Mental imagery as an emotional amplifier: Application to bipolar disorder

DOI: 10.1016/j.brat.2008.09.005

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Holmes, E. A., Geddes, J. R., Colom, F., & Goodwin, G. M. (2008). Mental imagery as an emotional amplifier: application to bipolar disorder. Behaviour Research and Therapy, 46(12), 1251–1258. doi:10.1016/j.brat.2008.09.005

Abstract

Cognitions in the form of mental images have a more powerful impact on emotion than their verbal counterparts. This review synthesizes the cognitive science of imagery and emotion with transdiagnostic clinical research, yielding novel predictions for the basis of emotional volatility in bipolar disorder. Anxiety is extremely common in patients with bipolar disorder and is associated with increased dysfunction and suicidality, yet it is poorly understood and rarely treated. Mental imagery is a neglected aspect of bipolar anxiety although in anxiety disorders such as posttraumatic stress disorder and social phobia focusing on imagery has been crucial for the development of cognitive behavior therapy (CBT). In this review we present a cognitive model of imagery and emotion applied to bipolar disorder. Within this model mental imagery amplifies emotion, drawing on Clark's cyclical panic model [(1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470]. We (1) emphasise imagery's amplification of anxiety (cycle one); (2) suggest that imagery amplifies the defining (hypo-) mania of bipolar disorder (cycle two), whereby the overly positive misinterpretation of triggers leads to mood elevation (escalated by imagery), increasing associated beliefs, goals, and action likelihood (all strengthened by imagery). Imagery suggests a unifying explanation for key unexplained features of bipolar disorder: ubiquitous anxiety, mood instability and creativity. Introducing imagery has novel implications for bipolar treatment innovation - an area where CBT improvements are much-needed.

Authors

Emily A. Holmes5
John R. Geddes1
Francesc Colom1
Guy M. Goodwin1

What This Study Is About

This research explores how mental imagery—the ability to "see with the mind's eye"—acts as a powerful emotional amplifier for people with bipolar disorder. The researchers propose that vivid mental pictures may drive the intense mood swings and high levels of anxiety often seen in this condition.

How They Studied It

This paper is a theoretical review that synthesizes existing brain science and clinical research. The authors analyzed how mental imagery (internal sensory experiences) differs from verbal thought (the "inner voice"). They looked at data from previous studies involving:

People with bipolar disorder and their experiences with anxiety and creativity.

Participants with other conditions like PTSD and social phobia.

Brain scan research showing that imagining a face activates the same brain regions as actually seeing one.

What They Found

The researchers found that mental imagery has a much stronger impact on emotion than verbal thoughts. They developed a "vicious cycle" model to explain bipolar symptoms:

Anxiety Amplification: When a person has a scary thought, an accompanying mental image (like a "flash-forward" to a future disaster) makes the fear feel more real and immediate, leading to increased avoidance.

Mood Elevation: During mania or hypomania, positive imagery (like picturing a grand success) can escalate excitement and impulsive behavior more than just thinking about the goal in words.

Creativity Link: The same high "imagery susceptibility" that fuels emotional volatility may also explain the high levels of creativity often associated with bipolar disorder, as imagery allows for novel combinations of ideas.

What This Might Mean

This suggests that traditional "talk therapy" (CBT), which often focuses on changing verbal thoughts, might be missing a key piece of the puzzle for bipolar disorder. If imagery is the "language of emotion," treatments may need to specifically target these internal pictures to help stabilize moods. While this model is based on strong existing evidence, the authors note that more direct experimental studies are needed to prove that people with bipolar disorder are naturally more prone to vivid imagery.

One Interesting Detail

The study notes that while people often experience "flashbacks" to past trauma, those with bipolar disorder may experience "flash-forwards"—vivid, intrusive mental images of future events, such as picturing their own suicide, which can dangerously increase the likelihood of impulsive action.

Mental imagery as an emotional amplifier: Application to bipolar disorder

Abstract

Authors

Mental imagery as an emotional amplifier: Application to bipolar disorder

Abstract

Authors

Mental imagery as an emotional amplifier: Application to bipolar disorder

Abstract

Authors

Mental imagery as an emotional amplifier: Application to bipolar disorder

Abstract

Authors

What This Study Is About

How They Studied It

What They Found

What This Might Mean

One Interesting Detail

What This Study Is About

How They Studied It

What They Found

What This Might Mean

One Interesting Detail

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