So thank you very much, Lisa, and thank you for inviting me to be part of the event today.
It’s a real pleasure to be here.
So I’m here to talk about the role of imagery in everyday life and in my everyday life I’m
a researcher and clinician, I work with people with psychosis and I predominantly, but not
exclusively, use cognitive behavioural approaches to understand the difficulties that people
I work with face and think about how we can use them to improve their quality of life
and I’m particularly influenced by ideas around how imagery might play a role in our
wellbeing and that’s what I’d really like to think about with you today and hopefully
it might maybe contribute to your own thinking about imagery and the role perhaps that it
plays for us in our daily life.
So, what do I mean by imagery?
Well, the definition of imagery has been very much disputed over time but as a cognitive
behaviour researcher and also just as a person, this definition makes a lot of sense to me
and has resonance.
So Kosslyn et al defined imagery as ‘the experience of seeing with the mind’s eye,
hearing with the mind’s ear and so on’.
So we’re not just referring to visual imagery here, although that is the most widely studied,
but also imagery in terms of our taste, smells and physical sensations as well.
And really this kind of definition of imagery I think speaks to and tells us about how essentially
internal mental imagery is a kind of quasi-perceptual experience, so it has a sense of reality to
it which then raises some really interesting questions about well what’s the difference
and what are the similarities between imagery and perception, which is something that researchers
have really been trying to think about and understand.
So, just to try and bring this to life a bit.
Fortunately this should be relatively straightforward to do because evidence suggests that broadly
speaking we can all imagine, we all have the capacity to have mental imagery.
So just to illustrate to you what this mental imagery might be like then, if I were to ask
you to look at this picture of a lemon and imagine taking a really long, slow bite into
it.
Or perhaps smelling this freshly cooked bacon, or maybe taking a stroll over this grass and
feeling the sensation of the grass beneath your feet, or perhaps instead maybe taking
a walk or a nice gentle stroll down this beach, feeling the sand beneath your toes and feeling
the warmth of the sun on you.
Now my guess is, at least some of you would have had to an extent, even if it’s just
I can see a few nods there, even if it’s just a very slight or mild experience, an
internal image of perhaps the sharpness of the lemon as you bite into it or the smell
or the sensation of the sand or the grass under your feet.
So from this perspective then I very much agree with Pablo Picasso’s quote where he
said that ‘everything you can imagine is real’.
I feel like I’m on potentially shaky ground getting into the nature of reality in a room
with a lot of philosophers in it but nonetheless just on a kind of basic phenomenological level,
those internal images that we have a sense of reality about them.
I think the importance of imagery is very much kind of highlighted by the fact that
it’s been thought about and written about throughout history.
So again, I feel like I might need to be corrected by the philosophers in the room – please
do step in if I’ve got the wrong end of the stick – but Plato as I understand it
wrote about imagery and he viewed images as being deceptions of external forms.
So he was there kind of tapping into and noticing the differences between perception and imagery.
Aristotle in what I think is a striking parallel to cognitive behavioural science today thought
that imagery was very central to memory and thought.
Fascinatingly in Ancient Rome they used a memory aide or a kind of memory pneumonic
called the Method of Loci which is still used today in order to support their oratory or
their public speaking.
So they would imagine an internal space or a location, sorry, they would imagine a place
or a location and then imagine a route around that place which they would memorise with
certain symbols or tokens at points along the route and so in order to remember their
speech, they just had to mentally recount the route in order to remember the order of
the points that they wanted to make.
It’s interesting that in the kind of late 19th and early 20th century there was what
we might kind of view as a fall of the interest of imagery around the time of behaviourism
becoming more popular.
There were lots of questions asked about ‘well actually can we really objectively and empirically
assess imagery because it requires so much introspection?’.
Fortunately, I think since the late 20th century there's been a resurgence of interest in imagery
and the role that it plays in our wellbeing and that’s been particularly supported by
cognitive neuroscience and some of the new methodologies we have available to investigate
imagery.
Another area which I think kind of points to the importance of imagery for us as people
is that we know that images occur cross-culturally, however what’s interesting is that the meaning
we ascribe to them seems to very much vary depending on the cultural context.
So for example in some religions or in some cultural groups, imagery in the form of spirits
or hearing voices might have a particular meaningful role in terms of social cohesion
and marking transitions, whereas very similar kinds of experiences occurring perhaps a Western
culture might be interpreted very differently and as a sign of mental illness.
So we know that culture’s quite likely – on the one hand the cross-cultural work demonstrates
for imagery as ubiquitous and therefore likely to be important for us all, but at the same
time it’s subjective and the meaning we ascribe to it will vary.
