Recurrent negative autobiographical memories and mental health

Background

Recurrent symptom-relevant negative autobiographical memories are common in patients with emotional disorders such as anxiety and depression, even among those without a trauma-related diagnosis. Recurrent negative autobiographical memories may also contribute to distress in non-clinical populations.

Methods

To examine the prevalence of recurrent negative autobiographical memories and associated psychological features, we recruited a student sample (n = 101) and a treatment-seeking sample of patients with emotional disorders (n = 123). We hypothesized that recurrent negative autobiographical memories would be associated with higher levels of psychological symptoms and rumination. We also conducted exploratory analyses of participants' most bothersome memory.

Results

In each sample, individuals who endorsed recurrent negative autobiographical memories had significantly higher depression, anxiety, and stress symptoms as well as greater rumination. In the treatment-seeking sample, where memories also had to be identified by patients as symptom-relevant, those who endorsed memories also had significantly higher clinician-rated symptom severity for their primary diagnosis. The majority of participants in each sample endorsed moderate or greater re-experiencing (sample 1: 79 %, sample 2: 66 %) and avoidance symptoms (sample 1: 78 %, sample 2: 58 %) related to their most bothersome memory.

Conclusion

Recurrent negative autobiographical memories relate to mental health symptoms in both clinical and non-clinical samples. Further research should explore whether targeting such memories reduces distress or improves wellbeing in these populations.

Hooking the Self Onto the Past: How Positive Autobiographical Memory Retrieval Benefits People With Social Anxiety

Do people with social anxiety (SA) benefit from positive memory retrieval that heightens self-relevant meaning? In this preregistered study, an analog sample of 255 participants with self-reported clinically significant symptoms of SA were randomly assigned to retrieve and process a positive social-autobiographical memory by focusing on either its self-relevant meaning (deep processing) or its perceptual features (superficial processing). Participants were then socially excluded and instructed to reimagine their positive memory. Analyses revealed that participants assigned to the deep processing condition experienced significantly greater improvements than participants in the superficial processing condition in positive affect, social safeness, and positive beliefs about others during initial memory retrieval and in negative and positive beliefs about the self following memory reactivation during recovery from exclusion. These novel findings highlight the potential utility of memory-based interventions for SA that work by "hooking" self-meaning onto recollections of positive interpersonal experiences that elicit feelings of social acceptance.

Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond

Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example.

Flashforward imagery in speech anxiety: Characteristics and associations with anxiety and avoidance

Speech anxiety (SA) is a highly prevalent social fear. Prospective ‘flashforward’ (FF) imagery of an upcoming social catastrophe may be a particularly important cognitive factor in SA persistence via eliciting anxiety and avoidance behaviors. Since earlier research on imagery and social anxiety has not strictly differentiated between types of negative imagery, the occurrence, precise features, and impact of FF imagery remain unclear. We therefore examined the phenomenological characteristics of FF imagery in SA and mapped the relationship between FF imagery features and anxiety and avoidance. Female participants who approached clinical levels of SA (N = 60) completed questionnaires on SA and avoidance behaviors, and rated anxiety and avoidance in anticipation of an actual speech. FF imagery and emotionally linked autobiographical memories were assessed with semi-structured interviews. All participants reported recurring FF images, which were experienced as vivid, distressing, field perspective images with accompanying negative feelings. Image distress and feelings of threat showed most consistent associations with SA and avoidance measures. Findings add to the conceptualization of SA, and support the clinical relevance of assessing FF imagery. Future experimental studies on FF imagery characteristics are necessary to test the proposed causal impact in SA persistence and to inform additional treatment targets.

Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships

OBJECTIVE

Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder.

DESIGN

This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes.

RESULTS

We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors.

CONCLUSION

We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.

Documenting the late positive potential towards self-imagery within social anxiety

Models of social anxiety propose that negative self-imagery is a maintenance factor of psychopathology, yet the mechanisms of this relationship are unclear. One proposed mechanism is attention towards self-images. However, self-image creation does not occur in isolation and is likely influenced by other mechanisms, such as anticipatory processing (AP). The current study aimed to investigate how trait social anxiety and AP influence motivated attention during self-imagery (i.e., late-positive potential; LPP). Participants (N = 40) with a mean age of 18.95 (SD = 1.22) completed AP manipulations and a self-imagery task. Results revealed that participants with high levels of social anxiety who engaged in AP demonstrated blunted LPP activity in the late time window (6000-10,000 ms) relative to those who engaged in Distraction. These results suggest that motivated attention towards self-imagery may be impacted by anticipatory processing, but less influenced by the valence of self-imagery. Given previous research has been limited in methodology, this study expands upon current research by documenting the neural mechanisms of self-imagery manipulations within social anxiety.

