Although many evidence-based practices focus on the cognitive aspects of mental disorders, research suggests that there may be a lack of helpful interventions that are not within the cognitive behavioral therapy (CBT) model of for "thoughts" fall, feelings and behaviors. "Some prevailing CBT models do not emphasize mental images by continuing to equate thoughts only with verbal manifestations. This is best shown in the counseling techniques and interventions of soliloquy, thought recordings and the ABC model (activating events, beliefs, consequences).
While these techniques should be praised for alleviating the symptoms of countless clients, there are other clients who are not served by these treatments. We suggest that a lack of focus on images can either lengthen the course of treatment for clients at best or, at worst, encourage clinicians to label clients as "resistant" because their images isolate negative affective responses.
Most clinicians in this area tend to neglect mental images, although research shows that mood disorders and the development of certain forms of psychopathology often correlate with negative images that contribute to the strength and production of negative emotions. It has been difficult to research and measure mental images in the past, but we now have evidence that mood disorders and psychopathology can be addressed through image work. As professional consultants, our job is to promote a holistic approach by not only addressing the symptoms of our clients, but also focusing primarily on preventing these symptoms.
Mental images can be defined as a representation and experience of sensory inputs without direct stimulus. Various theories for creating mental images have been proposed, but bio-information theory is the one we will discuss. In this theory there is a strong connection between image and emotion. This connection is attributed to physical and behavioral responses to images. For example, negative images often produce more negative emotional responses compared to neutral images alone (e.g., the idea that you are stuttering when you make a future speech in public increases your fear of future speech performance).
What does neuroscience say?
From a neuroscientific perspective, mental images are consistently involved in the spread of certain emotion regulation patterns. Research shows that this can occur because there are overlaps between different areas of the brain, depending on the type of image being perceived. There seems to be brain activity that overlaps between the frontal (cognitive function and voluntary movement / activity) and parietal (sensory processing) areas of the brain, regardless of image content, but there is also some overlap between parietal and occipital (visual processing) . Areas of the brain. This indicates a top-down process when retrieving information from long-term memory.
Damage to the occipital lobe can make it difficult for people to produce pictures, especially if they try to remember past memories. Neuroimaging also suggests a correlation between the activation of the visual cortex and the subjective assessment of the vivacity of an image by a person. This could explain why it is easier for someone to remember a memory that has an emotional component (sometimes called a flashbulb memory).
This seems to indicate a relationship between episodic memories (i.e. two people experiencing the same event may have a drastically different memory of that event) and how negative autobiographical memory can affect future behaviors . If I continue to view potential future situations negatively (for example, if I imagine that all future speeches are going badly), it is likely that my present and future match these images. If I can create a positive picture of the future (future speeches go smoothly), I rewrite my current, negative autobiographical memory to be more positive and therefore influence both my past and my future self in the direction of positivity.
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Advantages for customers
Working with mental images in counseling offers several advantages. First, it should be noted that the image work integrates the cognitive, emotional and somatic aspects of a person, with the emotional aspect in the foreground. This is important to take into account, since customers can rationally "know" that something applies to them, but they can "get stuck emotionally" in their previous mismatching behavior. Consultants working with images may be able to bypass the rational "knowledge" and actually address the emotional connections of clients to their images.
Second, images are often taught as a skill or to strengthen other skills. Since mental images connect different aspects of the brain, it has been shown that images increase imagination and memory. In addition, teaching images as a skill can help clients realize their power over their own images.
For example, we both used a simple image of a cupcake with a raspberry on top at customers. We ask customers to look at the picture of the cupcake and then close their eyes (if it is comfortable) and to imagine the cupcake in every detail. Then we ask them to change the cupcake in the picture they imagine, to remove the raspberry and to replace it with a blueberry. By being able to manipulate the cupcake image in this way, customers can practice changing more negative images that create negative emotions for them. For example, customers can imagine giving an eloquent speech without stuttering. Or a speech in which they stutter, but can remain calm and relaxed, no matter how well they speak. There are many different ways to convey mental image skills to support customers who do not fall within the scope of this article.
Third, in addition to mental disorders, there are several special areas that seem to benefit from the use of image work. For example, images can help customers tackle current problems by examining all sides of the problem in vivo and visualizing results and other alternatives. In this way, customers can not only effectively solve problems, but also get to the heart of emotional components that are often associated with their decisions. Mental images encourage clients to consider the temporal nature of situations by helping to reconstruct future beliefs about identity, which in turn increases goal setting and motivation. Linking images to a plan or displaying goals with images can increase confidence and belief that you can achieve them.
When images are applied to grief work, they can help clients process their grief reactions by re-viewing scenes associated with past loss. In addition, positive images can be promoted in order to provide customers with impulses for non-suicidal self-injuries or even to improve the results of sports training. Interestingly, mental images have also been included in the healing of sports injuries by reducing subjective pain responses.
Image and Emotion Regulation
Psychic images also play a crucial role in a number of mental disorders. For example, intrusive images are considered part of the diagnostic criteria for certain disorders, such as post-traumatic stress disorder (PTSD), and are often suggested in criteria that discuss “thought processes” related to anxiety, bipolar disorder, and obsessive-compulsive disorder. As a rule, these stressful images correspond to the core concerns of the present topic and serve to isolate the stressful emotions by working together with other symptoms. Examples include clients who have obsessive thoughts about insects who experience images of insects on their bodies, clients with test anxiety who have future-oriented images of themselves that fail a test, and military veterans with PTSD who are out of active service Return home and relive traumatic memories while doing fireworks.
