59 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. References American Psychiatric Association. (2013). 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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