Imagery rescripting and negative self-imagery in social anxiety disorder: a systematic literature review

BACKGROUND

Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets memories of distressing formative events linked to negative self-imagery (NSI). IR is thought to update unhelpful schema by addressing the needs of the younger self within the memory. An accumulating body of evidence indicates that by modifying NSI, IR can significantly affect distressing imagery, memory appraisal, and beliefs about the self.

AIMS

This systematic review aims to critically evaluate and synthesise literature investigating the existing research on the effects IR has on NSI in SAD.

METHOD

A systematic electronic search of Academic Search Complete, ProQuest, Medline, Scopus and PubMed was performed in February 2021 using pre-defined criteria. Ten studies met the inclusion criteria and were selected for review.

RESULTS

Analysis of the reviewed articles' findings identified three main themes: Changes to negative self-images, Memories linked to images and Encapsulated beliefs. IR was associated with significant decreases in image distress, image vividness, memory vividness, memory distress, and encapsulated beliefs. Although reductions were found with image frequency, they were non-significant. Interpretation of results is limited by the small number of studies.

CONCLUSIONS

IR appears to effectively alter images, memories and beliefs in SAD in as little as a single session. The findings indicate that IR could be utilised as a cost-effective intervention for SAD. However, additional studies and longer-term follow-ups are needed.

Apprehension about the future: Investigating the phenomenological characteristics of episodic future thinking in socially anxious adolescents

BACKGROUND AND OBJECTIVES

Social anxiety is a future-oriented mood characterized by apprehension about others' negative evaluations in anxiety-provoking social situations that may occur in the future. Episodic future thinking (EFT) is a form of future-oriented cognition that allows a pre-experiencing of our personal futures. The literature suggests that anxious individuals show increased negative expectancies about future events. However, few studies have been conducted on EFT in social anxiety. The current study investigated the phenomenological characteristics of EFT in adolescents with high and low social anxiety.

METHODS

Twenty-two high social anxiety (HSA) and 24 low social anxiety (LSA) adolescents simulated one anxiety-provoking social event and one neutral event. They then rated the phenomenological characteristics of the events.

RESULTS

HSA adolescents imagined anxiety-provoking social events from an observer perspective more than LSA adolescents. HSA adolescents also imagined anxiety-provoking social events as more negative and containing less clear contextual details than LSA adolescents. In contrast, no group differences were found for neutral events. Moreover, participants imagined more self-referential information for anxiety-provoking social events than neutral events. HSA participants imagined less other-referential information than LSA participants, regardless of the event type.

LIMITATIONS

This study used a subclinical sample with high and low social anxiety. The sample size was small, and only adolescents aged 15-17 years were included. It is difficult to generalize the present findings across different anxiety-provoking social events. The specificity of EFT was not evaluated.

CONCLUSIONS

Our findings highlight the importance of EFT in the psychopathology of adolescent social anxiety.

None the wiser: Year-long longitudinal study on effects of adversity on wisdom

Research on consequences of adversity appears inconclusive. Adversity can be detriment to mental health, promoting maladaptive patterns of thoughts. At the same time, posttraumatic growth studies suggest that overcoming major adversity facilitates growth in wisdom-related patterns of thoughts. We address this puzzle by examining how distinct types of adversity impact wisdom over time and how individual differences in self-distanced (rather than self-immersed) reflection on adversity relate to different wisdom trajectories. In a four-wave prospective year-long study, participants ( N = 499) recalled and reflected every three months on the most significant recent adverse event in their life. They reported how much they engaged in wise reasoning—intellectual humility, open-mindedness to diverse perspectives and change, search for compromises and resolution—as well as self-distancing during reflections. Independent raters identified seven distinct adversity types (e.g. social conflict, economic hardship, major trauma) in open-ended descriptions. Growth curve analyses revealed little evidence of positive change in wise-reasoning over the course of a year, and some evidence of negative change for health-related adversity. Although self-distancing was associated with stability in wisdom, self-immersing was associated with negative change in wisdom in reflections on social conflicts over time. We discuss implications these results have for adversity, change vs. resilience in character strengths, and self-distancing.

