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Open Access 01-04-2014 | Original Article

Positive Imagery Cognitive Bias Modification in Treatment-Seeking Patients with Major Depression in Iran: A Pilot Study

Authors: Hajar Torkan, Simon E. Blackwell, Emily A. Holmes, Mehrdad Kalantari, Hamid Taher Neshat-Doost, Mohsen Maroufi, Hooshang Talebi

Published in: Cognitive Therapy and Research | Issue 2/2014

Abstract

Cognitive bias modification paradigms training positive mental imagery and interpretation (imagery CBM-I) hold promise for treatment innovation in depression. However, depression is a global health problem and interventions need to translate across settings and cultures. The current pilot study investigated the impact of 1 week of daily imagery CBM-I in treatment-seeking individuals with major depression in outpatient psychiatry clinics in Iran. Further, it tested the importance of instructions to imagine the positive training materials. Finally, we examined the effects of this training on imagery vividness. Thirty-nine participants were randomly allocated to imagery CBM-I, a non-imagery control program, or a no treatment control group. Imagery CBM-I led to greater improvements in depressive symptoms, interpretive bias, and imagery vividness than either control condition at post-treatment (n = 13 per group), and improvements were maintained at 2-week follow-up (n = 8 per group). This pilot study provides first preliminary evidence that imagery CBM-I could provide positive clinical outcomes in an Iranian psychiatric setting, and further that the imagery component of the training may play a crucial role.

This small sample size is congruent with the study’s aims as a pilot study. We also note that the study could be considered as adequately powered to meet its primary aim on the basis of a formal power calculation using an effect size estimate derived from the most comparable previous study. The main aim of the current study was to evaluate the impact of the imagery CBM-I on symptoms of depression relative to the control groups. This is determined by the condition by time interaction in the ANOVA investigating change in scores on the BDI from pre to post-treatment. In the most comparable published study (Lang et al. 2012), the effect size for the equivalent interaction was large (η ² = .19). We might therefore plan to look for a large interaction effect in the current study. A power calculation (G*Power 3.1.7; Faul et al. 2007) to estimate the sample size needed to provide 80 % power to find a large effect size of η ² = .14 (i.e. the lowest boundary of a large effect size), α = .05, and using the most conservative estimate of correlation between repeated measures, r = 0, suggests that a total sample size N = 36, or n = 12 per group, would be needed.

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Title: Positive Imagery Cognitive Bias Modification in Treatment-Seeking Patients with Major Depression in Iran: A Pilot Study
Authors: Hajar Torkan
Simon E. Blackwell
Emily A. Holmes
Mehrdad Kalantari
Hamid Taher Neshat-Doost
Mohsen Maroufi
Hooshang Talebi
Publication date: 01-04-2014
Publisher: Springer US
Published in: Cognitive Therapy and Research / Issue 2/2014
Print ISSN: 0147-5916
Electronic ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-014-9598-8

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Positive Imagery Cognitive Bias Modification in Treatment-Seeking Patients with Major Depression in Iran: A Pilot Study

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