Mental Imagery and Psychological Well-being

Study Overview
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Brief Summary
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This study aims to investigate the effects of mental imagery practice on depression, behavioral activation, psychological well-being and other processes involved in depression such as anhedonia. We use a multiple baseline design in addition to a pre-post and follow-up standardized assessment design.

Detailed Description
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The purpose of this study is to determine if daily practice of mental imagery improves psychological variables such as motivation, behavioral activation, depression, mood, optimism, anhedonia, and psychological well-being, and if it's combination with activity planning is more effective than activity planning alone. This study will analyze the effect of 2 mental imagery conditions (planned activity imagery, best possible self) and a control condition of activity planning alone, administered to a general population over a 2-week period. Our hypotheses are an improvement for both experimental conditions (planned activities imagery and best possible self imagery) of mood, behavioral activation, depressive symptomatology, optimism, psychological well-being, cognitive and behavioral avoidance, and anhedonia, compared to the control condition. Several studies have been able to show the effect of either imagery condition on certain variables (notably behavioral activation and mood for the planned activity imagery as well as optimism and mood for the best possible self), but the interest of our study is to assess the effect of each of the proposed protocols on a broader range of variables. This will allow us to determine the specific effect of each protocol as well as to compare their effectiveness. In this study we will recruit 120 participants, randomly assigned to one of three conditions: (1) mental imagery of planned activities, (2) mental imagery of best possible self, (3) planned activity control group. All participants will be asked to complete a series of standardized assessments in 4 steps (at the first meeting, at the second meeting 15 days later, and a follow-up at 1 and 3 months post-intervention). The questionnaires will assess depression, behavioral activation, mood, optimism, imagery skills, anhedonia, and psychological well-being. In each group, participants will have to think about 4 activities to be implemented within the next two weeks, and answer about 10 questions about the chosen activities (rated from 0 to 10 on a visual analogical scale). These questions evaluate, among other things, the motivation, the anticipated effort, the anticipated pleasure, and the degree of avoidance related to each activity using a visual analog scale. This questionnaire will be completed at the first meeting and also after the completion of each activity, at home. The protocol is identical for each condition except for the content of the imagery exercise or no imagery exercise for the control condition. The participants in the experimental conditions will be instructed to repeat the 5-minute imagery exercise at home every day for 2 weeks and report in a booklet everyday their rating of the imagery exercise (vividness, difficulty and their mood after the exercise). At a second meeting 2 weeks later, all participants will be asked to complete the standardized assessments again and report whether or not the planned activities were completed, as well as conduct a semi-structured interview about their experience, the feasibility and difficulty of the task. Participants will then receive a follow-up survey by e-mail at 1 and 3 months post-intervention, in which they will again be asked to complete the selected standardized questionnaires. The booklets in which they reported the questionnaires about their planned activities (all conditions) and the ratings of imagery exercise (for experimental conditions) will be brought back on that meeting.

Official Title
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Can Mental Imagery Increase Behavioral Activation ?

Conditions
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Depression, Anhedonia

Intervention / Treatment
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* Behavioral: Mental Imagery
* Behavioral: Control condition (activity planification)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least some symptoms of depression (minimal score of 8 on the depression subscale of the HADS) Exclusion Criteria: Not ongoing psychotherapy at the time of the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental G1 - imagery of planned activity<br>In this condition, the participant will have to think about 4 activities he will plan to do during the next 2 weeks. He will then complete a questionnaire about all the activities he identified and think about the major obstacle that could prevent him to do each activity, and a solution for each one. Then he will proceed to a mental imagery exercise where he imagines doing the activity as vividly as possible. He then will proceed to go home and repeat the imagery practice every day for the next two weeks, and do the planned activities. He will report in a booklet ratings of the mental imagery exercise and the activities he did. | Behavioral: Mental Imagery<br>* Mental Imagery consists of imagining a situation in the most vivid way possible, including all sensory modalities (visual image, sensations, smells, sounds, emotions). It can be used to act as a motivational amplifier, by pre-experimenting a situation in imagination. The best possible self imagery consists of imagining the best version possible of one's self , after accomplishing all their major life goals, in a future where everything turned out the best way possible. What does this best version of you do, in terms of actions, on an everyday basis ? The planned imagery exercise consists of rehearsing an activity in a mental way, before actually doing it. It can help to visualize the outcome of this activity and benefits it can provide to the participant before actually getting it done.<br>|
