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Graduate Student Journal of Psychology
Fall 2024 - Vol. 23

Copyright 2024 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Effects of Absorption Training on Positive Activity 
Experiences for Individuals with Anhedonia: 

A Single Case Series
Angelica Tong & Ed Watkins

Department of Psychology, University of Exeter, Exeter, United Kingdom

 ‘A good life is characterised by complete absorp-
tion of what one does’ (Nakamura & Csikszentmihalyi, 
2009, p.195). Studies have suggested that being fully 
absorbed in activities is crucial to well-being and hap-
piness (Csikszentmihalyi, 1990; Nakamura & Csiksz-
entmihalyi, 2009; Tse et al., 2020). Specifically, the in-
ability to be absorbed in pleasurable activities seems to 
prevent people from enjoying the associated benefits 
such as improving one’s positive mood (Killingsworth 
& Gilbert, 2010; Lambert & Csikszentmihalyi, 2020; 
Watkins, 2016). For instance, Killingsworth and Gil-
bert (2010) found that individuals reported being less 
happy when their minds wandered regardless of how 
enjoyable the activities were. Furthermore, previous 
studies also raised the possibility that increased ab-
sorption in activities may counter rumination (Hven-
egaard et al., 2019; Watkins et al., 2011; Watkins et al., 
2012) which may interfere with an individual’s ability 
to experience pleasure and rewards from positive ac-
tivities (Watkins, 2016). This study sets out to explore 
the effects of Absorption Training (AT), a component 
of rumination-focused cognitive behavioural ther-
apy (RFCBT), which aims to increase absorption, 
in improving the experiences of positive activities in 
terms of positive affect and rumination among indi-
viduals with anhedonia, as suggested by the literature.
Absorption and Positive affect       
 One potential benefit of increased absorption 
is improving positive affect (PA) gained from activ-
ities  (Asakawa, 2004; Collin et al., 2008; Fullagar & 
Kelloway, 2009; Rogatko, 2007; Tse et al., 2020). Ab-
sorption is conceptualised as a flow experience that is 

associated with positive experiences and affect (Nor-
sworthy et al., 2021). Flow, introduced by Csikszent-
mihalyi (1975), refers to a state of deep absorption 
in an activity (Csikszentmihalyi, 1999). This absorb-
ing state is characterised by nine components such 
as simultaneous feelings of action-awareness merg-
ing, time transformation, complete concentration, 
a sense of control, a loss of self-consciousness, and 
an intrinsically rewarding experience (Csikszentmi-
halyi, 1990; Nakamura & Csikszentmihalyi, 2009). 
Furthermore, individuals possessing traits like  curi-
osity and persistence may have higher tendencies to 
experience flow (Csikszentmihalyi, 1990; Nakamura 
& Csikszentmihalyi, 2009). According to Csikszent-
mihalyi (1990), through repeated experiences of flow 
from positive activities providing potential for growth 
such as sports or work, people’s happiness and life 
satisfaction would increase (Csikszentmihalyi, 1999).  
 This association between flow and PA is support-
ed by empirical studies (Asakawa, 2004; Collin et al., 
2008; Fullagar & Kelloway, 2009; Rogatko, 2007; Tse 
et al., 2020). In Asakawa’s (2004) experience-sampling 
study (ESS) of Japanese undergraduates’ experiences 
of daily activities, participants’ levels of PA, such as en-
joyment, were the highest in the flow condition com-
pared to feeling relaxed or apathetic. Similarly, more 
intense daily flow experiences were associated with 
higher daily PA in a diary study of US adults (Collins 
et al., 2008). However, it is worth noting that the caus-
al relationship between flow and PA is not strongly es-
tablished since most studies on the two are correlation-
al (Asakawa, 2004; Collin et al., 2008; Tse et al., 2020). 

Existing literature has suggested an association between being absorbed in activities and improved experience in ac-
tivities in terms of better mood gain and reducing rumination. This single-case series aimed to collect methodological 
information and preliminary data for future trials regarding the effects of absorption training; a rumination-focused 
CBT component, on improving positive activity experiences among individuals with anhedonia using a multiple 
baseline design (N=16). There were no significant effects of absorption training found regarding the level of absorp-
tion, positive affect, and rumination during the positive activities which might be due to high baselines, limiting 
the effects of intervention. The effect sizes indicated that absorption training might have larger effects on improv-
ing absorption and reducing rumination than increasing positive affect during activities. In terms of suggestions 
for methodology, future clinical trials should target participants with higher levels of anhedonia using a larger and 
homogenous sample and provide higher-intensity training. It is also worth exploring whether absorption training has 
larger effects on specific types of populations such as clinically depressed individuals.
 Keywords: absorption training, Rumination-focused CBT, absorption, positive activities, rumination



