Measuring imaging ability: psychometric testing of the imaging ability questionnaire

Imagery ability assessments: a cross-disciplinary systematic review and quality evaluation of psychometric properties

BACKGROUND

Over the last two centuries, researchers developed several assessments to evaluate the multidimensional construct of imagery. However, no comprehensive systematic review (SR) exists for imagery ability evaluation methods and an in-depth quality evaluation of their psychometric properties.

METHODS

We performed a comprehensive systematic search in six databases in the disciplines of sport, psychology, medicine, education: SPORTDiscus, PsycINFO, Cochrane Library, Scopus, Web of Science, and ERIC. Two reviewers independently identified and screened articles for selection. COSMIN checklist was used to evaluate the methodological quality of the studies. All included assessments were evaluated for quality using criteria for good measurement properties. The evidence synthesis was summarised by using the GRADE approach.

RESULTS

In total, 121 articles reporting 155 studies and describing 65 assessments were included. We categorised assessments based on their construct on: (1) motor imagery (n = 15), (2) mental imagery (n = 48) and (3) mental chronometry (n = 2). Methodological quality of studies was mainly doubtful or inadequate. The psychometric properties of most assessments were insufficient or indeterminate. The best rated assessments with sufficient psychometric properties were MIQ, MIQ-R, MIQ-3, and VMIQ-2 for evaluation of motor imagery ability. Regarding mental imagery evaluation, only SIAQ and VVIQ showed sufficient psychometric properties.

CONCLUSION

Various assessments exist to evaluate an individual's imagery ability within different dimensions or modalities of imagery in different disciplines. However, the psychometric properties of most assessments are insufficient or indeterminate. Several assessments should be revised and further validated. Moreover, most studies were only evaluated with students. Further cross-disciplinary validation studies are needed including older populations with a larger age range. Our findings allow clinicians, coaches, teachers, and researchers to select a suitable imagery ability assessment for their setting and goals based on information about the focus and quality of the assessments.

SYSTEMATIC REVIEWS REGISTER

PROSPERO CRD42017077004 .

Self-Compassion and Psycho-Physiological Recovery From Recalled Sport Failure

Failure inherent to high-performance sport can precipitate emotional distress that can impair athletes’ performance and physical and mental health. Identifying factors that allow athletes to manage failure to sustain their health is critical. Self-compassion, treating oneself kindly in response to failure, may help athletes manage failure; it buffers against negative affective psychological responses, yet athletes often fear self-compassion. It is unknown whether the benefits of self-compassion extend to athletes’ physiological responses to failure and whether fear of self-compassion has an influence on psychological and physiological responses to failure, beyond self-compassion. The purpose of this study was to examine the influence of self-compassion on athletes’ psychological and physiological responses when recalling a sport failure and determine if fear of self-compassion exerted unique effects, beyond self-compassion. Participants (n = 91; M age = 21) were university or national-level athletes. In this laboratory-based, observational study, athletes were connected to a multi-modal biofeedback system to measure physiological responding at baseline, during a stress induction (imagining a past performance failure), and during a recovery period. Physiological responding was assessed according to athletes’ high-frequency heart rate variability (HRV), indexing parasympathetic nervous system activity, during the stress induction and recovery phase. Next, to assess psychological reactivity, athletes completed a series of scales (behavioral reactions, thoughts, and emotions). Regression analyses revealed that self-compassion predicted athletes’ HRV reactivity to the stress induction (β = 0.30, p < 0.05). There was no relationship between self-compassion and HRV recovery. Further, self-compassion predicted adaptive behavioral reactions (β = 0.46, p < 0.01), and negatively predicted maladaptive thoughts (β = −0.34, p < 0.01) and negative affect (β = −0.39, p < 0.01). Fear of self-compassion explained additional variance in some maladaptive thoughts and behavioral reactions. Results suggest that self-compassion promotes adaptive physiological and psychological responses in athletes relative to a recalled sport failure and may have implications for performance enhancement, recovery and health outcomes. Further, addressing athletes’ fears of self-compassion may also be important in promoting optimal psychological recovery.

Motor imagery ability assessments in four disciplines: protocol for a systematic review

INTRODUCTION

Motor imagery (MI) is a very popular and well-accepted technique in different disciplines. Originating from sport and psychology, MI is now also used in the field of medicine and education. Several studies confirmed the benefits of MI to facilitate motor learning and skill acquisition. The findings indicated that individual's MI ability might influence the effectiveness of MI interventions. Over the last two centuries, researchers have developed several assessments to evaluate MI's abstract construct. However, no systematic reviews (SR) exist for MI ability evaluation methods and their measurement properties.

