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Guided imagery (also known as guided affective imagery, or katathym-imaginative psychotherapy) is a mind-body intervention by which a trained practitioner or teacher helps a participant or patient to evoke and generate mental images [1] that simulate or recreate the sensory perception [2] [3] of sights, [4] [5] sounds, [6] tastes, [7] smells, [8] movements, [9] and images associated with touch, such as texture, temperature, and pressure, [10] as well as imaginative or mental content that the participant or patient experiences as defying conventional sensory categories, [11] and that may precipitate strong emotions or feelings [12] [13] [14] in the absence of the stimuli to which correlating sensory receptors are receptive. [15] [16]
The practitioner or teacher may facilitate this process in person to an individual or a group or you may do it with a virtual group. Alternatively, the participant or patient may follow guidance provided by a sound recording, video, or audiovisual media comprising spoken instruction that may be accompanied by music or sound. [17]
There are two fundamental ways by which mental imagery is generated: voluntary and involuntary.
The involuntary and spontaneous generation of mental images is integral to ordinary sensory perception, and cognition, and occurs without volitional intent. Meanwhile, many different aspects of everyday problem solving, scientific reasoning, and creative activity involve the volitional and deliberate generation of mental images. [18]
The generation of involuntary mental imagery is created directly from present sensory stimulation and perceptual information, such as when someone sees an object, creates mental images of it, and maintains this imagery as they look away or close their eyes; or when someone hears a noise and maintains an auditory image of it, after the sound ceases or is no longer perceptible.
Voluntary mental imagery may resemble previous sensory perception and experience, recalled from memory; or the images may be entirely novel and the product of fantasy. [19] [20] [21]
The term guided imagery denotes the technique used in the second (voluntary) instance, by which images are recalled from long-term or short-term memory, or created from fantasy, or a combination of both, in response to guidance, instruction, or supervision. Guided imagery is, therefore, the assisted simulation or re-creation of perceptual experience across sensory modalities. [22] [23]
Mental imagery can result from both voluntary and involuntary processes, and it comprises simulation or recreation of perceptual experience across all sensory modalities, [24] including olfactory imagery, gustatory imagery, haptic imagery, and motor imagery. [25] Nonetheless, visual and auditory mental images are reported as being the most frequently experienced by people ordinarily as well as in controlled experiments, [26] with visual imagery remaining the most extensively researched and documented in scientific literature. [27]
In experimental and cognitive psychology, researchers have concentrated primarily on voluntary and deliberately generated imagery, which the participant or patient creates, inspects, and transforms, such as by evoking imagery of an intimidating social event, and transforming the images into those indicative of a pleasant and self-affirming experience.
In psychopathology, clinicians have typically focused on involuntary imagery which "comes to mind" unbidden, such as in a depressed person's experience of intrusive unwelcome negative images indicative of sadness, hopelessness, and morbidity; [28] or images that recapitulate previous distressing events that characterize posttraumatic stress disorder. [29]
In clinical practice and psychopathology, involuntary mental images are considered intrusive when they occur unwanted and unbidden, "hijacking attention" to some extent. [30] [31]
The maintenance of, or "holding in mind" imagery, whether voluntary or involuntary, places considerable demands upon cognitive attentional resources, including working memory, redirecting them away from a specific cognitive task or general-purpose concentration and toward the imagery.
In clinical practice, this process can be positively exploited therapeutically by training the participant or patient to focus attention on a significantly demanding task, which successfully competes for and directs attention away from the unbidden intrusive imagery, decreasing its intensity, vividness, and duration, and consequently alleviating distress or pain. [32] [33]
Mental imagery, especially visual and auditory imagery, can exacerbate and aggravate a number of mental and physical conditions. [34]
This is because, according to the principles of psychophysiology and psychoneuroimmunology, the way an individual perceives his or her mental and physical condition in turn affects biological processes, including susceptibility to illness, infection, or disease; and that perception is derived significantly from mental imagery. That is to say that in some cases, the severity of an individual's mental and physical disability, disorder, or illness is partially determined by his or her images, including their content, vividness or intensity, clarity, and frequency with which they are experienced as intrusive and unbidden. [35]
An individual can aggravate the symptoms and intensify the pain or distress precipitated by many conditions through generating, often involuntarily, mental imagery that emphasizes its severity.
