Creating Silver Linings: Modifying negative mental imagery in anxiety

Anxiety-related disorders are characterized by persistent and excessive fear. Individuals with anxiety-related disorders often experience negative mental imagery involving past experiences or future feared situations. This can maintain anxiety and avoidance behavior. The evidence-based treatment for anxiety-related disorders is cognitive behavioral therapy, including exposure therapy during which patients are repeatedly exposed to feared stimuli and situations. It does not typically address negative mental imagery. Unfortunately, fear can return after initially successful exposure therapy, and not everyone is willing to start exposure therapy. This dissertation aimed to investigate whether modifying negative mental imagery may optimize exposure-based treatment for anxiety in a series of well-controlled laboratory experiments. Part I examined whether modifying negative mental imagery through a dual-tasking intervention reduces return of fear after fear extinction, which is procedurally similar to exposure therapy. Results showed that the dual-task intervention, holding a memory of an aversive film clip in mind while simultaneously making eye movements, reduced the unpleasantness of the aversive memory but did not reduce the return of fear compared to control groups. Part II examined whether modifying negative mental imagery through an imagery rescripting intervention enhances exposure willingness. Results showed that imagery rescripting, modifying negative mental imagery into more positive scenarios in imagination, reduced anxiety and negative threat beliefs, and increased willingness to face feared situations compared to control groups. Although these findings await replication in clinical samples, mental imagery-based interventions show great potential to modify negative mental imagery and to prepare individuals to engage in previously avoided situations.