Imaginal extinction without imagery: Dissociating the effects of visual imagery and propositional thought by contrasting participants with aphantasia, simulated aphantasia, and controls

Abstract

Imaginal exposure is a standard procedure of cognitive behavioral therapy for the treatment of anxiety and panic disorders. It is often used when in vivo exposure is not possible, too stressful for patients, or would be too expensive. Peter Lang's Bio-Informational Theory implies that imaginal exposure is effective because of the perceptual proximity of mental imagery to real events, whereas empirical findings suggest that propositional thought of fear stimuli (i.e., thinking about the stimuli without seeing them in the mind's eye) could be sufficient in therapeutical contexts. Exposure to propositional thought, instead of vivid mental imagery, would be more tolerable for patients since vivid imagery is associated with high emotional distress. To investigate whether mental imagery or propositional thought is crucial for the success of imaginal exposure, participants with the rare state of aphantasia (= absence of sensory mental imagery but with intact propositional thought) and two control groups were subjected to a fear conditioning paradigm followed by imaginal exposure and a reinstatement procedure. During imaginal exposure, control group 1 (N = 30) stared at a bright screen to disrupt visual imagery by incoming luminance (= simulated aphantasia), whereas control group 2 (N = 30) and participants with actual aphantasia (N = 30) kept their eyes closed. The results show […].