60

 Nevertheless, there is some indirect evidence regard-
ing the causal relationship between flow and PA (Full-
agar & Kelloway, 2009; Rogatko, 2007).  For instance, 
the experimental study by Rogatko (2007) found that 
participants’ levels of PA were higher after conducting 
high-flow than low-flow-inducing activities, yet, since 
flow and PA were measured simultaneously after the 
activities, the study could not conclude their temporal 
relationship. An ESS on architectural students doing 
studio work also found a positive association between 
the two and importantly, its time-lag analysis suggest-
ed flow preceded the changes in affect (Fullagar & Kel-
loway, 2009). Though more direct evidence regarding 
the causal relationship is required, these studies pro-
vide support that interventions that can      increase 
absorption in positive activities may increase PA gain. 
Absorption and Rumination 
 In addition to increasing PA, increased absorption 
may also reduce maladaptive rumination (Watkins et 
al., 2011; Watkins et al., 2012; Watkins, 2016). Ru-
mination has been suggested as both a state response 
(Martin & Tesser, 1996) and a trait-like tendency (No-
len- Hoeksema, 1991) while maladaptive state rumi-
nation (MSR) is defined as the momentary thoughts 
of focusing on implications and causes of one’s dis-
tress (Marchetti et al., 2018; Nolen-Hoeksema et al., 
2008). Through repeated occurrences of goal discrep-
ancies, MSR may develop into a habitual tendency of 
depressive rumination (Watkins & Nolen-Hoeksema, 
2014) which is suggested as a transdiagnostic pro-
cess of multiple mental disorders (Ehring & Watkins, 
2008; Nolen-Hoeksema, 2000; Nolen-Hoeksema et 
al., 2008; Nolen-Hoeksema & Watkins, 2011; Wat-
kins, 2008). Furthermore, maladaptive rumination 
may interfere with the ability to experience rewards 
from positive activities and contribute to anhedonia 
(Watkins, 2016), the reduced ability to experience 
pleasure in normally pleasurable activities (American 
Psychiatric Association, 2013). These hypothesised 
effects are supported by existing findings where the 
negative perception of feedback on one’s performance 
might reduce flow level and its associated benefits 
such as better performance (Lambert & Csikszentmi-
halyi, 2020). Similarly, negative mind-wandering was 
associated with reduced pleasure while doing plea-
surable activities (Killingsworth & Gilbert, 2010). 
 Encouragingly, increased absorption in activities 
is suggested to counter maladaptive rumination based 

on several theoretical principles (Watkins, 2016). First, 
it may shift the abstract processing style characteristic 
of depressive rumination to a more process-focused 
and concrete mindset (Dykman, 1998; Watkins, 2008, 
2016; Watkins & Roberts, 2020). Additionally, being 
more immersed and connected in positive activities 
may counter rumination such as running commen-
taries that evaluate one’s performance in mind and 
enhance individuals’ ability to experience pleasure 
and rewards from the activities (Watkins, 2016). 
These theories support the hypothesis that interven-
tions that increase absorption may reduce rumination 
during activities. However, it is important to note that 
these proposed effects have not yet been examined. 
Absorption Training 
 Absorption Training, a component of RFCBT, 
was developed based on the theoretical and empirical 
evidence in the literature regarding the association 
between increased absorption on improving PA and 
reducing maladaptive rumination. RFCBT is a treat-
ment for residual depression by targeting depressive 
rumination in which absorption is conceptualised as 
a flow experience (Watkins, 2016). Specifically, AT 
involves a mental imagery exercise of using a memo-
ry of being absorbed in activities to help individuals 
recapture the experience of being in an absorbed state 
of mind. Through daily practice, it aims to help par-
ticipants activate the absorbed mindset more easily 
during positive activities (Watkins, 2016). It is sug-
gested that by doing more positive activities with 
an absorbed state of mind, the training can reduce 
rumination by facilitating a shift to a more helpful 
absorbed mindset and counter the running com-
mentary that evaluates one’s performance during ac-
tivities (Watkins, 2016). Moreover, it may also help 
individuals improve their PA by better connecting 
them with the experiences and rewards of positive 
activities (Watkins, 2016) based on the suggested as-
sociation between flow and PA in existing research.
 Nevertheless, these proposed effects of AT on ab-
sorption, PA, and rumination are yet to be examined. 
There is indirect evidence of its effects on rumination 
where previous trials demonstrated that RFCBT has 
been effective in reducing depressive rumination 
(Hvenegaard et al., 2019; Watkins et al., 2011; Watkins 
et al., 2012). Yet, these trials did not examine AT as an 
isolated component (Hvenegaard et al., 2019; Watkins 
et al., 2011) and its effects on improving individuals’ 

TONG & WATKINS



61

ABSORPTION TRAINING, POSITIVE ACTIVITIES

days (Tanious & Onghena, 2019). The changes in the 
three variables after the introduction of AT will then 
be examined. As a preliminary study with resource 
constraints, a single-case experimental design (SCED) 
allows detailed and individualised data to be collected 
with fewer resources, such as not requiring a control 
group. (Morley et al., 2015; Tanious & Onghena, 
2019). Furthermore, by evaluating the intervention 
effects across multiple participants concurrently with-
in the same general period with the intervention be-
ing introduced at various time points, the MBD can 
increase the likelihood that the changes in the three 
variables are due to the effects of AT instead of factors 
such as history, cohort effect, and regression to mean 
(Morley et al., 2015; Onghena, 2020). Additional-
ly, participants’ tendencies to experience pleasure, 
flow, and maladaptive rumination will be measured.  

