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ObjectiveThis study investigated immersive virtual reality (IVR), as a novel technique to test executive function of healthy younger and older adults. We predicted IVR tasks to have greater predictive power than traditional measures when assessing age-related cognitive functioning due to the real-world validity of the tasks.MethodsParticipants (n=40) completed the Stroop colour–word test and the trail-making test (TMT) as traditional and commonly used assessments of executive functioning. Participants then completed three IVR tasks; a seating arrangement task, an item location task (both set in a virtual chemistry lab), and a virtual parking simulator.ResultsYounger adults completed significantly more parking simulator levels (ppppConclusionIVR measures (i.e. number of parking simulator levels completed and number of objects placed in the seating arrangement task) were found to be stronger contributors than existing traditional neuropsychological tasks in predicting age-related cognitive decline. Future research should investigate the implementation of these real-world-based tasks in clinical groups given this promising initial work.

Background: Negative mental imagery is ubiquitous in cognitive models of social anxiety and in the social anxiety literature. Previous research has shown that it is causal of increased anxiety, lower social performance ratings and lower implicit self-esteem. Despite its prevalence, few studies have investigated this imagery directly. Aims: This study aimed to provide an in-depth analysis of the phenomenology of negative imagery experienced by socially anxious individuals, and to compare recurrent and intrusive images with images deliberately generated by participants during the study. Method: Thirty-eight undergraduate students screened to be above average in social anxiety scores completed a computerized imagery questionnaire adapted from previous qualitative work. Results: Thematic analyses revealed four major image themes for intrusive images and three for deliberately generated images including interacting with others and anxiety symptoms. Most intrusive images were based on negative episodic memories and were experienced at least fortnightly. Images were primarily visual, auditory and somatic but could involve any sensory modality. Depression anxiety stress scale (DASS-21) scores were higher in participants who experienced intrusive imagery and increased with the frequency of intrusions. Emotionality was generally higher in intrusive images than generated images. Conclusions: The phenomenology of negative imagery experienced by socially anxious individuals is idiosyncratic and may be inherently different from images generated for use in experimental research. Theoretical and clinical implications are discussed.

Background and objectives This study sought to reconcile two lines of research. Previous studies have identified a prevalent and causal role of negative imagery in social phobia and public speaking anxiety; others have demonstrated that lateral eye movements during visualisation of imagery reduce its vividness, most likely by loading the visuospatial sketchpad of working memory. It was hypothesised that using eye movements to reduce the intensity of negative imagery associated with public speaking may reduce anxiety resulting from imagining a public speaking scenario compared to an auditory control task. Methods Forty undergraduate students scoring high in anxiety on the Personal Report of Confidence as a Speaker scale took part. A semi-structured interview established an image that represented the participant's public speaking anxiety, which was then visualised during an eye movement task or a matched auditory task. Reactions to imagining a hypothetical but realistic public speaking scenario were measured. Results As hypothesised, representative imagery was established and reduced in vividness more effectively by the eye movement task than the auditory task. The public speaking scenario was then visualised less vividly and generated less anxiety when imagined after performing the eye movement task than after the auditory task. Limitations Self-report measures and a hypothetical scenario rather than actual public speaking were used. Replication is required in larger as well as clinical samples. Conclusions Visuospatial working memory tasks may preferentially reduce anxiety associated with personal images of feared events, and thus provide cognitive resistance which reduces emotional reactions to imagined, and potentially real-life future stressful experiences.

Background: Mental imagery of the future has clear clinical importance, although little is known about intrusive, prospective imagery of personally-relevant events. Currently, no measure is available to assess this. Aims: The Impact of Future Events Scale (IFES) was created to assess the impact of intrusive, prospective, personally-relevant imagery. It was examined in relation to predictions about dysphoria. Method: To form the IFES, the IES-R (a measure of the impact of a past traumatic event on posttraumatic stress disorder symptomatology such as intrusive re-experiencing) was adapted item-by-item to assess intrusive “pre-experiencing” and imagery of specific, future events. Participants (N = 75) completed the IFES and assessments of depression, anxiety and general imagery use. Results: As predicted, the IFES significantly and positively correlated with depression scores. Analyses using subgroups of non-dysphoric and mild-dysphoric participants confirmed that the mild-dysphoric group reported significantly higher IFES scores, indicating higher levels of pre-experiencing of the future and related hyperarousal and avoidance. Conclusions: IFES provides a measure of the impact of “pre-experiencing” in the form of intrusive prospective, personally-relevant imagery, with sensitivity to group differences on the basis of depression scores. Further research is required to extend these finding into clinical depression and other psychopathological conditions.