A really nice example of that that I like is by Jocano who writes about how he visited
a little Philippine island and he found that the people that lived there could see what
they described as being like fairy like spirits in the trees.
He couldn’t see these spirits of course and so apparently they all felt very sorry
for him because of that, because he didn’t get the opportunity to experience these lovely
fairies.
So why do we imagine then?
If we know that it is common, what functions might it serve?
So I’d like to suggest to you four possibilities.
Maybe imagery helps us to feel, to experience and cope with our emotions, to remember our
past, to experience the present and also to take care of our future.
So, Emily Holmes who’s based now at Cambridge and her research group over the last ten to
fifteen years have done a lot of empirical experiments looking at the impact of imagery
on emotion and what they’ve found is, for example, if we ask people to say in their
heads the phrase ‘the sky is grey’, compared to imagining a picture of a sky being grey,
the picture is likely to have more of an impact on their mood.
So to put it another way, if we were to ask people to imagine a blue sky compared to just
saying the phrase ‘the sky is blue’ in your heads, that the picture of a blue sky
is more likely to improve your mood than just reading the statement ‘the sky is blue’.
So we know then that mental imagery has an impact on emotion and interestingly, and it’s
unsurprising, it seems to involve similar neuro-psychological processes as what are
involved in perceptions.
So that kind of harps back to, as we said earlier, it really is a quasi-perceptual experience
and importantly, perhaps imagery can have a greater impact on emotion than verbal thought.
So that’s really helpful for us as people and as clinicians in terms of thinking about
how can we best support people and improve their wellbeing.
Imagery is also really critical we know to our sense of self because our autobiographical
memory is at least partly image based.
It allows us to organise yourself in time, so to know what experiences we had at points
through life.
It allows us to remember specific events, so as I do regularly lose my phone, I’m
able to mentally trace back well when did I last have it and what was I doing?
And the fact that that’s an imaginal [sic] system enables it to be much richer and for
me to really be able to trace back what I did.
But we also know that images in the form of memory can be disrupted.
So Sam touched on post-traumatic stress and voices.
It’s an area that I’m particularly interested in so in my clinical role I run a post-traumatic
stress and psychosis clinic and what we know is that people who have experienced different
kinds of traumatic events, so childhood victimisation, different types of abuse, may be particular
vulnerable to experiencing intrusive, very vivid intense moments, often the worse moments
of trauma that come back to them out of the blue.
And particularly in the context of psychosis, perhaps might also as Sam kind of touched
on, not necessarily recognise a link between the intrusion they're experiencing and their
prior experience of trauma, potentially because the memory encoding has been so disrupted.
Imagery can also help us to make sense of ourselves.
So we know that in terms of internal mood states for example people often have images
associated with them.
So this is a picture or a piece done by Josephine McInerney who’s an art service user and
clinician herself and here the blue represents depression and the red a sense of excitement
and this is her expressing her internal imagery of internal depression being kind of kept
at bay, a sense of excitement growing and the depression being at a distance over a
period of time relative to the excitement.
So given the fact that we know that we have internal images representing our internal
state, it’s no surprise then that imagery content and our response to images can sometimes
shape distress and plays a role in mental health problems.
So for example, in social anxiety it’s very common for people to have an image of the
self doing something particularly shaming that’s going to be associated or cause some
form of rejection.
In obsessive compulsive disorder we know that people tend to have – or obsessive compulsive
difficulties – very intrusive frequent thoughts with ego dystonic content, so they don’t
fit with arguably what they want or what they value.
So for example having an intrusion of a child being killed or hurting someone in some way
and we know that in those kinds of difficulties people are particularly likely to feel responsible
for their intrusions and to believe that they might be coming true in real life and so that
causes distress and then people feel that they have to engage in some sort of behaviour
in an intent to neutralise the intrusion and that’s where the compulsive behaviour comes
in.
So it's both the content but also the beliefs about a response to the image in that situation
that’s problematic.
In generalised anxiety, actually interestingly the reverse is true.
We know that people who worry a lot – I’m a bit of a worrier myself so I can kind of
empathise with this – tend to experience more of a reduction in imagery actually.
So perhaps we know there’s individual differences in our experiences of imagery but people who
worry a lot, they may be particularly less likely to experience internal imagery.
And in terms of psychosis, the area that I work in, we know that hallucinations and certain
kinds of unusual beliefs are particularly likely to be associated with images, whether
memory based or images occurring in the here and now.
Thinking about some of the more helpful aspects of imagery though, we know that imagery can
help us to learn.
So this study was done where they asked people to mentally rehearse doing an exercise on
the piano.