For example, mental imagery has been shown to play a key role in contributing to, exacerbating, or intensifying the experience and symptoms of post-traumatic stress disorder (PTSD), [36] compulsive cravings, [37] eating disorders [38] such as anorexia nervosa [39] and bulimia nervosa, [40] spastic hemiplegia, [41] incapacitation following a stroke or cerebrovascular accident, [42] restricted cognitive function and motor control due to multiple sclerosis, [43] social anxiety or phobia, [44] bipolar disorder, [45] schizophrenia, [46] attention deficit hyperactivity disorder, [47] and depression. [48] [49]
The aforementioned challenges and difficulties are some of those for which there is evidence to show that an individual can aggravate the symptoms and intensify the pain or distress precipitated by the condition through generating mental imagery that emphasizes its severity.
The following elaborates the way in which such mental imagery contributes to or aggravates four specific conditions:
Posttraumatic stress disorder often proceeds from experiencing or witnessing a traumatic event involving death, serious injury, or significant threat to others or oneself; [50] and disturbing intrusive images, often described by the patient as 'flashbacks', are a common symptom of this condition across demographics of age, gender, and the nature of the precipitating traumatic event. [51] This unbidden mental imagery is often highly vivid, and provokes memories of the original trauma, accompanied by heightened emotions or feelings and the subjective experience of danger and threat to safety in the present "here and now". [52]
Individuals with social anxiety have a higher than normal tendency to fear situations that involve public attention, such as speaking to an audience or being interviewed, meeting people with whom they are unfamiliar, and attending events of an unpredictable nature. [53] As with posttraumatic stress disorder, vivid mental imagery is a common experience for those with social anxiety, and often comprises images that revive and replay a previously experienced stressful, intimidating or harrowing event that precipitated negative feelings, such as embarrassment, shame, or awkwardness. [54] [55] Thereby, mental imagery contributes to the maintenance and persistence of social anxiety, as it does with posttraumatic stress disorder. [56] [57]
In particular, the mental imagery commonly described by those suffering from social anxiety often comprises what cognitive psychologists describe as an "observer perspective". This consists of an image of themselves, as though from an observing person's perspective, in which those suffering from social anxiety perceive themselves negatively, as if from that observing person's point of view. [58] [59] Such imagery is also common among those suffering from other types of anxiety, who often have depleted ability to generate neutral, positive, or pleasant imagery. [60]
The capacity to evoke pleasant and positively affirming imagery, either voluntarily or involuntarily, may be a critical requisite for precipitating and sustaining positive moods or feelings and optimism; and this ability is often impaired in those suffering from depression. [61] Depression consists of emotional distress and cognitive impairment that may include feelings of hopelessness, pervasive sadness, pessimism, lack of motivation, social withdrawal, difficulty in concentrating on mental or physical tasks, and disrupted sleep. [62]
Whilst depression is frequently associated with negative rumination of verbal thought patterns manifested as unspoken inner speech, [63] ninety percent of depressed patients reporting distressing intrusive mental imagery that often simulates and recollect previous negative experiences, [64] [65] and which the depressed person often interprets in a way that intensifies feelings of despair and hopelessness. [66] [67] In addition, people suffering from depression have difficulty in evoking prospective imagery indicative of a positive future. [68] The prospective mental imagery experienced by depressed persons when at their most despairing commonly includes vivid and graphic images related to suicide, which some psychologists and psychiatrists refer to as "flash-forwards". [69] [70]
Bipolar disorder is characterized by manic episodes interspersed with periods of depression; [71] 90% of patients experience comorbid anxiety disorder at some stage; [72] and there is a significant prevalence of suicide amongst sufferers. [73] [74] Prospective mental imagery indicative of hyperactivity or mania and hopelessness contributes to the manic and depressive episodes respectively in bipolar disorder. [75]
The therapeutic use of guided imagery, as part of a multimodal treatment plan incorporating other suitable methods, such as guided meditation, receptive music therapy, and relaxation techniques, as well as physical medicine and rehabilitation, [21] and psychotherapy, aims to educate the patient in altering their mental imagery, replacing images that compound pain, recollect and reconstruct distressing events, intensify feelings of hopelessness, or reaffirm debilitation, with those that emphasize physical comfort, functional capacity, mental equanimity, and optimism.