Background: Flashbacks (intrusive memories of a traumatic event) are the hallmark feature of Post Traumatic Stress Disorder, however preventative interventions are lacking. Tetris may offer a 'cognitive vaccine' [1] against flashback development after trauma exposure. We previously reported that playing the computer game Tetris soon after viewing traumatic material reduced flashbacks compared to no-task [1]. However, two criticisms need to be addressed for clinical translation: (1) Would all games have this effect via distraction/enjoyment, or might some games even be harmful? (2) Would effects be found if administered several hours post-trauma? Accordingly, we tested Tetris versus an alternative computer game - Pub Quiz - which we hypothesized not to be helpful (Experiments 1 and 2), and extended the intervention interval to 4 hours (Experiment 2).Methodology/Principal Findings: The trauma film paradigm was used as an experimental analog for flashback development in healthy volunteers. In both experiments, participants viewed traumatic film footage of death and injury before completing one of the following: (1) no-task control condition (2) Tetris or (3) Pub Quiz. Flashbacks were monitored for 1 week. Experiment 1: 30 min after the traumatic film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz led to a significant increase in flashbacks. Experiment 2: 4 hours post-film, playing Tetris led to a significant reduction in flashbacks compared to no-task control, whereas Pub Quiz did not.Conclusions/Significance: First, computer games can have differential effects post-trauma, as predicted by a cognitive science formulation of trauma memory. In both Experiments, playing Tetris post-trauma film reduced flashbacks. Pub Quiz did not have this effect, even increasing flashbacks in Experiment 1. Thus not all computer games are beneficial or merely distracting post-trauma - some may be harmful. Second, the beneficial effects of Tetris are retained at 4 hours post-trauma. Clinically, this delivers a feasible time-window to administer a post-trauma "cognitive vaccine".

Background and objectives Involuntary autobiographical memories that spring unbidden into conscious awareness form part of everyday experience. In psychopathology, involuntary memories can be associated with significant distress. However, the cognitive mechanisms associated with the development of involuntary memories require further investigation and understanding. Since involuntary autobiographical memories are image-based, we tested predictions that visuospatial (but not other) established cognitive tasks could disrupt their consolidation when completed post-encoding. Methods In Experiment 1, participants watched a stressful film then immediately completed a visuospatial task (complex pattern tapping), a control-task (verbal task) or no-task. Involuntary memories of the film were recorded for 1-week. In Experiment 2, the cognitive tasks were administered 30-min post-film. Results Compared to both control and no-task conditions, completing a visuospatial task post-film reduced the frequency of later involuntary memories (Expts 1 and 2) but did not affect voluntary memory performance on a recognition task (Expt 2). Limitations Voluntary memory was assessed using a verbal recognition task and a broader range of memory tasks could be used. The relative difficulty of the cognitive tasks used was not directly established. Conclusions An established visuospatial task after encoding of a stressful experience selectively interferes with sensory-perceptual information processing and may therefore prevent the development of involuntary autobiographical memories., Highlights ► Involuntary memories present a transdiagnostic treatment target. ► Completing cognitive tasks after a stressful event may reduce involuntary memories. ► The visuospatial nature of the cognitive task may be critical in modulating effects.

This paper explores the proposal that there is a close link between counterfactual thinking and lying. Both require the imagination of alternatives to reality and we describe four studies which explore this link. In Study 1 we measured individual differences in both abilities and found that individuals with a tendency to generate counterfactual thoughts were also more likely to generate potential lies. Studies 2 and 3 showed that counterfactual availability influences people's ability to come up with lies and the extent to which they expect others to lie. Study 4 used a behavioural measure of deception to show that people tend to lie more in situations also known to elicit counterfactual thoughts. Overall, the results show that the imagination of alternatives to the past plays an important role in the generation of lies. We discuss the implications for the fields of counterfactual thinking and deception.

Highlights ► We examined differences in prospective mental imagery (PMI) in anxiety and depression. ► Patients wish depression or anxiety disorders reported less vivid positive PMI than controls. ► Patients with anxiety disorders reported more vivid negative PMI than controls. ► Both clinical groups reported greater levels of intrusive PMI than controls., Prospective negative cognitions are suggested to play an important role in maintaining anxiety disorders and major depressive disorder (MDD). However, little is known about positive prospective mental imagery. This study investigated differences in prospective mental imagery among 27 patients with anxiety disorders, 24 patients with MDD, and 32 control participants. Measures of both deliberately generated and intrusive imagery were completed. Results indicated that both patients with anxiety disorders and those with MDD provided poorer vividness ratings for deliberately generated prospective positive scenarios compared to the control group. Patients with anxiety disorders showed a greater ability to vividly generate imagery for prospective negative scenarios than both patients with MDD and control participants. Finally, both clinical groups reported greater levels of intrusive prospective imagery of personally-relevant events as compared to the control group. The current findings underline the necessity to target prospective positive mental imagery in treating MDD and anxiety disorders.