| Experimental: Experimental G2 - imagery of best possible self<br>In this condition, the participant will first have to do a mental imagery exercise where he imagines his best possible self, having accomplished all his big life goals, as vividly as possible. He will then have to think about 4 activities he will plan to do during the next 2 weeks, in line with the imagery exercise. He will then complete a questionnaire about all the activities he identified. He then will proceed to go home and repeat the imagery practice every day for the next two weeks, and do the planned activities. He will report in a booklet ratings of the mental imagery exercise and the activities he did. | Behavioral: Mental Imagery<br>* Mental Imagery consists of imagining a situation in the most vivid way possible, including all sensory modalities (visual image, sensations, smells, sounds, emotions). It can be used to act as a motivational amplifier, by pre-experimenting a situation in imagination. The best possible self imagery consists of imagining the best version possible of one's self , after accomplishing all their major life goals, in a future where everything turned out the best way possible. What does this best version of you do, in terms of actions, on an everyday basis ? The planned imagery exercise consists of rehearsing an activity in a mental way, before actually doing it. It can help to visualize the outcome of this activity and benefits it can provide to the participant before actually getting it done.<br>|
| Active Comparator: Control G3 - activity planification alone<br>In this condition, the participant will have to think about 4 activities he will plan to do during the next 2 weeks. He will then complete a questionnaire about all the activities he identified. There is no mental imagery exercise in this condition. He then will proceed to go home and receive the assignment to do the planned activities in the course of the next two weeks. He will report in a booklet ratings of the activities he did. | Behavioral: Control condition (activity planification)<br>* The participant identifies 4 activities that he plans to do in the course of the next 2 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depressive symptomatology | The Beck depression inventory- second edition (BDI-II) is a 21-items scale that assesses the severity of depressive symptoms during the last two weeks. The score may range from 0 to 63. Higher score indicates higher depressive symptoms (worse outcome). | Baseline | 
| Depressive symptomatology | The Beck depression inventory- second edition (BDI-II) is a 21-items scale that assesses the severity of depressive symptoms during the last two weeks. The score may range from 0 to 63. Higher score indicates higher depressive symptoms (worse outcome). | Two weeks after beginning of treatment (end of treatment) | 
| Depressive symptomatology | The Beck depression inventory- second edition (BDI-II) is a 21-items scale that assesses the severity of depressive symptoms during the last two weeks. The score may range from 0 to 63. Higher score indicates higher depressive symptoms (worse outcome). | 1 month after end of treatment | 
| Depressive symptomatology | The Beck depression inventory- second edition (BDI-II) is a 21-items scale that assesses the severity of depressive symptoms during the last two weeks. The score may range from 0 to 63. Higher score indicates higher depressive symptoms (worse outcome). | 3 months after end of treatment | 
| Behavioral activation | The Behavioral Activation for Depression Scale (BADS) is a 25-items scale that assesses behavioral activation. Five subscales have been identified: Activation, Behavioral Avoidance, Rumination, Work/School Impairment and Social Impairment. Activation may range from 0 to 42. Higher scores indicate greater activation level (better outcome) | Baseline | 
| Behavioral activation | The Behavioral Activation for Depression Scale (BADS) is a 25-items scale that assesses behavioral activation. Five subscales have been identified: Activation, Behavioral Avoidance, Rumination, Work/School Impairment and Social Impairment. Activation may range from 0 to 42. Higher scores indicate greater activation level (better outcome) | Two weeks after beginning of treatment (end of treatment) | 
| Behavioral activation | The Behavioral Activation for Depression Scale (BADS) is a 25-items scale that assesses behavioral activation. Five subscales have been identified: Activation, Behavioral Avoidance, Rumination, Work/School Impairment and Social Impairment. Activation may range from 0 to 42. Higher scores indicate greater activation level (better outcome) | 1 month after end of treatment | 
| Behavioral activation | The Behavioral Activation for Depression Scale (BADS) is a 25-items scale that assesses behavioral activation. Five subscales have been identified: Activation, Behavioral Avoidance, Rumination, Work/School Impairment and Social Impairment. Activation may range from 0 to 42. Higher scores indicate greater activation level (better outcome) | 3 months after end of treatment | 
| LOT | The Life Orientation Test (Revised) is a 10-items scale assesses one's dispositional level of optimism, providing meaningful insight into possible interventions, such as those to address harmful thought patterns. Scores can range from 0 to 24, being 0-13 Low Optimism, 14-18 Moderate Optimism, 19-24 High Optimism. | Baseline | 
