Extensive research on cognitive reappraisal and expressive suppression suggests that they produce distinct emotion outcomes. The present study, conducted in 2021, assessed whether these regulation strategies produced distinctive facial, vocal and linguistic responses to emotionally evocative, negative images relative to control conditions. Participants (N = 65) were asked to describe these images after being instructed to engage in cognitive reappraisal or no regulation, or expressive suppression compared to no regulation. Cognitive reappraisal was distinguished from no regulation by higher levels of vocal activity, more positive speech and less self-reported negative reactions to the images, suggesting that it changed the valence of the elicited emotion. Expressive suppression was distinguished from no regulation by diminished overall facial expressivity, negative facial expressivity and head movement deviation. These patterns indicate that these emotion regulation strategies result in distinct emotional responses across multiple emotional channels.

Whereas attentional control has been proposed as a broad-based protective factor for PTSD, data suggest that elevated control may be paradoxically associated with increased symptoms, particularly in the presence of other risk factors. The current study examined the unique and interactive effects of attentional shifting (i.e., the transfer of attention across stimuli) and attentional focusing (i.e., the maintenance of attention on relevant targets) with experiential avoidance on posttrauma symptom clusters, accounting for potential nonlinearities in the influence of shifting and focusing dimensions. Shifting models in survivors of heterogeneous trauma (N = 252; 75 % female; 85.7 % White/Non-Hispanic) identified shifting as a moderator of the linear effect of experiential avoidance on CAPS-5 arousal-reactivity (β = -.16, p = .008), with experiential avoidance holding positive associations with arousal-reactivity through shifting scores reaching 2/3SD above the mean. Focusing models, by contrast, identified experiential avoidance as a moderator of the quadratic effect (x) of focusing on CAPS-5 intrusions (β = .13, p = .010). Data failed to support effects of focusing at low levels of experiential avoidance (-1SD). A curvilinear effect of focusing emerged at average experiential avoidance, however, suggesting reductions in traumatic intrusions with increased focusing to mean values in the sample. At high experiential avoidance (+1SD), intrusions decreased with increases in focusing through average levels, but rebounded in response to focusing capabilities extending beyond the sample mean. Results are consistent with previous research suggesting nonlinearities in the effects of attentional control on posttrauma functioning and point to the importance of specific attentional processes in understanding avenues of risk and resilience.

Although positive emotion up-regulation via reappraisal increases electrocortical and subjective response to pictures, little is known about how situational factors may moderate its success. For instance, emotion regulation must at times be performed shortly after a cognitively demanding event. Here, we set out to determine whether positive emotion up-regulation would be compromised if performed after a difficult math task (hard math; n = 39) versus after an easy math task (easy math; n = 39). After randomly assigning participants to groups, we assessed reappraisal's effectiveness using the late positive potential (LPP) as a measure of picture salience and picture ratings. Results showed that positive emotion up-regulation via reappraisal was unaffected by math difficulty. Nonetheless, participants who had just completed a hard math task showed smaller LPPs overall, compared to those who had completed the easy math task. In contrast to prior work, across both math groups, reappraisal was only effective for neutral and not positive pictures. Therefore, recent prior cognitive demand does not appear to compromise reappraisal of neutral pictures, yet it remains possible that any recent demanding task (i.e., either high or low load) may compromise up-regulation for stimuli that are closer to ceiling - i.e., positive stimuli. Results are discussed in the context of a situation-specific approach to emotion regulation and the utility of positive emotion up-regulation in everyday life. Findings also suggest possible a mechanism underlying blunted response to stimuli, as has been observed in some forms of internalizing psychopathology.

Emerging evidence suggests that rescripting aversive memories related to obsessive-compulsive disorder (OCD) may improve symptoms and OCD-relevant cognitive and affective outcomes. We aimed to validate an online, audio-guided imagery rescripting protocol by comparing it with a focused, thought-listing control. A sample of Prolific online workers (n = 112) with high OCD symptoms identified a memory associated with OCD-related experiences, then were randomly assigned to complete either the rescripting or control task. Select outcomes were re-assessed one-week post-experiment. Feared self-perceptions improved for the rescripting, but not the control condition; these improvements were maintained for idiosyncratic and state feared-self beliefs, but not trait fear-of-self. Participants in the rescripting condition also reported significantly greater reductions in state anxiety and urge to neutralise, compared to controls. No changes were observed in obsessional beliefs for either condition. There were no between-condition differences in engagement in behavioural neutralisation post-experiment. A small but significant increase in reporting OCD symptoms was found at follow-up; this did not differ between conditions and was consistent with heightened awareness of symptoms. These findings provide preliminary evidence that imagery rescripting in a standardised audio-guided format may be an effective adjunctive treatment for OCD to facilitate cognitive and affective change.