A cognitive model of bipolar disorder suggests that mental imagery acts as an emotional amplifier of mood and may be heightened in bipolar disorder. First, we tested whether patients with bipolar disorder would score higher on mental imagery measures than a matched healthy control group. Second, we examined differences in imagery between patients divided into groups according to their level of mood stability. Mood ratings over approximately 6-months, made using a mobile phone messaging system, were used to divide patients into stable or unstable groups. Clinician decisions of mood stability were corroborated with statistical analysis. Results showed (I) compared to healthy controls, patients with bipolar disorder had significantly higher scores for general mental imagery use, more vivid imagery of future events, higher levels of intrusive prospective imagery, and more extreme imagery-based interpretation bias; (II) compared to patients with stable mood, patients with unstable mood had higher levels of intrusive prospective imagery, and this correlated highly with their current levels of anxiety and depression. The findings were consistent with predictions. Further investigation of imagery in bipolar disorder appears warranted as it may highlight processes that contribute to mood instability with relevance for cognitive behaviour therapy., Highlights ► Patients with bipolar disorder were compared to controls on mental imagery measures. ► Patients had higher scores on several imagery measures, e.g. more vivid imagery of future events. ► Patients were divided into groups according to their level of mood stability. ► Patients with unstable (versus stable) mood had higher levels of intrusive prospective imagery. ► Prospective imagery correlated highly with current levels of anxiety and depression.

We define intrusive prospective imagery as the experience of mental imagery of events that may happen in the future and which come to mind involuntarily. This everyday phenomenon may be exacerbated in psychological disorders such as bipolar disorder (Holmes, Geddes, Colom, and Goodwin, 2008) although specific measures to assess this have been lacking. We recently developed the Impact of Future Events Scale (IFES; Deeprose and Holmes, 2010), which is further examined in the current paper. In Study 1, adults volunteers (N=50) completed the IFES on two occasions, with 1-week between measurements. This revealed acceptable test-rest reliability. In Study 2, (N=90) IFES showed good internal consistency and confirmed two predictions. First, in the total sample risk for bipolar disorder (MDQ; Hirschfield et al., 2000) and IFES Total Score correlated positively. Second, when the sample was split into high (MDQ ≥ 7) and low (MDQ ≤ 6) bipolarity risk groups, higher IFES Total Scores were observed in the high risk group. We conclude that 1) IFES presents a useful measure for assessing intrusive prospective imagery with acceptable test-retest reliability and good internal consistency and 2) risk for bipolar disorder is associated with elevated IFES Total Scores with potentially important clinical implications.

Background Previous research indicates a much higher incidence of awareness during anaesthesia in children than in adults. The present study is the first large-scale, intraoperative assessment of awareness during paediatric anaesthesia using the isolated forearm technique, and the first large-scale study of memory function during paediatric anaesthesia. Methods One hundred and eighty-four children, 5–18 yr, underwent the isolated forearm technique during the first 17 min of surgery while receiving volatile anaesthesia. The isolated forearm technique was modified to accommodate brief or no paralysis. Bispectral index was monitored in a subset of 54 patients. Sixteen neutral words were played 20 times during surgery and, on recovery, implicit memory for these words was tested with a word identification task. Explicit memory for the surgical period was tested with a structured interview. Behavioural changes were assessed with age-appropriate questionnaires. Results No child had explicit recall of intraoperative events on recovery, and there was no evidence of implicit memory for words presented during anaesthesia. Two of 184 children made unambiguous and verified responses on the modified isolated forearm technique, an incidence of intraoperative awareness of 1.1%. One of these children reported that he was uncomfortable and not completely unconscious during surgery. Neither child had implicit memory for the neutral words, or adverse behaviour change. Conclusions The incidence of awareness during surgery in children is approximately eight times that measured in adults by postoperative recall. In contrast to adults, there is no evidence for preserved memory priming during anaesthesia.

Do patients form memories of intra-operative events when they are adequately anaesthetized? Studies of memory priming during anaesthesia with depth or awareness monitoring provide some evidence that they do, although only the most basic form of memory function, perceptual priming, persists when patients are unconscious. The probability of memory encoding increases as depth of anaesthesia decreases. There is a theoretical possibility that patients can be adversely affected, through memory priming, by comments made in the operating theatre, and some evidence that positive intra-operative suggestions can benefit patients.