Whether the guided imagery is provided in person by a facilitator, or delivered via media, the verbal instruction consists of words, often pre-scripted, intended to direct the participant's attention to imagined visual, auditory, tactile, gustatory or olfactory sensations that precipitate a positive psychologic and physiologic response that incorporates increased mental and physical relaxation and decreased mental and physical stress.
Guided imagery is one of the means by which therapists, teachers, or practitioners seek to achieve this outcome, and involves encouraging patients or participants to imagine alternative perspectives, thoughts, and behaviors, mentally rehearsing strategies that they may subsequently actualize, thereby developing increased coping skills and ability. [76]
According to the computational theory of imagery, [77] [78] [79] which is derived from experimental psychology, guided imagery comprises four phases: [80]
Image generation involves generating mental imagery, either directly from sensory data and perceptual experience, or from memory, or from fantasy. [81]
Image maintenance involves the volitional sustaining or maintaining of imagery, without which, a mental image is subject to rapid decay with an average duration of only 250 ms. [82] This is because volitionally created mental images usually fade rapidly once generated in order to avoid disrupting or confusing the process of ordinary sensory perception. [83] [84] [85]
The natural brief duration of mental imagery means that the active maintenance stage of guided imagery, which is necessary for the subsequent stages of inspection and transformation, requires cognitive concentration of attention by the participant. This concentrative attentional ability can be improved with the practice of mental exercises, including those derived from guided meditation and supervised meditative praxis. [86] [87] [88] Even with such practice, some people can struggle to maintain a mental image "clearly in mind" for more than a few seconds; [89] [90] [91] not only for imagery created through fantasy [92] but also for mental images generated from both long-term memory [93] and short-term memory. [94]
In addition, while the majority of the research literature has tended to focus on the maintenance of visual mental images, imagery in other sensory modalities also necessitates a volitional maintenance process in order for further inspection or transformation to be possible. [6]
The requisite for practice in sustaining attentional control, such that attention remains focused on maintaining generated imagery, is one of the reasons that guided meditation, which supports such concentration, is often integrated into the provision of guided imagery as part of the intervention. Guided meditation assists participants in extending the duration for which generated mental images are maintained, providing time to inspect the imagery, and proceed to the final transformation stage of guided imagery. [95] [96]
Once generated and maintained, a mental image can be inspected to provide the basis for interpretation, and transformation. [97] For visual imagery, inspection often involves a scanning process, by which the participant directs attention across and around an image, simulating shifts in perceptual perspective. [98]
Inspection processes can be applied both to imagery created spontaneously, and to imagery generated in response to scripted or impromptu verbal descriptions provided by the facilitator. [99] [100] [101]
Finally, with the assistance of verbal instruction from the guided imagery practitioner or teacher, the participant transforms, modifies, or alters the content of generated mental imagery, in such a way as to substitute images that provoke negative feelings, are indicative of suffering, or that reaffirm disability or debilitation for those that elicit positive emotion, and are suggestive of resourcefulness, ability to cope, and an increased degree of mental and physical capacity. [102] [103]
This process shares principles with those that inform the clinical psychology techniques of "imagery restructuring" or "imagery re-scripting" as used in cognitive behavioral therapy. [34] [104] [105]
While the majority of research findings on image transformation relate to visual mental imagery, there is evidence to support transformations in other sensory modalities such as auditory imagery. [6] and haptic imagery. [106]
Through this technique, a patient is assisted in reducing the tendency to evoke images indicative of the distressing, painful, or debilitative nature of a condition, and learns instead to evoke mental imagery of their identity, body, and circumstances that emphasizes the capacity for autonomy and self-determination, positive proactive activity, and the ability to cope, whilst managing their condition.
