Computerized positive mental imagery training versus cognitive control training versus treatment as usual in inpatient mental health settings: study protocol for a randomized controlled feasibility trial

Simon E Blackwell, Katharina Westermann, Marcella L Woud, Jan C Cwik, Torsten Neher, Christian Graz, Peter W Nyhuis, Jürgen Margraf, Simon E Blackwell, Katharina Westermann, Marcella L Woud, Jan C Cwik, Torsten Neher, Christian Graz, Peter W Nyhuis, Jürgen Margraf

Abstract

Background: Enhancing the capacity to experience positive affect could help improve recovery across a range of areas of mental health. Experimental psychopathology research indicates that a computerized cognitive training paradigm involving generation of positive mental imagery can increase state positive affect, and more recent clinical studies have suggested that this training could be used as an adjunct treatment module to target symptoms related to positive affect deficits, specifically anhedonia. The current study investigates the feasibility of adding a positive mental imagery computerized training module to treatment for patients in inpatient mental health settings, with a focus on increasing positive affect and reducing anhedonia. The positive mental imagery training (PMIT) is added to treatment as usual (TAU) in the inpatient setting, and compared to TAU alone, or TAU plus an alternative cognitive training module not hypothesized to increase positive affect, cognitive control training (CCT).

Methods: The study is a feasibility randomized controlled trial with three parallel arms. Up to 90 patients admitted to inpatient mental health treatment clinics in Germany will be randomized to PMIT + TAU, CCT + TAU, or TAU on a 1:1:1 ratio. PMIT or CCT consist of an introductory session followed by up to 8 full training sessions over 2 weeks. All three arms (including TAU) include regular completion of mood measures over the 2-week period. Outcome measures are completed pre and post this 2-week training/monitoring period, and at 2-week follow-up. Data will be presented in the form of both raw means and standardized effect sizes, with 95% confidence intervals, for both intention-to-treat and per-protocol samples.

Discussion: The study will inform feasibility of conducting a fully powered randomized controlled trial investigating the addition of the positive mental imagery training as a treatment adjunct to inpatient treatments for mental health, including potential refinement of study procedures, inclusion/exclusion criteria, and preliminary indications of the likely range of effect sizes.

Trial registration: clinicaltrials.gov, NCT02958228 (date registered: 4 November 2016).

Keywords: Anhedonia; Cognitive bias modification; Cognitive control training; Mental imagery; Positive affect.

Conflict of interest statement

Ethical approval for the study was provided by the committee of the Faculty of Psychology, Ruhr-Universität Bochum (Germany) approval no. 325. All participants provide written informed consent at the start of the eligibility assessment for the study. Not applicable The authors declare that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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