| LOT | The Life Orientation Test (Revised) is a 10-items scale assesses one's dispositional level of optimism, providing meaningful insight into possible interventions, such as those to address harmful thought patterns. Scores can range from 0 to 24, being 0-13 Low Optimism, 14-18 Moderate Optimism, 19-24 High Optimism. | Two weeks after beginning of treatment (end of treatment) | 
| LOT | The Life Orientation Test (Revised) is a 10-items scale assesses one's dispositional level of optimism, providing meaningful insight into possible interventions, such as those to address harmful thought patterns. Scores can range from 0 to 24, being 0-13 Low Optimism, 14-18 Moderate Optimism, 19-24 High Optimism. | 1 month after end of treatment | 
| LOT | The Life Orientation Test (Revised) is a 10-items scale assesses one's dispositional level of optimism, providing meaningful insight into possible interventions, such as those to address harmful thought patterns. Scores can range from 0 to 24, being 0-13 Low Optimism, 14-18 Moderate Optimism, 19-24 High Optimism. | 3 months after end of treatment | 
| PANAS | The Positive affect negative affect scale consists of two 10-item scales to measure both positive and negative affect. Each item is rated on a 5-point scale of 1 (not at all) to 5 (very much) | Baseline | 
| PANAS | The Positive affect negative affect scale consists of two 10-item scales to measure both positive and negative affect. Each item is rated on a 5-point scale of 1 (not at all) to 5 (very much) | Two weeks after beginning of treatment (end of treatment) | 
| PANAS | The Positive affect negative affect scale consists of two 10-item scales to measure both positive and negative affect. Each item is rated on a 5-point scale of 1 (not at all) to 5 (very much) | 1 month after end of treatment | 
| PANAS | The Positive affect negative affect scale consists of two 10-item scales to measure both positive and negative affect. Each item is rated on a 5-point scale of 1 (not at all) to 5 (very much). | 3 months after end of treatment | 
| Anhedonia | The Savoring belief Inventory (SBI) is an 24-items scale assessing individuals' attitudes regarding savoring positive experiences. Three subscales related to three temporal orientations are identified, one related to the past (reminiscence), one related to the present moment (present), and one related to the future (anticipation) each represented by 8 items. Higher scores indicate higher level of approach and savor pleasant events (better outcome). | Baseline | 
| Anhedonia | The Savoring belief Inventory (SBI) is an 24-items scale assessing individuals' attitudes regarding savoring positive experiences. Three subscales related to three temporal orientations are identified, one related to the past (reminiscence), one related to the present moment (present), and one related to the future (anticipation) each represented by 8 items. Higher scores indicate higher level of approach and savor pleasant events (better outcome). | Two weeks after beginning of treatment (end of treatment) | 
| Anhedonia | The Savoring belief Inventory (SBI) is an 24-items scale assessing individuals' attitudes regarding savoring positive experiences. Three subscales related to three temporal orientations are identified, one related to the past (reminiscence), one related to the present moment (present), and one related to the future (anticipation) each represented by 8 items. Higher scores indicate higher level of approach and savor pleasant events (better outcome). | 1 month after end of treatment | 
| Anhedonia | The Savoring belief Inventory (SBI) is an 24-items scale assessing individuals' attitudes regarding savoring positive experiences. Three subscales related to three temporal orientations are identified, one related to the past (reminiscence), one related to the present moment (present), and one related to the future (anticipation) each represented by 8 items. Higher scores indicate higher level of approach and savor pleasant events (better outcome). | 3 months after end of treatment | 
| Well-being | The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is a 14-items scale assessing mental well-being. The score may range from 14 to 70. Higher scores indicate higher mental well-being (better outcome). | Baseline | 
| Well-being | The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is a 14-items scale assessing mental well-being. The score may range from 14 to 70. Higher scores indicate higher mental well-being (better outcome). | Two weeks after beginning of treatment (end of treatment) | 
| Well-being | The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is a 14-items scale assessing mental well-being. The score may range from 14 to 70. Higher scores indicate higher mental well-being (better outcome). | 1 month after end of treatment | 
| Well-being | The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is a 14-items scale assessing mental well-being. The score may range from 14 to 70. Higher scores indicate higher mental well-being (better outcome). | 3 months after end of treatment | 
| Mental Imagery ability | The Plymouth Sensory Imagery questionnaire is a 35 items scale measuring the vividness of mental imagery in seven different modalities: vision, sound, smell, taste, touch, bodily sensation, and emotion. There is a sub-score for every modality, with score ranging from 5 to 50 (better outcome) and a total score ranging from 35 to 350 (better outcome) higher score indicating higher imagery ability. | Baseline | 
