Last updated on 20th June 2013
Research on the therapeutic use of imagery is blossoming ... so much so that it can be difficult, at times, to make sense of the wealth of emerging findings. In today's post I want to look briefly at three areas that currently interest me. One is a puzzle about why it sometimes seems helpful to "rescript" toxic memories to produce "fantasy" memories that clearly never really occurred (see, for example, methods described in the last blog post "Arntz & Jacob's new book "Schema therapy in practice": rescripting traumatic memories"). How could this sort of wish fulfilment be therapeutic? The second area I want to look at is how new understandings about associative memory networks can throw fresh light on these questions about imagery. And the third area is what implications all this has for potential developments in the use of embodied cognition.
So first the question about imagery rescripting. This intervention can be seen in the bigger picture of a spectrum of techniques that run from simply "experiencing" challenging memories by mindfully "turning towards" or "exposing" oneself to them (without obviously trying to change the memories), through methods where one "introduces" or "inserts" new meanings that one was unaware of at the time of the memory, through even further to deliberately imagining scenes that never actually happened or that are about a future that hasn't yet occurred (see the diagram below):
Why on earth can it be helpful to "expose" oneself to upsetting memories and then imagine fantasy images that haven't ever occurred? One helpful explanation is to broaden our understanding of how we can transform key meanings. So let's imagine that I was abused as a child and then was profoundly ashamed of what happened, believing (as abuse victims often do) that it was at least partly my fault, that I must be an awful, unloveable person, that what happened must be kept secret, and that others can't be trusted. Now if a caring, consistent, understanding therapist who I respect for their kindness, knowledge & experience, encourages me to tell them my story and then reacts to it very differently from my catastrophic expectation, what do I learn from this? And this isn't only cool, cognitive learning. In fact, probably much more importantly, it's a warm experienced learning complete with discussion, emotion, relief, safety, affection, and so on. And we know that imagery often carries emotion and meaning more potently than bare words. So if part of the message is that, as a child, I was not to blame, that I was a victim of other's abuse, and that I shouldn't have been treated like that ... then a powerful set of images making these points could be very helpful. The fact that the images didn't occur completely misses the point. In fact, it's because the images didn't occur and because toxic beliefs have taken hold, that we now choose to underline and drum in key emotional messages about being blameless, loveable, worth fighting for, worth caring about, valued, and so on, using the power of repeated images to make these points.
The famous neuropsychologist Donald Hebb argued that much learning was by association - "Cells that fire together wire together". Subsequent developments of Hebbian learning, such as BCM theory and Oja's rule have successfully applied this associative model to image processing and the formation & storage of memories. My next blog post - "Our minds work associatively: this is of central importance for psychotherapy and for life in general" - makes this point very well. I quote the Nobel prize-winner Daniel Kahnman's description of our ubiquitous tendency to respond to experiences "automatically", from what Kahneman describes as System 1 - "This complex constellation of responses occurred quickly, automatically, and effortlessly. You did not will it and you could not stop it. It was an operation of System 1. The events that took place as a result of your seeing the words happened by a process called associative activation: ideas that have been evoked trigger many other ideas, in a spreading cascade of activity in your brain. The essential feature of this complex set of mental events is its coherence. Each element is connected, and each supports and strengthens the others. The word evokes memories, which evoke emotions, which in turn evoke facial expressions and other reactions, such as a general tensing up and an avoidance tendency. The facial expression and avoidance tendency intensify the feelings to which they are linked, and the feelings in turn reinforce compatible ideas. All this happens quickly and all at once, yielding a self-reinforcing pattern of cognitive, emotional, and physical responses that is both diverse and integrated - it has been called ‘associatively coherent'.
So with, for example, posttraumatic stress disorder we have a situation of very powerful, at times, debilitating cascades of associative activation. Someone shouts at me in a way that's reminiscent of my abusive father. This "stone" thrown into the pool of my mind immediately sends out ripples in an immensely distressing, uncontrolled pattern. I feel like a helpless victim of the thoughts, emotions, physical sensations & behaviours that are triggered in System 1. What can I do about this? Well, one powerful & healing response is to deliberately set out to resculpt the associative cascade. This is already happening as I consciously & bravely choose to tell the story. I'm already "turning towards" and this is a new and direction-changing link in the old "freeze/flight" sequence of the original associative cascade. The presence of a caring listener adds further new & potentially helpful associations. Introducing meanings that I didn't understand at the time, and even adding completely fresh imagery, physical movements, voiced responses ... all of this, especially if emotionally intense, inserts new pathways, new links that disrupt the original, immensely distressing associative cascade. This set of understandings that emerges from updating our appreciation of how the mind works, makes very good sense of therapeutic methods - like rescripting with fantasy images that never actually occurred - that have sometimes seemed puzzling. And moving right out to the many research studies on the use of "If ... then ... " future planning with implementation intentions, one can easily appreciate how working to strengthen associative links can be relevant to future plans as well as past events.
And as for "embodied cognition" - Daniel Kahneman wrote "As cognitive scientists have emphasized in recent years, cognition is embodied; you think with your body, not only with your brain. The mechanism that causes these mental events has been known for a long time: it is the association of ideas ... I will adopt an expansive view of what an idea is. It can be concrete or abstract, and it can be expressed in many ways: as a verb, as a noun, as an adjective, or as a clenched fist. Psychologists think of ideas as nodes in a vast network, called associative memory, in which each idea is linked to many others." Quoting Kurt Lewin again "There is nothing as practical as a good theory". These understandings of System 1 associative mechanisms are so obviously relevant to the multiple posts that I've written about the underused and fascinating therapeutic resource potentially provided by embodied cognition.