Imagery and the Threatened Self

Perspectives on Mental Imagery and the Self in Cognitive Therapy

Lusia Stopa

• Publisher: Routledge
• Year: 2009
• Print ISBN: 9780415407595
• eBook ISBN: 9781134133666
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Imagery is important in cognitive therapy because images often trigger strong emotions, and imagery techniques such as imaginal reliving and imaginal rescripting are increasingly used in therapeutic treatments. Imagery and the Threatened Self considers the role that images of the self play in a number of common mental health problems and how these images can be used to help people to recover.

Stopa and her contributors focus specifically on images of the self which are often negative and distorted and can contribute to both the cause and the progression of clinical disorders. The book includes chapters on current theories of the self and on imagery techniques used in therapy, alongside chapters that examine the role of self-images and how images can be used in the treatment of disorders including:

• social phobia
• post-traumatic stress disorder
• eating disorders
• depression
• bipolar disorder.

Imagery and the Threatened Self is an original and innovative book that will appeal to both clinicians and students who are studying and practising cognitive therapy.

Chapter 1
Imagery and the threatened self

An introduction

Lusia Stopa

For what other dungeon is so dark as one’s own heart! What jailer so inexorable as one’s self!

(Nathaniel Hawthorne, The House of the Seven Gables)

The self can be a prison from which to view the world and for many people suffering from psychological disorders the building blocks of this prison are the distorted and dysfunctional images that they have of themselves, which are often based on past memories. The principal aims of this book are to explore the ways in which images of the self can contribute to the cause and maintenance of psychological disorders and to examine how imagery can be used in treatment to help people overcome their psychological difficulties. Imagery is one of the ‘hot topics in modern cognitive behaviour therapy’ (Holmes, Arntz, & Smucker, 2007, p. 298) and the publication of two journal special issues over the past five years attests to the theoretical importance of imagery as well as to its clinical relevance (see Memory, July 2004, vol. 12, no. 4 and Journal of Behaviour Therapy and Experimental Psychiatry, December 2007, vol. 38, no. 4). This introductory chapter describes the rationale for looking specifically at images of the self and provides the reader with a map of what the book covers. The chapter starts by defining imagery and considering why it is important in cognitive therapy, and goes on to look at the links between imagery and self-representation that form the core of the book. The final part of the introduction provides a brief summary of the content of the subsequent chapters.

What is a mental image? An image is a mental representation that occurs without the need for external sensory input. An image may represent the memory of an object, a place or an event; so, for example, I may see a bright red apple in a bowl before I leave for work and then have an image of the apple later in the morning when I start feeling hungry. We can create images of simple objects such as shapes (imagine a square) or use images to remember more complex autobiographical events (e.g. my first day at school). Images can be a direct reflection of reality; for example, it is possible to imagine a horse, or a particular experience such as rowing a boat, or sitting by the fireside. However, we can also create images of fantastical objects or of events that did not occur. Images occur in every sensory modality, so it is possible to have auditory, olfactory and tactile images as well as visual images. In posttraumatic stress disorder, re-experiencing can involve any or all of the sensory modalities; for example, an individual could re-experience a smell that was a characteristic of the trauma, such as burning rubber in a car accident or the smell of blood if the trauma involved injury. A great strength of imagery is its plasticity: people can imagine different outcomes, face their fears, rehearse behavioural sequences, transform old and painful memories, and create images that represent desired and feared parts of their selves.

In the field of psychology in general, the study of imagery has had a fairly chequered history, moving from being a central feature of enquiry in the early part of the twentieth century to being almost completely banished when behaviourism was at its peak (Baddeley & Andrade, 2000). The resurrection of imagery as a legitimate form of enquiry was largely due to Paivio’s (1965, 1969, 1971) application of experimental techniques to the study of imagery, which divorced it from earlier introspective approaches in which the phenomenonal features of imagery were examined through self-observation and self-report. Paivio (e.g. 1969) used a paired associates task, in which participants read pairs of words and then had to remember the second word when presented with the first, in order to examine the role of imagery in learning. Concrete words, which are more imageable, were easier to remember than abstract words, and Paivio formulated the dual coding hypothesis to explain this effect. According to the dual coding hypothesis, there are two independent but interacting systems—a verbally-based system and an image-based system—and concrete words are easier to remember because they can draw on information from both systems, whereas abstract words only have access to information encoded in the verbal system.