There is substantial interest in increased use of formative assessment in higher education. We report on the introduction of a minimal formative assessment measure. Tutors on a level one undergraduate psychology course provided assessment of individual student contribution to tutorials. Using a combination of rating scales and open-ended questions, we examined student (n = 49) and tutor (n = 8) perceptions of the impact of this assessment measure. Students reported increases in their perceptions of preparation, contribution, motivation and reward as a result of the assessment, whereas tutors did not. Implications for higher education practice and theory are discussed.

Priming during anaesthesia has been hard to replicate and the conditions under which it occurs remain poorly understood. We replicated and extended a recent study to determine whether intraoperative priming during propofol and nitrous oxide anaesthesia is a reliable phenomenon, whether it occurs due to awareness during word presentation and whether it is suppressed by a dose of fentanyl at induction.Words were played through headphones during surgery to 62 patients receiving propofol and nitrous oxide anaesthesia. Thirty-two patients received fentanyl 1.5 microg kg(-1) at induction and 30 received no fentanyl. Neuromuscular blocking drugs were not used. Depth of anaesthesia was measured using the bispectral index (BIS). Anaesthetic variables were recorded at 1 min intervals during word presentation. On recovery, implicit and explicit memory were assessed using an auditory word-stem completion test and a yes-no word-recognition test, respectively.BIS, blood pressure, end-tidal carbon dioxide and heart rate during word presentation did not differ between the study groups. The infusion rate of propofol and the patients' ventilatory frequency were significantly higher in the group not receiving fentanyl. No patient had unprompted explicit recall of surgery, although there was above-zero performance in six patients on the yes-no recognition task (P0.05). There was no physiological evidence of awareness during anaesthesia (median mean-BIS=38 in the no-fentanyl group and 42 in the fentanyl group). There was evidence for priming (mean priming score=0.09, P0.05 in the no-fentanyl study group; mean priming score=0.07, P0.05 in the fentanyl group) even when patients with momentary light anaesthesia (maximum recorded BISor =60) and/or positive recognition scores were excluded from the analysis.Existing knowledge can be primed by information presented during propofol and nitrous oxide anaesthesia. This priming is evidence of unconscious information processing and not the result of moments of awareness.

Student evaluation of modules is central to quality management and enhancement within higher education. However, the manner in which questionnaires are designed may inadvertently bias responses. Fifty-seven level 1 undergraduate students (45 women, 12 men) were randomised to evaluate an introductory psychology module on either bipolar (−2 to +2, n = 29) or unipolar (1 to 5, n = 28) scales. Consistent with previous research, ratings on bipolar scales generally elicited more positive evaluations than ratings on unipolar scales. The effects of the numeric values of rating scales were most pronounced when more abstract questions (e.g. ‘overall, how enjoyable was the module?’) than when more concrete questions (e.g. ‘how much did you contribute?’) were asked. Implications of the research for theory and practice in higher education are discussed.

Background Learning during anaesthesia has been demonstrated, but little is known about the circumstances under which it may occur. This study investigated the hypothesis that learning during anaesthesia occurs during, but not before, surgical stimulation. Methods Words were played through headphones to 64 day-surgery patients during propofol anaesthesia. Fourteen words were played repeatedly (15 times) for 1 min each either before (n=32) or during (n=32) surgical stimulation. The depth of anaesthesia was estimated using the bispectral index™ (BIS™). Heart rate, ventilatory frequency, mean arterial pressure, end-tidal carbon dioxide concentration, and infusion rate of propofol were recorded at 1 min intervals during word presentation. On recovery, memory was assessed using an auditory word stem completion test and word recognition test. Results The mean BIS™, arterial pressure, end-tidal carbon dioxide and heart rate during word presentation did not differ between the groups. The infusion rate of propofol and the ventilatory frequency were significantly greater in the during-surgical stimulation group. There was no evidence for explicit recall or recognition, nor of awareness during anaesthesia (median mean-BIS™=38 in the before-surgical stimulation group and 42 in the during-surgical stimulation group). Only patients who were played words during surgical stimulation showed significant implicit memory on recovery (mean score=0.08, P Conclusions Learning during anaesthesia seems more likely to occur during rather than before surgical stimulation at comparable anaesthetic depth. We hypothesize that surgical stimulation facilitates learning during anaesthesia, independently of its effects on anaesthetic depth.

Anesthesia research has focused on showing learning in the absence of awareness for good practical reasons. Crucially, continued learning during otherwise clinically adequate anesthesia may affect patients’ well-being on recovery. Theoretically, preserved perceptual priming during anesthesia offers a useful starting point for consciousness research by determining the limits of memory function during minimal (if not absent) consciousness. The big question for consciousness research is not to demonstrate absolutely unconscious processing, but rather to map out the cognitive and neurobiological processes that enable conscious experience itself.

