Motivation and emotion/Book/2023/Mental imagery and emotion

Overview


Have you ever been to therapy to unpack your trauma, express your emotions, and be yourself without judgment, but the therapist asks you to close your eyes and imagine yourself on the beach, in a tranquil location, somewhere far away? How did you feel afterward?

If you haven't experienced this yet, close your eyes and imagine yourself in your chosen location, somewhere that represents 'calm' for you. What do you see? How do you feel?



Imagination can differ for everyone (see Figure 2). From a neuroscience perspective, mental imagery is consistently implicated in the process of certain emotional regulation patterns (Pearson, 2019). Although it might seem like a time-waster, research suggests that, compared to verbal content, mental imagery elicits stronger emotions and can have an amplifying effect on individuals (Pearson, 2019). One main category of mental imagery applications used to achieve emotional regulation among mood disorders consists of repeated positive valence mental imagery (Shottnik & Linden, 2019). Furthermore, mental imagery can be employed to desensitise individuals from phobias and anxiety triggers, which can have significant, lasting effects. This 'imaginal exposure' approach has been successfully implemented in the treatment of various phobias and mental health disorders (Shottnik & Linden, 2019) which are explored further in this chapter.

Let's take a closer look at the underlying framework and theories of the relationship between mental imagery and emotional regulation, to gain a deeper understanding of why your therapist has asked you to close your eyes and imagine.

Focus questions:
 * What is the relationship between mental imagery and emotion?
 * How can mental imagery be applied to regulate emotion?
 * When can mental imagery be applied to regulate emotion?

The different types of emotions
Emotion has been defined as a "sudden, transient agitation caused by an acute experience of the core emotions: fear, surprise, joy, anger, interest, sadness, and disgust," or mental feelings of affection, pain, desire, hope, etc. (see Figure 3), distinct from cognitions or volitions (Cabanac, 2002). These emotions all have one thing in common: they are aroused by exposure of the subject to situations more or less related to motivation, and are either positively or negatively influenced (Cabanac, 2002). Furthermore, these emotions result in behaviour oriented toward or away from the stimulus that has caused the arousal (Cabanac, 2002). This poses the question: do all emotions follow the same pattern?

The basic postulate is that emotion is a disruption or disorganisation of the total individual and not an integrated process (Cabanac, 2002). In contrast, emotion is now viewed as an integrative response that serves various daily functions and aids survival by the initiation of fight or flight responses. This perspective underscores its biological function primarily as a mechanism for maintaining homeostasis (Cabanac, 2002), as discussed further later on. It has been proposed that there are five basic emotions: happiness, sadness, anger, fear, and disgust (Cabanac, 2002). These emotions usually occur with the achievement of sub-goals, frustration associated with a goal, plan or another person, loss of a goal, conflict of goals (including conflict with self-preservation), and the perception that something is noxious or toxic (Cabanac, 2002).

Conversely, a multi-dimensional model has been used to describe emotion, suggesting that emotions may result from the specific interaction of two components:
 * 1) non-specific arousal caused by the activation of the sympathetic nervous system, and
 * 2) a perception resulting from one's attribution of the cause of the arousal to the stimulus that had provoked the emotion in response (Cabanac, 2002).

What is mental imagery?
Mental imagery refers to the process of creating representations and experiencing sensory information in the absence of direct external stimuli (Pearson et al., 2015). These mental representations are often retrieved from memory and can lead individuals to re-experience something resembling the original stimulus or even conjure novel combinations of sensory inputs that may align with their goals, desires, and fantasies (Pearson et al., 2015). It is important to note that not all instances of mental imagery are voluntary. External events or internal associations can also trigger mental images, even when individuals do not wish to experience them, which can be particularly relevant in cases involving traumatic experiences (Pearson et al., 2015). Research has demonstrated that, in terms of evoking emotions, mental imagery surpasses the emotional impact of simply describing events and experiences in words (Pearson et al., 2015).

When compared to verbal descriptions of the same content, mental imagery tends to elicit stronger emotional responses (Pearson et al., 2015). Many individuals report that their mental imagery "feels real", despite their conscious awareness that these images are not based in reality and can profoundly influence their behaviour and their perception of specific experiences (Pearson et al., 2015). Moreover, it's worth emphasising that mental imagery plays a pivotal role in various mental and neurological disorders and their corresponding treatments, for instance, post-traumatic stress disorder (PTSD), which involve the unwanted recurrence of traumatic memories and nightmares, serving as prominent examples where clinically relevant mental imagery is a key factor (Pearson et al., 2015).

