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Images were more often linked to early memories in the patient sample, and the median age of this memory was Recurrent images were significantly more vivid and detailed in the patient sample and were more often accompanied by bodily sensations. All patients saw their images from an observer perspective, whereas all nonpatients saw their images as though they were looking at themselves in a mirror.

Psychotic Disorders Thirty-five patients with a diagnosis of schizophrenia were asked by Morrison et al. Just over half reported recurrent images.

Common themes included images about feared catastrophes associated with paranoia, traumatic memories, and images about the perceived source or content of voices.

Images were associated with a variety of emotions, of which the most common was fear. There were no differences in the prevalence of intrusions between the groups, and no members of a control sample reported this phenomenon.

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Gregory, Brewin, Mansell, and Donaldson interviewed 29 bipolar patients in remission concerning their experience of intrusive visual memories and other images when in a depressed, a euthymic, and a hypomanic state. Their main finding was that intrusive memories were more common in euthymic and depressed states, whereas other images were more common in depressed and hypomanic states. Compared with intrusive memories in the euthymic state, intrusive memories in depression were more distressing and more vivid and involved more reliving the experience.

During hypomania the intrusive images were as vivid as those the person experienced when depressed but were rated as much less distressing.

On the contrary, most were highly positive. Summary Intrusive images and memories appear to be a common feature of many disparate psychological conditions. Where the data have been collected, it is generally found that there are a relatively small number of recurrent intrusions, rarely exceeding six per person and more often ranging between one and three per person.

Recurrent intrusions also occur in healthy controls, but they are significantly less common, and when they do occur they are less frequent and less distressing. One of the most obvious ways in which intrusions differ between disorders is in their theme e. By and large, the content of these intrusions matches the specific content of verbal thoughts associated with each disorder.

Thus, in panic and agoraphobia, intrusions center around physical and mental catastrophe; in depression and bipolar disorder, around negative life events including interpersonal problems; in health-related anxiety, around illness and death; in social phobia, around public failure and humiliation; and so on.

Table 1 indicates that in certain disorders, particularly the anxiety disorders, images involving dreaded future situations or outcomes have usually been studied, whereas in depression and PTSD visual memories of painful or traumatic events have been the main focus. It is premature, however, to conclude that memory- and fantasy-based images can be unambiguously distinguished or are more important in some disorders than others.

For example, intrusive images concerning the future have been recorded in depression, PTSD, and the hypomanic phase of bipolar disorder Gregory et al. In many studies of intrusive imagery, no attempt was made to report which images corresponded exactly to autobiographical memories, and it was frequently found that fantasy-based images nevertheless contained memory-related material.

Thus, the relation between images and memories in these clinical conditions remains one in which a great deal more research is needed. Mental images, rather than verbal thoughts, of the substance or the context of its consumption create the strongest positive emotions of reward and relief.

Consistent with this, May et al. It is striking that virtually all studies describe these recurrent intrusions as being vivid, detailed, and accompanied by often extremely strong physical sensations and emotions.

Across disorders the visual modality is almost invariably the most common, but it is clear that sound, taste, and smell are also frequently involved.

Among the differences found are that in patients with PTSD, compared with those with depression, the intrusions are associated with greater helplessness and have more dissociative qualities such as out-of-body experiences or a sense of reliving the event in the present Birrer et al. Reynolds and Brewin conducted an exploratory factor analysis that suggested, consistent with this, that feeling helpless during an intrusive memory was associated with dissociation, whereas feeling fear was related to reliving the event in the present.

Of considerable importance are the accumulating observations that these intrusions are closely related to other aspects of disorders, including their course. Observations in samples with depression, PTSD, agoraphobia, social anxiety, and OCD are strongly suggestive that the events figuring in these memories were associated with either the onset or an exacerbation of the disorder. Hirsch, Clark, Mathews, and Williams provided further evidence for the functional role of imagery by experimentally manipulating the images that social phobia patients held in mind when interacting in a social situation.

Holding a negative rather than a neutral image in mind led to greater anxiety and more negative interpretations of performance. The review has also identified many areas in need of further research. However, the exact nature of how the scenes and incidents are chained together, and whether this is similar to that found in other temporally extended memories, has not been studied.

Similarly, the subjective report of the same memories recurring repeatedly has not been subject to empirical verification, and it is unclear whether these phenomena occur as exact or approximate repetitions. Finally, research is needed into why memories appear to occur more frequently from an observer viewpoint in some disorders than in others.