Mental imagery may occur in any sensory modality, although visual imagery has been most studied. A sensitive measure of the vividness of imagery across a range of modalities is needed: the shorter version of Bett's Questionnaire upon Mental Imagery (Sheehan, 1967, J. Clin. Psychology, 23, 386) uses outdated items and has an unreliable factor structure. We report the development and initial validation of the Plymouth Sensory Imagery Questionnaire (Psi-Q) comprising items for each of the following modalities: Vision, Sound, Smell, Taste, Touch, Bodily Sensation, and Emotional Feeling. An exploratory factor analysis on a 35-item form indicated that these modalities formed separate factors, rather than a single imagery factor, and this was replicated by confirmatory factor analysis. The Psi-Q was validated against the Spontaneous Use of Imagery Scale (Reisberg et al., 2003, Appl. Cogn. Psychology, 17, 147) and Marks' (1995, J. Mental Imagery, 19, 153) Vividness of Visual Imagery Questionnaire-2 (VVIQ-2). A short 21-item form comprising the best three items from the seven factors correlated with the total score and subscales of the full form, and with the VVIQ-2. Inspection of the data shows that while visual and sound imagery is most often rated as vivid, individuals who rate one modality as strong and the other as weak are not uncommon. Findings are interpreted within a working memory framework and point to the need for further research to identify the specific cognitive processes underlying the vividness of imagery across sensory modalities.

The current gold standard for assessment and monitoring of Parkinson9s disease (PD) is the unified PD rating scale (UPDRS). While a useful evaluation tool, its application for research is limited by the need for an experienced rater, intra and inter-rater reliability and a 5-point scale. The UPDRS is time-consuming with the specific motor assessment taking >15 minutes to administer. Rapid, objective tools are needed to aid monitoring of PD for research utility. A finger-tapping app (PD-Tap), developed for use on an iPod Touch, was used to test finger tapping performance in 16 patients with idiopathic Parkinson9s disease (mean age 66 years and disease duration 12 months) and 16 age-matched-controls (AMC). A fast finger-tapping task taking

Hales SA, Deeprose C, Goodwin GM, Holmes EA. Cognitions in bipolar affective disorder and unipolar depression: imagining suicide. Bipolar Disord 2011: 13: 651–661. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S. Objective: Bipolar disorder has the highest rate of suicide of all the psychiatric disorders. In unipolar depression, individuals report vivid, affect-laden images of suicide or the aftermath of death (flashforwards to suicide) during suicidal ideation but this phenomenon has not been explored in bipolar disorder. Therefore the authors investigated and compared imagery and verbal thoughts related to past suicidality in individuals with bipolar disorder (n = 20) and unipolar depression (n = 20). Methods: The study used a quasi-experimental comparative design. The Structured Clinical Interview for DSM-IV was used to confirm diagnoses. Quantitative and qualitative data were gathered through questionnaire measures (e.g., mood and trait imagery use). Individual interviews assessed suicidal cognitions in the form of (i) mental images and (ii) verbal thoughts. Results: All participants reported imagining flashforwards to suicide. Both groups reported greater preoccupation with these suicide-related images than with verbal thoughts about suicide. However, compared to the unipolar group, the bipolar group were significantly more preoccupied with flashforward imagery, rated this imagery as more compelling, and were more than twice as likely to report that the images made them want to take action to complete suicide. In addition, the bipolar group reported a greater trait propensity to use mental imagery in general. Conclusions: Suicidal ideation needs to be better characterized, and mental imagery of suicide has been a neglected but potentially critical feature of suicidal ideation, particularly in bipolar disorder. Our findings suggest that flashforward imagery warrants further investigation for formal universal clinical assessment procedures.

Abnormalities in mental imagery have been implicated in a range of mental health conditions. Imagery has a particularly powerful effect on emotion and as such plays a particularly important role in emotional disorders. In depression, not only is the occurrence of intrusive negative imagery problematic, but also the lack of positive (in particular, future-directed) imagery is important. The authors suggest that, in depression, imagery can exacerbate the effects of interpretation bias. This article outlines an experimental psychopathology subcomponents model of depression that focuses specifically on the role of imagery and interpretation bias in the maintenance of the disorder. The authors propose that negative intrusive imagery, a lack of positive imagery, and negative interpretation bias serve both independently and interactively to maintain depressed mood. Finally, the authors consider the implications of this imagery-based approach for the development of new cognitive treatments in this area. © 2009 Taylor and Francis.