METHODS AND ANALYSIS

The SR will evaluate available MI ability assessments and their psychometric properties in four relevant disciplines: sports, psychology, medicine and education. This involves performing searches in SPORTDiscus, PsycINFO, Cochrane Library, Scopus, Web of Science and ERIC. Working independently, two reviewers will screen articles for selection. Then all raw information will be compiled in an overview table-including the articles' characteristics (eg, a study's setting or the population demographics) and the MI ability assessment (psychometric properties). To evaluate the articles' methodological quality, we will use the COSMIN checklist. Then we will evaluate all the included assessments' quality and perform a best-evidence synthesis. Results of this review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

ETHICS AND DISSEMINATION

The SR is based on published data, and ethical approval is not required. This review will provide information on assessment performance and equipment, as well as its main focus and usefulness. Furthermore, we will present the methodological quality of all the included articles and assess the included instruments' quality. Ultimately, this will act as a valuable resource, providing an overview of MI ability assessments for individual clinical settings, treatment aims, and various populations. The SR's final report will be published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42017077004.

Randomized controlled trial of a brief cognitive-behavioral strategies intervention for the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer

OBJECTIVE

Patients receiving treatment for advanced cancer suffer significant symptom burden, including co-occurring pain, fatigue, and sleep disturbance. There is limited evidence for effective interventions targeting this common symptom cluster.

METHODS

A randomized controlled trial of a brief cognitive-behavioral strategies (CBS) intervention was conducted. A sample of 164 patients with advanced cancer receiving chemotherapy practiced imagery, relaxation, and distraction exercises or listened to cancer education recordings (attention-control) to manage co-occurring pain, fatigue, and sleep disturbance over a 9-week period. Symptom cluster severity, distress, and interference with daily life were measured at baseline and 3, 6, and 9 weeks. We also evaluated the moderating influence of imaging ability and number of concurrent symptoms, and mediating effects of changes in stress, anxiety, outcome expectancy, and perceived control over symptoms.

RESULTS

Compared with the cancer education condition, participants receiving the CBS intervention reported less symptom cluster distress at week 6 (M = 1.82 vs 2.15 on a 0-4 scale, P < .05). No other group differences were statistically significant. The number of concurrent symptoms moderated the intervention effect on symptom cluster interference. Changes in stress, outcome expectancy, and perceived control mediated the extent of intervention effects on symptom outcomes, primarily at weeks 6 and 9.

CONCLUSIONS

The brief CBS intervention had limited effects in this trial. However, findings regarding potential mediators affirm hypothesized mechanisms and provide insight into ways to strengthen future interventions to reduce the suffering associated with co-occurring pain, fatigue, and sleep disturbance.

Guided Imagery for Smoking Cessation in Adults: A Randomized Pilot Trial

This pilot study describes a randomized controlled trial of an audio CD—based interactive guided imagery program for smoking cessation for adults versus a wait-listed control. Feasibility, process measures, and biochemically validated abstinence were assessed at end of treatment (6 weeks) and 12 weeks, as well as at 52 weeks for intervention participants. Fifty-nine percent of intervention participants attended four of six guided imagery sessions, and 94% found the technique helpful for smoking cessation. Intervention participants had greater readiness to quit (Readiness to Quit Ladder, 8.3 vs. 7.2, p < .05) and lower state anxiety (Spielberger Index, 32 vs. 38, p < .05) at end of treatment than the control group. Abstinence rates in the intervention versus control groups were 36% versus 18% ( p = .43) at 6 weeks and 30% versus 12% ( p = .40) at 12 weeks, respectively. At 1 year, 24% of intervention participants remained abstinent. A guided imagery program for smoking cessation was feasible, perceived to be helpful, improved intermediate measures, and resulted in a trend toward smoking cessation.

Impact of a randomized possible selves experiment on new retirees' physical activity and identity

BACKGROUND

Retirement is not always associated with greater engagement in physical activity. Previous interventions informed by possible selves, a type of future-oriented self-representation, proved useful to increase physical activity in young adults. We thus wanted to explore if a similar intervention would yield favorable outcomes in new retirees. We also examined whether possible selves could help increase identity relative to the physical activity context. Identity circumscribes the meanings which help individuals define who they are in a given role (i.e., what it means to be a physically active person). The strength of identification as a physically active person increases when individuals endorse these meanings more strongly. Possible selves may be tied to identity as they allow individuals to imagine themselves as physically active, which has been argued to incite changes to one's sense of self. Hence, the overall aim of this study was to determine whether a possible selves intervention would increase physical activity behaviour and physical activity identity in a group of newly-retired individuals.