Method 
Participants
 Forty-one individuals were recruited through 
the University of Exeter research platform, SONA, 
(N=16), and snowball sampling on the messaging 
platform – WhatsApp (N=25). Inclusion criteria in-
cluded individuals aged 18 or above in the UK with 
access to electronic devices and reporting at least 
mild levels of anhedonia by scoring 1 or above on the 
Snaith-Hamilton Pleasure Scale (Snaith et al., 1995). 
Twenty-five individuals were found eligible after 
screening and four were unvailable during the study, 
yielding a final sample of twenty-one participants. 
 Five participants were excluded from the data anal-
ysis since four were unable to carry out the planned ac-
tivities three times per week and one reported having 
issues with AT,     discontining  practice. The remaining 
16  participants were included in the analysis. See Table 
1 for participants’ demographic details. All participants 
provided written informed consent and received reim-
bursement of £30 Amazon voucher upon completing 
the study. The study was approved by the University 
of Exeter Psychology Research Ethics Committee.
Design
 The single case series aimed to explore the ef-
fects of absorption training on the experiences of 
positive activities in terms of absorption, positive 
affect, and maladaptive state rumination for individ-
uals with anhedonia. A multiple baseline design was 
employed with participants randomly assigned by an 

experiences of positive activities have not been test-
ed. Previous studies have found that concrete mental 
imageries of positive memories may increase positive 
mood (Werner-Seidler & Moulds, 2012), and cog-
nitive training using positive mental imageries may 
reduce anhedonia in daily activities among depressed 
individuals (Blackwell et al., 2015). It is yet to be exam-
ined whether mental imagery of an absorbing memory 
can induce an absorbed mindset in positive activities in 
the present and thus improve the experiences. Hence, 
studies examining AT as an isolated component are 
needed to better understand such effects (Hvenegaard 
et al., 2019; Watkins et al., 2011). Additionally, ex-
perimental methodological information is required 
for examining AT’s  effects in future clinical trials.  
Current Study
 The study will explore the effects of absorption 
training. Its first aim is to use a single case series (SCS) 
to explore the effects of absorption training in im-
proving individuals’ experiences of positive activities 
based on their levels of absorption (flow), positive 
affect, and maladaptive state rumination. Specifical-
ly, this study targets individuals with anhedonia and 
examines AT’s effects on their experiences of positive 
activities. The second aim is to collect methodolog-
ical information for designing future clinical trials. 
 The hypotheses are as follows: Participants’ lev-
el of absorption while  completing       their selected 
activities will be higher after the introduction of AT 
compared to baseline (H1). Based on the association 
between increased absorption on PA and rumina-
tion (Asakawa, 2004; Csikszentmihalyi, 1990; Wat-
kins, 2016), it is also hypothesised that while      con-
ducting AT, participants will gain more PA from 
doing their selected activities (H2) and their levels 
of MSR in selected activities will decrease (H3).
 To explore these, this SCS will adopt a multiple 
baseline design (MBD) to evaluate AT’s effects on 
each participant individually. MBD involves using a 
baseline period as a control for each individual and 
introducing intervention at varying baseline lengths. 
The intervention effects are then explored within the 
individual and across the participants (Morley et al., 
2015). Specifically, this study will take repeated daily 
measurements of participants’ levels of absorption, 
PA, and MSR in positive activities during the baseline 
and AT phases and introduce AT to the participants 
at varying lengths of baseline from seven to fourteen 



62

TONG & WATKINS

algorithm using their assigned anonymized partic-
ipant identifier to varying baseline lengths ranging 
from 1 to 2 weeks before conducting the AT which 
lasted for 7 to 14 days. The baseline lengths allowed 
sufficient time for obtaining a stable baseline which 
can minimize the effects of confounds such as mat-
uration (Carr, 2005), and sufficient data to explore 
intervention effects where participants conduct-
ed their chosen activities for a minimum of three 
times in both the baseline and intervention periods. 
Materials and Measures
Screening and Dispositional Measures
 Individuals who were interested in joining the 
study completed the screening measure in the online 
survey during recruitment. The dispositional mea-
sures (Dispositional Flow Scale – 2 and Ruminative 
Response Scale – Short Form) were sent to eligible 
individuals via email. Participants were required to 
complete the dispositional measures either before 
or during the first meeting with the researchers. 
 Snaith-Hamilton Pleasure Scale (SHAPS; 
Snaith et al., 1995). The SHAPS is a 14-item self-re-
port measure of the ability to experience pleasure 
(e.g., I would find pleasure in my hobbies and pas-
times) using a 4-point scale (0 - disagree to 3 - strong-
ly agree). Higher total scores indicate lower tenden-
cies to experience pleasure (range 0 to 14). The scale 
has shown good criterion validity and satisfactory 
internal reliability, yielding a Kuder-Richardson 
score of 0.857 (Snaith et al., 1995). It was used as 
a screening measure to include individuals report-
ing elevated levels of anhedonia (scored 1 or above). 
 Dispositional Flow Scale – 2 short form 
(DFS-2 SF; Jackson et al., 2008). The DFS-2 SF is a 
9-item self-report instrument that assesses the ten-
dency of experiencing flow in a target activity (e.g., 
I am completely focused on the task at hand) using 
a Likert scale from 1(never) to 5 (always). The scale 
has shown acceptable internal consistency (α=.77) 
and good construct and divergent validities (Jack-
son et al., 2008). Its instruction was modified in 
this study to target frequencies of flow experiences 
in ‘all daily activities’ instead of in a specific activity. 
 Ruminative Response Scale – Short Form 
(RRS-SF; Treynor et al., 2003). The RRS-SF is a 10-
item, 4-point Likert scale (1 - almost never to 4 - almost 
always) self-report measure of ruminative tendencies 
in response to sad and depressive moods. Higher to-