| Mental Imagery ability | The Plymouth Sensory Imagery questionnaire is a 35 items scale measuring the vividness of mental imagery in seven different modalities: vision, sound, smell, taste, touch, bodily sensation, and emotion. There is a sub-score for every modality, with score ranging from 5 to 50 (better outcome) and a total score ranging from 35 to 350 (better outcome) higher score indicating higher imagery ability. | Two weeks after beginning of treatment (end of treatment) | 
| Mental Imagery ability | The Plymouth Sensory Imagery questionnaire is a 35 items scale measuring the vividness of mental imagery in seven different modalities: vision, sound, smell, taste, touch, bodily sensation, and emotion. There is a sub-score for every modality, with score ranging from 5 to 50 (better outcome) and a total score ranging from 35 to 350 (better outcome) higher score indicating higher imagery ability. | 1 month after end of treatment | 
| Mental Imagery ability | The Plymouth Sensory Imagery questionnaire is a 35 items scale measuring the vividness of mental imagery in seven different modalities: vision, sound, smell, taste, touch, bodily sensation, and emotion. There is a sub-score for every modality, with score ranging from 5 to 50 (better outcome) and a total score ranging from 35 to 350 (better outcome) higher score indicating higher imagery ability. | 3 months after end of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| self concordant motivation | The self concordance motivation scale is a scale in which the participant rates his motivation to pursue a goal based on 4 different reasons (external, introjected, identified and intrinsic) on a scale from 1 to 9, designed to measure if the motivation of a person relative to his goals is intrinsic or extrinsic. The self-concordance variable is calculated by averaging the intrinsic and identified ratings and subtracting the average external and introjected ratings. A higher score means higher self-concordance (better outcome) | Baseline | 
| Motivation to do this activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Motivation to do this activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Positive anticipation of the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Positive anticipation of the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Anticipated pleasure resulting in the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Anticipated pleasure resulting in the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Anticipated satisfaction resulting in the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Anticipated satisfaction resulting in the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Anticipated Gratification resulting in the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Anticipated Gratification resulting in the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Anticipated difficulty to do the activity | Assessment on a scale from 0 (minimum, better outcome) to 10 (maximum, worse outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Anticipated difficulty to do the activity | Assessment on a scale from 0 (minimum, better outcome) to 10 (maximum, worse outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Avoidance of the activity | Assessment on a scale from 0 (minimum, better outcome) to 10 (maximum, worse outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Avoidance of the activity | Assessment on a scale from 0 (minimum, better outcome) to 10 (maximum, worse outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Importance of the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Importance of the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Difficulty to find time to do the activity | Assessment on a scale from 0 (minimum, better outcome) to 10 (maximum, worse outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Baseline | 
| Difficulty to find time to do the activity | Assessment on a scale from 0 (minimum, better outcome) to 10 (maximum, worse outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right before doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Perceived difficulty after doing the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right after doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Perceived mood after doing the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right after doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Perceived pleasure after doing the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right after doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Perceived satisfaction after doing the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right after doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Perceived gratification after doing the activity | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Right after doing the activity (during the two weeks intervention, reporting in the booklet, at home) | 
| Difficulty of the mental imagery exercise | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Everyday at home during the two weeks intervention period, right after doing the imagery exercise (reporting in the booklet, at home) | 
| Mood after doing the mental imagery exercise | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Everyday at home during the two weeks intervention period, right after doing the imagery exercise (reporting in the booklet, at home) | 
| Vividness of the mental imagery exercise | Assessment on a scale from 0 (minimum, worse outcome) to 10 (maximum, better outcome) of the effects and costs of this activity perceived by the participant. The question is asked for each identified activity. | Everyday at home during the two weeks intervention period, right after doing the imagery exercise (reporting in the booklet, at home) |