As a result, symptoms become less incapacitating, pain is to some degree decreased, while coping skills increase. [107] [108] [109] [110]
In order for the foregoing process to take place effectively, such that all four stages of guided imagery are completed with therapeutic beneficial effect, the patient or participant must be capable of or susceptible to absorption, which is an "openness to absorbing and self-altering experiences". [111] [112] This is a further reason why guided meditation or some form of meditative praxis, relaxation techniques, and meditation music or receptive music therapy are often combined with or form an integral part of the operational and practical use of the guided imagery intervention. For, all those techniques can increase the participant's or patient's capacity for or susceptibility to absorption, thereby increasing the potential efficacy of guided imagery. [113] [114]
The United States National Center for Complementary and Integrative Health (NCCIH), which is among twenty-seven organizations that make up the National Institutes of Health (NIH), classifies guided imagery and guided meditation, as mind–body interventions, one of five domains of medical and health care systems, practices, and products that are not presently considered part of conventional medicine. [115]
The NCCIH defines mind-body interventions as those practices that "employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms", and include guided imagery, guided meditation and forms of meditative praxis, hypnosis and hypnotherapy, prayer, as well as art therapy, music therapy, and dance therapy. [116]
All mind–body interventions, including the aforementioned, focus on the interaction between the brain, body, and behavior and are practiced with intention to use the mind to alter physical function and promote overall health and wellbeing. [117] [118]
There are documented benefits of mind-body interventions derived from scientific research firstly into their use in contributing to the treatment a range of conditions including headaches, coronary artery disease and chronic pain; secondly in ameliorating the symptoms of chemotherapy-induced nausea, vomiting, and localised physical pain in patients with cancer; thirdly in increasing the perceived capacity to cope with significant problems and challenges; and fourthly in improving the reported overall quality-of-life. In addition, there is evidence supporting the brain and central nervous system's influence on the immune system and the capacity for mind-body interventions to enhance immune function outcomes, including defense against and recovery from infection and disease. [119] [120] [121] [122] [123]
Guided imagery has also demonstrated efficacy in reducing postoperative discomfort as well as chronic pain related to cancer, arthritis, and physical injury. [124] [125] [126] Furthermore, the non-clinical uses for which the efficacy of guided imagery has been shown include managing the stress of public performance among musicians, enhancing athletic and competitive sports ability, and training medical students in surgical skills. [127] The evidence that it is effective for non-musculoskeletal pain is encouraging but not definitive. [128]
Evidence and explanations for the effectiveness and limitations of creative visualization come from two discreet sources: cognitive psychology and psychoneuroimmunology.