Clinically derived theoretical models of dissociative identity disorder (DID) suggest that these individuals experience shifts in cognitive functioning between identity states. While prior research has found no objective inter-identity differences in memory, the present study investigated whether such differences are evident in a related cognitive domain: attentional processing. It was hypothesized that individuals with DID would exhibit differences in their attentional bias (AB) toward concern-related stimuli. They were compared to individuals with PTSD who experienced interpersonal childhood trauma, simulators enacting different identity states, and non-clinical adults. Based on cognitive models in anxiety, individuals with PTSD were expected to show a vigilance-avoidance AB pattern for concern-related stimuli. Non-clinical comparisons were expected to show a weaker AB effect than the clinical groups. Participants (n = 95) completed a visual spatial dot-probe task with both short (200 ms) and long (1250 ms) exposure conditions, displaying angry (i.e., concern-related stimuli) and happy facial expressions (i.e., control stimuli). In addition, participants completed post-task measures of state anxiety and state dissociation. The results did not reveal significant AB differences between identity states in individuals with DID, although differences were observed between identity states in the simulator group. Moreover, no significant AB differences were found between individuals with DID, PTSD, and non-clinical groups. State anxiety and state dissociation scores were not significantly related to AB scores. Findings provided no support for shifts in attentional processing between identity states in DID. Furthermore, we found no evidence for a hypervigilant-avoidant AB pattern for concern-related stimuli in PTSD.

Trauma-focused therapies like Imagery Rescripting (ImRs) are seldom offered to patients who are underweight with comorbid eating disorders (uED) and PTSD, due to doubts about their emotional and cognitive capacities. However, high rates of PTSD comorbidity in this group highlight the need for tailored trauma interventions. This study examines therapists' experiences applying ImRs in this population, with a focus on specific challenges and how Peer Group Supervision sessions (PGSs) supported treatment delivery.

Generalized anxiety disorder is characterised by aversive mental images of feared outcomes. This study investigated whether a single session of imagery rescripting would produce greater reductions in anxious response, threat appraisals, and intrusive images regarding a feared event than imaginal exposure among individuals high in trait worry.

Occupational burnout affects between 11 % and 30 % of healthcare professionals and is associated with staff sickness, job turnover, increased costs and poorer quality of care. This study aimed to compare the effects of two theoretically distinctive interventions for burnout in healthcare professionals.

Imagery Rescripting (ImRs) is a well-established psychotherapeutic intervention for treating aversive memories, such as those related to interpersonal transgressions. However, questions remain regarding the optimal implementation of ImRs, particularly concerning which components are most effective. In this experimental study (N = 271), we examined whether guiding participants to imagine forgiving versus taking revenge on a transgressor would differentially affect key emotional and cognitive outcomes. Additionally, we investigated the moderating role of the initial victim-transgressor commitment. Participants were instructed to imagine being the victims in a fictional interpersonal transgression. The imagined transgressor was a person with whom they had either a weak or strong commitment. Participants then engaged in an audio-guided ImRs session oriented toward either forgiveness or revenge, before indicating their aggressive inclinations, positive and negative affect, justice-related satisfaction, and feelings of empowerment. Results indicated that forgiveness-oriented ImRs led to lower aggressive inclinations and negative affect, as well as higher justice-related satisfaction, compared to revenge-oriented ImRs. No differences emerged between conditions in positive affect and feelings of empowerment. Moreover, the effectiveness of both ImRs approaches was independent of the victim-transgressor commitment. These findings suggest that forgiveness-oriented ImRs may offer a promising approach to reduce the emotional consequences of transgressions, with a reduced risk of increasing aggressive inclinations among victims. This highlights the potential value of incorporating forgiveness into ImRs protocols. However, given the fictional nature of the transgression and the standardized, non-clinical setting, further research is needed to evaluate the clinical applicability of these findings.