Participants aged 18 and older, diagnosed with bipolar disorder and presenting with at least mild symptoms of anxiety, were randomly assigned to receive Imagery-Based Emotion Regulation (IBER) in addition to treatment as usual (TAU), or TAU alone (Steel et al., 2023). IBER was administered over a period of up to 12 sessions across 16 weeks (Steel et al., 2023). Furthermore, the researchers examined the treatment's impact on participant outcomes, including anxiety, depression, mania, and mood stability, at both the 16-week and 32-week follow-up assessments (Steel et al., 2023).

The study identified that intrusive mental imagery is associated with anxiety and mood instability within bipolar disorder, thereby representing a novel treatment target (Steel et al., 2023). IBER is a concise, structured psychological intervention designed to empower individuals to employ the necessary skills for regulating the emotional impact of these intrusive images (Steel et al., 2023).

The study's outcomes indicated that imagery-focused interventions for bipolar disorder and other mental health conditions warrant further investigation (Steel et al., 2023).

The physiology process
The neural mechanisms of mental imagery within psychotherapy have been extensively investigated using functional imaging methods over the years. It is proposed that, during mental imagery, the sensory aspects of a mental image play a fundamental role in eliciting emotions (Skottnik & Linden, 2019). Even when the semantic content is matched across modalities, mental imagery consistently generates stronger emotional responses and unlike visual perception, mental imagery does not rely on external visual stimuli; instead, it constitutes a purely mental operation (Skottnik & Linden, 2019).

Furthermore, emotional experiences have been identified to be highly associated with activation in brain areas that extend beyond those directly involved in core affect (Skottnik & Linden, 2019). Across emotional categories, researchers have observed activation in prefrontal areas associated with higher-order cognitive processes (Skottnik & Linden, 2019). In contrast, brain activation related to emotions has been detected throughout the entire visual cortex (see Figure 4), suggesting that higher-level visual areas reliably activate even in the absence of visual stimulation (Greening et al., 2022). This underscores their broader function in relation to emotions.

Importantly, studies have shown that mental imagery is equally effective as other common mood induction procedures in eliciting emotional states which highlights the capacity of mental imagery to effectively modulate the emotional system (Greening et al., 2022).

Cognitive reappraisal theory
Cognitive reappraisal theory is considered one of the most effective emotion regulation strategies. It involves altering how one thinks or appraises a given situation (Denson & Tan, 2023). Instead of getting immersed in negative feelings and thoughts, this theory encourages individuals to take a step back and perceive a provoking event objectively. Cognitive reappraisal involves achieving an objective perspective by mentally picturing the provoking event from a third-person viewpoint and considering any positive aspects or lessons that can be learned from the event, for example, someone who is prone to anger may often interpret ambiguous situations in a hostile way (Denson & Tan, 2023). According to this theory, individuals can engage in reappraisal by trying not to take provocations personally and considering alternative interpretations (Denson & Tan, 2023). This strategy can serve as a way to manage recurring emotions associated with past experiences and is most effective when used before the onset of intense emotions (Denson & Tan, 2023). The theory emphasises that if this strategy is employed promptly, it may completely prevent the emergence of strong negative emotions or, at the very least, reduce the duration and intensity of the emotional experience (Denson & Tan, 2023). Cognitive reappraisal can be learned, but it is also considered a dispositional ability.

Empirical research has shown that reappraisal is more effective in reducing anger compared to rumination (Wang & Yin, 2023). Engaging in reappraisal before encountering a provocation can significantly alter the course of the emotion (Wang & Yin, 2023). Research on the relationship between cognitive appraisals and emotions presents two prevailing views. The first view suggests that cognitive appraisals cause emotions, meaning the way we interpret an eliciting event determines how our emotions respond to it, therefore, mental imagery can change interpretations of the same eliciting event, potentially leading to different emotional responses (Yarwood, 2022). The second view posits that emotions cause appraisals. According to this perspective, cognitive appraisals occur after emotions are experienced, resulting in changes in psychological and behavioural elements, for example, upon hearing a gunshot, one might automatically experience fear, followed by cognitive appraisals of unexpectedness and the ability to cope (Yarwood, 2022). Alternatively, an individual might feel anger without immediately understanding why, prompting them to search for the reasons behind their emotions. This then poses the idea that cognitive appraisals and mental imagery can be powerful tools for eliciting positive emotions in response to negative emotions tied to an event and gaining a better understanding of why one feels a certain way after an event (Yarwood, 2022).

