Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework

Stress and anxiety: counterpart elements of the stress/anxiety complex

The relationship between stress and anxiety is complicated. Stress initially arises from one's environment; anxiety overlays physiological arousal, cognitive appraisals, emotional states, and behavioral responses. Both are components of a stress-anxiety complex, which has evolved to enable individuals to adapt to their environment and achieve equilibrium. Anxiety disorders, which result when this mechanism goes awry, occur along a spectrum. One of the main variables affecting anxiety disorders is the extent of stress. Each anxiety disorder should be evaluated along a stress axis, leading to improved case conceptualization and intervention strategies.

Pretraumatic Stress Reactions in Soldiers Deployed to Afghanistan

Posttraumatic Stress Disorder is a diagnosis related to the past. Pre-traumatic stress reactions, as measured by intrusive involuntary images of possible future stressful events and their associated avoidance and increased arousal, have been overlooked in the PTSD literature. Here we introduce a scale that measures pre-traumatic stress reactions providing a clear future-oriented parallel to the posttraumatic stress reactions described in the diagnostic criteria for PTSD. We apply this pre-traumatic stress reactions checklist (PreCL) to Danish soldiers before, during, and after deployment to Afghanistan. The PreCL has good internal consistency and is highly correlated with a standard measure of PTSD symptoms. The PreCL as answered before the soldiers' deployment significantly predicted level of PTSD symptoms during and after their deployment, while controlling for baseline PTSD symptoms and combat exposure measured during and after deployment. The findings have implications for the conceptualization of PTSD, screening, and treatment.

The warrior in the machine: neuroscience goes to war

Ever since Stone Age men discovered that knapping flint produced sharp stone edges that could be used in combat as well as for cooking and hunting, technological advances of all kinds have been adapted and adopted by the military.The opportunities provided by modern neuroscience are proving no exception, but their application in a military context is accompanied by complex practical and ethical considerations.

Hypomanic Experience in Young Adults Confers Vulnerability to Intrusive Imagery After Experimental Trauma: Relevance for Bipolar Disorder

Emotional mental imagery occurs across anxiety disorders, yet is neglected in bipolar disorder despite high anxiety comorbidity. Furthermore, a heightened susceptibility to developing intrusive mental images of stressful events in bipolar disorder and people vulnerable to it (with hypomanic experience) has been suggested. The current study assessed, prospectively, whether significant hypomanic experience (contrasting groups scoring high vs. low on the Mood Disorder Questionnaire, MDQ) places individuals at increased risk of visual reexperiencing after experimental stress. A total of 110 young adults watched a trauma film and recorded film-related intrusive images for 6 days. Compared to the low MDQ group, the high MDQ group experienced approximately twice as many intrusive images, substantiated by convergent measures. Findings suggest hypomanic experience is associated with developing more frequent intrusive imagery of a stressor. Because mental imagery powerfully affects emotion, such imagery may contribute to bipolar mood instability and offer a cognitive treatment target.

Are C-reps contextual representations? A reply to Brewin and Burgess

Brewin and Burgess (2013) argue that our recent papers investigating the role of contextual representations in intrusive memories do not pose a challenge to dual-representation theory as originally claimed (Pearson, 2012; Pearson, Ross, & Webster, 2012). Here I point out that their alternative explanation for our results can be rejected using data already published in both papers. I also argue that their definition of what constitutes a contextual representation renders their revised dual-representation theory incompatible with experimental results that have previously been argued in the literature to support it. Valuable though their contribution is, it does not impact on our main conclusion that abstract contextual representations serve to increase intrusive memories for traumatic material.

[Mental Imagery: Neurophysiology and Implications in Psychiatry]

OBJECTIVE

To provide an explanation about what mental imagery is and some implications in psychiatry.

METHODS

This article is a narrative literature review.

