the 71 HIV-infected children for which we obtained an answer, no child was known for PAH. However, only two had been screened for PAH, and the diagnosis was not confirmed. In conclusion, PAH in HIV-infected children is possibly underestimated due to lack of screening. Systematic echocardiographic evaluation should be performed in HIV-infected children

Fishing for happiness: The effects of generating positive imagery on mood and behaviour

Experimental evidence using picture–word cues has shown that generating mental imagery has a causal impact on emotion, at least for images prompted by negative or benign stimuli. It remains unclear whether this finding extends to overtly positive stimuli and whether generating positive imagery can increase positive affect in people with dysphoria. Dysphoric participants were assigned to one of three conditions, and given instructions to generate mental images in response to picture–word cues which were either positive, negative or mixed (control) in valence. Results showed that the positive picture–word condition increased positive affect more than the control and negative conditions. Participants in the positive condition also demonstrated enhanced performance on a behavioural task compared to the two other conditions. Compared to participants in the negative condition, participants in the positive condition provided more positive responses on a homophone task administered after 24 h to assess the durability of effects. These findings suggest that a positive picture–word task used to evoke mental imagery leads to improvements in positive mood, with transfer to later performance. Understanding the mechanisms underlying mood change in dysphoria may hold implications for both theory and treatment development