In our latest video, “Rethinking Anxiety Treatment for Diverse Minds,” we explore groundbreaking research on how people with aphantasia—a condition where individuals cannot voluntarily generate mental imagery—respond to traditional imagery-based therapeutic techniques for anxiety.
Hosted by Tom Ebeyer, founder of the Aphantasia Network, this episode features Dr. Merlin Monzel from the University of Bonn, whose research examines whether imaginal exposure therapy, a common technique for treating anxiety and phobias, can be effective for the estimated 4 percent of the population who cannot generate mental pictures.
Imaginal Exposure Therapy: Effectiveness Without Mental Imagery
Dr. Monzel’s research addresses a critical question in mental health treatment: Is mental imagery actually necessary for imaginal exposure therapy to work? His team investigated this using a procedure called “imaginal extinction,” an experimental analog of imaginal exposure.
In this study, participants from three groups—those with aphantasia, a control group of typical visualizers, and a “simulated aphantasia” group (visualizers who looked at bright light to temporarily disrupt visualization)—underwent a three-phase experiment:
- Acquisition phase: Participants were conditioned to associate a neutral object (like a Christmas bauble) with an electric shock, establishing a fear response.
- Imaginal extinction phase: Participants were asked to imagine the object without the accompanying shock.
- Reinstatement phase: The fear memory was briefly reinstated before testing whether extinction had occurred.
Throughout all phases, researchers measured both physiological fear responses (skin conductance) and subjective reports of fear.
Surprising Findings
The research revealed several important findings:
- Imaginal extinction worked equally well for all groups, including those with aphantasia, suggesting mental imagery is not necessary for this therapeutic technique.
- Aphantasics reported less subjective fear than controls, despite showing similar physiological fear responses, indicating that non-imagery-based exposure might be less distressing than imagery-based techniques.
Alexithymia Connection
An intriguing finding in Dr. Monzel’s research relates to alexithymia—a condition characterized by difficulty identifying and describing one’s own emotions. The data showed a decoupling between physiological arousal and subjective emotional experience in aphantasics, similar to what is often observed in people with alexithymia.
Dr. Monzel noted that multiple studies have found a significant overlap between aphantasia and alexithymia, suggesting that aphantasics may process emotional information differently. Recent unpublished research even suggests that people with very low (but not absent) mental imagery abilities might experience more difficulties with emotional awareness than those with complete aphantasia, leading to the provocative hypothesis that “weak imagery is worse than having none.”
Clinical Applications and Language Modification
For mental health professionals working with aphantasics, Dr. Monzel’s research suggests that imaginal exposure therapy can still be effective with simple language modifications. Instead of asking clients to “imagine” scenarios, therapists can use alternative terms such as:
- “Describe playing with a dog in as much detail as possible”
- “Think about playing with a dog”
- “Write down a story with a dog in as much detail as possible”
These minor adjustments in language can make imagery-based therapeutic techniques more accessible to aphantasics while maintaining their effectiveness.
Research Limitations and Future Directions
Dr. Monzel acknowledged some limitations in the current research, including a shortened memory consolidation period and the need for validation in real clinical practice. However, the study’s strengths include measurements beyond self-report and careful experimental control of fear acquisition.
Future research directions include:
- Testing other imagery-based techniques beyond exposure therapy
- Investigating the strategies aphantasics naturally employ in place of visualization
- Understanding variations within the aphantasic population, particularly between those who struggle with their condition and those who have developed effective compensatory strategies
Beyond Deficits: Potential Advantages
The interview highlighted that aphantasia may offer certain cognitive advantages. Dr. Monzel described the “visual impedance effect,” where excessive visual details can slow problem-solving in typical visualizers. Research has found that people with lower mental imagery abilities are better at extracting relevant information when presented with problems containing unnecessary visual details, suggesting aphantasia might confer some cognitive benefits.
Conclusion
“Rethinking Anxiety Treatment for Diverse Minds” provides compelling evidence that traditional therapeutic approaches can be effectively adapted for people with aphantasia. With appropriate language modifications and awareness of different cognitive styles, mental health professionals can ensure their treatments are inclusive and effective for diverse minds.
For qualified mental health professionals interested in learning more about treating clients with aphantasia, or for individuals with aphantasia seeking knowledgeable therapists, visit aphantasia.com for resources and information.