Intrusive Images

It occurred to me several years ago that it was odd that the imaginative apparatus utilized a sensory pathway, namely the vocal pathway for hallucinations but employed a strictly verbal pathway for the experience of delusions. A series of studies were conducted (one in which I participated in as an author) which found that intrusive images actually occurred in 72.5% of paranoid individuals (Schulze et al, 2013; Morrison, 2002). These intrusive images had a very high degree of conviction and showed the same variation and associated distress as did the voices as well as the narrative description of the delusion. Consequently, a question is raised as to whether the images are the true or basic experience and that the verbal rendition of the delusions simply represents a verbal description of the images. Additionally, there is a strong possibility that the intrusive images are parallel to the voices and represent the paranoid set more than the verbal narrative. On reflection, however, it seems that the verbal narrative of the delusion is present to some degree all of the time and operates as a strongly held belief and thus cannot have a secondary position to the images. Please let me know your opinion regarding this.

It would be truly great if one could ask the individual to close their eyes and image the verbal reconstruction of the delusion and see whether it matches the intrusive image. There is some evidence that these images can be induced and modified through a procedure known as re-scripting which has been popular in the treatment of anxiety. The re-scripting consists of changing the content of the image to a more positive image or even adding humor into the image. To our knowledge, no paper has been published that examines the impact of re-scripting on the experience of delusions.

Let’s discuss this topic on Friday and before then, please send over your comments or questions related to this material.

Morrison, A. P., Beck, A. T., Glentworth, D., Dunn, H., Reid, G. S., Larkin, W., & Williams, S. (2002). Imagery and psychotic symptoms: A preliminary investigation. Behaviour Research and Therapy, 40(9), 1053-1062.

Schulze, K., Freeman, D., Green, C., & Kuipers, E. (2013). Intrusive mental imagery in patientswith persecutory delusions. Behaviour Research and Therapy, 51(1), 7-14. https://doi.org/10.1016/j.brat.2012.10.002

-ATB