“Imagery is central to the maintenance of SAD. Research has shown that people with SAD almost invariably experience imagery relating to their fears,” Peter McEvoy, PhD, an associate professor at the School of Psychology and Speech Pathology at Curtin University in Australia, told Psychiatry Advisor. “It is a particularly potent mode of cognition, and research has shown that it has a stronger effect on emotion than verbal thoughts. Similar neural pathways are activated whether we are imagining a situation or actually experiencing it.”

Because mental imagery often involves multiple senses, it can create more intense physiological effects. A vivid image of failure — which might involve visual imagery of one failing and auditory imagery of observers’ ridicule — for example, “will trigger a more intense anxiety reaction than just thinking the thought ‘I’m going to fail,’” said McEvoy.

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A study he co-authored, which appeared in the February issue of Behaviour Research & Therapy, explored the use of an imagery-enhanced CBT program in treating SAD.4 Participants in the imagery-enhanced group were 26% more likely than controls to complete treatment, and effect sizes were also larger for the this group.

“Using imagery encourages clients to be very specific about their predictions, because we ask them to actually imagine them playing out in their mind’s eye,” McEvoy said. This alone sometimes helps patients recognize that their fears are relatively benign or unlikely to occur, and when they test the images in actual social situations, the discrepancy between reality and the imagined scenario is often obvious.

“Rather than asking a client what they think, it might be more powerful for therapists to ask the client to ‘see, hear and feel’ what they think,” he added. “Once they are engaged emotionally in their predictions, modifying these beliefs may be more powerful.”