RESULTS

There are many terms in which imagery representations are described in different fields of research. They are defined as perceptions in the absence of an external stimulus, and can be created in any sensory modality. Their neurophysiological substrate is almost the same as the one activated during sensory perception. There is no unified theory about its function, but it is possibly the way that our brain uses and manipulates the information to respond to the environment.

CONCLUSIONS

Mental imagery is an everyday phenomenon, and when it occurs in specific patterns it can be a sign of mental disorders.

Improving Outcome of Psychosocial Treatments by Enhancing Memory and Learning

Mental disorders are prevalent and can lead to significant impairment. Some progress has been made toward establishing treatments; however, effect sizes are small to moderate, gains may not persist, and many patients derive no benefit. Our goal is to highlight the potential for empirically supported psychosocial treatments to be improved by incorporating insights from cognitive psychology and research on education. Our central question is: If it were possible to improve memory for the content of sessions of psychosocial treatments, would outcome substantially improve? We leverage insights from scientific knowledge on learning and memory to derive strategies for transdiagnostic and transtreatment cognitive support interventions. These strategies can be applied within and between sessions and to interventions delivered via computer, the Internet, and text message. Additional novel pathways to improving memory include improving sleep, engaging in exercise, and using imagery. Given that memory processes change across the lifespan, services to children and older adults may benefit from different types and amounts of cognitive support.

Positive Imagery Cognitive Bias Modification in Treatment-Seeking Patients with Major Depression in Iran: A Pilot Study

Cognitive bias modification paradigms training positive mental imagery and interpretation (imagery CBM-I) hold promise for treatment innovation in depression. However, depression is a global health problem and interventions need to translate across settings and cultures. The current pilot study investigated the impact of 1 week of daily imagery CBM-I in treatment-seeking individuals with major depression in outpatient psychiatry clinics in Iran. Further, it tested the importance of instructions to imagine the positive training materials. Finally, we examined the effects of this training on imagery vividness. Thirty-nine participants were randomly allocated to imagery CBM-I, a non-imagery control program, or a no treatment control group. Imagery CBM-I led to greater improvements in depressive symptoms, interpretive bias, and imagery vividness than either control condition at post-treatment (n = 13 per group), and improvements were maintained at 2-week follow-up (n = 8 per group). This pilot study provides first preliminary evidence that imagery CBM-I could provide positive clinical outcomes in an Iranian psychiatric setting, and further that the imagery component of the training may play a crucial role.

Mental imagery during daily life: Psychometric evaluation of the Spontaneous Use of Imagery Scale (SUIS)

The Spontaneous Use of Imagery Scale (SUIS) is used to measure the tendency to use visual mental imagery in daily life. Its psychometric properties were evaluated in three independent samples (total N = 1297). We evaluated the internal consistency and test-retest reliability of the questionnaire. We also examined the structure of the items using exploratory and confirmatory factor analysis. Moreover, correlations with other imagery questionnaires provided evidence about convergent validity. The SUIS had acceptable reliability and convergent validity. Exploratory and confirmatory factor analysis revealed that a unidimensional structure fit the data, suggesting that the SUIS indeed measures a general use of mental imagery in daily life. Future research can further investigate and improve the psychometric properties of the SUIS. Moreover, the SUIS could be useful to determine how imagery relates to e.g. psychopathology.

Beyond words: sensory properties of depressive thoughts

Verbal thoughts (such as negative cognitions) and sensory phenomena (such as visual mental imagery) are usually conceptualised as distinct mental experiences. The present study examined to what extent depressive thoughts are accompanied by sensory experiences and how this is associated with symptom severity, insight of illness and quality of life. A large sample of mildly to moderately depressed patients (N = 356) was recruited from multiple sources and asked about sensory properties of their depressive thoughts in an online study. Diagnostic status and symptom severity were established over a telephone interview with trained raters. Sensory properties of negative thoughts were reported by 56.5% of the sample (i.e., sensation in at least one sensory modality). The highest prevalence was seen for bodily (39.6%) followed by auditory (30.6%) and visual (27.2%) sensations. Patients reporting sensory properties of thoughts showed more severe psychopathological symptoms than those who did not. The degree of perceptuality was marginally associated with quality of life. The findings support the notion that depressive thoughts are not only verbal but commonly accompanied by sensory experiences. The perceptuality of depressive thoughts and the resulting sense of authenticity may contribute to the emotional impact and pervasiveness of such thoughts, making them difficult to dismiss for their holder.