The clinical importance of understanding mental images in the treatment of clients with emotional dysregulation is of paramount importance. Recent research supports the idea that images can create stronger emotions than verbal content and can even have a reinforcing effect. For example, if an image promotes fear-raising content, it can increase a person's fear. It can also reinforce positive messages, for example if one imagines positive results through image testing for an upcoming public speech.
Given that the "reality" of images (or lack of image production) can affect a person's belief in these images, it is essential for consultants to understand the content of customer images in order to better provide intervention strategies . The client's perception of the "reality" of their images seems to increase the power of the content and to influence not only emotions and behaviors, but also beliefs. 
A strategic clinical intervention
There are various ways to promote images as a clinical intervention. The following five specific strategies are summarized based on how they can be used in the session. Although these interventions are different, they also overlap at times.
1) Competition for images: When planning counseling measures, it may be advisable to follow the saying "fight fire with fire" in order to promote the greatest reduction in symptoms in the shortest possible time. In this case, "competing" with tasks that use similar cognitive resources can help reduce the stressful vivacity of the images. This is due to the "overload" of the brain. The competitive strategy differs from distraction coping techniques in that the images are processed simultaneously.
This strategy is often one of the first steps in the systematic desensitization of phobias, since the combination of mental images with relaxation often has a therapeutic effect in order to reduce the burden on this phobia. This is because a client cannot physiologically feel anxious and calm at the same time. It is also suspected that this is why desensitization and reprocessing of eye movements work – the use of bilateral stimulation by the clinician while the client's image is exposed overloads the brain and reprocesses the image.
2) Exposure to images: One of the most common and proven techniques is to expose customers to intrusive or stressful images. The reason why exposure works is because it targets images that cause increased emotional dysregulation so customers can self-regulate over time. Eventually the client will see a picture and will not have a negative emotional response to it. The exposure therapy also shows documented evidence of a reduction in the client's exposure to the images during the therapy protocol.
3) Retraining images: Retraining or "rewriting" images is intended to train customers in generating positive images in response to neutral environmental conditions or in converting a stressful image into a more neutral form. This is particularly helpful for depression, as a lack of positive future images seems to isolate the symptoms of depression. With both methods – generating positive images or adapting a more neutral form – the critical process seems to promote alternatives to the customer's current image or its lack.
In a sense, producing positive images is relatively new. The advisor would like to promote the production of positive images in response to ambiguous cues to help clients in turn produce more positive images for novel stimuli. One aspect of computer-based training known as cognitive bias modification is an example of this strategy. Research suggests that this strategy alleviates depression symptoms in clients by promoting positive images about the future.
4) Questions about images: While the "reality" of mental images seems to predict the quality and impact of the images, another strategy for addressing images is to examine the mental representations yourself. This is similar to CBT's verbal thought work. With the advent of third-wave mindfulness and behavioral therapies such as acceptance and attachment therapy, consultants could take a metacognitive approach to their intervention strategy for images. The aim of this type of picture is to question the “truth” of the reported picture and to promote the functionality of the customer. A client would be encouraged to go back to the picture and address his truth (i.e. did everyone really laugh at me during my speech? Did I really stutter all the time?). If the customer now realistically remembers the picture, he can remember the picture as it actually occurred.
5) Transformation images: In this work, customers are asked to create an image and to modify, adapt or manipulate it (rotating in space) in order to promote autonomy over the image and to reduce the occurrence of stressful images. The ability to control the image allows customers to create a safe place for themselves in a stressful image, transform the image into something else (e.g., turn a snake into a balloon), or otherwise manipulate the image (like we did it with the cupcake mentioned earlier in the article). This is similar to questioning images, but also encourages the customer to empower them to control the image themselves. Guided images as a technique are an example of this strategy in which images are transformed as a result of the intervention.
Steps to Integrate Images into Clinical Work
When dealing with mental images in counseling, advisors should weigh up the advantages and risks of integrating the tool into sessions. As professional consultants, it is imperative that we conduct thorough reviews to determine if clients are stable enough to target their images. If not, it may be appropriate to first provide them with some coping tools and techniques to increase security. Second, customers need to be able to produce images for image work to be effective. This is also an important assessment.
An easy way to do this is to ask customers to imagine an important family member or friend who is generating positive feelings in them. Then invite customers to tell you what that person looks like from head to toe. If customers don't have someone who meets these criteria, find an image of an object, ask customers to display the image for a minute, then speak to them for a few minutes, then return to the image and ask them to do so Draw picture picture in their heads and tell you what they see. If customers cannot return the image, they may not be suitable for image work and need further investigation.
As with any intervention that we use, we must give our customers an appropriate consent and discuss the potential advantages and disadvantages of image work. Customers need to be informed that images can create intense emotions, but some information about why this can help reduce their fear of the process. In addition, the therapeutic relationship is still of paramount importance; Clients need to trust the relationship to get the most benefit from therapy. Consultants may want to get additional training to deal with customer images. This can help consultants feel better prepared to deal with mental images and work with clients from different backgrounds.
Conclusion
We hope that all consultants have access to interventions that help their clients get better. As all on-site consultants know, some interventions work seamlessly with certain clients and not with others. The more competent we are with the interventions with which we have to address customer concerns, the more we can do great work. We believe that mental images are an intervention that professional consultants can include in their toolbox to improve the quality of customer care.
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Katie Gamby is a licensed professional advisor and assistant professor at Malone University in Ohio. Her research and writing interests include client wellness, mental images, schema therapy, and spiritual handling. She enjoys serving the state of Ohio through several professional associations. Contact them at [email protected].
Michael Desposito is a licensed professional advisor in a private practice in Ohio and president of a government advisory department in Ohio. He has presented a range of topics at national, state, and local conferences, including emotion regulation and mood disorders, positive therapy and pedagogy practices for LGBTGEQIAP + populations, and wellness. Contact him at [email protected].
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