METHODS

A total of 294 participants were randomized into one of three groups: (a) a repeated group with three possible selves image generation exposures, (b) a one-time group with one possible selves image generation exposure, or (c) a control group. Participants completed self-report measures at baseline and follow-up assessments were taken at weeks 4, 8, and 12 of the study. The measures for the outcomes of interest were the Godin Leisure Time Exercise Questionnaire and the modified Exercise Identity Scale.

RESULTS

Repeated measures mixed-effects models analyses with maximum likelihood estimation revealed no significant differences between groups on physical activity behaviour (p = 0.34) or physical activity identity (p = 0.97) at follow-up time points. However, a time effect was found for physical activity (p <.01) and physical activity identity (p <.01), which increased across time (baseline-to-12-week follow-up) in all three groups. Such a time effect (inconsequential to group assignment) suggests that the observed increases in physical activity and identity cannot be attributed to an exposure to a possible selves intervention.

CONCLUSIONS

While the intervention failed to significantly increase physical activity identity and physical activity in newly retired individuals, we suggest future research directions for interventions targeting new retired individuals.

Patterning of Pain and Power With Guided Imagery

Using Martha Rogers’ science of unitary human beings, changes in pain and power among 42 patients were examined in relation to the use of a guided imagery modality. Participants were randomly assigned to treatment and control groups and repeated measures MANCOVA was used to detect differences in pain and power over a 4-day period of time. The treatment group’s pain decreased during the last 2 days of the study. No differences in power emerged. Guided imagery appeared to have potential as a useful nursing modality for chronic pain sufferers.

A content review of cognitive process measures used in pain research within adult populations

BACKGROUND AND OBJECTIVE

Previous research suggests that measures of cognitive process may be confounded by the inclusion of items that also assess cognitive content. The primary aims of this content review were to: (1) identify the domains of cognitive processes assessed by measures used in pain research; and (2) determine if pain-specific cognitive process measures with adequate psychometric properties exist.

DATABASES AND DATA TREATMENT

PsychInfo, CINAHL, PsycArticles, MEDLINE, and Academic Search Complete databases were searched to identify the measures of cognitive process used in pain research. Identified measures were double coded and the measure's items were rated as: (1) cognitive content; (2) cognitive process; (3) behavioural/social; and/or (4) emotional coping/responses to pain.

RESULTS

A total of 319 scales were identified; of these, 29 were coded as providing an un-confounded assessment of cognitive process, and 12 were pain-specific. The cognitive process domains assessed in these measures are Absorption, Dissociation, Reappraisal, Distraction/Suppression, Acceptance, Rumination, Non-Judgment, and Enhancement. Pain-specific, un-confounded measures were identified for: Dissociation, Reappraisal, Distraction/Suppression, and Acceptance. Psychometric properties of all 319 scales are reported in supplementary material.

CONCLUSIONS

To understand the importance of cognitive processes in influencing pain outcomes as well as explaining the efficacy of pain treatments, valid and pain-specific cognitive process measures that are not confounded with non-process domains (e.g., cognitive content) are needed. The findings of this content review suggest that future research focused on developing cognitive process measures is critical in order to advance our understanding of the mechanisms that underlie effective pain treatment.

SIGNIFICANCE

Many cognitive process measures used in pain research contain a 'mix' of items that assess cognitive process, cognitive content, and behavioural/emotional responses. Databases searched: PsychInfo, CINAHL, PsycArticles, MEDLINE and Academic Search Complete. This review describes the domains assessed by measures assessing cognitive processes in pain research, as well as the strengths and limitations of these measures.

Guided Imagery for Total Knee Replacement: A Randomized, Placebo-Controlled Pilot Study

OBJECTIVES

To determine the effect of guided imagery (GI) on functional outcomes of total knee replacement (TKR), explore psychological and neuroimmune mediators, and assess feasibility of study implementation.

DESIGN

Investigator-blinded, randomized, placebo-controlled pilot study.

SETTINGS

Hospital, surgeon's office, participant's home.

PARTICIPANTS

82 persons undergoing TKR.

INTERVENTIONS

Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments.

OUTCOME MEASURES

Gait velocity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Function scale.

