Mental Imagery Training Increases Wanting of Rewards and Reward Sensitivity and Reduces Depressive Symptoms

doi:10.1016/j.beth.2017.04.002

Behavior Therapy

Volume 48, Issue 5, September 2017, Pages 695-706

https://doi.org/10.1016/j.beth.2017.04.002 Get rights and content

Highlights

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Effects of internet-delivered imagery training of rewarding stimuli were examined.
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Mental imagery training is effective in alleviating blunted reward sensitivity.
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Increases in reward sensitivity were associated with reduced depressive symptoms.
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Training group also showed increased approach of positive activities.
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Training can add to existing treatments and prevention strategies for depression.

Abstract

High reward sensitivity and wanting of rewarding stimuli help to identify and motivate repetition of pleasant activities. This behavioral activation is thought to increase positive emotions. Therefore, both mechanisms are highly relevant for resilience against depressive symptoms. Yet, these mechanisms have not been targeted by psychotherapeutic interventions. In the present study, we tested a mental imagery training comprising eight 10-minute sessions every second day and delivered via the Internet to healthy volunteers (N = 30, 21 female, mean age of 23.8 years, Caucasian) who were preselected for low reward sensitivity. Participants were paired according to age, sex, reward sensitivity, and mental imagery ability. Then, members of each pair were randomly assigned to either the intervention or wait condition. Ratings of wanting and response bias toward probabilistic reward cues (Probabilistic Reward Task) served as primary outcomes. We further tested whether training effects extended to approach behavior (Approach Avoidance Task) and depressive symptoms (Beck Depression Inventory). The intervention led to an increase in wanting (p < .001, η²_p = .45) and reward sensitivity (p = .004, η²_p = .27). Further, the training group displayed faster approach toward positive edibles and activities (p = .025, η²_p = .18) and reductions in depressive symptoms (p = .028, η²_p = .16). Results extend existing literature by showing that mental imagery training can increase wanting of rewarding stimuli and reward sensitivity. Further, the training appears to reduce depressive symptoms and thus may foster the successful implementation of exsiting treatments for depression such as behavioral activation and could also increase resilience against depressive symptoms.

Section snippets

Participants

A priori power analyses using G*Power (Faul, Erdfelder, Lang, & Buchner, 2007) confirmed that a sample size of N = 28 would meet the following parameters: α = .05, β = .20, two groups (training and waitlist control), two measurements (before and after training), and a correlation among repeated measures of 0.6 (Pizzagalli, Jahn, & O’Shea, 2005). Foreseeing at least one dropout per group, we included N = 30 participants. This sample size can detect a medium-sized effect (f = .25), which was

Intervention and wanting

All participants completed all sessions at the planned date. Furthermore, they reacted promptly during the ratings of wanting every 90 seconds (overall M = 293 msec, overall SD 207 msec, overall range: 160 – 1205 msec), indicating that they were not asleep or distracted, but focused on the training session.

Food stimuli comprised cake, chips, burgers, chocolate, ice cream, meat dishes, French fries, pizza, and candy. Activities used for training included watching movies, partying, relaxing,

Discussion

In this study, a guided imagery training focusing on thoughts, emotions, and sensations associated with rewarding edibles and activities successfully increased wanting of these stimuli and reward sensitivity in terms of an enlarged response bias toward a probabilistic reward cue in a healthy sample that was preselected for low reward sensitivity. Further, we observed faster approach toward positively rated edibles and activities and decreased depressive symptoms in the training group. Our

Conclusion

The present study revealed that mental imagery of positive thoughts, feelings, and sensations concerning food and activities efficaciously increased wanting and reward sensitivity along with faster approach toward these stimuli, thereby reducing depressive symptoms. Given successful replication, this intervention might be relevant for the treatment and prevention of depression.

