Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications

Abstract

Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.

Seeing light at the end of the tunnel: Positive prospective mental imagery and optimism in depression

“…Szpunar and Schacter, 2013), and it could be this frequent engagement in positive imagery (rather than vividness per se) that relates to optimism. Thus, the nature of the relationship between positive mental imagery and optimism, and whether training positive mental imagery can lead to sustained beneficial changes in optimism in clinical populations such as depressed individuals remains to be determined (Holmes et al, 2016). …”

“…A neglected area in psychopathology research concerns optimism and the ability to imagine a more positive future - something that may be of particular relevance to depression (Holmes et al, 2016). Most people are staunch “optimists”, expecting good rather than bad things to happen to themselves in the future (Weinstein, 1980).…”

Effects of Engaging in Repeated Mental Imagery of Future Positive Events on Behavioural Activation in Individuals with Major Depressive Disorder

“…While the BA approach is specifically tailored around these difficulties, for example teaching clients to engage in scheduled activities despite their negative feelings and lack of motivation (Martell et al 2010), identifying cognitive processes that can be used to directly address such difficulties could provide an additional and complementary route to increasing behavioural engagement. One such process could be the simulation of potentially rewarding future activities and their outcomes via mental imagery (Holmes et al 2016). …”

“…In the context of depression, mental imagery of potentially rewarding activities may be particularly useful in increasing behavioural activation (Holmes et al 2016). Simulating possible future events or courses of action via mental imagery allows us to “pre-experience” them and their emotional consequences (Moulton and Kosslyn 2009; Schacter et al 2008; Suddendorf and Corballis 2007), from fears (Lang 1979) to pleasures (Kavanagh et al 2005).…”

Treatment of Intrusive Suicidal Imagery Using Eye Movements

“…If the psychological processes underlying both suicidal ideation and the decision to act on suicidal thoughts are understood, it could help develop specific interventions to target suicidal ideation when it first emerges and prevent the transition to a suicide attempt [4]. Imagery represents one form of thought that can be tackled in this context [17].…”