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trauma memories & social anxiety. intrusive ‘images’ are very commonly associated with anxiety provoking situations for people with social anxiety disorder. these images are often visual but may also occur as an internal felt-sense or via other (often multiple) sensory channels.

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trauma memories & social anxiety

  • intrusive ‘images’ are very commonly associated with anxiety provoking situations for people with social anxiety disorder.

  • these images are often visual but may also occur as an internal felt-sense or via other (often multiple) sensory channels.

  • intrusive visual images of social situations are typically from an ‘observer’ rather than from a ‘first person’ perspective.

  • the majority of subjects can link intrusive images to early memories when typically the social anxiety disorder first became particularly troublesome.

  • holding the intrusive negative image (instead of a neutral or positive image) aggravates symptoms (feelings, attentional biases & mis-estimations) and performance – as judged by the subject, others involved socially, & by external observers

  • non socially anxious subjects also have their performance disrupted if trained to hold negative rather than neutral images of their performance

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clinical implications 2

  • educate socially anxious subjects about the frequency, type, importance, origins, effects, and management of images.

  • emotional processing of associated early memories is likely to be helpful in its own right and may guide the nature of subsequent coping image work.

  • consider training social anxiety sufferers to hold coping rather than negative images before and during social challenges.

  • it is reasonable to encourage these coping ‘images’ to involve a variety of sensory channels for example visual, felt-sense & auditory.

  • coping visual images should be from a ‘first person’ rather than an ‘observer’ perspective.

  • try training preparatory coping images (guided or self-directed) as a sequence involving experiencing initial difficulties, but progressively mastering the social interaction with eventual successful outcome.

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trauma memories & agoraphobia

  • when questioned, all of a group of 20 agoraphobics – but none of a group of 20 matched controls – reported having distinct recurrent intrusive ‘images’ in agoraphobic situations.

  • most intrusive ‘images’ involved several sensory modalities such as vision, internal ‘felt-sense’, sound, touch, smell & taste (note vision wasn’t always present as a component).

  • on discussion, all subjects linked an aversive memory to the intrusive ‘image’, but only 15% (3/20) reported having thought about the content of the memory prior to the interview.

  • the mean age at the time of the memory was 14.3 years.

  • 75% (15/20) of the subjects believed the memory affected their anxiety in agoraphobic situations.

  • common themes with both intrusive images and associated memories were of catastrophic danger and of a negative view of self (such as the self intimidated, humiliated and misunderstood).

Day SJ, Holmes EA & Hackmann, A. Occurrence of imagery and its link with early memories in agoraphobia. Memory 2004; 12(4): 416-27

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clinical implications 3

  • when asking about intrusive ‘images’ in agoraphobia (or other psychological disorders) it may be worth getting the sufferer to imagine (or actually revisit) an upsetting episode

  • note that recurrent intrusive images can come visually or as a internal felt-sense or via other (often multiple) sensory channels

  • although on questioning the majority of subjects can link this intrusive image to an early memory, they may well not have made this link before

  • subjects often recognize quite readily that the image tends to aggravate their symptoms

  • exploring the meaning and beliefs around the image and memory may well make good sense

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trauma memories & OCD

  • of 34 inpatients with OCD, 71% (24/34) reported that they had intrusive visual images when their OCD was really bad.

  • for patients with visual images, 33% (8/24) recognized their images as memories of actual aspects of earlier traumas.

  • when the remaining 16 patients with visual images were asked about their earliest recollection of having had similar sensations and feelings, 94% (15/16) could identify a particular traumatic experience that was linked to the visual image.

  • the perceived similarity between the visual image & the memory of the traumatic experience was very high, both in terms of sensory characteristics and in terms of interpersonal meanings.

  • it seems likely that many of the 29% (10/34), who did not report intrusive visual images, might have reported ‘images’ if questioned about felt-sense and other sensory channels.

Speckens A, Ehlers A, et al Imagery and early traumatic memories in obsessive compulsive disorder. BABCP Annual Conference Abstracts: p.44. York, 2003

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  • Hinrichson H, Morrison T, et al. Triggers of vomiting in bulimic disorders: the roles of core beliefs and imagery.BABCP Annual Conference Abstracts: page 8. York, 2003.

  • Cooper M, and Turner H. The effect of using imagery to modify core beliefs in bulimia nervosa: an experimental pilot study. BABCP Annual Conference Abstracts: pp 8-9. York, 2003.

  • Osman S, Cooper M, et al. Spontaneously occurring images and early memories in people with body dysmorphic disorder. Memory 2004; 12(4): 428-36

  • Brewin CR, Watson M, et al. Memory processes & course of anxiety and depression in cancer patients.Psychol Med 1998; 28: 219-24.

  • Finkenauer C, and Rimé B. Keeping emotional memories secret: health and subjective well-being when emotions are not shared. Journal of Health Psychology 1998; 3(1): 47-58.

  • Morrison A. Trauma and psychosis: cause, consequence, common processes and clinical implications.BABCP Annual Conference Abstracts: p 21. York, 2003.