tal scores suggest higher tendencies to ruminate (range 
10 to 40). It has two subscales – brooding and reflec-
tion with brooding suggested as the most pathological 
rumination (Treynor et al., 2003). Hence, five items 
from the Brooding subscale which has shown satis-
factory internal consistency (α=.77) (Treynor et al., 
2003) were administered at the start of the study (e.g., 
When you feel sad, down, or depressed, how often do 
you think “Why can’t I handle things better?”) to as-
sess participants’ maladaptive ruminative tendency. 
Daily Survey
 Throughout the 21-day study, participants 
were prompted to complete a daily survey once via 
email or text messages at their preferred time be-
fore midnight with questions assessing their lev-
els of absorption, PA, and MSR in positive activ-
ities stemming from the validated scales below. 
 Flow State Scale. The 36-item, 5-point Likert 
scale (1 - strongly disagree to 5 -strongly agree), Flow 
State Scale (FSS; Jackson & Marsh, 1996) is a self-re-
port instrument that assesses the situational-spe-
cific experience of flow with a satisfactory internal 
consistency reported (α =.83) ( Jackson & Marsh, 
1996). Six items from the FSS (e.g., ‘When doing 
the activity, time seemed to alter ‘either slowed down 
or speeded up’) measuring absorption-related di-
mensions - complete concentration, time distortion, 
loss of self-consciousness, action-awareness merg-
ing, autotelic experience (Norsworthy et al., 2021) 
were included in the daily survey to assess AT’s ef-
fects on participants’ levels of absorption in activities. 
 Positive Affect. The impacts of AT on partici-
pants’ PA in activities were assessed by the item ‘Doing 
this activity improved my positive mood’ using a Likert 
scale from 1 (strongly disagree) to 5 (strongly agree). 
 Brief State Rumination Inventory. The Brief 
State Rumination Inventory (BSRI; Marchetti et al., 
2018) is an eight-item self-report measure of MSR 
in response to negative mood using a visual analogue 
scale from 0 (completely disagree) to 100 (completely 
agree). Higher total scores represent higher degrees of 
MSR (range from 0 to 800). It has shown high inter-
nal consistency (α=.91) and good construct and crite-
rion validities (Marchetti et al., 2018). Five items that 
correlate positively with the RRS Brooding subscale 
(Treynor et al., 2003) were included in the daily survey 
(e.g., ‘When doing the activity, it is hard for me to shut 
off negative thoughts about myself ’) to assess whether 



63

AT can reduce participants’ level of MSR in activities. 
Activities Planning
 During the first meeting, participants were guid-
ed to select a positive activity to undertake during the 
study. Specifically, they were first guided to consider a 
few suitable positive activities. The selection criteria 
are any activities (1) that they found positive, (2) they 
could get absorbed in doing, (3) they enjoy doing the ac-
tivities and would like to do more of them and (4) they 
could get distracted sometimes and found it hard to en-
gage in the activities. They then selected one planned 
activity they would like to undertake three times per 
week and scheduled the time to do it during the study. 
Absorption Training
 The AT was tailored to the participants’ planned 
activities with a training session followed by daily 
practices. First, a training session guided by the AT 
manual was conducted      where participants were 
first guided to identify a memory of being absorbed 
in the planned activity according to the flow crite-
ria (Csikszentmihalyi, 1990). Participants were then 
prompted to imagine themselves in the memory and 
describe their sensory-perceptual experiences, such as 
body sensations, smell, and sounds. Next, a mental 
imagery exercise was conducted to help participants 
recreate that absorbing experience with the researcher 
prompting them to recapture the sensory-perceptual 
experience using the participants’ descriptions of the 
experience. The exercise was recorded while  being 
conducted. After the exercise, the researcher checked 
whether the participants had a positive experience by 
asking about their feelings or levels of energy. Partic-
ipants were then instructed to conduct and schedule 
the daily practice. Following the session, participants 
received the audio recordings of the exercise via email 
or text messages and practiced activating the absorbed 
mindset by listening to the audio recordings daily. 
Procedure 
 The study targeted individuals who wanted to im-
prove their engagement and performance in activities 
that they enjoy by advertising on SONA or WhatsApp. 
Individuals interested in participating clicked on the 
SONA or WhatsApp link, directing them to an on-
line survey. In the survey, participants first read an 
information sheet about the study and were told it 
would investigate whether a mental strategy can im-
prove their moods and performance in pleasurable 
activities. Those who gave their informed consent to 

participate could continue with the survey. They then 
completed the screening measure and were instruct-
ed to create their anonymized identifier at the end of 
the survey. Individuals eligible for the study were later 
contacted within 48 hours via email or text messages 
with the link to the baseline measures and arranged a 
meeting with the researchers. Individuals not eligible 
were notified and received a debriefing form via email. 
The participant identifiers of the eligible individuals 
were sent to the research supervisor via email and were 
allocated to various baseline lengths using an algo-
rithm by the research supervisor. The researchers were 
then notified of the randomization results via email.
 During the 21-day study, participants completed 
three meetings with the researchers via video confer-
encing to encourage participation throughout the 
study and allow the researchers to make adjustments 
promptly if participants raised any concerns regard-
ing conducting the planned activities and AT during 
subsequent meetings. In the first meeting, partici-
pants first completed the baseline measures on dis-
positional flow, trait rumination, and demographic 
questions followed by an explanation of the study’s 
requirements by researchers and activity planning.
 Following the meeting, participants conducted 
the planned activities a few times per week and re-
corded their experiences over the 21 days by complet-
ing a daily survey as instructed. Participants received 
the link to the survey once on the online survey tool, 
Qualtrics, via email or text messages daily at their 
preferred times and completed it before midnight. 
Following the baseline period ranging from 1 to 2 
weeks, a second meeting was arranged where  AT was 
introduced. Afterward, participants practiced AT dai-
ly alongside doing the planned activities and the daily 
survey until the third meeting. At the end of the study, 
a third meeting was conducted to review the effects of 
AT and debrief the participants. Lastly, participants 
received the reimbursement (£30 vouchers) via email.  
Data Analysis
 Visual analysis of participants’ data on graphi-
cal plots (Morley, 2015) and statistical analyses us-
ing the RcmdrPlugin.SCDA plug-in package for R 
software (Bulté & Onghena, 2013) was performed.
 To determine the statistical significance of the 
results, a non-parametric significance test – random-
ization test (RT), which requires arrangements of in-
tervention being randomized, was used since repeated 