Toward a visuospatial developmental account of sequence-space synesthesia

Sequence-space synesthetes experience some sequences (e.g., numbers, calendar units) as arranged in spatial forms, i.e., spatial patterns in their mind's eye or even outside their body. Various explanations have been offered for this phenomenon. Here we argue that these spatial forms are continuous with varieties of non-synesthetic visuospatial imagery and share their central characteristics. This includes their dynamic and elaborative nature, their involuntary feel, and consistency over time. Drawing from literatures on mental imagery and working memory, we suggest how the initial acquisition and subsequent elaboration of spatial forms could be accounted for in terms of the known developmental trajectory of visuospatial representations. This extends from the formation of image-based representations of verbal material in childhood to the later maturation of dynamic control of imagery. Individual differences in the development of visuospatial style also account for variation in the character of spatial forms, e.g., in terms of distinctions such as visual versus spatial imagery, or ego-centric versus object-based transformations.

Mental imagery, emotion and psychopathology across child and adolescent development

Mental imagery-based interventions are receiving increasing interest for the treatment of psychological disorders in adults. This is based on evidence that mental imagery potently influences the experience of emotion in non-clinical samples, and that a number of psychological disorders are marked by syndrome-specific, distressing abnormalities in mental imagery. During childhood and adolescence, neurocognitive development impacting mental imagery processes may moderate its relationship with clinically-relevant emotional symptoms at a number of potential loci. Crucially, these changes could impact vulnerability to distressing mental imagery and the efficacy of mental imagery-based clinical interventions. This review synthesises evidence pertaining to developmental changes in the role and content of mental imagery, and in the cognitive sub-processes required to generate and sustain mental images. Subsequently, we discuss implications for understanding the developmental relationship between mental imagery, emotion and psychopathology. Translational cognitive neuroscience research investigating the content, emotional impact and neurocognitive substrates of mental imagery across development may reveal insights into trajectories of vulnerability to symptoms of a number of psychological disorders. If proper consideration is given to developmental factors, techniques based on mental imagery may be valuable as part of a treatment armoury for child and adolescent clinical populations and those at risk of emotional disorders.

An emerging paradigm: a strength-based approach to exploring mental imagery

Mental imagery, or the ability to simulate in the mind information that is not currently perceived by the senses, has attracted considerable research interest in psychology since the early 1970's. Within the past two decades, research in this field-as in cognitive psychology more generally-has been dominated by neuroscientific methods that typically involve comparisons between imagery performance of participants from clinical populations with those who exhibit apparently normal cognitive functioning. Although this approach has been valuable in identifying key neural substrates of visual imagery, it has been less successful in understanding the possible mechanisms underlying another simulation process, namely, motor imagery or the mental rehearsal of actions without engaging in the actual movements involved. In order to address this oversight, a "strength-based" approach has been postulated which is concerned with understanding those on the high ability end of the imagery performance spectrum. Guided by the expert performance approach and principles of ecological validity, converging methods have the potential to enable imagery researchers to investigate the neural "signature" of elite performers, for example. Therefore, the purpose of this paper is to explain the origin, nature, and implications of the strength-based approach to mental imagery. Following a brief explanation of the background to this latter approach, we highlight some important theoretical advances yielded by recent research on mental practice, mental travel, and meta-imagery processes in expert athletes and dancers. Next, we consider the methodological implications of using a strength-based approach to investigate imagery processes. The implications for the field of motor cognition are outlined and specific research questions, in dynamic imagery, imagery perspective, measurement, multi-sensory imagery, and metacognition that may benefit from this approach in the future are sketched briefly.