Images and Hotspots in Anxiety Disorders

Jerry Kennard Health Pro
  • The way we think often involves images rather than words, or sometimes both. Like a movie we play out scenes in our mind and almost like a dream, we can experience the emotional outcomes. A person who is anxious can often generate some dramatic and upsetting negative imagery. What starts out as concern over the length of time their partner has been driving develops into images of him or her falling to sleep behind the wheel and eventually being mangled in some terrible crash.


    Images can be truly upsetting. Imagining the loss of a loved one, perhaps because they have rejected you or because they are very ill, is a troubling thing. People with health or social anxieties or those prone to panic often ‘see’ themselves in situations where they are vulnerable and unable to cope. Reducing such images can be part of treatment and this is certainly something being refined in the treatment of those with post-traumatic stress disorder (PTSD) who experience flashbacks.

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    Images tend to mean something and it can be helpful for the person affected to unpack the images they see and to verbalize their meaning rather than simply be affected by the emotions they stir. For example, let’s imagine that Jack has to give a presentation to work colleagues. In the days leading up to the presentation his imagination stirs. He sees himself stumbling over his words, sweating and shaking, and his audience laughing at him. He sees himself running out of the room, humiliated. He feels sick at the thought and his anxiety levels begin to peak.


    One way of tackling issues like Jack is experiencing is to weigh up the evidence for and against the negative imagery he is generating. The first step is for him to articulate the exact nature of his negative images. In Jack’s case it’s about lack of confidence and, as is often the case with anxious imagery, a memory of a time some years ago when he felt self-conscious because of something he was expected to do in front of others. Next, it would help if he weighs up the evidence both in favor and against these images. Very often it’s a case of worry over real hard evidence.


    Problematic mental imagery occurs with almost all anxiety disorders but are probably most intense in those suffering with PTSD. Usually the person experiences a worst moment or moments of trauma known as ‘hotspots’. These hotspots tend to relate to physical or emotional threat experienced by the person. Trauma focused cognitive therapy involves a technique called imaginal reliving, in which hotspot moments are focused on and recalled. The aim is to allow for better processing of the event and the association it has for the person. For example a hotspot image of being mugged at knifepoint may be associated with the meaning that ‘I’m going to die.’ Manipulating the concept might lead to a place where the person thinks, ‘I know I didn’t die.’ The interpretation of the event and the sense of ‘nowness’ that accompanies it, is known to reduce as a result of such approaches.

Published On: August 16, 2014