ABSORPTION TRAINING, POSITIVE ACTIVITIES



64

TONG & WATKINS

measurements of each participant in SCED might result 
in autocorrelation and violate parametric assumptions 
(Heyvaert & Onghena, 2014; Tanious & Onghena, 
2019). RT was performed for each participant to obtain 
the individual p-value for AT’s effects on absorption, 
PA, and MSR. The combined p-values were comput-
ed from the meta-analyses of individual p-values using 
Pearson's method (1934) (Bulté & Onghena, 2013). 
 Regarding effect sizes calculation, the non-para-
metric effect size index – percentage of data exceeding 
the median (PEM) which calculates the proportion of 
data points during the AT phase that exceeds the medi-
an of baseline data (Ma, 2006) was used for computing 
individual effect sizes for the three variables. PEM small-
er than 0.7, between 0.7 and 0.89, and between 0.9 and 
1, represent questionable, moderate, and high effec-
tiveness (Ma, 2006). The overall effect sizes were com-
puted by taking the average of all individual effect sizes.
 Data of participants who did not complete the 
planned activities and surveys at least three times in 
both the baseline and intervention periods and did 
not conduct AT during the intervention period at 
least three times were excluded from the data analysis.

Results
Statistical Analysis: Randomization Test and 
Effect Size Calculations
 A non-parametric significance test – RT (Tanious 
& Onghena, 2019) was used to examine whether AT 
can increase participants’ levels of absorption and 
PA and reduce their level of MSR in the planned ac-
tivities. The effect sizes regarding the three outcomes 
were calculated using the index – PEM (Ma, 2006).  
 The results showed that there were mean increases 
in absorption (0.38 points) and PA (0.35 points) and 
decreases in MSR (-30.29 points) after the introduc-
tion of AT among the participants. Medium effect siz-
es were found for the changes in absorption (79.70%) 
and MSR (77.06%) and a small effect size was found 
for PA (49.75%) (Table 2). However, the RT indicat-
ed that the changes were not significant (p > 0.05). 
 Regarding the effects of AT on non-planned ac-
tivities, only three participants conducted the non-
planned activities at least twice in both baseline and 
AT phases. The amount of data collected was lim-
ited for conducting a significant statistical analysis. 
Visual Analysis 
 The impacts of AT on participants’ experiences 

of positive activities in this SCS was also examined 
by visual inspection of the multiple-baseline data 
in graphical plots concerning      the changes in lev-
el and trend (Morley, 2015) of absorption, PA, and 
MSR while doing positive activities across the base-
line and AT phases. Data representing the daily scores 
reported by each participant regarding the three 
variables during the planned and non-planned activ-
ities are presented in Figures 1, 2, and 3 respectively. 
 Regarding the change in absorption, the dai-
ly scores reported for most of the       baseline peri-
ods were stable. Seven participants showed an 
increase in absorption after the introduction of 
AT and four exhibited a slight upward trend con-
tinuously. However, the scores of nine partici-
pants reflected no change during the AT phase. 
 Regarding the change in PA, most baseline peri-
ods were stable while one participant showed a pattern 
of decrease. Three participants showed an increase 
in PA gained after the introduction of AT while one 
continued to show an upward trend; the level of PA 
remained stable for the other two participants during 
the AT phase. Five participants showed no change and 
conclusions could not be drawn for seven participants 
due to unstable scores across both phases. One partici-
pant’s level of PA decreased contrary to the hypothesis. 
 Regarding the change in MSR, most of the 
baseline scores were stable or decreasing. After the 
introduction of AT, three participants exhibited de-
creases in MSR levels      compared to baseline. Ten 
participants showed no obvious change during the 
AT phase. Conclusions cannot be drawn for three 
participants due to unstable scores across both phases.
 The visual inspection results were consistent with 
the RT results for each individual, indicating that there 
were no significant effects of AT on the three variables 
shown. 
Dispositional Tendencies
 Participants reported tendencies to experience 
flow, pleasure, and rumination. Participants reported 
moderate tendencies to experience flow (Mean: 2.84, 
SD: 0.58). The tendencies to experience pleasure (scores 
ranging from 1 to 14) and rumination (scores rang-
ing from 8 to 20) varied across participants (Table 3).

Discussion 
 To our knowledge, this single case series is the 
first to explore the effects of absorption training on 