Guided imagery is employed as an adjunctive technique to psychological therapies in the treatment of many conditions, including those identified in the previous sections. It plays a significant role in the application of cognitive approaches to psychotherapy, including cognitive behavioral therapy, rational emotive behavior therapy, schema therapy, and mindfulness-based cognitive therapy. [129]
These therapies derive from or draw substantially upon a model of mental functioning initially established by Aaron T. Beck, a psychiatrist and psychoanalyst who posited that the subjective way in which people perceive themselves and interpret experiences influences their emotional, behavioral, and physiological reactions to circumstances. He additionally discovered that by assisting patients in correcting their misperceptions and misinterpretations, and aiding them in modifying unhelpful and self-deprecating ways of thinking about themselves and their predicament, his patients had more productive reactions to events, and developed a more positive self-concept, self-image, or perception of themselves. [130] [131]
This use of guided imagery is based on the following premise. Everyone participates in both the voluntary and involuntary spontaneous generation of visual, auditory and other mental images, which is a necessary part of the way in which a person solves problems, recollects the past, predicts and plans the future, and formulates their self-perception, self-image, or the way they 'view' and perceive themselves. [92] [132] [4]
However, this self-image can be altered and self-regulated with the aid of mind-body interventions including guided imagery, by which an individual changes the way he or she visualizes, imagines, and perceives themselves generally, and their physical condition, body image, and mental state specifically. [133]
The term "psychoneuroimmunology" was coined by American psychologist Robert Ader in 1981 to describe the study of interactions between psychological, neurological, and immune systems. [134]
Three years later, Jean Achterberg published a book called Imagery in Healing that sought to relate and correlate contemporaneous evidence from the then emerging scientific study of the way mental processes influence physical and physiological function, with particular emphasis on mental imagery, to the folklore she extrapolated from a set of diverse ancient and geographically indigenous practices previously described as 'shamanism' by the historian of religion and professor at the University of Chicago, Mircea Eliade; and a number of anthropologists and ethnologists. [135] [136]
The fundamental hypothesis of psychoneuroimmunology is concisely that the way people think and how they feel directly influences the electrochemistry of the brain and central nervous system, which in turn has a significant influence on the immune system and its capacity to defend the body against disease, infection, and ill health. Meanwhile, the immune system affects brain chemistry and its electrical activity, which in turn has a considerable impact on the way we think and feel. [137]
Because of this interplay, a person's negative thoughts, feelings, and perceptions, such as pessimistic predictions about the future, regretful ruminations upon the past, low self-esteem, and depleted belief in self-determination and a capacity to cope can undermine the efficiency of the immune system, increasing vulnerability to ill health. Simultaneously, the biochemical indicators of ill health monitored by the immune system feeds back to the brain via the nervous system, which exacerbates thoughts and feelings of a negative nature. That is to say, we feel and think of ourselves as unwell, which contributes to physical conditions of ill health, which in turn cause us to feel and think of ourselves as unwell. [138]
However, the interplay between cognitive and emotional, neurological, and immunological processes also provides for the possibility of positively influencing the body and enhancing physical health by changing the way we think and feel. For example, people who are able to deconstruct the cognitive distortions that precipitate perpetual pessimism and hopelessness and further develop the capacity to perceive themselves as having a significant degree of self-determination and capacity to cope are more likely to avoid and recover from ill health more quickly than those who remain engaged in negative thoughts and feelings. [139]
This simplification of a complex interaction of interrelated systems and the capacity of the mind to influence the body does not account for the significant influence that other factors have on mental and physical well-being, including exercise, diet, and social interaction.
Nonetheless, in helping people to make such changes to their habitual thought processes and pervasive feelings, mind-body interventions, including creative visualization, when provided as part of a multimodal and interdisciplinary treatment program of other methods, such as cognitive behavioral therapy, have been shown to contribute significantly to treatment of and recovery from a range of conditions.
In addition, there is evidence supporting the brain and central nervous system's influence on the immune system and the capacity for mind-body interventions to enhance immune function outcomes, including defense against and recovery from infection and disease. [140]
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.
Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.
Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation, as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis followed by synthesis.
A mental image is an experience that, on most occasions, significantly resembles the experience of 'perceiving' some object, event, or scene, but occurs when the relevant object, event, or scene is not actually present to the senses. There are sometimes episodes, particularly on falling asleep and waking up, when the mental imagery may be dynamic, phantasmagoric and involuntary in character, repeatedly presenting identifiable objects or actions, spilling over from waking events, or defying perception, presenting a kaleidoscopic field, in which no distinct object can be discerned. Mental imagery can sometimes produce the same effects as would be produced by the behavior or experience imagined.
Psychological trauma, mental trauma or psychotrauma is an emotional response to a distressing event or series of events, such as accidents, rape, or natural disasters. Reactions such as psychological shock and psychological denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, difficulties with interpersonal relationships and sometimes physical symptoms including headaches or nausea.
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD). In EMDR, the person being treated recalls distressing experiences whilst doing bilateral stimulation, such as side-to-side eye movement or physical stimulation, such as tapping either side of the body.
