Individuals with schizophrenia exhibit a range of verbal and nonverbal impairments during social interaction, which contribute to reduced interaction quality and broader social dysfunction. To optimize clinical interventions, it is essential to identify the mechanisms underlying these deficits. Building on previous findings demonstrating reduced emotional mimicry in schizophrenia, the present study examined whether gaze aversion is associated with instances of failed mimicry during naturalistic conversation. In a within-partner design, interacting partners (n = 20) each engaged in one conversation with an individual with schizophrenia (n = 20) and one with a matched healthy control (n = 20). Prior analyses using OpenFace-based video coding revealed diminished emotional mimicry in the schizophrenia group. In the present study, the same video recordings were reanalyzed using FaceReader to extract gaze direction. We specifically examined gaze aversion during the interaction and, more critically, during episodes of failed mimicry, defined as instances in which participants did not reciprocate their partner's smile. Results indicated that although individuals with schizophrenia did not display significantly greater overall gaze aversion across the entire interaction, they exhibited significantly greater gaze aversion when their partner was smiling. This pattern was associated with a higher proportion of failed mimicry accompanied by gaze aversion in the schizophrenia group compared to controls. These findings suggest that reduced visual attention may represent one mechanism contributing to emotional mimicry deficits in schizophrenia. Clinical implications are discussed, along with the potential role of stigma in exacerbating these processes.
Cognitive biases are implicated in the maintenance of obsessive-compulsive disorder (OCD), yet findings from reaction-time paradigms remain mixed. Eye-tracking offers a direct window into these attentional processes. We examined symptom-specific attentional patterns in university students selected for high vs. low contamination fear (HCF n = 10, LCF n = 10) and high vs. low checking (HC n = 10, LC n = 10) from a screened sample (N = 774). Participants viewed symptom-matched (disgust or checking) and general threat pairs against neutral images. Attentional bias was indexed as vigilance (first fixation and latency), disengagement (first-fixation duration), and maintenance (fixation count and total duration). Results indicated that attentional biases were primarily evident during the maintenance stage rather than early orienting. For the contamination dimension, significant interaction emerged for maintenance. Specifically, HCF participants demonstrated significantly reduced gaze maintenance for disgust images compared to threat and neutral images, consistent with a vigilance-avoidance pattern suggestive of attentional avoidance. For the checking dimension, while significant main effects for image type indicated rapid orienting to checking cues and sustained viewing of checking and threat-related images across all participants, these effects were not significantly moderated by symptom group. Findings indicate that attentional bias in OCD is heterogeneous and partially distinct across symptom subtypes. These results underscore the value of symptom-matched stimuli and gaze metrics, support cognitive bias modification to symptom dimensions, and highlight eye-tracking as a useful tool for parsing vigilance, disengagement, and maintenance. Limitations, clinical implications, and future directions are discussed.
Exposure to a stressful trauma after successful treatment can lead to relapse, known as fear reinstatement. In the laboratory, fear reinstatement involves re-exposing individuals to an aversive unconditioned stimulus (US) after successful extinction learning, leading to the reinstatement of fear to a previously threatening conditioned stimulus (CS). While fear reinstatement is typically thought to evoke the return of old fear, preliminary evidence suggests that using a qualitatively different US during reinstatement can elicit new fear (i.e., this new US is expected to follow the CS instead of the US used in training). This study aimed to expand on this finding by examining safety behaviors, a behavioral response that minimizes US onset. To this end, participants first acquired conditioned fear and safety behaviors to the CS, followed by extinction learning to it. On the second day, some participants encountered a novel reinstatement US (Cross-US), while others received either the same US as in acquisition for reinstatement (Same-US) or no reinstatement manipulation (No-US). After reinstatement manipulation, the Cross-US group showed a larger increase in US avoidance and US expectancy to the novel US compared to the other groups. Our findings suggest that reinstatement elicits new fear and safety behaviors, underlying that treatment might benefit from addressing a range of safety behaviors.
