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Cited by 69Memory and Neural MechanismsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMemory Processes and Influences

A review on mental imagery in fear conditioning research 100 years since the ‘Little Albert’ study

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Mertens, Gaëtan, Krypotos, Angelos-Miltiadis, Engelhard, Iris M.·2020·Behaviour Research and Therapy
DOI 10.1016/j.brat.2020.103556
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Abstract

Since the seminal 'Little Albert' study by Watson and Rayner (1920), fear conditioning has become one of the most commonly used paradigms for studying the etiology of anxiety-related disorders. In a fear conditioning procedure, a (neutral) conditioned stimulus (CS) is paired with an aversive unconditioned stimulus (US), resulting in fear-related conditioned responses (CRs) to the CS. Whereas fear conditioning research initially focused on observable elements in the environment (i.e., CSs, USs, and their contingency) and their effects (i.e., CRs), subsequent research indicated that attention should also be given to unobservable mental events (e.g., intrusive memories of aversive outcomes) to more fully account for the symptomatology of anxiety disorders. In this paper, we review the research relating to four major research questions on the relationship between mental imagery and fear conditioning: (1) Can mental imagery substitute for actual stimulus administration? (2) Can mental imagery inflate CRs? (3) Can fear conditioning result in the installment of mental images as CRs (i.e., intrusions)? (4) Can mental imagery-based interventions reduce CRs? For all these research questions, tentative confirmatory evidence has been found and these findings corroborate contemporary conditioning theories. Nonetheless, we point to several open questions and methodological issues that require further research.

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  • If patients with anxiety disorders experience intense threat imagery, they might be too anxious or unwilling to confront feared stimuli, which could explain the low attrition rates in exposure therapy.

    “If patients with anxiety disorders experience intense threat imagery, they might be too anxious [27, 28] or unwilling to confront feared stimuli [28–30], which could explain the low attrition rates in exposure therapy.”

    From Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE) (2023) · cites this paper as [30]

    Section 3.1 reports that imagined threat contingencies increased avoidance responses in a laboratory task, and Section 4.2 says approach behavior is needed for exposure therapy. The paper does not establish that intense threat imagery makes patients with anxiety disorders too anxious or unwilling to confront feared stimuli; Section 4.2 presents the role of imagery in promoting approach as a question for future research. It does not address exposure-therapy attrition rates, which the citing sentence offers as its own possible explanation. (LLM, conf=0.82)

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  • Intrusive prospective imagery, involving simulations of immediate future threat related to a current or upcoming social situation, may be of specific interest to address due to its anticipatory and preparatory function.

    “Intrusive prospective imagery, involving simulations of (immediate) future threat related to a current or upcoming social situation, may be of specific interest to address due to its anticipatory and preparatory function (e.g., Mertens, Krypotos, and Engelhard 2020).”

    From Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention. (2024) · cites this paper as Mertens, Krypotos, and Engelhard 2020

    Section 4.1 (page not provided) describes mental imagery in fear conditioning as simulating possible future situations and serving anticipatory and preparatory functions. The review does not establish those functions specifically for intrusive imagery about social situations, or say that such imagery is a particular priority to address. Section 4.2 discusses imagery-based interventions for anxiety-related disorders more generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Findings are in line with the view that targeting FFs with a short EMDR intervention may result in decreased imagery vividness and distress and lowered threat appraisal, mainly lower perceived probability of the imagined outcome.

    “Our findings are also in line with the view that targeting FFs with a short EMDR intervention may result in decreased imagery vividness and distress and lowered threat appraisal, mainly in terms of lower perceived probability of the imagined outcome”

    From Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention. (2024) · cites this paper as Mertens, Krypotos, and Engelhard 2020

    Section 3.4 reports that a laboratory model of EMDR’s eye-movement component can reduce the vividness and emotional intensity of aversive memories and attenuate some subjective fear ratings. It does not report that a short EMDR intervention targeting feared future images lowers threat appraisal or the perceived probability of the imagined outcome; the reviewed experiments recalled visual stimuli used in fear conditioning. The reference list names a study of eye movements and flashforwards, but does not establish those additional outcomes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Mental imagery of potential threats can result in fear and avoidance learning.

    “It has been emphasized in fear conditioning research that mental imagery of potential threats can result in fear and avoidance learning (e.g., Krypotos et al. 2020;Mertens, Krypotos, and Engelhard 2020;Mueller, Sperl, and Panitz 2019).”

    From Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention. (2024) · cites this paper as Mertens, Krypotos, and Engelhard 2020

  • The high levels of threat appraisal found fit well with the proposed impact of prospective imagery on anxiety.

    “the high levels of threat appraisal that we found fits well with the proposed impact of such prospective imagery on anxiety (Mertens, Krypotos, and Engelhard 2020).”

    From Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention. (2024) · cites this paper as Mertens, Krypotos, and Engelhard 2020

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4 of the 125 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavior therapy for PTSD. New York: Guilford Press.
  2. Hermans, D., Boddez, Y., & Vervliet, B. (2019). The experimental study of mental health problems -building on Watson & rayner (1920). Classical studies in clinical psychology. Thousand Oaks: SAGE Publishing.
  3. Holzman, A. D., & Levis, D. J. (1991). Differential aversive conditioning of an external (visual) and internal (imaginal) CS: Effects of transfer between and within CS mod- alities. Journal of Mental Imagery, 15(3-4), 77-90. Retrieved from https://psycnet. apa.org/record/1992-18638-001.

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Authors
Mertens, G., Krypotos, A.-M., & Engelhard, I. M.
Affiliations
Utrecht University (NL)
Corresponding author
Mertens, Gaëtan
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2020-03
Volume
126
Pages
103556
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2020.103556
OpenAlex
W3000759845
Cited by
69
References
125
Citations by year
2026: 11 · 2025: 5 · 2024: 15 · 2023: 14 · 2022: 6 · 2021: 13 · 2020: 5
FWCI
5.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Behaviour Research and Therapy (publishedVersion, cc-by)
  • Research portal (Tilburg University) (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Funders
Netherlands Organisation for Scientific Research
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
Keywords
mental imagery, fear conditioning, anxiety disorders, conditioned stimulus, unconditioned stimulus, conditioned response, intrusive memories, conditioning theory
MeSH terms
Conditioning, Psychological, Extinction, Psychological, Fear, Humans, Imagination, Research, History, 20th Century, History, 21st Century

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