A flashback, or involuntary recurrent memory, is a psychological phenomenon in which an individual has a sudden, usually powerful, re-experiencing of a past experience or elements of a past experience. These experiences can be frightful, happy, sad, exciting, or any number of other emotions. The term is used particularly when the memory is recalled involuntarily, especially when it is so intense that the person "relives" the experience, and is unable to fully recognize it as memory of a past experience and not something that is happening in "real time".
Involuntary memory, also known as involuntary explicit memory, involuntary conscious memory, involuntary aware memory, madeleine moment, mind pops and most commonly, involuntary autobiographical memory, is a sub-component of memory that occurs when cues encountered in everyday life evoke recollections of the past without conscious effort. Voluntary memory, its opposite, is characterized by a deliberate effort to recall the past.
An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), Tourettes syndrome (TS), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.
Creative visualization is the cognitive process of purposefully generating visual mental imagery, with eyes open or closed, simulating or recreating visual perception, in order to maintain, inspect, and transform those images, consequently modifying their associated emotions or feelings, with intent to experience a subsequent beneficial physiological, psychological, or social effect, such as expediting the healing of wounds to the body, minimizing physical pain, alleviating psychological pain including anxiety, sadness, and low mood, improving self-esteem or self-confidence, and enhancing the capacity to cope when interacting with others.
Gordon Howard Bower was a cognitive psychologist studying human memory, language comprehension, emotion, and behavior modification. He received his Ph.D. in learning theory from Yale University in 1959. He held the A. R. Lang Emeritus Professorship at Stanford University. In addition to his research, Bower also was a notable adviser to numerous students, including John R. Anderson, Lawrence W. Barsalou, Lera Boroditsky, Keith Holyoak, Stephen Kosslyn, Alan Lesgold, Mark A. Gluck, and Robert Sternberg, among others.
Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.
Motor imagery is a mental process by which an individual rehearses or simulates a given action. It is widely used in sport training as mental practice of action, neurological rehabilitation, and has also been employed as a research paradigm in cognitive neuroscience and cognitive psychology to investigate the content and the structure of covert processes that precede the execution of action. In some medical, musical, and athletic contexts, when paired with physical rehearsal, mental rehearsal can be as effective as pure physical rehearsal (practice) of an action.
Richard McNally is a Professor and Director of Clinical Training at Harvard University's Department of Psychology. As a clinical psychologist and experimental psycho-pathologist, he studies anxiety disorders and related syndromes, such as post-traumatic stress disorder, obsessive-compulsive disorder, and complicated grief.
Fred W. Mast is a full professor of Psychology at the University of Bern in Switzerland, specialized in mental imagery, sensorimotor processing, and visual perception. He directs the Cognitive Psychology, Perception, and Research Methods Section at the Department of Psychology of the University of Bern.
Audio therapy is the clinical use of recorded sound, music, or spoken words, or a combination thereof, recorded on a physical medium such as a compact disc (CD), or a digital file, including those formatted as MP3, which patients or participants play on a suitable device, and to which they listen with intent to experience a subsequent beneficial physiological, psychological, or social effect.
Emily A. Holmes is a clinical psychologist and neuroscientist known for her research on mental imagery in relation to psychological treatments for post traumatic stress disorder (PTSD), bipolar disorder, and depression. Holmes is Professor of Clinical Neuroscience at Karolinska Institute in Sweden. She also holds an appointment as Honorary Professor of Clinical Psychology at the University of Oxford.
Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.
Hyperphantasia is the condition of having extremely vivid mental imagery. It is the opposite condition to aphantasia, where mental visual imagery is not present. The experience of hyperphantasia is more common than aphantasia and has been described as being "as vivid as real seeing". Hyperphantasia constitutes all five senses within vivid mental imagery; however, "visual" mental imagery research dominates the literature, and there is a lack of research on the other four senses.
Imagery Rescripting is an experiential therapeutic technique that uses imagery and imagination to intervene in traumatic memories. The process is guided by a therapist who works with the client to define ways to work with particular traumatic memories, images, or nightmares.