Neural Mechanisms and Efficacy of Imagery Rescripting for Fear of Failure: A Randomized Controlled Neuroimaging Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 81
- 试验地点
- 1
- 主要终点
- BOLD fMRI activation to autobiographical criticism scenarios
研究概览
简要总结
This randomized controlled trial investigates the neural and psychophysiological mechanisms of Imagery Rescripting (ImRs) in individuals with high fear of failure. Participants (N=81, aged 21-34) were randomized to ImRs or an active control condition. The intervention targeted autobiographical memories of parental criticism across four sessions delivered within two weeks. Neuroimaging (fMRI), skin conductance, and self-report measures were assessed pre- and post-intervention (accordindly, TP1, TP5), with follow-ups at 3 and 6 months (accordingly, TP6, TP7). The primary aim was to examine whether ImRs reduces neural and subjective reactivity to autobiographical criticism memories and whether prediction error or memory reconsolidation disruption underlie therapeutic effects.
详细描述
Fear of failure is a common psychological problem often associated with parental criticism and maladaptive perfectionism. Imagery Rescripting (ImRs) is a therapeutic technique derived from schema therapy that aims to modify distressing autobiographical memories by introducing corrective experiences in imagination. While ImRs has shown efficacy in anxiety and personality disorders, its underlying neural mechanisms remain insufficiently understood.
This randomized controlled neuroimaging trial investigated the effects of ImRs on autobiographical memories of criticism in young adults with high levels of fear of failure. The study specifically examined whether therapeutic change is driven by disruption of memory reconsolidation or by prediction error mechanisms, both of which have been proposed as key pathways for updating maladaptive memories.
Participants (N=81, aged 21-34) meeting inclusion criteria for high fear of failure (Performance Failure Appraisal Inventory ≥ 108) were randomized in a 2:1 ratio to either an ImRs intervention group or an active control group. Exclusion criteria included psychiatric disorders (e.g., PTSD, major depression), active pharmacotherapy, history of childhood abuse, and contraindications to MRI.
All participants underwent two fMRI sessions (pre- and post-intervention), four intervention sessions within a two-week period, and follow-up assessments at 3 and 6 months. During fMRI, participants listened to personalized autobiographical scenarios: five involving parental criticism and five neutral ones. In the ImRs group, the criticism scenario was modified by introducing an imagined therapist figure who interrupted the critical interaction, addressed the child's needs, and suggested alternative positive outcomes. In the control group, participants engaged in a structurally similar neutral imagery task without therapeutic modification.
Primary outcomes included changes in neural activation (BOLD fMRI) in fear-related brain regions (amygdala, thalamus, insula, ventromedial prefrontal cortex) when processing criticism versus neutral memories. Secondary outcomes included functional connectivity between prefrontal and subcortical regions, subjective ratings of arousal and emotions during scenarios, and questionnaire-based measures of fear of failure, perfectionism, and failure-related schemas. An exploratory outcome examined activation of the caudate nucleus during rescripting as a neural correlate of prediction error.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Basic Science
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 40 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •adults aged 18-35
- •high fear of failure
- •not currently undergoing psychotherapy or psychopharmacotherapy
- •no severe punitive experiences in the past
排除标准
- •current severe affective disorders
- •current severe anxiety
- •current severe personality disorders
- •active suicidality
- •psychosis
- •substance abuse
研究组 & 干预措施
Imagery Rescripting
Four ImRs sessions over 2 weeks, targeting autobiographical criticism memory. Therapist-guided rescripting involved modifying the "hotspot" scene (critical interaction) with protective interventions addressing unmet needs.
干预措施: Imagery Rescripting (Behavioral)
Sham Neutral Imagery
Four neutral imagery sessions over 2 weeks. Participants imagined neutral interpersonal interactions matched in structure and duration to ImRs but with rescription of neutral instead of criticism memories.
干预措施: Sham Neutral Imagery (Behavioral)
结局指标
主要结局
BOLD fMRI activation to autobiographical criticism scenarios
时间窗: Pre-treatment (TP1) and 2-weeks post-treatment (TP5).
Blood-oxygen-level dependent (BOLD) signal in fear-related regions (amygdala, thalamus, insula, vmPFC) during listening to criticism vs. neutral autobiographical scenarios. Contrasts analyzed for anticipation (ANT), hotspot (HOT), and combined phases.
