Fotolit2/Purchased from Deposit Photos
Source: Fotolit2/Purchased from Deposit Photos

Getting "stuck" happens when a person fails at one of the following tasks:

1. Recognizing patterns of destructive thinking, feeling, and acting.

2. After recognizing the pattern, failing to learn and use interventions which defeat the destructive patterns, and facilitate maintenance of the new pattern.

Cognitive therapists often teach patients how their thoughts feed into their emotional states and behavioral responses. In addition, they teach ways to revise thinking and maintain a new approach.

But, perhaps an often overlooked aspect of thoughts is that they aren't limited to cognitive self-statements, which tend to become the emphasis in most therapies.  

Indeed many fear-provoking cognitive patterns contain catastrophic futuristic imagery (imagery in which you see yourself as helpless/powerless in a future scene).

Dr. Aaron Beck emphasized that images, fantasies, memories, and dreams are important means to accessing the cognitive appraisals we're giving to an event.1

As an illustration, a client with anxiety might easily have the following conversation with a therapist who appreciates the role of thoughts and imagination in producing their fear:

Therapist: So, is it accurate to say that you felt afraid?
Client: Yes, I felt afraid, but really the word afraid's an understatement.  I felt extremely scared, nervous, edgy...almost panicked really.
Therapist: That didn't feel good!
Client: No. It didn't!  
Therapist: I know you don't want to feel this way on purpose. But, could I challenge you with a question?
Client: Yes, please! I want to start thinking differently about stuff! 
Therapist: Okay, so just a question: what if you took the position that you sometimes scare yourself by imagining something, including a scary/helpless outcome?
Client: Okay.
Therapist: I know that sounds strange—why would we scare ourselves for Pete's sake—but what if, for the sake of discussion, you just took that position for a moment. Willingly or unwillingly, you're imagining a scary outcome and feeling terrified. Taking that stance...what might you be imagining which scares you?

So, if you accept that you sometimes scare yourself, you can apply this question:  What are YOU imagining that scares you?

A popular acronym in the self-help community that FEAR stands for a Fantasized Experience Appearing Real.  

In fact, recent research on Imagery-Enhanced Cognitive Behavioral Therapy suggests that training people to imagine differently can actually lead to greater compliance, a higher tendency to complete treatment, and greater effect sizes.2

In addition, research suggests that imagining catastrophic outcomes is associated with fear.3

So, applying this research to our popular acronym, if you’re feeling fearful, it might benefit to not only question/revise what you're telling yourself, but to also question/revise what you're fantasizing.

The thoughts and images you hold in your mind provoke emotion, impact your biology, and drive you toward comfortable, habitual (not always helpful) behaviors.

Questions to counter your catastrophic imagery: What am I fantasizing? Is it real? Do I know for a fact that this is what will occur? Were it to occur, what could I do to help myself? Then what? And then what?

  • Simply reminding yourself that your fantasy isn’t a reality can help you cope, problem solve, tolerate temporary discomfort, deal with inconveniences and ask for help.  
  • Also, consider applying these classic cognitive questions to your fantasy: Were this event to happen, is this truly a catastrophe? Realistically, what is the worst thing that can happen? What is the best thing that can happen? What is most likely to happen?

Want to take it a step further? Enhance through fantasizing a positive outcome first and visualizing yourself practicing your coping second.4

  • Fantasizing the positive outcome first can remind you that a positive outcome is a possibility. It might also serve to relax you, lowering your anxiety.
  • Following this with mental rehearsal of yourself coping successfully with the feared circumstance, including the positive emotion which follows successful coping alternatives, can serve to energize and motivate you. 
  • You might also become aware of new coping alternatives as you mentally rehearse.

Gaining traction? Visualization efficacy has been reported in relation to academics, alcoholism, anxiety, athletics, cancer, dating, motivation, mood states, music performance, pain management, parenting, post-operative and post-procedural compliance/healing, phobias, public speaking and more (based on a narrowed search of anxiety and imagery in the ProQuest library database).  

How have you used mental rehearsal and positive imagery to help yourself? Please comment below!

References

1. Hackmann, A., Holmes, E. A., & Bennett-Levy, J. (2011). Oxford Guide to Imagery in Cognitive Therapy. Oxford: OUP Oxford.

2. Mental health; new anxiety disorders study findings have been reported from university of regina (imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: A benchmarking study). (2015, Mar 21). Psychology & Psychiatry JournalRetrieved from https://login.libproxy.edmc.edu/login?url=https://search-proquest-com.libproxy.edmc.edu/docview/1662454729?accountid=34899

3. Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30, 349-362. doi:10.1016/j.cpr.2010.01.001

4. Topping, L. A. (2015). Comparing the effects of mental imagery and fantasy on anxious performers (Order No. 1598659). Available from ProQuest Central; ProQuest Dissertations & Theses Global. (1719288648). Retrieved from https://login.libproxy.edmc.edu/login?url=https://search-proquest-com.libproxy.edmc.edu/docview/1719288648?accountid=34899

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