An Exploratory Randomized Controlled Trial Comparing Positive Imagery Shifts and Cognitive Restructuring in Enhancing Behaviour Activation for Depression.

Increasing participation in rewarding activities is a key therapeutic aim for depression. Mental imagery has been shown to enhance engagement in planned activities, as it possesses the capacity to augment motivation and affect. To examine whether the use of imagery is beneficial for behavioural activation in depression, this study compared an imagery-based technique (i.e., positive imagery shifts [PISs]) with another verbal-analytical processing technique (i.e., cognitive restructuring [CR]) and the waitlist (WL) group. Depressed participants (N = 111) were randomized to PISs, CR and WL conditions. The PISs and CR groups then underwent the 7-day training. Questionnaires were administered at six time points: preintervention, postintervention, 1-week follow-up, 1-month follow-up, 3-month follow-up and 6-month follow-up. Overall, compared with the WL group, both the PISs and CR groups demonstrated significant increases in behavioural activation, with the effects lasting for at least 6 months. Furthermore, these two groups also showed significant improvements in depressive symptoms, activity ratings and negative affect. However, a significant increase in positive affect, which served as one of the potential mechanisms underlying its therapeutic effectiveness, was only observed in the PISs group. PISs and CR exhibited comparable effectiveness in treating depression. In particular, PISs significantly enhanced positive affect among depressed participants. These findings indicate the therapeutic potential of PISs in the treatment of depression.