Revisualizing the Role of Imagery in Mental Healthcare

Visualization is often used in mental wellness and therapy, but what does this mean for those with aphantasia?
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imagery in mental healthcare

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“Imagine you are walking toward an ocean – feel the sun on your skin, the ocean spray on your face – listen to the rolling waves….”

This kind of visualization is a popular relaxation technique. Can you feel yourself becoming relaxed? Can you transport yourself to that place in your mind?

About 4% of the population can’t – they have aphantasia, which is the inability to generate sensory mental imagery. Even for people who can create images in their mind’s eye, how vivid and effortful it is can vary.

Imagery in Mental Healthcare: A Go-To Tool for Practitioners

There is plenty of research that supports imagery as a powerful wellness and relaxation technique, and it is a core part of many talk therapies like cognitive behavioral therapy. “Visualize your goal” and “imagine how this scene plays out” are popular exercises that can support people shape their thoughts and motivations into something positive and constructive. But what does this mean for the significant number of people with aphantasia for whom voluntary visualization is not an option? 

Growing awareness of the importance of our mental health and well-being means that there is more focus on talking about issues and seeking help, but there has actually never been any documented research on the role of mental imagery differences in mental healthcare experiences. Now, in collaboration with the largest organization dedicated to aphantasia awareness, the Aphantasia Network, researchers with expertise in mental health and mental imagery are making it their job to find out.

Challenges People With Aphantasia May Experience When Seeking Mental Healthcare

Aphantasia is not, in itself, a disorder – most people go their whole lives not knowing they have it. Aphantasia is one end of a mental imagery spectrum, and most individuals develop effective alternative strategies for even the trickiest cognitive tasks – such as mental rotation and holding many items in mind simultaneously. But what might be the outcome if no alternative is provided? This could mean that those with different mental imagery abilities may respond less to treatment, feel like it’s not for them, or conclude that they can’t be helped.

Research also suggests that people with aphantasia may not experience mental health issues in the most expected way. For example, they may be less susceptible to intrusive images such as flashbacks in post-traumatic stress disorder (PTSD) or negative mental body images in eating disorders. Because intrusive images are considered a key symptom of various conditions, people with aphantasia may face challenges in receiving a prompt and accurate diagnosis. There is already the idea that if people with aphantasia don’t get these symptoms, they are somehow resistant to these mental health conditions altogether. The reality is they may just experience the conditions differently. 

Mental healthcare should be accessible for everyone, regardless of individual ability to visualize. Therefore, a good personalized therapy should be adaptable to focus on techniques that do not rely on visualization. Nevertheless, imagery differences are currently not a core part of practitioner training for most therapies, so practitioners are not necessarily aware that these differences exist. If there are barriers that therapists and practitioners don’t even know about, it may impact the therapeutic relationship for which trust and understanding are so important. 

3 Essential Next Steps in Improving Personalized Mental Healthcare for Those With Aphantasia

Because subjective, internal experiences are such a huge factor in mental health, it is critical to understand how individual differences in mental imagery affect assessment, diagnosis, and treatment outcomes. Moving forward, we have three goals we hope to achieve with this work:

  1. First, to increase public awareness of mental imagery differences, including understanding when it may impact quality of life. 
  2. Second, to increase awareness of mental imagery differences amongst mental health professionals so that they are mindful of how they frame their questions and exercises. For example, scripts or language choices can be adapted to better fit the individual, such as changing visualization-specific phrases to be more inclusive. Dr Paulina Trevena, a practising hypnotherapist with aphantasia, suggests, “imagine any way you like”.
  3. Third, to improve our scientific understanding of the role of mental imagery in mental healthcare and inspire the development of new techniques and practices in personalized medicine.

Have you ever sought mental healthcare and would like to share your experience? Regardless of your level of mental imagery, you can contribute to this important research. We invite you to take part in a research study exploring the role of imagery in mental healthcare.

Monzel, M., Vetterlein, A., & Reuter, M. (2022). No general pathological significance of aphantasia: An evaluation based on criteria for mental disorders. Scandinavian Journal of Psychology. doi:10.1111/sjop.12887
Pounder, Z., Jacob, J., Evans, S., Loveday, C., Eardley, A. F., & Silvanto, J. (2022). Only minimal differences between individuals with congenital aphantasia and those with typical imagery on neuropsychological tasks that involve imagery. Cortex; a Journal Devoted to the Study of the Nervous System and Behavior, 148, 180–192. doi:10.1016/j.cortex.2021.12.010
Dance, C. J., Ipser, A., & Simner, J. (2022). The prevalence of aphantasia (imagery weakness) in the general population. Consciousness and Cognition, 97(103243), 103243. doi:10.1016/j.concog.2021.103243
Dawes, A. J., Keogh, R., Andrillon, T., & Pearson, J. (2020). A cognitive profile of multi-sensory imagery, memory and dreaming in aphantasia. Scientific Reports, 10(1), 10022. doi:10.1038/s41598-020-65705-7
Zeman, A., Dewar, M., & Della Sala, S. (2015). Lives without imagery - Congenital aphantasia. Cortex; a Journal Devoted to the Study of the Nervous System and Behavior, 73, 378–380. doi:10.1016/j.cortex.2015.05.019
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As a PhD Psychologist, and it seems about 95% aphantasic, I had a huge advantage in working with patients over my 25 years of clinical practice. It took me about 10 years to get fully beyond the theoretical approaches I had learned: client-centered therapy, behavior therapy, cognitive behavior therapy, family therapy, and some gestalt therapy. With those as “ground” rather than “figure” I learned to fully connect to the patient’s present experience and allow myself to be led to what would work for that person, in the here-and-now. I was not distracted by the “details” of what I knew: that was the secret sauce. Most often my patients who had been in therapy previously (about half) would remark: “Hank, talking to you is like talking to a regular person!” I would joke “well?” as I smiled, they would say “Oh, you know that I mean!” and then we would have a good laugh — and go on. The proof was in the pudding. The average number of visits decreased by 15 to 30 at the start of my career to 4 to 6 visits. They, not I, determined whether they now saw themselves as being “past” the matters that brought them in. In a very real sense, I took the “heart” of each approach. That would have been much more difficult, I am thinking, if I had not been aphantasic.