Imagery rescripting (ImR) has demonstrated efficacy in reducing symptoms of social anxiety disorder (SAD). However, there are many logistical and psychological barriers that prevent individuals with SAD from accessing treatment. The efficacy of remote treatment methodologies, such as internet videoconferencing, has recently been demonstrated across a range of mental disorders. However, the efficacy of videoconferencing-delivered ImR (vImR) has not yet been examined. The present study aims to examine the efficacy and acceptability of vImR for SAD in a multiple baseline trial utilising the waitlist control group from a larger randomised controlled trial (RCT). 35 participants (M = 37.86; SD = 12.90) received no intervention for 8-weeks, then received an 8-session manualised vImR treatment protocol. Within-group analyses indicated negligible effect sizes from baseline to pre-treatment (SIAS-6: d = 0.22; 95 % CI: 0.25 - 0.69; SPS-6: d = -0.03; 95 % CI: 0.49 - 0.44). Large effect sizes were found from pre-treatment to post-treatment (SIAS-6: d = 0.81; 95 % CI: 0.32-1.29; SPS-6: d = 0.80; 95 % CI: 0.30-1.27) and pre-treatment to 3-month follow-up (SIAS-6: d = 0.85; 95 % CI: 0.36-1.33; SPS-6: d = 0.90; 95 % CI: 0.40-1.38). At post-treatment, 66 % of participants no longer met criteria for SAD (74 % at 3-month follow-up). Benchmarking analyses indicated similar treatment effect sizes to in-person ImR for SAD. Participants rated the program as highly acceptable. The results indicate that the mechanisms of ImR appear to be transferable to vImR and therefore this may be a viable remote treatment option for individuals with SAD who do not respond to first-line treatments.

Exposure to natural disasters, such as bushfires, increases vulnerability for poor psychological outcomes. Large scale reviews have increased our understanding of risk factors associated with disaster related maladjustment, however this relationship remains unclear. This study examined the effect of exposure to resource loss in the post-bushfire disaster environment on fear learning and extinction pathways. Participants (70 adults; 73 % female, 17-58 years of age, M = 23.77, SD = 8.16) were randomly allocated to view scenes depicting post-bushfire resource loss (post-bushfire disaster group) or no disaster (community group) followed by all participants completing a discriminative Pavlovian conditioning task including habituation, conditioning, extinction, and retest phases. During acquisition, one shape (CS+) was paired with an aversive tone as the unconditioned stimulus (UCS) and another shape (CS-) was presented alone, while both CSs were presented alone during extinction and retest phases. Subjective ratings of fear, worry and sadness, were obtained before and after picture viewing and between learning task phases whilst ratings of CS pleasantness and arousal were obtained before and after learning task phases. Skin conductance responses (SCR) were recorded to the CSs during all phases. The post-bushfire disaster group reported more subjective fear, worry and sadness after viewing images relative to the community group. The post-bushfire disaster group also showed significantly larger orienting SCRs to both CSs during acquisition relative to the community group and significantly smaller orienting SCRs to both CSs and undifferentiated anticipatory SCRs during extinction relative to the community group. During retest, the post-bushfire disaster group exhibited significantly larger anticipatory SCRs to both CSs compared to the community group. There were no group differences in between phase ratings of CS+ and CS- unpleasantness and arousal and no group differences in subjective anxiety ratings between learning task phases. Exposure to post-bushfire resource loss may increase fear conditioning and generalisation to safe stimuli, impair safety learning, and increase reactivity when re-exposed to fear stimuli.

Changing maladaptive trauma-related cognitions may be crucial in trauma-focused cognitive behaviour therapy (TF-CBT). We identified common maladaptive cognitions during TF-CBT's trauma narration and processing phase and examined their relationship with trauma type and post-traumatic stress symptoms (PTSS). We also assessed whether maladaptive trauma-related cognitions (overgeneralization, assimilation), more balanced and functional cognitions (accommodation), and negative emotions during this phase of TF-CBT were associated with PTSS.

Imagery Rescripting (ImRs) is a transdiagnostic technique to treat aversive memories of real (traumatic) experiences, or of aversive fantasies, such as nightmares and future projections. ImRs is getting increasingly popular, and can be used either as a standalone treatment or as part of treatment packages consisting of different techniques. It has been more than 25 years ago that a detailed treatment protocol of Imagery Rescripting (ImRs) was published (Arntz, A., & Weertman, A. (1999). Treatment of childhood memories; theory and practice. Behaviour Research and Therapy, 37(8), 715-740). New clinical and research insights have led to changes in the protocol, and large scale studies are based on this updated protocol. The most important changes include that it is now strongly recommended that the therapist does the rescripting in the first sessions, while the patient does the rescripting during the later sessions; and that the rescripting should start at the most difficult moment of the memory (the "hotspot"). Moreover, a standard series of questions helps to deepen the emotional processing, while specific ingredients of the rescripting help to increase the impact of the corrective experience offered by the technique. This paper presents and discusses the updated protocol as it has been developed and tested in the treatment of childhood trauma. It also offers solutions for possible problems that can be encountered in clinical practice, and discusses variations of the technique, including how to apply it to adulthood trauma's, to nightmares, and to a range of disorders and clinical problems, including pathological grief, and feared future catastrophes. It is explained that the working mechanism does not rely on installing false memories, and how therapists can prevent that false memories are installed. Finally, the paper provides a set of practical appendices including a treatment rationale and a handout that can be given to patients.

