Behind Guided Imagery, CBT, & Mindfulness
Cognitive-Behavioral Therapy is a therapeutic intervention that combines cognitive and behavioral approaches designed by Aaron Beck in the late 1960s.
Imagery was always relevant to CBT, given that many of our thoughts and feelings are accompanied by internal images. These include those referring to the past, such as rumination on loss that can lead to depression, and those referring to anticipated failure or rejection that often generate anxiety.
CBT challenges dysfunctional patterns of thoughts, feelings, and behavior by using cognitive restructuring strategies that lead to behavioral change. Challenging the internal imagery that blocks behavioral change can be achieved using guided imagery techniques to restructure imagery and rescript inner scenarios that often play out when clients face challenges, compulsions, or fears.
In the preface to the Oxford Guide to Imagery in Cognitive Therapy (Hackmann et al., 2011, p. xxv), Beck writes, “developing a cognitive theory of psychopathology initially relied on my patients’ ability to share their inner cognitions; a process that was significantly aided by imagery. In this sense, imagery contributed to the evolution of cognitive therapy theory and practice.”
Some contemporary examples of how guided imagery is used in CBT include:
- Cognitive restructuring
For symptoms of post-traumatic stress disorder (PTSD), like flashbacks, cognitive restructuring inserts new and incompatible images into post-traumatic memories (Grey et al., 2002).
- Imagery rescripting
Imagery rescripting is commonly used to treat symptoms of PTSD, including flashbacks and nightmares (Arntz & Weertman, 1999; Smucker et al., 1995).
There is also evidence that it can enhance positive mood states and overcome depression (Holmes et al., 2006; Wheatley et al., 2007).
- Imaginal desensitization
This technique has the client imagine a feared stimulus until they habituate to it. This is used to treat phobias (Wolpe, 1958).
- Imaginal flooding
Another method for overcoming phobias and social anxiety is where a feared stimulus is repeatedly presented through imagery without reinforcement or any counterconditioning process (Stampfl & Levis, 1967).
The third-wave behavioral therapies combined CBT with mindfulness techniques to alleviate stress, anxiety, and depression. Often, the mindfulness components of third-wave therapies use imagery to decenter from identification with thoughts and feelings that prevent behavioral change.
Examples include the Acceptance and Commitment Therapy (ACT) “thoughts are like” exercise, available in this free worksheet, which deploys a lot of visual metaphors as images to facilitate cognitive defusion.
The ACT approach understands how internal imagery often traps us in inner scripts that block behavioral change. ACT uses a combination of imagery and linguistic rescripting to support value-driven action.
How Does Guided Imagery Work?
Guided imagery works by using the imagination to stimulate all five sensory channels in addition to inner self-talk, often using affirmations.
It works because our brain and related neurophysiology find it almost impossible to distinguish between imagined experience and reality, such that we often respond to our imagination as strongly as if it were really happening (De Paolis et al., 2019).
For example, our brain responds when we imagine potential failure or rejection by flooding us with anxiety, which results in unpleasant symptoms like breathlessness, a racing heart, a dry mouth, and sweating as if the threat were very real.
In the same way, guided imagery mobilizes the power of our imagination to produce positive mind–body effects (Felix et al., 2018). Due to the brain’s neuroplasticity, guided imagery can be used to carve out new neural pathways that literally rewire our brains to experience the world differently (Edwards, 2007).
In short, guided imagery is a multi-sensory visualization intervention that can be a useful form of self-help or used with therapy, counseling, and coaching clients to overcome a range of life and health challenges (Utay & Miller, 2006).
What our readers think
A great collection of resources Jo Nash and I welcome the reference list! It is my intention to work through each of these to better support myself and those with whom I work. Thank you!