Mental imagery is not a widely researched field in clinical psychology and presents incredible relevance in the treatment of many clinical disorders, such as social phobia, schizophrenia, depression, PTSD among others. The development of this field will help drive advances in theory and treatment.
From our review on clinical studies we found that typically imagery exercises are specific to the disorder we are treating. Depending on the condition, the cognitive process is different and the experiences as well as the measurement has to be created accordingly. Mental imagery processes can be a relevant component in the effectiveness of treatment such as imagery rescripting in Cognitive Behavioral Therapy (CBT), schema-focused therapy and cognitive bias modification training. Unfortunately, there’s a lack of guidance for the appropriate application of mental imagery in treatment.
In this article we aim to outline how cognitive imagery processing works, following the computational theory of imagery proposed by Stephen Kosslyn and colleagues [1]. This theory describes how the generation and transformation of mental imagery influences patterns of behavior. These processes consist of 4 stages:
1. Image generation
Mental images can be created in two distinct ways:
First, we can create an image from immediate perceptual information. For example: we can look at a picture, create a mental image of the picture with our mind, and then maintain a mental image as we close our eyes. Second, we can create an image from previously stored information held in our long-term memory.
We store images using all of our senses. Most frequently we experience visual and auditory mental images, but there are also olfactory, gustatory and haptic images.
Images are created through deliberate or involuntary recall processes.
When using imagery as a treatment, experimental psychology focuses on deliberately generated images whereas psychopathology works with involuntary imagery that arises uninvited in our minds.
2. Image maintenance
After the image is generated, it decays very quickly. The average duration is only 250 milliseconds. In order to work with imagery in treatment we need to maintain it for longer periods of time. Our capacity to maintain the image also depends on our general attention resources that can become rapidly depleted. Research shows that this stage of the process is part of the executive function of our working memory rather than a separate visually-based process.
3. Image inspection
Image inspection is what furthers the cognitive process. Usually the inspection requires the interpretation of characteristics. For example: we look at an object and we will notice its location, position, size, light, etc… Through this process we are encoding the object’s geometric properties.
Studies on cerebral activity indicate that the processes that contribute to image inspection are different from those utilized during image generation and maintenance.
One of the most researched aspects of image inspection is mental scanning in which the focus of attention on an image is shifted from one point to another.
4. Image transformation
This is the stage of divergent thinking where we create different perspectives. We use it daily during problem-solving and the creative process. Within this stage, there are 3 processes:
Mental rotation is one of the most studied aspects of image transformation. The main takeaway is that the more complex the mental rotation the longer it takes for us to respond to it.
Mental synthesis is a combination of mental rotation and image restructuring. Through the transformation of specific parts of an image we can discover novel patterns and new insights. This process is commonly used in design, reasoning and problem-solving.
Imagery restructuring or Imagery rescripting is used in Cognitive Behavioral Therapy (CBT) although less studied in the field of clinical psychology. These techniques help patients transform their distressing imagery by modifying the meaning of the triggering image.
A number of measures have been developed to understand the individual subjective experience of mental imagery. One of the most common measures is vividness which refers to the luminosity and clarity of the image. Another one is “how real it feels”. Study shows that Eye Movement Desensitization and Reprocessing (EMDR) and attentional breathing in Mindfulness-Based Cognitive Therapy (MBCT) were found to reduce vividness and emotionality of negative memories. Other studies have found that imagery tasks are more effective at reducing subjective vividness and emotionality than comparable verbal tasks.
Mental imagery has the capacity to activate physiological and behavioral responses and its impact on emotions can be exploited in different behavior therapies. There is a vast opportunity to advance this area of research.
[1] Kosslyn, Stephen M., et al. “Neural foundations of Imagery.” Nature Review Neuroscience, vol. 2, no. 635-642, 2001, https://doi.org/10.1038/35090055.
[2] Pearson, David G., et al. “Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework.” Clinical Psychology Review, 2013, doi: 10.1016/j.cpr.2012.09.001.