They’d not had any – I don’t think they’d played the piano previously – and what they
found was that the people who had mentally rehearsed it, actually performed better when
it came to doing the exercise in real life.
And it seems as though – or what the authors concluded was that there's something about
mentally rehearsing an action that actually lays down similar neuro-psychological processes
that are involved in the early stages of motor skill learning if you were going to do it
in objective reality.
And so this is something that’s’ used widely.
We can use it to help improve our performance in things, so in sports psychology very extensively
used, this idea of mental imagery.
So people like Mo Farah when he did his amazing Olympic performance, I would imagine that
he probably has done some form of mental imagery and mental rehearsal exercises as part of
his training.
What we know from that research, what’s particularly helpful is that we need to focus
on strategies when we’re doing the imaginal rehearsal, not the outcome.
So for example if I was trying to imagine me rehearsing my talk today and hope that
it might go OK, it wouldn’t be much good me focusing on the outcome and sitting at
home and relaxing afterwards, it’s actually about me trying to practice it through in
my head and then I’m more likely to hopefully do OK.
So, given all this importance of imagery then, it’s no wonder that imagery has been widely
used in the psychotherapies.
So there’s reports of imagery being used in Shamanic healing practices dating back
at least 20,000 years, and imagery is used widely across the psychotherapeutic disciplines,
so gestalt and psychodynamic therapies in terms of say empty chair type techniques;
systemic therapy in terms of narrative therapy and externalising a problem and creating a
visual image of it; obviously the arts therapies across all the modalities, so art, music,
dance, drama; the expression and modification of imagery is the tool by which those therapies
work; and cognitive behaviour therapy which possibly might not necessarily be viewed as
originating from a very imagery focused place.
Actually Aaron Beck, the originator of CBT, did much of his early research around dreams
and the role of dreams in depression and he kind of highlighted in his early writings
the potential role of imagery in emotional distress and as I’ve said, the kind of cognitive
neuro-science work in recent years has recently led to an increased focus on imagery and this
has been kind of paralleled by developments within the talking CBT therapies in terms
of compassionate mind therapy, acceptance and commitment therapy and mindfulness based
cognitive therapy, that all view imagery as being really important.
So, just to finish off them, to give you a little flavour of how we might use an imagery
based approach in a talking therapy, and I'm going to highlight this in relation to overcoming
nightmares.
So we know that sleep difficulties and nightmares are very common, of course they have a wide
impact on us and our wellbeing.
We all know what it’s like to have a bad night’s sleep.
And increasingly there’s an evidence base building around how we can use imagery techniques
to modify nightmares, reduce the distress associated with them and improve sleep.
So, I’m going to talk about someone who I’ll call Sharifa and she’d experienced
in the last ten years, a number of inter-personal assaults by a gang on her estate and she had
PTSD in relation to this and was experiencing nightmares about three to four times a week.
So very distressing for her and the worst moments of the nightmare was this imagine
of a gang standing over her and during this she had the thoughts, the meaning was ‘they’re
going to kill me and I’ve got no control’.
So she would wake from these nightmares, understandably feeling very scared and distressed.
So what we did was we used the nightmare re-scripting protocols that have been developed, did psycho-education
about imagery in her nightmares, we took a narrative of the nightmare so what the actual
image was in a lot of detail and then we thought about how can we re-script this?
How can we change the meaning of the nightmare, the fact that you think you’re going to
die and that you’ve got no control, to have a better outcome?
And she came up with this idea of well actually maybe what I can do, she didn’t want to
get into fighting back with the attackers because she thought that she might be more
harmed or that might get her into more danger, but she was able to recognise that actually
this is just a nightmare and from doing the imagery exercises there’s things I can do
to try and change the image.
So what she did was she decided to shrink her attackers in the nightmare and so we produced
outside of dreaming obviously a new memory re-scription.
She imagined it free, we recorded it and she imagined the attackers getting smaller and
then over the coming weeks listened to that recording at home to really try and reinforce
that nightmare, or the new dream outcome, and she experienced a reduction in nightmare
frequency and distress in the weeks following that and she reported that during her dreams
she had more of an awareness of the fact that actually I am safe now, the attackers are
in the past, they can’t get to me now and I do have some control because actually I
can influence what the attackers are doing to me in the dream.
So, I hope I’ve kind of given you a bit of a flavour, maybe encouraged you to think
more about how imagery is central to our sense of wellbeing, that it shapes our past, present
and future self and perhaps most importantly that we as clinicians, or therapists, or general
public, can make beneficial use of imagery in our day to day lives.
So I’d like to thank some of the people that I’ve worked with or whose work has
influenced my ideas in the area and yeah, thank you very much for listening.