Paivio’s work provided the impetus for the systematic experimental investigation of imagery, which has taken place over the past 30 to 40 years in the field of cognition and in the field of learning and memory (see Baddeley, 1997, or Parkin, 2000, for an overview). One principal controversy concerns the best way to understand and conceptualise the underlying nature of the imagery system and whether imagery should be seen as the product of an analogue or a propositional system. Proponents of the analogue argument base their case on a substantial body of evidence that demonstrates similarities between scanning visual images and visual perception (e.g. Kosslyn, 1980; Shepard & Metzler, 1971). According to the analogue view, images can be seen essentially as mental percepts that can undergo transformations. The contrasting propositional view, advocated in its most extreme form by Pylyshyn (e.g. 1981), is that images are an epiphenomenon of a propositional system of representation in which knowledge is represented as a collection of propositions that are unrelated to any specific sensory modality. Kosslyn’s computational model of imagery (e.g. 1980), while being firmly positioned within the analogue camp, demonstrates how propositional knowledge can be integrated with analogue representations. He argues that there are two different types of information that are stored about objects: one is in the form of an image file that stores basic information about features of the image such as shape, and the other is a propositional file that contains information about the properties of an object.

There are a number of interesting implications from this brief review of some of the key points and controversies that have arisen in the study of imagery. First, in psychology generally, most studies of imagery have concentrated on visual images and have looked primarily at single images or at images of objects such as shapes. While discrete images can play a role in psychological problems (e.g. the image of a specific phobic stimulus such as a snake or spider), imagery is commonly much more complex and frequently represents events and/or people. Importantly in the clinical field, images often represent the self in relation to events and/or in relation to other people. This area of imagery has been almost completely ignored, other than in the clinical field. Second, although there has been no explicit examination in cognitive therapy of whether the system underlying imagery is essentially analogue or propositional, there is a clear implicit assumption in the field that images are analogue representations, and importantly that it is both possible and beneficial to manipulate these representations through techniques such as imagery rescripting. Indeed, the assumptions behind imagery rescripting seem to be entirely consistent with Kosslyn’s (1980) proposal that images contain both representational and propositional codes, but it includes the assumption that changing representational codes can influence propositional codes. Finally, the current focus on imagery in cognitive therapy seeks to combine a cognitive science approach through experimental assessment of the features and impact of images (e.g. Holmes et al., 2007) with a phenomenological approach that asks patients to describe their images and then uses this information to intervene (e.g. Hackmann, Clark, & McManus, 2000).

Historically, imagery has been used as a therapeutic technique in a number of schools of psychotherapy. In his book Imagery in Psychotherapy, Jerome Singer (2006) presents a useful typology in which he divides therapies into two broad categories: therapies that have a ‘narrative, experiential, imagery emphasis’ and therapies that emphasise ‘rational thought and cognitive approaches’ (p. 69). The former, which includes Freudian and Jungian therapies, is heavily dependent on imagery, often realised in the form of fantasy images and dreams. Until recently, the latter, which includes behavioural and cognitive therapies, has apparently relied less on imagery; but, as Singer points out, behavioural methods such as systematic desensitisation have always relied on imagery when they employed techniques such as imaginal exposure. Lang’s work (e.g. 1977, 1978, 1994; Lang, Levin, Miller, & Kozak, 1983) on the role of imagery in the development and maintenance of fears was particularly influential in legitimising both the study and the therapeutic use of imagery, and more cognitively based therapies are increasingly using imagery as part of a repertoire of therapeutic techniques.

Lang’s bio-informational theory of emotion (Lang, 1977; Lang, Cuthbert, & Bradley, 1998) proposes that emotional episodes are coded in memory as a series of interlinked units that form an emotion network. When one unit is activated, this activation can spread to adjacent units, and if enough units are activated or if the strength of the overall activation is exceeded, then the whole emotion episode is triggered. The activation of a network through any route (e.g. verbal, visual, somatic) is important because it triggers emotions, which Lang conceptualises as action dispositions, i.e. preparatory states such as flight or fight that are designed to help the organism to survive in response to actual or perceived threat. A fundamental premise of this theory in all its variants is that emotion networks are dependent on language and that they can be activated by any matching input, e.g. an external stimulus, an internal image, a symbolic representation, a feeling state.

Imagery is particularly important in this theory because ‘images of action and emotion prompt activation in the appropriate efferent system’ (Lang et al., 1998, p. 659, emphasis added). In other words, an image creates the same outputs in the response systems as does the actual experience itself. Lang’s work on the role of images in emotion and on the effects of systematic desensitisation follows directly from this assertion and paved the way for the development of imagery-based treatments. However, despite the influence of Lang’s work on using imagery in treatments such as systematic desensitisation, it is only relatively recently that imagery-based interventions such as imagery rescripting have become mainstream methods within cognitive therapy. Imagery rescripting, which is discussed in more detail in Chapter 3, is a method of restructuring meaning that was originally developed for the treatment of sexual abuse and trauma (Smucker & Dancu, 1999) and for personality disorders (Arntz & Weertman, 1999). Despite the recent developments in its use in cognitive therapy, imagery rescripting is not an entirely new technique and has its roots in Janet’s work on hypnosis at the beginning of the twentieth century (see Edwards, 2007, for a more detailed discussion).

