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

Expanding the toolset of experimental Psychopathology: The Trier Social Stress Test induces a personally relevant emotional memory

Despite the remarkable progress in developing effective psychological interventions for emotional disorders, our understanding of the mechanisms driving therapeutic change remains strikingly limited. To bridge this gap, we need to refine experimental paradigms with high ecological validity and establish their clinical utility. In this study, we replicate and extend previous findings that the Trier Social Stress Test (TSST) can evoke persistent, sensory rich, and personally meaningful emotional memories. One week after the TSST, a student sample (N = 146) reported greater negative valence, arousal, and lack of control in response to TSST-related versus control cues. Participants reported intrusive memories, the content of which reflects the personal relevance, sensory richness, and emotionality of the TSST memory. Re-imagining the TSST through guided imagery evoked heightened emotional responses (skin conductance, heart rate, and self-report) and participants evaluated themselves more negatively due to the TSST. These effects correlated with trait anxiety. However, comparisons to a naïve sample that only experienced the TSST through guided imagery (N = 38) revealed that some findings, including changes in self-image, were not memory-induced. We conclude with concrete examples of how the paradigm can expand our toolset to further unravel mechanistic underpinnings of memory-focused interventions.

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.

Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention

Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative 'flashforward' imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1-week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14-17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group-based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary. Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974.

Targeting negative flashforward imagery in speech anxiety with a visuospatial dual-task: Do attenuated flashforwards lead to less anxiety and avoidance?

BACKGROUND AND OBJECTIVES

It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech.

METHODS

Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech.

RESULTS

Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech.

LIMITATIONS

The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample.

CONCLUSIONS

Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears.

Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes

Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.

Repetition and practice. Developing mental training with young violinists: a collaboration

Mental training has been used successfully by professional musicians and athletes, yet rarely applied in pedagogical processes. As research in neuroscience can now explain how it connects to the processes of learning, its application and adaptation in pedagogy can now be explored. The aim of this mixed methods study was to investigate concepts of repetition and practice with mental training, and discuss adaptations for young violinists, to include attention, awareness, and creative musicality. Three exercises were developed with nine students (average age 8). The first involved creation of imagery, followed by physical practice; the second alternated mental imagery with physical practice; the third involved concurrent use of physical practice and mental imagery. Results of the first exercise indicate heightened awareness of technical skill; self-discovery of bow control, speed and distribution, tone production improvements and an ability to sustain longer notes post-mental training (Z = -2.666, p = 0.008 and Z = -2.670, p = 0.008). Observations from the second and third exercises include student experimentation with concepts of musical interpretation, an eagerness to repeat repertoire (≥ 5 times) and increased self-awareness of technical and musical accomplishments. The research suggests that mental training can be adapted for younger learners, that it encourages collaboration in the pedagogical process, and develops student self-awareness of the cognitive and physical processes of violin playing.