65

improving the experiences of positive activities among 
individuals with mild levels of anhedonia. This prelim-
inary study also aimed to collect methodology infor-
mation for future clinical trials. It is hypothesized that 
AT can improve absorption and positive affect and re-
duce maladaptive state rumination experienced during 
the planned positive activities. Although there were ex-
pected increases in absorption and PA and a decrease 
in MSR shown after AT was introduced, the results 
indicated that the effects of AT were not significant.   
Absorption 
 Analyses did not show a strong effect of AT on in-
creasing participants’ absorption levels during planned 
activities. This contrasts with the proposed effects of 
AT where by practicing getting into the absorbed state 
daily using a mental imagery exercise of an absorb-
ing memory, individuals will be more likely to acti-
vate an absorbed mindset during activities (Watkins, 
2016). Methodological issues could have contribut-
ed to the results, such as participants reporting fairly 
positive experiences in the planned activities and var-
ied levels of anhedonia at baseline, and the effective-
ness of training sessions and daily practice were not 
monitored. Methodological issues will be discussed 
further in later sections. Moreover, the medium ef-
fect size found for changes in absorption could mean 
that a larger effect may be found in larger samples. 
Positive Affect 
 Questionable effects of AT on improving PA 
gained from doing the planned activities were also in-
dicated by the results. Another proposed effect of AT 
is that by better connecting individuals with the expe-
riences and rewards of positive activities and improv-
ing their abilities to experience pleasure with increased 
absorption, there will be improved positive mood gain 
(Watkins, 2016). The proposed effect is supported by 
previous findings demonstrating individuals’ PA in-
creased during flow despite their causal relationship 
not being strongly established (Asakawa, 2004; Col-
lin et al., 2008; Fullagar & Kelloway, 2009; Rogatko, 
2007; Tse et al., 2020). The study’s results could be due 
to the negligible increase in absorption among partic-
ipants after the introduction of AT being insufficient 
to improve participants’ PA. Furthermore, only a small 
effect size was found which may be explained by only 
one item being used to measure the changes in PA. 
Single-item measures could be more prone to random 
error and are less able to capture different facets of PA 

(Sarstedt & Wilczynski., 2009). Moreover, nine partic-
ipants reported a median of four on the item’s 5-point 
scale at baseline meaning only reporting the highest 
point of the survey during the AT phase would pass 
the thresholds for effect size calculations. To address 
these issues, future studies could use multiple-item 
measurements such as the Positive and Negative Affect 
Schedule scale (Watson et al., 1988) which measures 
different types of PA and has shown high sensitivity to 
momentary fluctuations of mood (Watson et al., 1988). 
Maladaptive State Rumination 
 Similarly, no particular effects of AT on reduc-
ing the MSR experienced by participants during the 
planned activities were shown. Existing literature sug-
gested AT may reduce rumination by getting individ-
uals immersed in the process of the activities instead 
of evaluating their performances and inducing the 
concrete absorbed mindset to counter the ruminative 
thinking style (Watkins, 2016). Likewise, the result 
could be due to the increase in absorption in this study 
following AT being insufficient to counter rumination. 
Previous findings demonstrated that RFCBT, with AT 
as a component, was effective in reducing depressive 
rumination (Hvenegaard et al., 2019; Watkins et al., 
2011; Watkins et al., 2012). However, it is important to 
note that previous RCTs had higher intensities of treat-
ment with multiple therapy sessions. Nevertheless, the 
medium effect size found suggested that future stud-
ies with improved design may detect a stronger effect.
Methodological Limitations and Suggestions
 This study has identified methodological infor-
mation that may be valuable for future large-scale 
trials. First, the effects of AT shown might be limit-
ed by high levels of absorption and PA and low levels 
of MSR reported at baselines. As this study targeted 
activities that participants found enjoyable and po-
tentially absorbing, participants might have high ac-
tivity-specific tendencies to experience flow and PA in 
these activities despite exhibiting generally mild lev-
els of anhedonia. As previous findings indicated, the 
results of dispositional measures are not the same as 
aggregated assessments of momentary trait-relevant 
behaviour (Augustine & Larsen, 2012). Targeting 
dispositional tendencies within a particular context 
such as participants’ tendencies to experience flow in 
a specific activity may better predict participants’ ex-
periences than a general dispositional measure (Jack-
son et al., 2008). Thus, to obtain the desired baseline 

ABSORPTION TRAINING, POSITIVE ACTIVITIES



66

TONG & WATKINS

levels of the three variables to better examine AT’s 
effects, future studies could use measures assessing 
participants’ activities-specific flow propensity such as 
the DFS-SF (Jackson et al., 2008) during activities se-
lection to select relatively low-flow inducing activities. 
 Second, the participants reported varied levels of 
anhedonia (ranging from 1 to 14). It could be possible 
that the intensity of AT in this study was insufficient to 
improve the experiences of positive activities for indi-
viduals with high levels of anhedonia. To better explore 
AT’s effects in a population with anhedonia and target 
individuals with less positive experiences in activities, 
future studies could include a larger and more homog-
enous sample of individuals with higher levels of anhe-
donia; those scoring 3 or above, the cut-off score for an-
hedonia, in SHAP (Snaith et al., 1995). It may also be 
useful to explore AT’s effects in specific types of popu-
lation such as those with higher ruminative tendencies.  
 Third, the study did not monitor the effectiveness 
of the training session which may impact the interven-
tion outcomes. Mental imagery research has found 
that higher levels of imagery vividness reported in the 
training session led to greater reductions in depression 
symptoms (Blackwell et al., 2015). Although research-
ers had checked participants’ moods or levels of ener-
gy after the training session, participants’ responses 
might have been subject to demand characteristics 
where they overstated the training’s effects (Nichols & 
Maner, 2008). To limit the impacts of demand char-
acteristics and assess the effects of the training session, 
future studies should administer validated scales such 
as the FSS (Jackson & Marsh, 1996) to assess partic-
ipants’ level of state flow during the training session.  
 Fourth, the adherence rates of daily practice 
were low and only three participants completed the 
daily practice. Though the impacts of the frequency 
of daily practice on AT’s effects are uncertain due to 
the small sample size, large effect sizes were found for 
some changes in absorption, PA, and MSR among 
participants who completed the AT daily suggesting 
the impacts of frequency daily practice may be worth 
exploring. Moreover, there was no measurement of ac-
tive engagement during the daily practice such as how 
absorbed participants were. Previous evidence suggest-
ed more active engagements with the intervention had 
led to better treatment outcomes in mental imagery in-
tervention (Blackwell et al., 2015). To examine wheth-
er AT could have larger effects, future studies should 