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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Reward insensitivity is a potential key mechanism regarding the maintenance of depression. However, there is a lack of research examining and comparing the effectiveness of different psychological interventions in modifying reward insensitivity. This four-arm randomized controlled trial (RCT) investigated a two-week online intervention. After screening for eligibility, a total of 336 participants were randomized, and 224 participated per-protocol. Participants were assigned to either a) behavioral activation, b) mindfulness and gratitude, c) a combination of both, or d) a waitlist control condition. They received videos and implemented daily exercises. Reward sensitivity and depressive symptoms served as primary outcomes. Behavioral activation and mindfulness significantly improved depressive symptoms and reward sensitivity. However, the effects of behavioral activation were not superior. The combination treatment versus the waiting group was insignificant regarding reward insensitivity. Explorative analyses revealed that all intervention groups reduced anhedonia substantially. Our findings imply that brief online interventions with behavioral activation and mindfulness-based approaches can impact reward insensitivity, while effects for a combination were less clear. Nonetheless, our results do not allow us to infer the differential effectiveness of the interventions. There is a clear need for treatments better targeting maintaining factors of depression, such as reward insensitivity. Clinical trial registration number: NCT05402150
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LERs emphasised that people often tell them to avoid negative imagery and that this is unhelpful. Experimental studies showed that imagining positive events (compared with verbal processing)95 is more powerful for increasing positive affect, and enhancing positive future imagery can increase motivation and reward sensitivity72 and protect against low mood.75 Our consultations also suggested that positive future imagery could disrupt worry and increase positive approach behaviour.
Emotional mental imagery is a powerful part of our mental landscape. Given its capacity to depict, process, and generate emotional events, mental imagery could have an important role in psychological therapies. This Series paper explores whether harnessing emotional mental imagery is meaningful to young people; ways in which interventions use emotional mental imagery; contextual and individual factors influencing intervention effectiveness; and mechanisms underpinning imagery techniques. We completed a systematic review of imagery interventions and consulted young people with lived experience (n=10) and leading international experts (n=7). The systematic search identified 86 papers covering a diverse range of imagery interventions. Across the seven categories of techniques reviewed, imagery rescripting for aversive memories, techniques targeting positive imagery, and imagery-enhanced protocols indicated the most potential. The report suggests that harnessing emotional mental imagery in psychological interventions could be a promising approach to reduce anxiety and depression and that mental health science could inform the development of new interventions and help to maximise intervention effectiveness.
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Together with the present finding, the data suggest that despite reductions in reward processing (Dillon et al., 2009), some sensitivity to rewards is present in previously maltreated persons, which can be used in therapeutic settings. For example, Linke and Wessa (2017) showed that mental imagery training may increase reward sensitivity and reduce depressive symptoms. Second, little is known regarding differential effects of subgroups with specific childhood trauma histories.
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^☆: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

^☆☆: The authors thank Jonas Neubert and Jana Eyemann for their assistance in data acquisition.

View full text

Mental Imagery Training Increases Wanting of Rewards and Reward Sensitivity and Reduces Depressive Symptoms☆,☆☆

Highlights

Abstract

Section snippets

Participants

Intervention and wanting

Discussion

Conclusion

Conflict of Interest Statement

Current Opinion in Psychology

Psychiatry Research

Psychoneuroendocrinology

Biological Psychiatry

Biological Psychiatry

Trends in Cognitive Science

Journal of Psychiatric Research

Biological Psychiatry

Journal of Psychiatric Research

Biological Psychiatry

Journal of Behavior Therapy and Experimental Psychiatry

Personality and Individual Differences

Journal of Affective Disorders

Biological Psychiatry

Biol Psychiatry Cogn Neurosci

Frontiers in Behavioral Neuroscience

Psychiatry Research

Using the OECD equivalence scale in taxes and benefits analysis

Economic & Labour Market Review

Beck Depression Inventory-II (BDI-II)

Positive imagery-based cognitive bias modification as a web-based treatment tool for depressed adults: A randomized controlled trial

Clinical Psychological Science

Food-pics: An image database for experimental research on eating and appetite

Frontiers in Psychology

Co-Occurring Depressive and Substance Use Disorders in Adolescents: An Examination of Reward Responsiveness During Treatment

Journal of Psychotherapy Integration

Blunted neural response to rewards prospectively predicts depression in adolescent girls

Psychophysiology

Intelligence moderates reinforcement learning: A mini-review of the neural evidence

Journal of Neurophysiology

Why don’t you try harder? An investigation of effort production in major depression

PLoS One

Emotional imagery: assessing pleasure and arousal in the brain’s reward circuitry

Human Brain Mapping

Varenicline as a smoking cessation aid in schizophrenia: Effects on smoking behavior and reward sensitivity

Psychopharmacology (Berl)

G*Power 3: A flexible statistical power analysis for the social, behavioral, and biomedical sciences

Behavior Research Methods

Abnormal neural sensitivity to monetary gains versus losses among adolescents at risk for depression

Journal of Abnormal Child Psychology