Background and objectives Mental images of threat are common in social anxiety disorder and could impede exposure to fear-relevant situations. Landkroon et al. (2022) found that imagery rescripting of anticipated future threat, compared to no-task, increases willingness of non-clinical individuals to conduct a social anxiety-related behavioral experiment. The aim of this two-day preregistered extended replication study was to examine whether the effects persist beyond the intervention session by scheduling the behavioral experiment 1-7 days after the intervention. Methods On Day 1, 60 pre-screened participants were asked to design a behavioral experiment to test an idiosyncratic negative belief about a feared social situation. They were then randomly assigned to imagery rescripting (focused on their worst feared outcome of the behavioral experiment) or no-task. Participants’ willingness to do the behavioral experiment and their threat beliefs was measured. On Day 2, they were asked to carry out the behavioral experiment. Results The imagery rescripting group, compared to the control group, did not show increased willingness or compliance to do the behavioral experiment on Day 1 or 2. Furthermore, the imagery rescripting did not lead to greater reductions in threat beliefs on either day. Limitations The quality of the imagery rescripting intervention was not assessed, and given the brief nature of the intervention, any effects may have dissipated before participants decided whether to carry out the behavioral experiment. Conclusions There was no evidence that imagery rescripting leads to changes in willingness or compliance to do a fear-relevant behavioral experiment. More research is needed to examine interventions that can enhance exposure in socially anxious people.
Dissociative symptoms are common across nearly all psychiatric disorders, especially in posttraumatic stress disorder (PTSD). Yet, our understanding of their underlying mechanisms remains limited. This study presents a new theoretical framework, the habit-goal framework of dissociation, which conceptualizes dissociative symptoms as habitual experiential avoidance. We propose that, due to repetition and negative reinforcement, dissociative symptoms transform into mental habits that are automatically elicited by negative emotions. Using self-report measures, we investigated two core assumptions of this framework in 55 individuals (46 women, six men, three otherwise identified; Mage = 42.55 (14.59)) with PTSD and long-term dissociative symptoms, currently receiving PTSD treatment. Firstly, we examined whether dissociation is a form of experiential avoidance, by assessing participants’ beliefs about the positive (e.g., relief) and negative consequences of dissociation. Secondly, we investigated whether dissociative symptoms are more under habitual than goal-directed control, by assessing the subjective automaticity and goal-directedness of the initiation of dissociation. In line with our expectations, most participants identified negative emotions as their primary trigger to dissociate, and experienced dissociation as a way of emotional avoidance. However, dissociation frequency was associated with beliefs about negative, but not positive consequences of dissociation. Furthermore, consistent with the habit-goal framework, participants experienced dissociative symptoms as being initiated automatically rather than being under goal-directed control, and increasingly so over time. To conclude, we found partial support for the habit-goal framework of dissociation. This study marks a first step to test this promising model of the persistence of dissociative symptoms and its implications for treatment.
While intrusive memories are common following a traumatic event, they taper off over time for the majority of individuals. For others, intrusions persist and become the cardinal symptom of posttraumatic stress disorder. Post-event memory retrieval may be a factor in the persistence of intrusive memories. Better processing of contextual details surrounding a traumatic event may limit the generalizability of intrusions, subsequently reducing their frequency and related distress. In a trauma film paradigm study, participants (N = 87) watched a 12 min clip of a fictional assault and were then randomly assigned to retrieve contextual details (i.e., details before and after the assault), general gist details (i.e., details about the assault itself), or film-independent details (control; i.e., film-independent details about study participation) via text message later the same day. Trauma film-related memory intrusions were prospectively assessed for a total of four days. While there was no main effect of condition on overall intrusion frequency, context and gist retrieval decreased intrusion distress and vividness over time (ds = 0.26 - 0.32) relative to the control, and resulted in lower overall self-reported intrusive memory severity at follow-up in the gist condition (d = 0.36). Notably, this study manipulated memory retrieval rather than encoding, arguing that systematic retrieval of the trauma film content potentially enhanced trace specificity. Among trauma survivors, altering memory encoding is often not logistically feasible, whereas early interventions that better target memory retrieval may help reduce the distress of intrusive memories and prevent chronic psychopathology.
The rapid advancement of information technology has substantially increased stress levels in modern society, highlighting the critical need for effective strategies to manage and reduce stress. This study investigated psychophysiological approaches to stress reduction by examining the effects of direct palm contact with natural materials. A within-subject design was used, involving 44 young Chinese adults (mean age: 21.2 ± 0.3 years), who were instructed to make direct palm contact with two natural materials: wood and grass. Physiological responses were measured through blood pressure readings and electroencephalography (EEG), while psychological responses were assessed using the Semantic Differential Method (SDM) and the State-Trait Anxiety Inventory (STAI). The results showed that direct palm contact with grass significantly lowered diastolic blood pressure and increased alpha and beta brainwave activity compared to the control condition (contact with wood). Psychological assessments revealed that participants felt moderately comfortable, relaxed, and less anxious after making contact with grass. These findings suggest that direct physical interaction with grass may be an effective way to reduce psychophysiological stress in adults.
