The Magical Power of Image: Efficacy of Imagery-related Interventions

Enormous literature showed that images had magical power. Image is both practical and transformational in its essence (Hochman, 2000). Akhter Ahsen does his seminal works on the significance and viability of Image. Ahsen named his psychology eidetic psychotherapy. By eidetic, he means the bright and repeatable image of lively details (Ahsen, 1977a). Contrary to William James, Ahsen believes that we can step in the same river at the same point as many times as we wish because the mental experiences of time it is preserved in the eidetic image. Images are much stronger than words. This therapy focuses on images rather than words. The effect of eidetic therapy on trauma situations is well established and gaining its popularity with the advancement of time. It asserts that the body learns to handle the trauma with the repetition of troublesome images. Otherwise, due to painful experiences of the trauma, the body avoids reliving the trauma. This leads to fixation instead of resolution. The impact of the image in the development of psychopathology has been the area of interest of many researchers. They concluded that images that are positive in nature are helpful and a source of wellbeing, while the intrusive mental images are profoundly troublesome and disruptive, adding to keeping up with psychopathology (Iyadurai, Hales, Blackwell, Young, & Holmes, 2020).  Past studies showed that if the negative, painful images are not resolved or avoided, then the problem develops. Evidence of the effectiveness of eidetic therapy has been seen with patients with trauma (Ehsan & Rowlan (2021), phobia (Dolan & Sheikh, 1977), OCD, depression, insomnia, and intellectual disability (Akhter et al., 2021; Syed, Neelofur, Moran, & O'Reilly, 2020), etc. In a recent study with women who faced domestic violence and subsequently developed posttraumatic stress symptoms, image therapy was used as a method of treatment. Victims demonstrated significant reductions in post-traumatic stress disorder by completing treatment (Kamran Ehsan & Rowland, 2021). 

Numerous contemporary researchers ‘showed the efficacy of imagery-based interventions (Mertens, Krypotos, & Engelhard, 2020). Few studies that were conducted in the context of the COVID 19 pandemic depicted worth mentioning findings. They demonstrated the vital role of imagery in developing and treating both physical and psychological issues. For instance, an experimental approach was utilized to explore whether COVID-19-related mental images lead to a fearful response in a study.  Respondents vividly imagined neutral, standard fear and COVID-19 related narrative scenes. It was exhibited that health anxiety was associated with imagery vividness, anxiety, avoidance, hyperarousal, and disappointment, during imagery of COVID-19 scenes. Furthermore, findings showed that individuals with high levels of health anxiety were more inclined to terrible mental imagery of contracting COVID-19 which may be a significant component adding to the worsening and chronicity of excessive health anxiety in times of a pandemic (Benke, Schonborn, Habermann, & Pane-Farre, 2022). Likewise, another review was intended to explore the acceptability and viability of telephone-delivered behavioural activation with mental imagery in older individuals living in isolation during the Covid-19 pandemic to treat depressive symptoms. Results showed that behavioural activation with mental imagery delivered over the telephone is practically acceptable and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation (Pellas, Renner, Ji, & Damberg, 2022).

Comparable findings have been demonstrated on patients with physical problems. For instance, to evaluate the impact of brief guided imagery on patients suffering chronic, fibromyalgia-related pain, training in brief guided imagery was found to be associated with marked improvement in pain management, mood, overall activity, walking ability, routine work, relationships with others, sleep, and enjoyment of life (Kaplun, Roitman, & Rosenbloom, 2021). Likewise, almost similar results have been exhibited in regard to the metacognitive intervention of narrative imagery. Authors revealed that integrating narrative and meta-cognitive therapies with mental imagery seems functional and promising for young individuals with cystic fibrosis (Russell, Strodl, Connolly, & Kavanagh, 2021). Imagery-related therapies have substantial effects on health conditions like phantom limb pain. To investigate whether graded motor imagery helps diminish phantom limb pain in people who have gone through limb amputations.  The participants in the experimental group depicted significant improvements in pain than the control group. Further, the participants in the experimental group had significantly greater improvements than the control group in pain interference at all subsequent points (Limakatso, Madden, Manie, & Parker, 2020).

The efficacy of image-based therapies on trauma-related circumstances is evident. For instance, Haeyen and Staal (2020) revealed that imagery rehearsal therapy is effective for trauma-related nightmares to access their traumatic memories. Additionally, they reported that the images are saved in non-verbal, visual, or audiovisual language.  Similarly, in the case of the relationship between images and social anxiety, past research has shown the association between imagery and social anxiety in youngsters. Existing cognitive models of social anxiety show that negative self-images play a critical part in keeping up the disorder. However, some evidence is that children and young people with higher social anxiety report more negative, observer's perspective images (Chapman, Halldorsson, & Creswell, 2020).  To see the relationship between the images in suicidal ideation, images are related to suicidal ideation. Typically, suicidal tendencies are evaluated by verbal contemplations rather than by getting information about mental images. A review was conducted to see the role of imagery in the patients of borderline personality disorder with and without comorbid posttraumatic stress disorder and patients with major depressive disorder. These two groups were compared. Suicide-related images were found in all groups. More vivid images were reported by the patients with borderline personality disorder with comorbid posttraumatic stress disorder than patients with major depressive disorder. Childhood trauma, the severity of past suicide attempts, and frequency of previous suicide attempts were significantly related to suicidal imagery in all the study participants. The authors demonstrated that suicide-related mental imagery occurs in borderline personality disorder and is connected with suicidal ideation (Schultebraucks, Duesenberg, Di Simplicio, Holmes, &Roepke, 2020).

It is not only the empirical research that talked about the role of the image, but also much non-empirical work is available that showed the powerful impact of the image. In his book, Positive Imaging (1981), Norman Vincent Peale, demonstrated many illustrations of the powerful effects of images. He demonstrated that images precede the action.  In his book, he reported many case studies regarding the powerful effects of images. One of the most powerful impacts of images can be seen in dreams. Dreams are in the form of images. These images produce the same effects as the waking state typically produces. In our daily experience, dreams produce a very powerful impact on the body. The magical and powerful effects of dreams can be seen in the cases of nocturnal emissions. Nocturnal emission may generally accompany by erotic dreams, where a person experiences involuntary ejaculation of semen during sleep without any stimulation. Dreams can make a person terrified or fearful.  Sometimes even a person can get panic because of the images.  In the case of panic anxiety, sometimes the symptoms are triggered/generated merely through the image (maybe in the form of smell or sound of the event). For instance, while talking to a flood victim, a client narrated that the smell of the floodwater in the room reminds him of the whole flood disaster. The “avoidance” such as avoiding talking, thinking, and avoiding going there are mostly taken as coping by most people. But it does not work. Deliberate avoidance evokes a recurrent intrusive image, which ultimately makes the body uncomfortable. So, eidetic therapy is helpful to process the image. The eidetic therapy is brief and economical, and it can be used successfully with patients who are not communicative. Much research is needed to understand the relationship between the imagery and problems stemming from the relationship and/or developmental. The efficacy of eidetic therapy is needed to address issues such as substance abuse, personality-related issues, and sexual problems.


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About the Author

Naeem Aslam is an Assistant Professor at the National Institute of Psychology, Centre of Excellence, Quaid-e-Azam University, Islamabad