require higher completion rates (80%) of daily practice 
and include measures to monitor the effectiveness of 
daily practice such as participants’ levels of absorption. 
 Fifth, the study only lasted for a short period 
with a single training session and a daily practice pe-
riod of 7 to 14 days. A study examining RFCBT re-
ported latency of treatment effects where the effects 
only showed within two to six weeks after initiation 
of treatment (Watkins, 2007). Subsequent RCT also 
indicated significant treatment effects on reducing 
depressive rumination resulting from 12 to 16 ses-
sions of RFCBT (Hvenegaard et al., 2019; Watkins 
et al., 2011; Watkins et al., 2012). Despite this study 
being conducted in a non-clinical context, a longer 
period allows potential latency effects to be shown 
and more data collection. Moreover, multiple ses-
sions may be required to provide more training ac-
cording to the participants’ progress (Blackwell et 
al., 2015). To improve the training’s quality, a longer 
study period with more than two weeks of daily prac-
tice and multiple training sessions may be beneficial.  
 Sixth, the duration of activities conducted by par-
ticipants, which might affect their level of absorption, 
was not recorded. Previous research has suggested that 
a sufficiently long period may be required to enter into 
flow (Copperstone, 2004; Rogatko, 2007). For in-
stance, Rogatko (2007) found a positive association be-
tween PA and high-flow-inducing activities that were 
conducted for one hour. In contrast, Copperstone 
(2004) found no significant improvements for flow 
components such as time distortion, loss of self-con-
sciousness, and action-awareness merging among 
counselors in a 10-minute psychotherapy session after 
receiving flow training. However, it is important to 
note that the flow training was different from AT and 
the study by Copperstone (2004) targeted psychother-
apy sessions instead of pleasurable activities. Neverthe-
less, future studies can require participants to conduct 
the activities for longer periods such as 30 minutes, 
and examine whether AT’s effects would increase. 
 Lastly, without a control group, this study’s results 
can be attributed to other factors such as history, co-
hort effect, or regression to mean instead of AT (Mor-
ley et al., 2015; Onghena, 2020). Although the MBD 
could arguably reduce the possibility that the results 
were influenced by these factors (Morley et al., 2015; 
Onghena, 2020), future group studies should include 
control groups to better examine the effects of AT.



67

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Implications and Future Directions 
 This study indicated that AT warrants further 
studies with refined methodology. In terms of prac-
tice implications, the study raised the possibility that it 
may benefit individuals who want to improve their ex-
periences in positive activities. However, this assump-
tion requires caution since no strong evidence regard-
ing the effects of AT was found. Nevertheless, nearly 
all participants reported expected changes in absorp-
tion, PA, and MSR, and the medium effect sizes for ab-
sorption and rumination were found. This suggested 
that stronger effects of AT may be found particularly 
regarding the absorption and rumination in studies 
with larger sample sizes and refined methodology. 
 Apart from methodological issues, there are 
several issues future studies should address. First, 
it is crucial to explore whether dispositional ten-
dencies to experience rumination, flow or pleasure 
may influence AT’s effects. Stratification of inter-
vention recipients is crucial in examining interven-
tions’ effects, which enables early prediction of re-
cipients’ response patterns and allows interventions 
to be tailored to the individual (Fu et al., 2013). 
 Furthermore, AT’s effects on depressed individu-
als are also worth exploring. Previous evidence found 
that concrete mental imagery of positive memories can 
improve mood in depressed individuals (Werner-Se-
idler & Moulds, 2012). Similarly, AT, a mental imagery 
exercise recapturing the sensory-perceptual experiences 
in absorbing memory, may induce an absorbed mind-
set in positive activities (Watkins, 2016). However, de-
pressed patients were found to have reduced vividness 
when generating mental imagery of positive memo-
ries (Werner-Seidler & Moulds, 2011) and were more 
prone to compare their current states with the positive 
memories (Holmes et al., 2016; Rimes & Watkins, 
2005; Treynor et al., 2003; Watkins, 2008). These find-
ings indicate that evidence of AT in a non-clinically di-
agnosed population may not be directly transferable to 
depressed individuals and a higher intensity of AT in-
terventions may be needed for the clinical population. 
Conclusion
 In conclusion, this preliminary study is the first 
to examine the effects of absorption training of rumi-
nation-focused CBT in improving experiences of pos-
itive activities for individuals with anhedonia, which 
could be a new application of mental imagery exercises 
apart from those evidenced in the existing literature. 

The effect sizes indicated that absorption training 
might have stronger effects on improving absorption 
and reducing rumination than increasing positive af-
fect in activities. Future studies can further explore 
whether it can benefit individuals to improve their 
experiences in positive activities for both clinical and 
non-clinical populations. Additionally, several meth-
odological issues merit consideration in designing 
future trials, such as high benchmark levels of absorp-
tion, rumination, and positive activities in activities at 
baseline, varied levels of anhedonia reported, and un-
certain effectiveness of training components. To refine 
the methodology and better conclude the effects of 
absorption training, future studies should target larger 
and homogenous samples with higher levels of anhe-
donia and their experiences of low flow-inducing activ-
ities. Future studies should also provide higher-inten-
sity training such as having multiple training sessions, 
requiring more frequent daily practice, and monitor-
ing participants’ training progress. As for stratifica-
tion of intervention recipients to better understand 
which group will benefit the most from absorption 
training, exploring whether the effects of absorption 
training would vary among individuals with different 
dispositional tendencies such as those with high ru-
mination tendencies and depressed individuals could 
be beneficial for future intervention development.