Background and objectives Mentalization-Based Treatment (MBT), including brief psychoeducational modules, has shown promising effects in reducing aggression among adolescents and forensic populations. However, little is known about the mechanisms through which MBT exerts its effects. This preliminary pilot study aimed to explore changes in hostile attribution following participation in an MBT psychoeducational module using a multimodal assessment approach. Methods The six sessions (three meetings) of the MBT-Introductory Group were delivered to a total of 58 participants across four groups: inmates, juvenile delinquents, high school students, and young adults. Pre- and post-intervention assessments combined quantitative measures with qualitative analyses to examine changes in different facets of hostile attribution. Tasks included ambiguous facial expression recognition, interpretation of visual scenes, the Ambiguous Intentions and Hostility Questionnaire, and interpretation of self-recalled interpersonal situations. Results Participation in the MBT module was associated with a reduction in hostile attributions among young adults and juvenile offenders; results among high school students were mixed depending on the task type, while among inmates, changes were observed only for specific stimulus formats. Conclusions Despite several limitations, this preliminary study suggests that psychoeducational MBT modules may be associated with changes in hostile attribution bias. The findings suggest that mentalization-based frameworks may represent a potentially promising direction for preventive and rehabilitative interventions for at-risk youth, including brief psychoeducational formats.
Introduction Body Dysmorphic Disorder (BDD) is a mental health condition characterised by clinically significant preoccupation with appearance, resulting in distress and functional impairment. Safety behaviours such as checking, adjusting and comparing one's appearance are proposed to maintain BDD symptoms, with newer safety behaviours emerging through modern technology. However, our current gold-standard interview for assessing these behaviours has not been updated for the digital age. Objective We aimed to establish whether people with BDD engage in safety behaviors assisted by digital tools. Methods Via a clinical interview, we gathered frequency data from 37 individuals with BDD about whether they engaged in these additional behaviours. Results Our findings suggests that classic safety behaviours, particularly appearance comparison behaviours, also occur in digital contexts. Additionally, a cluster analysis revealed that participants who report engaging in classic safety behaviours also tend to endorse digital behaviours such as checking their image via photo taking, comparing themselves to others online and editing images of themselves. Conclusions These findings highlight the need to assess and treat digital safety behaviours when working with individuals with BDD.
The Effort Expenditure for Rewards Task (EEfRT; Treadway et al., 2009) is a central paradigm to assess reward motivation and effort-based decision-making. Ensuring methodological consistency across studies is vital for replication and cross-study comparability. In this systematic review, we aimed to characterize similarities and differences in study design, sample characteristics, task modifications, analyses, and results across studies with clinical samples of internalizing disorders or unselected samples with a range of internalizing symptoms that used the EEfRT. We identified 42 manuscripts, comprising 46 studies, published between 2009 and November 2025. Most studies used a cross-sectional design (n = 35; 76%) and examined effort-based decision-making among unselected samples with a range of internalizing symptoms (n = 26; 57%). Notably, half of the studies (n = 23; 50%) modified the original task design of the validation study (Treadway et al., 2009). Most studies (n = 33; 72%) utilized the proportion of hard task choice as the EEfRT outcome variable. Findings revealed that individuals diagnosed with an internalizing disorder or with greater internalizing symptom severity among unselected samples, as compared to healthy control groups, had less motivation to exert effort to win a monetary reward in approximately 40% of the studies. In addition, the probability of earning the reward upon completing the trial and the magnitude of the reward proved to be critical components of the decision-making process. We conclude by discussing methodological challenges and recommendations for future research.
The jumping to conclusions (JTC) bias is frequently measured using probabilistic reasoning tasks like the beads task and its variants. The JTC bias has theoretical links to the development of delusions and delusional ideation beliefs. However, in more recent work, the ability for these tasks to accurately measure the JTC bias has been questioned, with inconsistent results being reported which contradict the previous delusions theory. In this paper we discuss four limitations of JTC tasks related to validity: first, interpreting scores and defining JTC behaviour, second, participant experiences of task difficulty and the impact on aspects of data quality including attention, motivation, and comprehension, third, ecological validity and the reliance on probabilistic rules, and fourth, variability in participants strategies while completing JTC tasks. Through discussion of each of these limitations we demonstrate how JTC task outcomes may be misconstrued and we encourage careful consideration of how the JTC bias is measured in future research.