Depictive theory and biased-competitive theory
The depictive and biased-competitive theories have been integrated to provide a framework that describes the relationship between mental imagery and emotion regulation. Relative complexity evidence obtained from tasks like mental rotations and image scanning formed the basis for a prominent theory of mental imagery, known as the depictive theory. This theory is founded on the idea that mental images are not merely internal representations describing visuospatial information (Denson & Tan, 2023). Instead, they depict this information because the format of an image is quasi-pictorial. This suggests that while a mental image is not claimed to be a literal picture in the head, it nevertheless represents content through resemblance and retrieves information from memory (Greening et al., 2022).

According to the depictive theory, mental imagery involves the top-down production of neural representations of memory, similar to those produced by perception, and is associated with a conscious experience of 'seeing in the mind's eye' (Greening et al., 2022). This theory emphasises that emotion regulation involves effortful control or attention to modulate emotional reactivity, including both down-regulation (reducing a negative response, making it less negative) and up-regulation (enhancing a negative response, making it more negative) (Greening et al., 2022)).

In line with the biased-competitive theory, when two stimuli compete for representation within a given brain region, they do so in a mutually inhibitory manner and the stimulus that becomes prioritised is the one biased, either by stimulus properties or by top-down attention control processes (Greening et al., 2022). Extending this framework to emotion regulation, when emotional stimuli are regulated using distraction or reappraisal, the individual begins to prioritise a representation that competes with the representation of the external emotion elicitor (Greening et al., 2022).

Combining the depictive theory with the biased-competitive theory suggests, therefore, that mental imagery could facilitate emotion regulation by activating internally generated representations that compete with external, stimulus-driven representations and experiences. This process would inhibit the downstream processing of the external emotion elicitor in emotion sensitivity regions, such as those within the fear network (Wang & Yin, 2023).

Schema therapy
The term "schema" is derived from the theory of information processing, which suggests that information is sorted in human memory by themes (Dadomo et al., 2016). The idea is that our experiences are sorted in our autobiographical memory by storing mental diagrams from the early years of life, attributing meaning to them so that experiences are stored at a non-verbal level (Dadomo et al., 2016). Schemas act as filters through which individuals categorise, predict, and interpret the world.

This therapeutic framework relies heavily on the concept of schema modes, which are relatively independent organised patterns of thinking, behaving, and feeling that underlie different states of consciousness. These modes represent the present emotional and cognitive states, and coping responses that are active at any given time and are commonly triggered by emotional events, which allow the individual to shift rapidly between different modes (Schaich et al., 2020). In schema therapy, emotions and emotion regulation are closely linked to the concept of schema modes.

Schema modes are associated with dysregulated emotional states or dysregulatory strategies that therapists address during sessions and are categorised based on the negative or positive emotional states associated with the experience (Schaich et al., 2020). The first macro-category of modes consists of child modes, specifically the vulnerable child mode, which includes three sub-categories: lonely child, abandoned and abused child, and humiliated and inferior child (Dadomo et al., 2016). The second macro-category focuses on maladaptive coping modes, which can also be referred to as coping mechanisms. This category includes three coping sub-categories: dysfunctional coping modes concerning avoidance strategies, overcompensation, and surrender strategies (Dadomo et al., 2016). The third macro-category concerns the dysfunctional parent which consists of the punitive parent and the demanding parent, and are usually derived from parents or other attachment figures. The last macro-category encompasses healthy adult and happy child modes (Dadomo et al., 2016).

Schema therapy has an overarching strategy and stages to regulate emotions. Refer to figure 5 for a description of the different stages.



These exercises alter the traumatic experiences and develop new meaning through the therapist's support in the mental imagery. During imagery re-scripting, negative emotions are transformed by meeting the individuals unmet needs, leading to two significant effects on the client (Schaich et al., 2020). Firstly, the individual realises that they deserve recognition and protection, and secondly, the healing experience offers a different perspective on the traumatic situation, providing new possibilities to handle similar situations in a safe manner (Dadomo et al., 2016). As a result of the structural changes incorporated into schema therapy, the initial emotional dysregulation due to pathological modes allows for alteration of emotions and emotional regulation (Dadomo et al., 2016). The features of the therapy are able to offer full recovery and assists the clients through managing negative emotions and making life-changing alterations.

