When the present visits the past: Updating traumatic memories in social phobia

Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
Journal of Behavior Therapy and Experimental Psychiatry (Impact Factor: 2.23). 01/2008; 38(4):386-401. DOI: 10.1016/j.jbtep.2007.07.003
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Research suggests that distorted images of the self are common in social phobia and play a role in maintaining the disorder. The images are often linked in thematic and sensory detail to distressing memories that are clustered around the onset or worsening of the disorder. This has led to speculation about the likely benefit of working directly with these memories to improve symptoms of social phobia. In this exploratory study, we describe a process of cognitive restructuring followed by imagery rescripting to update the meanings of distressing memories and images in social phobia. We first present illustrative clinical examples and then data of 14 patients with social phobia, on whom we developed this approach. Patients attended an imagery rescripting session in which a semi-structured interview was used to identify their recurrent images, the associated memories and their meanings. Next the identified memory was evoked and elaborated. We updated the meaning of the memory by first using cognitive restructuring to arrive at new perspectives and then linking these perspectives with the memory using imagery techniques. The procedure resulted in significant within session change in beliefs, and in image and memory distress and vividness. One week later significant change was seen in social phobia cognitions and a self-report measure of social anxiety. Rescripting distressing memories in social phobia appears to be an effective way of modifying maladaptive beliefs linked to recurrent negative imagery. This paper presents our exploratory investigation of how to work with the memories and encourages more rigorous investigation in this area.

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    • "Recent studies suggest that image-based cognitions may play a role in the development and maintenance of disorders such as anxiety (e.g., Hackmann and Holmes, 2004) or depression (Patel et al., 2007). As a result, several papers have described imagery-based psychotherapeutic techniques in the treatment of psychological disorders (e.g., Grunert et al., 2007; Hunt and Fenton, 2007; Wild et al., 2007). While the role of verbal cognitions in chronic pain has received much interest, little attention has been paid to the possible role of cognitions in imagery form (pain-related mental images) in the maintenance of disability and distress. "
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    ABSTRACT: Research into mental imagery has increased our understanding of a range of psychological problems. However, there has been little study into the spontaneous mental images experienced in response to chronic pain. This study aimed to explore the prevalence and characteristics of these pain-related mental images. Four hundred ninety-one people with chronic pain who had attended a pain clinic were sent invites to participate and 105 people responded (21%). A mixed-methods approach (quantitative and qualitative) was used to explore the prevalence of pain-related mental imagery, differences between imagers and non-imagers, and the content of imagery in pain. In our sample, 36% of respondents reported having mental images of their pain, with the majority describing them as clear and vivid (83%), experienced daily (80.5%), and distressing (83%). Participants who experienced mental images reported higher depression scores, higher anxiety and higher pain unpleasantness. Frequency of imagery was associated with greater pain unpleasantness. Content analysis of the pain images revealed emerging themes relating to the sensory qualities of pain, anatomical representations, pain as a form of threat or attack, pain as an object, and pain as an abstract image. This study describes themes and characteristics of pain-related mental imagery and confirms that they are a frequent, vivid and distressing experience for many chronic pain sufferers. The results of this study suggest that pain-related mental imagery could provide an additional route for assessment and intervention. Further research should focus on assessment, measurement and intervention in clinical populations.
    European journal of pain (London, England) 05/2014; 18(5). DOI:10.1002/j.1532-2149.2013.00409.x · 2.93 Impact Factor
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    • "These descriptions have led to novel, theory-based imagery rescripting interventions (e.g. Wild et al., 2007, 2008), which in some cases circumvent the traditional verbal reappraisal strategies use in cognitive therapy (e.g. Wheatley et al., 2007). "
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    ABSTRACT: Case reports and clinical experience suggest some individuals with anxiety-disorders experience an overwhelming fear of losing control of basic bodily functions in public. However, many features of bowel- and/or bladder-obsession, such as the accompanying cognitive processes or content, have not been described. Given the role of intrusive imagery in maintaining psychological disorders, this study examines mental imagery as a specific form of cognitive content in bowel/bladder obsession. Twenty participants reporting intrusive imagery linked to a fear of losing control of bowel or bladder function in public completed semi-structured interviews on the nature and characteristics of their mental imagery and its relationship to past events. Imagery was characterised by a predominance of physically-based and visual, ‘flash-forward’ mental events. This future-oriented imagery tended to end with the feared catastrophe (public incontinence) occurring, or was truncated, ending before the catastrophic event. Distressing past events significantly influenced the content of such imagery. Qualitative analysis of imagery interviews enabled a thorough thematic characterisation of imagery content and identification of seven coherent themes: visceral urgency, total exposure, self-as-inferior, absence-of-control, contamination/disgust, rejection-of-failing-self and judgemental-others. This first description of intrusive mental imagery in bowel/bladder obsession reveals thematic and phenomenological characteristics that may represent foci for novel imagery-based interventions.
    Journal of Obsessive-Compulsive and Related Disorders 07/2013; 2(3):233–240. DOI:10.1016/j.jocrd.2013.04.005 · 1.18 Impact Factor
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    • "Thus, it seems that one critical difference between high and low SA individuals might be the extent to which they tend to appraise their images as being accurate self-representations that convey something meaningful about themselves and how they come across to others in social situations (see Clark & Wells, 1995). It is logical, therefore, that imagery rescripting (IR), a cognitivebehavioral intervention for SAD (Nilsson, Lundh, & Viborg, 2012; Wild & Clark, 2011; Wild, Hackmann, & Clark, 2007) and other psychological problems (see Arntz, 2012), is hypothesized to work by instilling a " meta-cognitive shift [in patients] towards seeing the distressing self as being the product of their own mind rather than mirroring reality " (Wild et al., 2007, p. 399). In essence, IR guides patients through an elaborate reappraisal process in which they are instructed to recount the earlier autobiographical memories upon which their images are based while adopting a " wiser " (i.e., a more balanced or realistic) and more self-compassionate present-day perspective. "
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    ABSTRACT: The link between social anxiety (SA) and maladaptive emotion regulation has been clearly established, but little is known about the spontaneous regulation strategies that may be activated during social stress by negative involuntary mental images and whether the nature of such strategies might distinguish individuals with high vs. low trait SA. Participants with high (n = 33) or low (n = 33) trait SA performed an evaluative speech and reported whether they experienced an involuntary negative mental image during the task. They also rated their negative affect (NA) and positive affect (PA) and the extent to which they viewed their image as being controllable and malleable. Finally, they described the types of strategies they spontaneously used to try to control or change their image intrusions. Reported strategies were then subjected to a content analysis and categorized by blinded coders. Among high SA participants, image controllability was both diminished overall and positively correlated with PA. Whereas 90% of low SA individuals reported that they spontaneously self-regulated by altering the content or perceptual features of their images, only about half of the high SA participants used this strategy, with the other 50% reporting that they either suppressed their images or succumbed passively to them in whatever form they took. Although these initial findings require replication in future experimental studies on clinical samples, they also help to enrich our understanding of the strategies that are commonly used by high and low SA individuals to manage their image intrusions during in-vivo stress and suggest potential avenues for future research on the role of imagery in adaptive and maladaptive emotion regulation.
    Journal of Behavior Therapy and Experimental Psychiatry 05/2013; 44(4):426-432. DOI:10.1016/j.jbtep.2013.05.002 · 2.23 Impact Factor
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