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als recall less vivid positive memories. Cognition 
&Amp; Emotion, 25(6), 1087–1103. https://doi.
org/10.1080/02699931.2010.531007 

Werner-Seidler, A., & Moulds, M. L. (2012). Mood 
repair and processing mode in depression. Emo-
tion, 12(3), 470–478. https://doi.org/10.1037/
a0025984



72

Table 1

Demographic data for participants

TONG & WATKINS



73

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Table 2

Scores at baseline and during absorption training for 16 participants

Note. PEM, the percentage of data points exceeding the median

aTest statistics used in randomization test: mean difference of change in scores from AT to baseline phases 
(AT-baseline) of all participants

bcombined p-values computed by meta-analysis of individual p-values with the multiplicative approach using 
Pearson’s method (1934) in RcmdrPlugin.SCDA plug-in (Bulté & Onghena, 2013)

cAverage effect size for all participants. PEM: <70% reflects questionable effectiveness. 70% to 89% reflects mod-
erate effectiveness. 90% or above suggests large effects (Ma, 2006)

dAverage scores from daily survey questions – Baseline phase: Questions 4-9e; Questions 15f; Questions 10-14g; 
Absorption training phase: Questions 5-10e; Questions 16f; Questions 11-15g



74

TONG & WATKINS

Table 3

Participants’ dispositional tendencies to experience rumination, flow, and pleasure

Note. RRS-SF, Ruminative Response Scale – SF; DFS-2 SF, Dispositional Flow Scale – 2 short form; SHAPS, 
Snaith-Hamilton Pleasure Scale. 



75

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 1

Sixteen participants’ levels of absorption during positive activities in a 21-day period
Participant 1

Baseline Absorption Training

Participant 2

Days

A
bs

or
pt

io
n

Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 3
Baseline Absorption Training

A
bs

or
pt

io
n

Days

Note. The vertical dotted line is the point of transition from baseline to introduction of absorption training.



76

TONG & WATKINS

Figure 1 (cont.)

Participant 4

Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 5

Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 6
Baseline Absorption Training

A
bs

or
pt

io
n

Days



77

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 1 (cont.)
Participant 7

Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 8
Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 9
Baseline Absorption Training

A
bs

or
pt

io
n

Days



78

TONG & WATKINS

Figure 1 (cont.)

Participant 10
Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 11
Baseline Absorption Training

A
bs

or
pt

io
n

Days

Participant 12
Baseline Absorption Training

A
bs

or
pt

io
n

Days



79

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 1 (cont.)

Participant 13
Baseline Absorption Training

Participant 14
Baseline Absorption Training

Days

A
bs

or
pt

io
n

A
bs

or
pt

io
n

Days

Participant 15
Baseline Absorption Training

A
bs

or
pt

io
n

Days



80

TONG & WATKINS

Figure 1 (cont.)

Participant 16
Baseline Absorption Training

A
bs

or
pt

io
n

Days

        : planned activity without absorption training
        : planned activity with absorption training
        : non-planned activity without absorption training
        : non-planned activity with absorption training 



81

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 2

Sixteen participants’ levels of positive affect during positive activities in a 21-day period.
Participant 1

Baseline Absorption Training

Days

Po
sit

iv
e A

ffe
ct

Participant 2
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 3
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Note. The vertical dotted line is the point of transition from baseline to introduction of absorption training.



82

TONG & WATKINS

Figure 2 (cont.)

Participant 4
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 5
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 6
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days



83

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 2 (cont.)

Participant 7
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 8
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 9
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days



84

TONG & WATKINS

Figure 2 (cont.)

Participant 10
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 11
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 12
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days



85

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 2 (cont.)

Participant 13
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 14
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

Participant 15
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days



86

TONG & WATKINS

Figure 2 (cont.)

Participant 16
Baseline Absorption Training

Po
sit

iv
e A

ffe
ct

Days

        : planned activity without absorption training
        : planned activity with absorption training
        : non-planned activity without absorption training
        : non-planned activity with absorption training 



87

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 3

Sixteen participants’ levels of maladaptive state rumination during positive activities in a 21-day period.
Participant 1

Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 2
Baseline Absorption Training

R
um

in
at

io
n

Days

Note. The vertical dotted line is the point of transition from baseline to introduction of absorption training.



88

TONG & WATKINS

Figure 3 (cont.)

Participant 3
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 4
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 5
Baseline Absorption Training

R
um

in
at

io
n

Days



89

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 3 (cont.)

Participant 6
Baseline Absorption Training

R
um

in
at

io
n

Days
Participant 7

Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 8
Baseline Absorption Training

R
um

in
at

io
n

Days



90

TONG & WATKINS

Figure 3 (cont.)

Participant 9
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 10
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 11
Baseline Absorption Training

R
um

in
at

io
n

Days



91

ABSORPTION TRAINING, POSITIVE ACTIVITIES

Figure 3 (cont.)

Participant 12
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 13
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 14
Baseline Absorption Training

R
um

in
at

io
n

Days



92

TONG & WATKINS

Figure 3 (cont.)

Participant 15
Baseline Absorption Training

R
um

in
at

io
n

Days

Participant 16
Baseline Absorption Training

R
um

in
at

io
n

Days

        : planned activity without absorption training
        : planned activity with absorption training
        : non-planned activity without absorption training
        : non-planned activity with absorption training 


