In this article we relate observations of intrusive memories and images across a variety of disorders to models of memory and imagery drawn from cognitive psychology and cognitive neuroscience. Harvey, Watkins, Mansell, & Shafran, 2004 Hirsch & Holmes, 2007). In contrast, there is increasing empirical research suggesting that intrusive visual images and memories are a common feature of many disorders (i.e., a transdiagnostic process A. Consistent with this, psychological theories of mental disorders have given much more attention to the role of various kinds of negative verbal thought than to the role of visual intrusions ( Brewin, 1998 Hackmann & Holmes, 2004). Recurrent and intrusive images feature in the diagnostic criteria for posttraumatic stress disorder (PTSD), acute stress disorder, and obsessive–compulsive disorder (OCD) but are not mentioned in relation to the majority of other mental disorders ( American Psychiatric Association, 2000). Finally, we discuss the treatment implications of the new model and relate it to existing forms of psychological therapy. The revised model is used to explain how the different types of distressing visual intrusions associated with clinical disorders arise, in terms of the need for correct interaction between the neural systems supporting S-reps and C-reps via visuospatial working memory. We revise our previous dual representation theory of posttraumatic stress disorder to place it within a neural systems model of healthy memory and imagery.
Evidence from cognitive psychology and neuroscience implies distinct neural bases to abstract, flexible, contextualized representations (C-reps) and to inflexible, sensory-bound representations (S-reps). Both memory and imagery appear to rely on common networks involving medial prefrontal regions, posterior regions in the medial and lateral parietal cortices, the lateral temporal cortex, and the medial temporal lobe. Patients with posttraumatic stress disorder, other anxiety disorders, depression, eating disorders, and psychosis frequently report repeated visual intrusions corresponding to a small number of real or imaginary events, usually extremely vivid, detailed, and with highly distressing content. Involuntary images and visual memories are prominent in many types of psychopathology.
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