Involuntary autobiographical memories and future projections in social anxiety

Intrusive involuntary memories and images are a cardinal phenomenon in a range of psychological disorders, but not systematically examined in social anxiety. We examined potential biases upon generating involuntary versus voluntary memories and future projections in individuals with high and low levels of social anxiety. Participants recorded involuntary and voluntary autobiographical events, and their associated emotional response in a structured mental time travel diary. High social anxiety was associated with more intense anxiety and embarrassment and greater use of a range of emotion regulation strategies upon generating all types of autobiographical events. Involuntary (versus voluntary) memories and future events were associated with a heightened emotional response independent of social anxiety, and memories were associated with more embarrassment than imagined future events. The effects of high versus low social anxiety and involuntary versus voluntary generation process were independent from each other. The findings have implications for affective and cognitive models of involuntary memories and future projections in emotional disorders.

How imagining personal future scenarios influences affect: Systematic review and meta-analysis

Imagining the future is a fundamental human capacity that occupies a large part of people's waking time and impacts their affective well-being. In this meta-analysis, we examined the effect of (1) positive future imagination and (2) negative future imagination on affect, and (3) compared the affective responses between imagining the future and remembering the past; lastly, we (4) examined potential moderating variables in this regard. We identified 63 experimental studies (N = 6813) from different research areas and combined studies that applied the best possible self imagination task, future worry induction, and episodic future simulation, respectively. Findings yielded that imagining the future has a moderate to strong impact on affect, and it has a stronger influence on affect compared to remembering the past. Relevant moderator variables in each research area were also identified. We discuss the findings for the field of psychology in general and clinical psychology in particular. More elaborate research on personal future imagination seems crucial for the further advancement of clinical applications for mental health complaints. We conclude with recommendations for future research on the impact of future imagination on affective well-being.

Perpetuating factors of social anxiety: a serial mediation model

BACKGROUND

There is evidence that individuals with high levels of social anxiety utilize more safety behaviours and experience more post-event processing than those with lower levels of social anxiety. There are also data to suggest that the relationship between safety behaviour use and social anxiety symptoms is mediated by perceived control of one's anxiety. Furthermore, it has been suggested that post-event processing influences anticipatory anxiety for a future social situation.

AIM

A direct link between the perpetuating factors of social anxiety described above has not been established in the literature. The aim of the current study was to test a model examining the relationship between these constructs.

METHOD

Participants first completed a battery of questionnaires. They then participated in an impromptu, 3-minute speech and were informed they would be videotaped. Following the speech, participants completed measures of anxiety and were instructed to return the following week. During the second session, they were informed they would deliver an additional speech and provided ratings of their anxiety in anticipation of delivering the second speech.

RESULTS

The results of a serial mediation support that greater levels of social anxiety lead to less perceived control over one's anxiety, leading to increased safety behaviour use. The increase in safety behaviours led to an increase of post-event processing which resulted in greater anticipatory anxiety for a future speech task.

CONCLUSIONS

This study provides novel evidence for the importance of perceived control in the genesis of social anxiety, which has implications for treatment.

Concreteness of idiographic worry and anticipatory processing

BACKGROUND AND OBJECTIVES

Worry and anticipatory processing are forms of repetitive negative thinking (RNT) that are associated with maladaptive characteristics and negative consequences. One key maladaptive characteristic of worry is its abstract nature (Goldwin & Behar, 2012; Stöber & Borkovec, 2002). Several investigations have relied on inductions of worry that are social-evaluative in nature, which precludes distinctions between worry and RNT about social-evaluative situations. The present study examined similarities and distinctions between worry and anticipatory processing on potentially important maladaptive characteristics.

METHODS

Participants (N = 279) engaged in idiographic periods of uninstructed mentation, worry, and anticipatory processing and provided thought samples during each minute of each induction. Thought samples were assessed for concreteness, degree of verbal-linguistic activity, and degree of imagery-based activity.