RESULTS

Outcomes for 58 participants (29 receiving GI and 29 controls) were analyzed at 6 months after surgery. The most frequent reason for noncompletion was protocol-driven exclusion at 6 months for having the contralateral knee replaced before the study endpoint (n = 15). With imaging ability as a moderator, gait velocity, but not WOMAC Function score, was significantly improved at 6 months in the GI group. Participants in the GI group, but not the control group, had lower WOMAC Pain scores at 3 weeks after surgery than at baseline. Hair cortisol concentration was significantly lower at 6 months after surgery than at baseline in the GI group but not the control group. GI group participants had lower treatment adherence but greater treatment credibility than the control group.

CONCLUSION

Randomized controlled trials of GI in the TKR population are feasible, but inclusion/exclusion criteria influence attrition. Further studies are needed to elaborate this study's findings, which suggest that guided imagery improves objective, but not patient-reported, outcomes of TKR. Hair cortisol concentration results suggest that engagement in a time-limited guided imagery intervention may contribute to stress reduction even after the intervention is terminated. Further investigation into optimal content and dosing of GI is needed.

Effectiveness of guided imagery relaxation on levels of pain and depression in patients diagnosed with fibromyalgia

AIM

The aim of this study was to evaluate the effects of guided imagery as a nursing intervention for pain management and depression in patients diagnosed with fibromyalgia.

BACKGROUND

Many studies support the use of guided imagery to improve patient outcomes. Guided imagery has been used for different purposes and it is thought to be an effective intervention for people suffering from nonmalignant pain.

DESIGN

A 2-group quasi-experimental study was conducted during 8 weeks by the University of Nursing in Almeria (Spain).

METHODS

Patients diagnosed with fibromyalgia aged 18 to 70 years (n = 60) were randomly assigned to a guided imagery group (n = 30) or a control group (n = 30). The outcomes measures were scores for pain with the McGill Pain Questionnaire long form (MPQ-LF) and the Visual Analogue Scale (VAS) and depression with the Beck Depression Inventory and the VAS for depression. The effects were examined at baseline, postintervention (4th week), and at the end of the study (8th week).

RESULTS

Treatment efficacy was analyzed by using a t test for paired samples. Temporal changes in the scores were examined by using a 2-way repeated-measures analysis of variance. The treatment group reported statistically significantly lower levels of pain (P < .046) and depression (P < .010) than the control group at the week 4 evaluation. A statistically significant effect on pain as measured by the daily VAS diary was also found in the experimental group. At week 8, no significant differences were found for pain.

CONCLUSION

Patients diagnosed with fibromyalgia may benefit from this nursing intervention in terms of relieving pain and depression. Guided imagery relaxation therapy could be incorporated as part of fibromyalgia treatment to promote health among people with fibromyalgia.

RELEVANCE TO CLINICAL PRACTICE

Guided imagery as a nursing intervention can alleviate pain and depression in patients diagnosed with fibromyalgia.

Biological mechanisms related to the effectiveness of guided imagery for chronic pain

Specific aims of this pilot study were to (a) determine the effect of a guided imagery (GI) intervention over an 8-week period on pain and pain disability in a sample of persons with chronic noncancer pain (CNCP) and (b) analyze the mediating effects of neuroendocrine and neuroimmune functioning on the effectiveness of GI on outcome variables. A simple interrupted time-series design (12-week period) was used. GI was introduced at Week 4 and used daily by 25 participants for the remaining 8 weeks. Measures of pain and pain disability were obtained at the beginning of the study period and at six repeated 2-week intervals. Measures of hypothalamic-pituitary-adrenal (HPA) axis activation (plasma cortisol), immune-mediated analgesia (lymphocyte subset counts and proliferation), and immune-mediated hyperalgesia (interleukin-1β) were obtained at the beginning of the study and at Week 11. Usual pain levels were lower after the introduction of GI at Week 4 (Wilks' λ = 52.31; df = 2, 22; p = .000). Pain disability levels were lower after the introduction of GI at Week 4 (Wilks' λ = 5.98; df = 6, 18; p = .001). Correlation coefficients between change scores of dependent variables and mediating variables were not significant. GI was effective in reducing pain intensity and pain disability over an 8-week period; however, the results did not support the expected effects of decreased HPA axis activation, improved immune-mediated analgesia, and reduced immune-mediated hyperalgesia in mediating these outcomes. These findings may be related to procedural and theoretical issues and limitations related to the study design.

