Article summary:
- Intrusive mental images can powerfully influence emotion, behaviour and physiology, yet are often overlooked in therapy.
- Professor Emily Holmes says these images can be both distressing and helpful, offering insight into a client’s inner world.
- Therapeutic techniques include recognising images as unreal, rescripting their meaning, and using imagery in adaptive ways.
- Imagery-competing tasks, like playing Tetris, can reduce trauma-related intrusions without requiring detailed disclosure.
- Holmes encourages psychologists to engage with imagery as a valuable clinical tool alongside verbal techniques.
- She will explore this topic in her keynote at the APS Festival of Psychology, 16–18 May on the Gold Coast, Queensland.
Clinical psychologist Professor Emily Holmes says involuntary mental images provide fascinating insights into an individual's state of mind. When these images are distressing, therapeutic techniques can help, but we can also harness them for our benefit.
Humans are very logocentric. We teach children to use words to express themselves, and we use language to convey what's on our minds.
Nevertheless, our brains are abuzz with both words and images – though the latter tend to be locked away like secrets, rarely shared or discussed.
Professor Emily Holmes, based at Uppsala University in Sweden, is intrigued by involuntary mental images – those that pop into our minds uninvited. It’s a topic she has researched for some time. She describes them as "sensory representations – pictures of scenes, sometimes also a sound or smell that come up intrusively where someone visualises a past event or imagines a future perspective".
At her keynote address at APS's Festival of Psychology in May, Emily will explain why she believes society undervalues them and what they tell us.
"Many people are a lot more comfortable with words and we don't tend to talk about the images in our heads," says Professor Holmes.
She believes that despite their fleeting nature – lasting just 200 milliseconds unless we retain them – images can be more powerful than words.
"Intrusive images can occur in the flash of an eye, so it's very easy to minimise their importance, but they can have an incredible impact on our emotions, physiological system, behaviour and beliefs."
Science has proved these reactions.
"If you imagine a strong torch light shining into your eyes, your pupils will likely expand instantly. If you imagine eating a favourite food, you will start to salivate," says Professor Holmes. "These images can act like action templates that tell us what to do."
Benefits of intrusive images
Professor Holmes believes mental images can often be beneficial. A mental flash of an empty fridge might prompt a decision to shop after work, for example.
Sometimes they're our brain's way of keeping us safe from a future threat.
Someone who's been in a bushfire may retain images of what things look like just before so they can watch out for warning signs in the future. When facing an impending cyclone, people may start to visualise what may happen to their home or loved ones so they can stay safe, she says.
Furthermore, our brain can deliver images faster than words.
"A flashing image of a crocodile in a creek will likely provoke a quick response. The brain has learnt these visual mechanisms for very good reasons."
When images become distressing
While intrusive images are a natural part of cognition, they can at times be distressing.
"Examples include repeated vivid images from a difficult past experience or worries about a dangerous future event," says Prof Holmes.
Trauma memories, for example, often manifest in imagery rather than verbal rumination.
"These images can be very vivid and believable, and become troubling when they appear repeatedly," she says.
Intrusive images may be considered as contributing to a disorder when they disrupt functioning in daily life, she adds.
"If visions of a car crash stop someone from driving to work or vivid memories of a childhood incident cause depression, it may be time to seek help."
An image is much more memorable – terrible when negative, but wonderfully helpful when positive. An image really does say 1000 words."
Therapeutic approaches
People with post-traumatic stress disorder (PTSD), social phobia or obsessive-compulsive disorder (OCD) often experience disturbing images, but they may struggle to discuss them, says Professor Holmes.
"This may be because they lack the words or have never been asked about them."
But these images merit clinical assessment, she says.
"Ignoring them could mean overlooking influential material. It's the psychologist’s role to discern the form of these thoughts (both images and words) and whether they fit into a broader pattern of symptoms indicating a mental disorder."
Professor Holmes identifies four techniques therapists can use to help clients process, interpret or alter distressing images.
1. Learn that the image isn't real
Images hijack our attention. A flashback to a trauma, like a car crash, can feel immediate and real to the person experiencing it. In contrast, someone with bipolar disorder might vividly imagine driving a car fast, finding it so appealing that they feel compelled to act on it.
"This metacognitive technique involves helping the client to recognise the image is not real – it’s just an image. What can they do to demonstrate to themselves that the image is not real in the here-and-now? And when it's seen as ‘just an image’ this tends to reduce the need to act on it."
Professor Holmes says that while this technique seems simple, it can be "profoundly exciting when someone realises what they're seeing isn't real and can adapt accordingly".
2. Reinterpret the image
Reinterpreting an image, known as "imagery rescripting", gives it a new meaning.
"We can view an image in various ways and transform the images so its meaning changes. Children are fantastic at this. We can learn to make choices in how we perceive images."
She uses the example of someone with social phobia who thinks they look terrible on a video call, which prevents them from speaking.
"You can rescript a memory's origin, helping the person see themselves as perfectly ok, which creates a new, helpful image. This simple rescript of a problematic image can be transformative, enabling the person to calm down and focus better on the conversation."
3. Use images in a positive way
This technique encourages people to use imagery in a soothing, adaptive or reassuring way, which can be helpful in a variety of contexts.
For example, images can be used to create a mental 'safe space', which can be calming. Images aid memory – so helping a client create rich images of themselves undertaking a task they need to do in the future (e.g. homework), can help increase the likelihood of them completing the task.
4. Use imagery-competing tasks
The imagery competing-task technique is a newer method that can be used to reduce the number of times intrusive imagery comes to mind.
This approach is beneficial for those experiencing intrusive images after trauma, such as people in a war or individuals who've been in a car crash. For some people, talking about the trauma in detail can be frightening, so light-touch techniques can be a useful complement, says Professor Holmes.
"We also don't want to challenge the trauma's validity, so we aim to modify the image's intrusive nature, not the image itself."
Professor Holmes has recently researched how an imagery-competing task intervention including a computer game can reduce intrusive images for trauma sufferers.
In the trials, participants were asked to reactivate their intrusive memory very gently by describing it in about five non-emotional words. They then learn to use mental rotation, and play Tetris (a visually absorbing electronic game in which players arrange puzzle pieces as they fall) for 20 minutes using mental rotation.
"If the intervention procedures are timed correctly, our results show that the traumatic image tends to stop intruding by the next day. This is exciting as a brief intervention, including Tetris, is gentle and doesn't require the person to discuss their trauma."
The power of images
Professor Holmes urges psychologists to engage with mental imagery – both in their practice and personally.
She adds that working with imagery can enhance practice across psychological disorders. Psychologists can also teach these techniques as self-help tools for clients.
Professor Holmes believes there's tremendous scope in using images to our advantage that we are yet to explore.
"Learning to control them, instead of being controlled by them, opens up exciting possibilities. For instance, you can deliberately visualise brand-new scenarios that may be more interesting or useful, which logical verbal thinking can't achieve," she says.
This may be helpful in getting teenagers to do their homework, or adults to progress in their careers or make an important life decision.
"An image is much more memorable – terrible when negative, but wonderfully helpful when positive," she adds. "An image really does say 1000 words."
Professor Emily Holmes will be delivering the keynote at APS member symposium Festival of Psychology, which takes place 16-18 May 2025 on the Gold Coast, Queensland. For more information or to buy your ticket, click here.
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