Performance Failure Appraisal Inventory (PFAI)
时间窗: Screening, pre-treatment (TP1), 2-weeks post-treatment (TP5), 3- & 6-month follow-up (TP6, TP7)
The Performance Failure Appraisal Inventory was used to assess fear of failure. It is a 35-item questionnaire that measures the strength of subjective beliefs about the consequences of failure. The PFAI has five subscales: fear of experiencing shame and embarrassment; fear of devaluing one's self-esteem; fear of having an uncertain future; fear of important others losing interest, and fear of upsetting important others, with scores ranging 35-175. Higher scores indicate higher level of fear of failure.
Frost Multidimensional Perfectionism Scale (FROST)
时间窗: Pre-treatment (TP1), 2-weeks post-treatment (TP5), 3- & 6-month follow-up (TP6, TP7).
35-item questionnaire assessing perfectionism dimensions: Personal Standards, Organization, Concern Over Mistakes, Doubts About Actions, Parental Expectations, and Parental Criticism. Scores range 35-175. Higher scores indicate higher level of perfectionism.
SCL recordings
时间窗: Screening, pre-treatment (TP1), 2-weeks post-treatment (TP5), 3- & 6-month follow-up (TP6, TP7)
Skin conductance level (SCL) was collected during the audio-guided scenarios' imagery at pre-treatment, treatment, post-treatment, and follow-up sessions. SCL was acquired using Biopack MP160 EDA-MRI system, with a sampling frequency of 2000Hz. The signal was resampled into 1000Hz, then smoothed with median (100 samples), and filtered with a high-passed 1Hz filter. We calculated normalized change in SCL with equation 100#(SCLStim-SCLbaseline/SCLbaseline), where SCLStim is the mean signal value during the stimulus and SCLbaseline is an SCL reaction during the baseline preceding the first part in each scenario (Sugimine et al., 2020). Our primary outcome was SCL during the imagery of different scenarios, separated for anticipation and hotspot parts.
Functional connectivity (fMRI)
时间窗: Pre-treatment (TP1) and 2-weeks post-treatment (TP5)
Psychophysiological interaction (PPI) and ROI-to-ROI connectivity between vmPFC/dlPFC and fear-related subcortical regions (amygdala, insula, thalamus, hippocampus, PCC, ACC, precuneus) during criticism vs. neutral autobiographical scenarios.
Subjective ratings at the end of all sessions
时间窗: Pre-treatment (TP1), 2-weeks post-treatment (TP5), 3- & 6-month follow-up (TP6, TP7)
Subjective ratings at the end of all sessions - participants were asked to evaluate each fragment of the presented scenarios according to several measures: immersion, focus, emotions (happiness, sadness, guilt, fear, anger, disgust) on a 9-point Likert scale (very low-very high), and valence (very negative-very positive), scores ranging 1-9 for each factor.
Failure-related Schemas (FA-YSQ)
时间窗: Pre-treatment (TP1), 2-weeks post-treatment (TP5), 3- & 6-month follow-up (TP6, TP7).
Failure-related subscale of the Young Schema Questionnaire (YSQ). Higher scores indicate stronger maladaptive beliefs about failure. Scores ranges from 0 to 54.
次要结局
- Working Alliance Inventory (WAI, short form)(6-month follow-up (TP7).)
- Beck Depression Inventory(Screening, 6-month follow-up)
- Yale-Brown Obsessive-Compulsive(Screening, 6-month follow-up)
- M.I.N.I. Mini International Neuropsychiatric Interview(Screening)
- Social Anxiety Disorder Scale (DSM)(Screening, 6-month follow-up)
- Panic Disorder Scale (DSM)(Screening, 6-month Follow-up (TP7))
- Generalized Anxiety Disorder Scale(Screening, 6-month Follow-up (TP7))
- Post-Traumatic Stress Symptoms Scale (DSM)(Screening, 6-month Follow-up (TP7))
- Structured Clinical Interview for DSM-5 (SCID-5-PD)(Screening)
- Drug Abuse Screen Test(Screening)
研究者
Jaroslaw Michalowski
Professor
University of Social Sciences and Humanities, Warsaw