RESULTS

Both worry and anticipatory processing were characterized by reduced concreteness, increased abstraction of thought over time, and a predominance of verbal-linguistic activity. However, worry was more abstract, more verbal-linguistic, and less imagery-based relative to anticipatory processing. Finally, worry demonstrated reductions in verbal-linguistic activity over time, whereas anticipatory processing demonstrated reductions in imagery-based activity over time.

LIMITATIONS

Worry was limited to non-social topics to distinguish worry from anticipatory processing, and may not represent worry that is social in nature. Generalizability may also be limited by use of an undergraduate sample.

CONCLUSIONS

Results from the present study provide support for Stöber's theory regarding the reduced concreteness of worry, and suggest that although worry and anticipatory processing share some features, they also contain characteristics unique to each process.

Early memories in social anxiety: A meaningful and enduring collaboration with my Dad

In this short paper in honour of my father's Festschrift, I describe a recent collaboration with him in which we joined forces to investigate the nature of autobiographical images and memories in social anxiety. I outline our work together and the unique insights that were gleaned from our interactive contributions. Then, I reflect on how this collaboration has helped to lay the foundation for subsequent work in my lab and illuminate new directions in my program of research, enhance my career as a scientist-practitioner, and ultimately, enrich both my personal and professional identities. In so doing, I aim to highlight one of the most important and enduring aspects of my father's legacy: the profound positive impact he has on the people with whom he has worked.

Self-Focused Cognition in Social Anxiety: A Review of the Theoretical and Empirical Literature

Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.

Can I Really Do This? An Examination of Anticipatory Event Processing in Social Anxiety Disorder

Clark and Wells (1995) posit that anticipatory processing before a social situation serves to maintain social anxiety. More specifically, ruminative processes similar to post-event processing (PEP) may occur in anticipation of anxiety provoking social events, and in this article, we have labelled this type of anticipatory rumination anticipatory event processing (AnEP). Participants (n = 75) with social anxiety disorder (SAD) completed measures of anticipatory event processing, trait anxious rumination, social anxiety, state anxiety, and PEP, in the context of completing videotaped exposures twice as part of manual-based group cognitive behavioral therapy. AnEP was significantly positively associated with trait anxious rumination and social anxiety and was associated with state anxiety during the first videotaping. AnEP at the two time points was significantly correlated and decreased across the two taped exposures. Greater AnEP at the first taping was associated with greater PEP the following week. PEP after the first videotaped exposure then significantly related to AnEP for the second videotaped exposure several weeks later. Discussion focuses on the similarities between PEP and AnEP as well as implications for cognitive models and treatment of SAD.

An empirical analysis of Moscovitch's reconceptualised model of social anxiety: How is it different from fear of negative evaluation?

Cognitive-behavioural models propose that excessive fear of negative evaluation is central to social anxiety. Moscovitch (2009) instead proposes that perceived deficiencies in three self attributes: fears of showing signs of anxiety, deficits in physical appearance, or deficits in social competence are at the core of social anxiety. However, these attributes are likely to overlap with fear of negative evaluation. Responses to an online survey of 286 participants with a range of social anxiety severity were analysed using hierarchical multiple regression to identify the overall unique predictive value of Moscovitch's model. Altogether, Moscovitch's model provided improvements in the prediction of safety behaviours, types of fears and cognitions; however only the fear of showing anxiety subscale provided unique information. This research supports further investigations into the utility of this revised model, particularly related to utility of explicitly assessing and addressing fears of showing anxiety.

Die Spontaneous Use of Imagery Scale (SUIS)–Entwicklung und teststatistische Prüfung einer deutschen Adaption

Zusammenfassung. Mentale Vorstellungsbilder spielen bei zahlreichen kognitiven, motorischen und emotionalen Prozessen eine bedeutende Rolle. Die Spontaneous Use of Imagery Scale (SUIS; Kosslyn, Chabris, Shephard & Thompson, 1998 ) ist ein Selbstbeurteilungsinstrument zur Erfassung von interindividuellen Unterschieden hinsichtlich des alltäglichen Gebrauchs mentaler Vorstellungsbilder. In zwei Studien wurde eine deutsche Adaption der SUIS entwickelt und psychometrisch erprobt. Mittels konfirmatorischer Faktorenanalyse wurde in beiden Studien die Eindimensionalität der Skala nachgewiesen. Erste Validitätshinweise ergeben sich aus Beziehungen der SUIS zu Maßen von bildhaften (visuell-imaginativen) sowie verbal-gedanklichen kognitiven Stilen (Studie 1, N = 216). Mit der deutschen Version konnten auch positive Zusammenhänge mit Hypomanie repliziert werden. In der zweiten Studie (N = 447) konnte die interne Konsistenz der deutschen Version durch eine Erweiterung der Skala deutlich verbessert werden. Mit der erweiterten Version der SUIS liegt nun erstmalig für den deutschsprachigen Raum ein Instrument vor, das die Imaginationsneigung reliabel erfassen kann.

