Search

Tailoring interventions to the individual has been hypothesized to improve treatment efficacy. Personalization of target-specific underlying mechanisms might improve treatment effects as well as adherence. Data-driven personalization of treatment, however, is still in its infancy, especially concerning the integration of multiple sources of data-driven advice with shared decision-making. This study describes an innovative type of data-driven personalization in the context of StayFine, a guided app-based relapse prevention intervention for 13- to 21-year-olds in remission of anxiety or depressive disorders (n = 74). Participants receive six modules, of which three are chosen from five optional modules. Optional modules are Enhancing Positive Affect, Behavioral Activation, Exposure, Sleep, and Wellness. All participants receive Psycho-Education, Cognitive Restructuring, and a Relapse Prevention Plan. The personalization approach is based on four sources: (1) prior diagnoses (diagnostic interview), (2) transdiagnostic psychological factors (online self-report questionnaires), (3) individual symptom networks (ecological momentary assessment, based on a two-week diary with six time points per day), and subsequently, (4) patient preference based on shared decision-making with a trained expert by experience. This study details and evaluates this innovative type of personalization approach, comparing the congruency of advised modules between the data-driven sources (1–3) with one another and with the chosen modules during the shared decision-making process (4). The results show that sources of data-driven personalization provide complementary advice rather than a confirmatory one. The indications of the modules Exposure and Behavioral Activation were mostly based on the diagnostic interview, Sleep on the questionnaires, and Enhancing Positive Affect on the network model. Shared decision-making showed a preference for modules improving positive concepts rather than combating negative ones, as an addition to the data-driven advice. Future studies need to test whether treatment outcomes and dropout rates are improved through personalization.

Speech anxiety (SA) is a highly prevalent social fear. Prospective ‘flashforward’ (FF) imagery of an upcoming social catastrophe may be a particularly important cognitive factor in SA persistence via eliciting anxiety and avoidance behaviors. Since earlier research on imagery and social anxiety has not strictly differentiated between types of negative imagery, the occurrence, precise features, and impact of FF imagery remain unclear. We therefore examined the phenomenological characteristics of FF imagery in SA and mapped the relationship between FF imagery features and anxiety and avoidance. Female participants who approached clinical levels of SA (N = 60) completed questionnaires on SA and avoidance behaviors, and rated anxiety and avoidance in anticipation of an actual speech. FF imagery and emotionally linked autobiographical memories were assessed with semi-structured interviews. All participants reported recurring FF images, which were experienced as vivid, distressing, field perspective images with accompanying negative feelings. Image distress and feelings of threat showed most consistent associations with SA and avoidance measures. Findings add to the conceptualization of SA, and support the clinical relevance of assessing FF imagery. Future experimental studies on FF imagery characteristics are necessary to test the proposed causal impact in SA persistence and to inform additional treatment targets.

IntroductionRuminative (abstract verbal) processing during recall of aversive autobiographical memories may serve to dampen their short-term affective impact. Experimental studies indeed demonstrate that verbal processing of non-autobiographical material and positive autobiographical memories evokes weaker affective responses than imagery-based processing. In the current study, we hypothesized that abstract verbal or concrete verbal processing of an aversive autobiographical memory would result in weaker affective responses than imagery-based processing.MethodsThe affective impact of abstract verbal versus concrete verbal versus imagery-based processing during recall of an aversive autobiographical memory was investigated in a non-clinical sample (n = 99) using both an observational and an experimental design. Observationally, it was examined whether spontaneous use of processing modes (both state and trait measures) was associated with impact of aversive autobiographical memory recall on negative and positive affect. Experimentally, the causal relation between processing modes and affective impact was investigated by manipulating the processing mode during retrieval of the same aversive autobiographical memory.ResultsMain findings were that higher levels of trait (but not state) measures of both ruminative and imagery-based processing and depressive symptomatology were positively correlated with higher levels of negative affective impact in the observational part of the study. In the experimental part, no main effect of processing modes on affective impact of autobiographical memories was found. However, a significant moderating effect of depressive symptomatology was found. Only for individuals with low levels of depressive symptomatology, concrete verbal (but not abstract verbal) processing of the aversive autobiographical memory did result in weaker affective responses, compared to imagery-based processing.DiscussionThese results cast doubt on the hypothesis that ruminative processing of aversive autobiographical memories serves to avoid the negative emotions evoked by such memories. Furthermore, findings suggest that depressive symptomatology is associated with the spontaneous use and the affective impact of processing modes during recall of aversive autobiographical memories. Clinical studies are needed that examine the role of processing modes during aversive autobiographical memory recall in depression, including the potential effectiveness of targeting processing modes in therapy.