Replacing worry with images of positive outcomes reduces negative intrusions, worry and trait anxiety in GAD. However, the possibility that replacing worry with positive imagery, unrelated to worry content, can terminate a stream of worry has not been tested. High worriers (N = 201) were randomly allocated to receive training to replace worry with an unrelated positive image (active condition) or a control condition. Participants completed the stop worry task (SWT) in which they were instructed to engage in worry, and then stop worrying. Participants in the active condition were asked to bring a positive image to mind if they began to worry during the stop worry phase. We conducted exploratory comparisons of two modes of delivery of each condition: (i) non-guided (no experimenter guidance), (ii) with experimenter guidance (via videocall). Participants in the active condition were better able to stop worrying overall during the SWT than those in the control condition, with stronger effects within experimenter-facilitated condition compared to the non-guided condition. Participants in the active condition were also better at initially shifting away from worry and sustaining this shift than the control condition - irrespective of whether they received experimenter guidance. Within the experimenter-guided condition, the active condition sustained longer streams of non-negative thoughts than the control condition. Perceived ability to stop worrying was better in the active versus control condition. Hence, replacing worry with an unrelated positive image helps high worriers to stop worrying. Our preliminary findings suggest that this approach holds promise as a tool to reduce worry.
OBJECTIVE:Dysfunctional beliefs play an important role in social anxiety disorder (SAD). Modifying the appraisal of such beliefs may be facilitated through emotion-based approach-avoidance modification trainings (eAAMTs). This study aimed to examine the feasibility and therapeutic potential of an eAAMT for SAD in a randomized-controlled pilot-study. METHOD:N = 30 participants with SAD were randomly allocated to an eAAMT-SAD, a non-active control condition, or a swipe-control condition (n = 28 analyzed). Participants in the eAAMT-SAD-condition received four 30-min-sessions of eAAMT-SAD within two weeks. They were instructed in using (a) swipe movements (day 1), (b) articulation of words with strong affective valence (day 2), and (c) deliberate expressions of emotion (days 3-4) to pull/push beliefs functional/dysfunctional towards/away from themself on a smartphone screen. The non-active control condition did not receive any training, participants in the swipe-control condition exclusively used swipe movements to pull/push functional/dysfunctional beliefs towards/away from themselves. Outcomes (symptom severity, agreement with (dys-)functional beliefs) were assessed immediately prior to training (T1), after the last training day (T2) and after a follow-up of 28 days (T3). RESULTS:Results demonstrated the intervention's feasibility and indicated that participants in the eAAMT-SAD condition experienced a greater reduction in anxiety symptoms compared to both control conditions, with small to moderate effect sizes (pre-post: non-active control: g = 0.42, swipe-control: g = 0.39; pre-follow-up: non-active control: g = 0.56, swipe-control: g = 0.64). CONCLUSION:Future studies should replicate these findings with larger samples and explore the feasibility and therapeutic potential of eAAMTs for other mental disorders.
Background and objectives People with Internet Gaming Disorder (IGD) tend to make risky decisions regarding monetary rewards, but it remains unclear whether they also make risky decisions regarding social rewards. Therefore, this study aims to explore if social rewards (both game-related and real-life) can influence their risky decision-making. Methods In this study, 35 individuals with IGD (18 men) and 35 healthy controls (HC) (18 men) participated in an adapted Balloon Analogue Risk Task (BART), in which social rewards rather than monetary rewards served as incentives to explore their risk preferences. Results (1) individuals with IGD had significantly higher risk preferences than the HC in both game-related and real-life social rewards. (2) Individuals with IGD had significantly higher risk preferences under game-related social rewards than real-life social rewards. However, there was no difference between the conditions for the HC. (3) IGD-20 scores of individuals with IGD were significantly positively correlated with risk preferences under game-related social rewards, while they were significantly negatively correlated with risk preferences under real-life social rewards. Limitations Interpretation of findings is limited to college samples and may not generalize to other populations. Conclusions Findings suggest that individuals with IGD make risky decisions regarding social rewards, especially in game-related social rewards. Meanwhile, their risky preferences for different social rewards are associated with the severity of IGD.