Out of the shadows and into the spotlight: Social blunders fuel fear of self-exposure in social anxiety disorder

In a study designed to clarify and extend previous research on social blunders in social anxiety, 32 participants with social anxiety disorder (SAD), 25 anxious control (AC) participants with anxiety disorders other than SAD, and 25 healthy control (HC) participants with no history of anxiety problems estimated the costs of hypothetical blunders committed by either themselves or by others. Participants with SAD rated the costs of their own imagined blunders as highly inflated relative to both AC and HC participants. In contrast, for blunders participants imagined others committing, only SAD and healthy control participants' cost estimates differed from one another. Moreover, concerns about revealing self-flaws--and, in particular, about appearing socially incompetent--accounted for significant, unique variance in SAD participants' exaggerated cost estimates of self blunders, over and above symptoms of social anxiety and depression. These results enhance our understanding of how and why socially anxious individuals negatively appraise social blunders and help to clarify the potential function and role of social mishap exposures in the treatment of SAD.

Mental imagery and post-event processing in anticipation of a speech performance among socially anxious individuals

The present study investigated whether post-event processing (PEP) involving mental imagery about a past speech is particularly detrimental for socially anxious individuals who are currently anticipating giving a speech. One hundred fourteen high and low socially anxious participants were told they would give a 5 min impromptu speech at the end of the experimental session. They were randomly assigned to one of three manipulation conditions: post-event processing about a past speech incorporating imagery (PEP-Imagery), semantic post-event processing about a past speech (PEP-Semantic), or a control condition, (n=19 per experimental group, per condition [high vs low socially anxious]). After the condition inductions, individuals' anxiety, their predictions of performance in the anticipated speech, and their interpretations of other ambiguous social events were measured. Consistent with predictions, high socially anxious individuals in the PEP-Imagery condition displayed greater anxiety than individuals in the other conditions immediately following the induction and before the anticipated speech task. They also interpreted ambiguous social scenarios in a more socially anxious manner than socially anxious individuals in the control condition. High socially anxious individuals made more negative predictions about their upcoming speech performance than low anxious participants in all conditions. The impact of imagery during post-event processing in social anxiety and its implications are discussed.

Within the mind's eye: Negative mental imagery activates different emotion regulation strategies in high versus low socially anxious individuals

BACKGROUND AND OBJECTIVES

The link between social anxiety (SA) and maladaptive emotion regulation has been clearly established, but little is known about the spontaneous regulation strategies that may be activated during social stress by negative involuntary mental images and whether the nature of such strategies might distinguish individuals with high vs. low trait SA.

METHODS

Participants with high (n = 33) or low (n = 33) trait SA performed an evaluative speech and reported whether they experienced an involuntary negative mental image during the task. They also rated their negative affect (NA) and positive affect (PA) and the extent to which they viewed their image as being controllable and malleable. Finally, they described the types of strategies they spontaneously used to try to control or change their image intrusions. Reported strategies were then subjected to a content analysis and categorized by blinded coders.

RESULTS

Among high SA participants, image controllability was both diminished overall and positively correlated with PA. Whereas 90% of low SA individuals reported that they spontaneously self-regulated by altering the content or perceptual features of their images, only about half of the high SA participants used this strategy, with the other 50% reporting that they either suppressed their images or succumbed passively to them in whatever form they took.

LIMITATIONS AND CONCLUSIONS

Although these initial findings require replication in future experimental studies on clinical samples, they also help to enrich our understanding of the strategies that are commonly used by high and low SA individuals to manage their image intrusions during in-vivo stress and suggest potential avenues for future research on the role of imagery in adaptive and maladaptive emotion regulation.