Why are images important? To begin with, images are often associated with high levels of affect in therapy. The assumption that imagery has a particularly strong association with emotion had not been systematically investigated until recently, when Holmes, Mathews, Mackintosh, and Dalgleish (2008) demonstrated that participants had stronger emotional responses to images of word—picture combinations than to sentences. Their study directly compared imagery with verbal processing and showed not only that imagery produces stronger emotional responses than verbally presented material, but also that imagery appears to have a causal effect on emotion and on evaluative learning. The images used in this study were based on pictures of people in different situations (e.g. a skier at the edge of a slope, a person riding a bicycle) and of objects and places (e.g. a knife, a cliff edge, a flight of stairs). These images do not necessarily have personal meaning and resonance for the participants, but the increased emotional responses that they provoked compared to their verbal counterparts raises a question over the potential impact of images that are personally meaningful, and in particular of images that represent the self.

Our ability to create images of the self is the central theme of this book. Self-representations that take the form of images are likely to have direct and important emotional consequences because perception of self is fundamental to the individual’s mood, functioning, and psychological well-being (see Chapter 2). There is some preliminary evidence to support this idea. Positive images of the self in social anxiety reduce anxiety in social situations, improve self and observer ratings of performance, and increase the accessibility of positive memories (Stopa & Jenkins, 2007). Conversely, negative images of the self increase anxiety and impair performance in confident speakers, block benign inferences, and increase accessibility of negative memories (Hirsch, Meynen, & Clark, 2004; Hirsch, Mathews, Clark, Williams, & Morrison, 2006; Hirsch, Clark, & Mathews, 2006; Stopa & Jenkins, 2007). Imagery rescripting usually involves manipulating the self in the image in some way, either by bringing in a different self (e.g. bringing the adult self into a memory of the child self) or bringing another person in to rescue or comfort the self in the distressing memory. Recently, imagery rescripting has been used successfully to treat distressing memories in social phobia (Wild, Hackmann, & Clark, 2007, and see Chapter 4) and in depression (Wheatley et al., 2007).

In order to understand how and why images of the self can play a pivotal role in the development and maintenance of psychological difficulties, we need to consider the triadic relationship between imagery, autobiographical memory and the self. There are well-acknowledged links between the self and autobiographical memory (see Conway & Pleydell-Pearce, 2000, for a review). The autobiographical memory store contains different types of information that Conway and Pleydell-Pearce categorise as knowledge about life time periods (e.g. when I was at school/university), memory about general events (e.g. travelling to work, learning to drive), and event-specific memories (e.g. my wedding day, falling off the climbing frame and breaking my leg). This store of memories provides the knowledge base from which individuals construct representations of self. Memories that are critical in shaping our sense of who we are have been called ‘self-defining memories’ (Singer & Salovey, 1993) and are discussed in more detail below. The autobiographical memory base is the bedrock of the individual’s identity and provides a sense of stability and continuity.

Self-defining memories are those memories that seem to encapsulate the individual’s life-story (Beike, Kleinknecht, & Wirth-Beaumont, 2004). They are usually associated with high levels of emotion and are critical to an individual’s sense of well-being and to his or her goals (Singer & Blagov, 2004). Self-defining memories can, of course, be either positive or negative, but in clinical practice we are much more likely to encounter and have to deal with negative self-defining memories. This particular type of memory often seems to confirm or define how an individual sees himself or herself. A child who has been bullied, for example, may remember one particular incident that confirmed that he or she was different and would never fit in. Traumatic memories may represent a special kind of self-defining memory for some people. An individual who saw himself ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of contributors
• Acknowledgements
• 1 Imagery and the threatened self: An introduction
• 2 Psychological theories of the self and their application to clinical disorders
• 3 How to use imagery in cognitive-behavioural therapy
• 4 Imagery and the self in social phobia
• 5 Agoraphobia: Imagery and the threatened self
• 6 Imagery and psychological threat to the self in PTSD
• 7 Imagery and the self following childhood trauma: Observations concerning the use of drawings and external images
• 8 Imagery and the negative self in eating disorders
• 9 Evolved minds and compassion-focused imagery in depression
• 10 Imagery and memories of the social self in people with bipolar disorders: Empirical evidence, phenomenology, theory and therapy