Exposure to war and terrorism presents a significant, global mental health challenge. Such adverse events give rise to extreme stress, resulting in widely varying psychological outcomes, from minimal impact to severe anxiety and related symptoms. Adolescence, a developmental period marked by an increased prevalence of anxiety disorders, may render individuals particularly vulnerable to the psychological consequences of war. Identifying biomarkers predicting risk is critically important for early detection and intervention efforts. Considerable research examines the role of variation in firsthand (direct) threat learning processes in the emergence of enduring anxiety symptoms, highlighting potential learning-related biomarkers. However, observational (vicarious) threat learning, whereby individuals learn about potential dangers by observing others' responses, has received limited attention. This longitudinal study examined whether observational threat acquisition and its generalization predicted subsequent anxiety symptom severity in 65 adolescents approximately one year later during exposure to acute war-related stress. At baseline, we assessed observational learning of safety and threat associations and their subsequent generalization, using psychophysiology and cognitive indices, alongside generalized anxiety disorder (GAD) symptoms. Approximately one year later, six weeks into the Israel-Hamas war (2023), GAD symptoms were reassessed. Results showed difficulty in adapting threat responses across contexts with varying threat levels, and cue overgeneralization, as measured in the laboratory, predicted elevated GAD symptoms during the war. These findings suggest difficulties in the adaptation and generalization of observational threat learning may increase vulnerability to anxiety during times of acute stress, highlighting its potential as an early risk marker.

Hazardous drinking and posttraumatic stress disorder (PTSD) frequently co-occur and lead to greater impairment and dysfunction than either condition alone. Anxiety sensitivity (AS; i.e., the fear of the anxiety-related sensations and consequences) is a transdiagnostic risk factor for hazardous drinking and PTSD that may serve to inform novel, integrated intervention development for these co-occurring conditions. However, an integrated intervention to specifically target AS in the context of hazardous drinking and PTSD symptoms has not yet been developed or tested. The present study aimed to develop and test the acceptability and efficacy of an integrated, novel computer-based personalized feedback intervention (PFI) in a sample of community adults with hazardous drinking, at least subclinical PTSD symptoms, and elevated AS. Participants (N = 101; M = 31.7) were randomized to either an integrated PFI condition (n = 50) focused on PTSD, AS, and alcohol, or an active comparison condition (n = 51) focused exclusively on alcohol use. Compared to the active comparison condition, acceptability ratings were greater for the integrated condition. Latent growth curve models found that participants in both conditions reported statistically significant reductions in alcohol-related cravings/urges and intention to reduce drinking. Participants randomized to the integrated condition reported statistically significantly lower PTSD symptom severity and average daily drinking quantity as well as greater motivation to reduce drinking over time relative to participants in the active comparison condition. Findings provide preliminary support for an integrated approach targeting PTSD, AS, and hazardous drinking, and underscore the need for their continued development.

This study examined the acceptability of a new fatigue-focused Cognitive Bias Modification training for interpretations (CBM-I) for those with long term health conditions (LTC) and the feasibility of delivering a randomised controlled trial of fatigue-focused CBM-I compared to control training. Effects on fatigue-related interpretation bias, self-reported fatigue, depression and anxiety were also explored.

Overgeneral autobiographical memory (OGM), the inability to recall specific events and instead recall general memories, is a well-known feature of psychopathology. Although OGM has been regarded as a deficit in generative retrieval, recent studies highlight the role of direct and involuntary (associative) retrieval in OGM. We propose the accessibility model, which discards the hierarchical structure of autobiographical memory and truncated search hypothesis. The accessibility model assumes that memory representations of different specificities are structured in parallel, and compete to be retrieved. The model contends that direct and generative retrieval are serial processes (i.e., direct retrieval initially, followed by generative retrieval), and specific and general memory accessibility each affect OGM. We argue that increased accessibility of negative general memories and decreased accessibility of positive specific memories underlie OGM in depression. These changes in accessibility are differentially associated with hippocampal abnormalities, memory suppression, self-referential processing, and positivity biases, suggesting different mechanisms depending on emotional valence. Furthermore, we propose that metacognitive monitoring and control are required to initiate generative retrieval when retrieved memories are goal inconsistent. The accessibility model integrates existing basic memory and OGM research, which may lead to improved memory therapeutics, and new avenues for research development.

To develop effective and acceptable interventions for reducing distress in adults living with chronic pain, understanding the psychological processes presumed to underlie therapeutic approaches is needed. This longitudinal study examined the relative contribution of illness perceptions (grounded in the common-sense model informing cognitive behavioural therapy) and compassion (key to compassion-focused therapy) in predicting anxiety and depression in chronic pain, and explored whether effects were mediated by worry and rumination.