Individual difference variables and the effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain

Clinicians in acute care settings are often called upon to manage cancer pain unrelieved by medications. Cognitive-behavioral strategies, such as relaxation and imagery, are recommended for cancer pain management; however, there appear to be individual differences in their effects. This pilot study examined variation in pain outcomes achieved with progressive muscle relaxation (PMR) and analgesic imagery interventions among hospitalized patients with cancer pain, and assessed the influence of four individual difference variables (cognitive ability, outcome expectancy, previous experience, and concurrent symptoms) on pain relief achieved with each intervention. A crossover design was used in which 40 hospitalized cancer patients received two trials of PMR, two trials of analgesic imagery, and two trials of a control condition. In comparing means between treatment and control conditions, both PMR and analgesic imagery produced greater improvements in pain intensity, pain-related distress, and perceived control over pain than the control condition. However, individual responder analysis revealed that only half of the participants achieved a clinically meaningful improvement in pain with each intervention. Patients who achieved a meaningful improvement in pain with analgesic imagery reported greater imaging ability, more positive outcome expectancy, and fewer concurrent symptoms than those who did not achieve a meaningful reduction in pain. Similar relationships were not significant for the PMR intervention. Investigators should continue efforts to identify factors that moderate the effects of cognitive-behavioral pain coping strategies so that clinicians can identify the most beneficial treatments for individual patients.

Mental reinstatement of context and return of fear in spider-fearful participants

Extant findings in the animal and human conditioning literature demonstrate that renewal, termed return of fear in studies with humans, occurs when reexposure to a previously feared phobic stimulus occurs in a context different than the one present during extinction. The present study investigated whether mental reinstatement of the treatment context at follow-up could attenuate context-based return of fear. Forty-eight spider-fearful individuals received exposure therapy in one of two contexts, and were followed-up 1 week later in the treatment or a new context. Half of the participants received instructions to mentally reinstate the treatment context before the follow-up test. Self-report data replicated previous research on contextually driven return of fear. Furthermore, participants who mentally reinstated the treatment context, before encountering the phobic stimulus in a new context at follow-up, had less return of fear than those who did not. Limitations of the current study, as well as implications for phobia treatment, are discussed.

A pilot study to predict success with guided imagery for cancer pain

Guided imagery, as other nonpharmacologic strategies, has been demonstrated to be useful for some patients. However, no tested method exists to identify which patients are likely to benefit from this pain management strategy. This pilot study tested a model to predict success with guided imagery. Major concepts tested included imaging ability, outcome expectancy, history of imagery use, match with preferred coping style, and perceived credibility of the imagery provider. A one-group pretest-posttest design was used. A sample of 62 hospitalized cancer patients currently experiencing pain rated >/=3 on a 0 to 10 scale completed questionnaires and used an audiotaped imagery intervention. Pain outcomes examined included mean pain intensity and distress, positive and negative affect, and perceived control over pain. A path analysis was conducted using multiple regression to evaluate relationships proposed in the model. Previous history with imagery predicted outcome expectancy. Imaging ability predicted mean pain intensity, positive affect, and perceived control over pain. Outcome expectancy was not a significant predictor of any pain outcomes. Baseline status and concurrent symptoms, measured as covariates, also played a significant role in predicting outcomes. Variance explained in pain outcomes ranged from 10% to 52% (adjusted R(2) = 3% to 48%). Further exploration of model variables is warranted. Findings suggest that after considering current symptom experience, imaging ability may be a useful variable to assess in order to determine whether guided imagery is an appropriate intervention for individual patients.

Measuring imaging ability in children

INTRODUCTION

Guided imagery has been suggested as an intervention to help children cope with noxious symptoms associated with medical care. A measure of imaging ability, that is, the ability to generate vivid mental images and to experience those images as if they were real, could be helpful in identifying children most likely to succeed in relieving symptoms with guided imagery. The purpose of this study was to test psychometric properties of a new instrument, the Kids Imaging Ability Questionnaire (KIAQ).

METHOD

Three expert clinicians and researchers were asked to review the KIAQ to assess content validity. A convenience sample of 58 children were invited to complete the questionnaire twice to obtain data for tests of reliability and criterion-related validity.

RESULTS

Content validity, internal consistency (alpha =.75-.76), and test-retest reliability (r =.73) were acceptable. Criterion-related validity using the Singer Fantasy Proneness Interview as a standard was poor (rho =.31-.46).

DISCUSSION

Some psychometric properties were acceptable; however, continued research will be necessary to test validity of the questionnaire and demonstrate a relationship between KIAQ score and success with imagery. With continued research, pediatric nurses may use the KIAQ in practice to identify children most likely to benefit from guided imagery.