Cognitive bias modification
In the field of clinical psychology research, it has been recognised that mental imagery is a powerful driver of emotion. Emotional disorders, including PTSD, social anxiety, and depression, are characterised by syndrome-specific abnormalities in mental imagery content. Treatment interventions aimed at reducing distressing mental imagery are increasingly being developed in clinical practice. Approaches within cognitive bias modification therapy (CBM), such as real or imaginal exposure and imagery re-scripting, have been used to target intrusive images of trauma (flashbacks) in PTSD, reduce the influence of negative mental imagery in depression, and modify negative images of the self in social anxiety (Burnett, Lau & Holmes, 2013). It has been observed that in major depression with depressed mood, generating mental imagery of a positive event can increase positive interpretations of ambiguous stimuli, reduce depressed mood, and enhance performance on behavioural-centred tasks (Burnett, Lau & Holmes, 2013).

Negative interpretation bias is the tendency to interpret ambiguous stimuli negatively and is thought to play a causal role in vulnerability to emotional disorders (Yang et al., 2017). CBM aims to train a bias to automatically imagine positive resolutions for novel uncertain situations encountered in daily life. Additionally, depressed individuals often struggle to imagine positive future events and tend to interpret unexpected information negatively, known as a negative interpretation bias (Yang et al., 2017). In the case of depressed clients, the focus of CBM is to strengthen positive mental imagery through repeated positive imagery generation and consistent positive resolutions of the negative emotions associated to the event (Yang et al., 2017).

CBM consists of two domains: attention bias modification and interpretation bias assessment. Attention bias modification involves the presentation of a central fixation cross followed by the brief appearance of a threat and non-threat cue, manipulating attention away from negative information to reduce this bias (Martinelli, Grill & Baum, 2022). Stimuli such as a face with an angry expression and a face with a neutral expression can be used to achieve this alteration. Conversely, interpretation bias assessment involves cognitive tasks that disambiguate otherwise unfavourable sentences, images, or paragraphs as either positively or negatively valanced (Martinelli, Grill & Baum, 2022). Among the proposed cognitive biases, attention and interpretation biases have been most comprehensively targeted in CBM paradigm development. These paradigms investigate the modifiability of cognitive biases with the primary goal of exploring potential causal relationships between cognitive biases and psychological health elements (Martinelli, Grill & Baum, 2022). Furthermore, they operate through contingencies between training stimuli, where successful task completion is facilitated by processing stimuli in a manner opposite to and mutually exclusive of the assumed adverse processing style (Martinelli, Grill & Baum, 2022). Considering that CBM is mostly computerised, this strategy has the potential to efficiently reach many individuals and is increasingly implemented in clinical interventions.

During phase two of schema therapy, the individual doesn't experience a down regulation of negative emotions. - True + False
 * type=""}

{What are the two domains of CBM? - Dysfunctional parent and happy adult + Interpretation and attention
 * type=""}

Is mental imagery beneficial for emotion regulation?
Models of mental illness commonly identify mental imagery as a key strategy for the reduction of negative emotion, through the sensory simulation of non-current events which is hypothesised to drive affective reactions to thoughts about non-current events (Wicken, Keogh & Pearson, 2021). This suggests that mental imagery is a proposed 'emotional amplifier' of mental content. One suggested function of mental imagery is to make thoughts more emotionally evocative through sensory simulation, which can be helpful both in planning for future events, remembering the past, and managing the emotions which are associated with certain events (Wicken, Keogh & Pearson, 2021). Additionally, it is a hindrance when thoughts become overwhelming and maladaptive, such as anxiety and depressive disorders (Wicken, Keogh & Pearson, 2021). Further, various research supports the hypothesis that, compared with verbal processing of experiences and events, mental imagery elicits stronger emotion and has been effective in reducing the effects of negative emotions and train individuals to emerge and maintain positive emotions long term (Wicken, Keogh & Pearson, 2021).

Conclusion
This book chapter delves deeply into the various applications of mental imagery in regulating emotions. It explores specific theories and concepts to enhance our understanding of this vital connection and emerges as a potent tool for emotion regulation and maintaining psychological well-being. Its impact can vary from person to person, often evoking strong emotions that can help transform distressing feelings associated with ambiguous or traumatic experiences.

The interaction between mental imagery and emotions becomes evident in cognitive reappraisal theory, which proposes that altering our perception of situations can influence our emotional responses. Therefore, strengthening the ability to mentally envision positive outcomes and events can trigger positive emotions and provide insights into emotional reactions. Furthermore, the integration of the depictive and biased-competitive theories offers an effective framework for comprehending how mental imagery can be applied clinically to help individuals shift their perceptions and regulate their emotions.

Future research into the positive effects of mental imagery on emotion regulation would greatly enhance our understanding of this relationship and its practical clinical applications. Mental imagery stands as a pivotal element in emotion regulation and mental health, and a deeper grasp of its mechanisms can contribute to universal emotional well-being and psychological health.