Chronic worry is the defining characteristic of Generalized Anxiety Disorder (GAD). According to Tom Borkovec’s Cognitive Avoidance Theory of Worry, worry is a verbal and thought-based activity. Essentially, when a person is worrying, it is like they are talking to themselves in their head about potential bad things that may happen in the future. This idea of ‘verbal’ worry is contrasted with imagery-based worry, which involves picturing in great detail one’s feared situation using all of one’s senses. An example of this difference can be seen in worrying about the future consequences of a fight with a partner. In the verbal style of thinking, negative self-talk such as “we are going to break up” or “I won’t be able to be alone” repeat over and over in one’s mind. On the other hand, mental imagery entails imagining the details of what it would be like to break up; for example, picturing the look on your partner’s face, hearing their voice etc.
Mental images, as opposed to verbal thoughts, incite a stronger emotional response that is accompanied by more intense physical and sensory reactions. This may be a reason why some people tend to think more in words and statements when they worry – to avoid feeling these strong emotions and sensations. In fact, research shows that people who worry a lot often report being uncomfortable and sometimes scared of their emotions or the sensations in their body. But emotions are normal and are needed to emotionally process fear.
Say your greatest fear is losing your job. The Cognitive Avoidance Theory of Worry says that worrying about losing your job using vague words and statements (e.g., “What if I lose my job and something really bad happens?”) will not cause the same intense emotional and physical reactions as creating a mental image of that same scenario. So, in a way, there is a gain to thinking in words while worrying – it temporarily keeps uncomfortable emotions at bay. But, this gain is only short-lived. Yes, vividly imagining losing your job will likely cause you to feel tense in your body and in your gut. But, repeatedly creating mental images of this scenario without engaging in any action to avoid or suppress the images actually allows you to confront your fears and process what it would mean if you did lose your job. Encountering a feared situation in the imagination also allows one to develop a different perspective – for example, perhaps you realize that there are people you could turn to for help if things got dire. Or perhaps you realize that losing your job may lead to new opportunities that you’ve never been able to consider. Researchers have suggested recently that encouraging general practice in mental imagery, whether that involves worry scenarios or pleasant situations, may help reduce chronic pathological worry.
Skodzik and colleagues from the University of Muenster designed a study to investigate whether training worriers to think more habitually in images helps to reduce worry and improve well-being. Participants were individuals who scored high on a questionnaire measuring chronic worry. The researchers compared a comprehensive one-session training program that they developed to help people generate and use mental images in their everyday lives to a control condition that consisted of no intervention. The control condition allowed the researchers to determine whether their intervention was better than not delivering an intervention at all.
The training program had four modules that were intended to foster the ability to create vivid, detailed and emotionally filled mental images of everyday positive and negative situations. The first training module involved the participants familiarizing themselves with mental imagery, and included identifying mental imagery in everyday life experiences such as daydreaming. In the second module, participants learned how to differentiate between verbal and imagery styles of thinking. The third module taught participants how to generate mental imagery effectively by listening to audio recordings of positive and negative scenarios, and how to use their mind’s eye to activate and engage their senses. In the final module, participants practiced imagining 10 common worry scenarios for 30 seconds each. Participants described their images aloud and researchers gave feedback and prompts to encourage more sensory activation where needed. After completing the one session of training with the researchers, the participants were then instructed to practice thinking in mental images every day for the following week using the techniques they learned in the session. Participants filled out various questionnaires at the very start of the study and 7 days later, after completing the training, which made it possible for researchers to check for changes in worry and in their use of mental imagery. Participants in the control condition completed the same questionnaires at the start of the study and 7 days later to allow for a comparison.
People who received the training program reported that they had increased their engagement in mental imagery during the 7-day period. Those in the control condition remained the same in their use of mental imagery; in other words, their style of thinking did not change. People who received the training program also reported an improvement in worry during the week that they practiced incorporating mental imagery in their daily life, but the researchers could not determine for certain whether this improvement was in fact due to greater engagement in imagery; another study is needed to more definitively link the two. For the moment, this study’s promising results show the potentially positive effect of using mental imagery interventions in the treatment of chronic worry. The results are particularly interesting considering that the training involved only one session with a researcher who guided them through the techniques to use during the week. It remains to be seen whether therapies that incorporate mental imagery prove to be beneficial in treating chronic worry and GAD.