Research on Moral Injury (MI) is largely based on cross-sectional observational studies, mostly retrospective. Progress in understanding the causal mechanisms between exposure to potentially morally injurious events (PMIEs) and MI is hindered by a lack of adequate study designs. Current experimental psychopathology paradigms rely on mental imagery, thereby limiting ecological validity and affording minimal scope to model moral decision-making and behavior relevant to MI. We propose two complementary pathways to advance causal inference in the field of MI: leveraging natural experiments to study real-world exposure to PMIE and its associations with MI-related outcomes, and development of new experimental paradigms exploiting behavioral economic games to ethically model moral transgressions in the lab.
Counterfactual thinking, mental simulations about how a situation could have turned out differently (if only … then … thoughts), increase grief and depression levels following bereavement. Thoughts about how (in)actions of oneself could have prevented the death (i.e., self-referent upward counterfactuals), are detrimental to post-loss mental health. Conversely, thoughts about how one's current situation could be (even) worse (i.e. downward counterfactuals), are theorized to improve post-loss mental health. There is limited information about what counterfactuals bereaved people spontaneously generate, who generates them, and how they relate to grief and depression severity. Using a Counterfactual Generation Task, we aimed to clarify the associations of characteristics of a generated counterfactual with loss-related characteristics and grief and depression levels in a bereaved sample (N = 343). Counterfactuals were predominantly upward (98%), self-referent (67%), and undid death (74%). Participants who had experienced unexpected, unnatural, or partner or child death generated more upward counterfactuals about undoing death. Higher grief levels were reported by participants who generated upward (vs. downward) counterfactuals and (self-referent) upward counterfactuals about undoing death (vs. other upward counterfactuals). Following bereavement, downward counterfactuals are rare but potentially adaptive, whereas upward counterfactuals about undoing death are common and can interfere with psychological adaptation to bereavement.
Imagining our behaviors and thereby anticipating their rewarding or unrewarding emotional consequences may motivate our choice behavior. This has great potential for clinical interventions aiming to motivate the engagement in adaptive behaviors. We investigated the difference in emotionality between mental imagery and verbal thought and its effect on subsequent choice behavior using a within-subject experimental design with pupil dilation as a measure of emotional arousal. Adults from the general population (N = 40) first imagined and constructed sentences concerning icon-word pairs yielding a positive or negative scenario and then chose between two icons from the same valence (positive or negative) but different thought modalities (mental imagery and verbal thought). Pupil dilation and self-reported emotionality were greater in response to mental imagery than verbal thought, irrespective of valence. Imagined compared to verbalized icons were chosen more often than expected by chance in positive comparisons but not less often than expected by chance in negative comparisons. Our findings extend previous work demonstrating the emotion amplifying quality of mental imagery on a subjective, physiological, and behavioral level. They further provide evidence for the potential to motivate choice behavior using mental imagery as an emotional amplifier in clinical interventions.
BACKGROUND:Forgiveness supports interpersonal repair and psychological well-being but relies on capacities that may be compromised in narcissistic individuals. Contemporary models allow for a more nuanced differentiation of narcissistic facets, with increasing evidence linking antagonistic narcissism to reduced forgiveness. As dual-process models propose both reflective and automatic levels of information processing, this study integrated direct (self-report) and indirect (Implicit Association Test) measures to examine associations between antagonistic narcissism and forgiveness in a clinical sample. METHODS:The study included 102 female patients recruited from a psychosomatic clinic. Antagonistic narcissism and forgiveness were assessed using self-report questionnaires and Implicit Association Tests. Associations were examined using Spearman correlations and hierarchical regression analyses testing the incremental validity of implicit antagonistic narcissism beyond explicit measures. RESULTS:Implicit antagonistic narcissism (AN-IAT) was significantly associated with both implicit and explicit forgiveness indicators, showing lower implicit forgiveness and reduced benevolence alongside higher avoidance. In hierarchical regressions, the AN-IAT explained unique variance in implicit, state, and dispositional forgiveness beyond explicit antagonistic narcissism, demonstrating incremental validity. Explicit antagonistic narcissism showed limited associations, relating to higher revenge motivation and lower dispositional forgiveness. CONCLUSIONS:Implicit antagonistic narcissism was robustly associated with lower forgiveness across state, and trait levels. These findings highlight the value of integrating indirect and direct approaches to capture distinct levels of narcissistic functioning and underscore the clinical importance of addressing implicit relational schemas in individuals with pronounced antagonistic traits.
