Major Depressive Diorder, Low Self-Esteem, Mood Disorders
Conditions
Keywords
Imagery Rescripting, Depression, Primary care
Brief summary
In the current study we aim to investigate the feasibility, acceptability, and effectiveness of ImRs offered by mental health assistants within primary care to reduce depressive symptoms. In a single-case experimental design (SCED) study, the following hypotheses will be tested: 1. ImRs results in a reduction of depressive symptoms compared to baseline, and this reduction lasts up to six months. 2. Patients with complaints of depressive symptoms find ImRs an acceptable form of intervention when offered by mental health assistants within a general practice setting. Participants will wait for 2-4 weeks and then receive 5 sessions of ImRs over a period of 10 weeks. During these sessions, negative memories related to their depressed feelings are rescripted.
Detailed description
The study consists of a multiple-baseline case series in which the effectiveness and feasibility of Imagery Rescripting as a therapeutic technique will be investigated within primary care, with the aim of reducing depressive symptoms. The intervention will be provided by the mental health assistants (POH-GGZ) at the GP practice that is linked to the University of Amsterdam (Huisartsenpraktijk UvA). These mental health assistant have been trained in Imagery Rescripting. In the study, participants are randomly assigned to a baseline condition of 2-4 weeks, and a subsequent intervention condition of 10 weeks. During the intervention, all patients receive five sessions of Imagery Rescripting (45 minutes per session). Throughout these 12-14 weeks, and for 4 weeks after, participants complete bi-weekly (i.e., twice per week) measurements. The total number of bi-weekly measurements is thus 32-36, depending on the baseline condition that participants are randomized to. In addition, there will be 5 longer questionnaires, including a 3 and 6-month follow-up. Participants that are invited to the study but that do not want to participate will receive care as usual by the mental health assistant.
Interventions
BEHAVIORALImagery Rescripting
During ImRs, the patient brings a negative memory to mind and changes, together with the therapist, the outcome of the memory into a more positive
Sponsors
University of Amsterdam
UvA Huisartsen
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
A multiple-baseline case series design will be used. All participants will first complete a baseline phase without intervention, and then undergo 10 weeks of Imagery Rescripting intervention (5 sessions). Participants are randomized to different waitlist (baseline) durations (2, 3 or 4 weeks), and intervention effectiveness is evaluated by comparing the change over time of bi-weekly self-reported depressive symptoms, self-esteem, and core beliefs.
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Main complaint of depressive feelings, as indicated by both the mental health assistant and the patient. * HADS score for the depression subscale ≥ 11. * Ability to understand, read, write and speak Dutch or English. * Age between 18 and 70. * Willingness to participate in the study and treatment.
Exclusion criteria
* Acute suicide risk (BDI-II-item9 score of 3). * If the mental health assistant suspects that the patient may have a primary diagnosis of bipolar disorder, psychosis, substance use disorder, low IQ, or if the patient suffers from serious neurological problems such as dementia, then the patient is not included. There will not be a formal assessment of a primary diagnosis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Depressive symptom severity | 16-18 weeks, twice a week | Depressive symptom severity is assessed with the PHQ-2 (Kroenke et al., 2003). The PHQ-2 consists of the first two items of the PHQ-9 and measures the frequency of depressed mood and anhedonia in the past week. Scores range from 0-6 and higher scores mean more depressive symptoms. |
| Self-esteem | 16-18 weeks, twice a week | Self-esteem will be measured with a single question "How have you felt about yourself in the past week?" Participants rate this question on a scale from -100 (very negative) to +100 (very positive). |
| Dysfunctional core beliefs | 16-18 weeks, twice a week + 3 month and 6 month follow-up | Participants will formulate these negative beliefs about themselves or the world/other people together with the mental health assistant during the first session and then rate how convincing these beliefs are on a scale from 0 (not at all convincing) -100 (very convincing). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital Anxiety and Depression Scale | Baseline, pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up | Measures depressive and anxious symptoms on a 14 item scale (Zigmond \& Snaith, 1983). Scores range from 0-21 per scale (Anxiety and Depression) and higher scores reflect higher symptom severity. |
| Rosenberg Self-Esteem Scale | Baseline, pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up | Measures self-esteem with 10 items scored on a 4-point scale, scores range from 0 to 30, and higher scores reflect higher self-esteem (Rosenberg, 1965). |
| Suicidal thoughts | Baseline, pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up | Suicidal thoughts are measured using item 9 of Beck's depression inventory (BDI-II) |
| Emotional memory | Pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up | We will measure the following characteristics of the reported memories that will be rescripted: Vividness, Emotional Intensity, Emotional Impact, Intrusivity. These characteristics will be assessed with subscales of the Memory Experiences Questionnaire (MEQ; Vividness and Emotional Intensity) and two added subscales (Emotional Impact, Intrusivity). These measures are based on a previous study that these indices of a negative emotional memory related to depression scores (Stemerding et al., 2025). Each aspects is scored from 1-5 and higher scores mean stronger vividness, emotional intensity, emotional impact and intrusiveness. |
Countries
Netherlands
Contacts
CONTACTLotte Stemerding
Outcome results
None listed