Psychology and Neuroscience of Memory and Imagery Memory Involuntary memory Intrusive memories combine two areas of research in cognitive psychology: involuntary memory and autobiographical memory. The study of involuntary memory, although minimal compared with that of voluntary memory, has a long history in psychology, stretching back at least as far as Ebbinghaus Berntsen, It is generally seen as an associative process, in which the cue alone is sufficient to prompt retrieval, in contrast to the strategic, deliberative nature of voluntary recall.

A number of researchers have proposed that involuntary retrieval results in memory contents remaining more consistent over time, as the alterations introduced by deliberate search and reconstruction are absent e. Differences between voluntary and involuntary recall were reviewed by Berntsen Compared with the former, the latter were more likely to involve specific episodes, to influence mood, and to come with an accompanying bodily reaction. Moscovitch proposed that associative involuntary retrieval has its neural basis in the functioning of the hippocampus and surrounding medial temporal cortex, which reinstate a previous conscious experience by activating a network of areas involved in the original perception of the event.

Voluntary retrieval, by contrast, depends on the instigation of an appropriate strategy through activity in the prefrontal cortex, which then, if successful, also produces MTL activation.

By contrast, activation of more lateral and anterior prefrontal areas appears to reflect top-down modulation by variables such as effort, deliberate choice of strategy, and postretrieval processing in dealing with, for example, interference between multiple potentially relevant memories e. Autobiographical memory Traditionally, autobiographical memory and episodic memory have been treated as virtually interchangeable terms for a single memory system, with autobiographical memory referring to the specific subset of knowledge relating to the self and its personal history Baddeley, From the time of Janet , however, many of those studying the recall of highly emotional events have proposed the existence of an image-based memory system that captures sensory and perceptual details of significant scenes and is distinct from a verbally based narrative memory system.

A perceptual memory system supporting conscious experience was also part of the more general memory framework proposed by Johnson Drawing on these theories, Brewin, Dalgleish, and Joseph put forward a dual representation theory of PTSD, in which the traumatic event was represented in two parallel memory systems.

The situationally accessible memory SAM system contains detailed sensory and perceptual images that can be accessed only involuntarily and that form the basis for flashbacks and nightmares relating to the traumatic moments themselves. This system is thought to be supported primarily by subcortical structures and by areas of the brain directly involved in perception rather than in higher order cognitive control.

The lack of involvement of structures such as the hippocampus results in a memory that is not contextualized but experienced as happening again in the present.

The verbally accessible memory VAM system contains records of conscious experience that can be either automatically or deliberately retrieved and that support communication, reappraisal, and consequent alteration of life goals. This system requires the ability to flexibly access and manipulate a variety of information, can situate such information in its appropriate spatial and temporal context, and is assumed to depend on prefrontal areas of the brain as well as MTL structures such as the hippocampus Brewin, Both systems are conceived of as part of normal memory but as functioning abnormally in PTSD.

Conway , proposed a similar separation between episodic and autobiographical memory systems. The episodic system retains highly detailed sensory and perceptual knowledge over relatively brief retention intervals measured in minutes and hours.

It is an image-based system possessing little if any conceptual organization and is located in posterior temporo-occipital areas. Retrieval is involuntary i. Retention of this episodic information usually depends on its integration within autobiographical memory, a knowledge-based, conceptually organized system located in prefrontal anterior-temporal areas that can be accessed either automatically or strategically.

Its context is the immediate past and egocentric orientation of the individual perceiver. A similar distinction between a short-term episodic memory and a long-term autobiographical memory system forms part of a computational model of consciousness described by Baars, Ramamurthy, and Franklin More recently, however, Conway put forward evidence that episodic memory is not restricted to short-term storage and that its contents, even though relatively inaccessible without the necessary retrieval cues, may even be permanent.

He further proposed that PTSD may be characterized by the intrusion into consciousness of episodic elements that are lacking a frame of conceptual, contextualizing knowledge. Neuroscience of Fearful Memories Finally, recent advances in the neuroscience of fearful memories—specifically the acquisition and reconsolidation of involuntary responses—appear poised to become relevant to the clinical disorders reviewed earlier.

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New York: Wiley. Control and automatic processing during tasks requiring sustained attention: A new approach to vigilance.

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Within this system, object maps are topographically organized and depict objects or scenes relative to the perceiver. Attention: Selective processes in vision and hearing.

Unpublished manuscript. Importantly, they noted that patients had often not made the link between the image and the corresponding memory and appeared to become aware of it for the first time during the study. I have found no one text Varieties of attention.

Of considerable importance are the accumulating observations that these intrusions are closely related to other aspects of disorders, including their course. Auditory-visual integration during multimodal object recognition in humans: A behavioural and electrophysiological study.

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