Nervenheilkunde 2017; 36(09): 719-725
DOI: 10.1055/s-0038-1627517
Universitätsklinikum Ulm
Schattauer GmbH

Zum Einsatz und Nutzen mentaler Bilder oder Imaginationen in der kognitiven Verhaltenstherapie

The use and benefit of mental imagery or imagination in cognitive behavioral therapy
C. Schaitz
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
J. Kröner
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
H. Graf
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
Z. Sosic-Vasic
1   Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
› Author Affiliations
Further Information

Publication History

eingegangen am: 01 July 2017

angenommen am: 17 July 2017

Publication Date:
20 January 2018 (online)


Da mentale Bilder und Imagination tatsächlichen sensorischen Erfahrungen ähneln, beeinflussen sie menschliches Lernen und Verhalten und können im Vergleich zu verbaler Verarbeitung Emotionen besser aktivieren und verändern. Zudem sind aversive mentale Bilder in Form von Intrusionen an der Ätiologie und Psychopathologie vieler psychischer Störungen beteiligt, weshalb sie in der modernen Verhaltenstherapie als Behandlungsmethode vielfach eingesetzt werden. Dabei hat sich insbesondere die Methode des Imagery Rescripting (ImR) als effektive Behandlungsmethode für die posttraumatische Belastungsstörung, Angststörungen wie die soziale und spezifische Phobie, affektive Störungen sowie zur Therapie von Persönlichkeitsstörungen hervorgetan und ihre Wirksamkeit anhand randomisiert kontrollierter Studien bewiesen. Da beim ImR aversiv erlebte mentale Bilder, die den verschiedenen Störungen zugrunde liegt, in angenehmere mentale Vorstellungen umschreiben werden, wird eine Reduktion der mit der Störung assoziierten Beschwerden und Symptome ermöglicht.


Since mental images and imagination resemble actual sensory experiences, they can influence human learning and behavior, and may activate and change emotions better than in verbal processing. In addition, aversive mental images in the form of intrusions are involved in the etiology and psychopathology of many mental disorders, which is why they are widely used in modern behavioral therapy as a common treatment. In particular, the method of imagery rescripting (ImR) has proven to be an effective treatment method for posttraumatic stress disorder, anxiety disorders such as social and specific phobia, affective disorders as well as for the treatment of personality disorders, and has proven its effectiveness also in various randomized controlled trials. Because ImR allows the change of aversive mental images, which are underlying the various disorders, into a more comfortable mental presentation, a reduction of symptoms and symptoms associated with the disorder is accomplished.

  • Literatur

  • 1 Kahl KG, Winter L, Schweiger U. The third wave of cognitive behavioural therapies: what is new and what is effective?. Curr Opin Psychiatry 2012; 25 (06) 522-8.
  • 2 Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther 2016; 47 (06) 869-85.
  • 3 Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiat 1993; 50 (12) 971-4.
  • 4 Holmes EA, Arntz A, Smucker MR. Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and outcomes. J Behav Ther Exp Psychiatry 2007; 38 (04) 297-305.
  • 5 Holmes EA, Mathews A. Mental imagery in emotion and emotional disorders. Clin Psychol Rev 2010; 30 (03) 349-62.
  • 6 Kosslyn SM, Ganis G, Thompson WL. Neural foundations of imagery. Nat Rev Neurosci 2001; 02 (09) 635-42.
  • 7 Kavanagh DJ, Andrade J, May J. Imaginary relish and exquisite torture: The elaborated intrusion theory of desire. Psychol Rev 2005; 112 (02) 446-67.
  • 8 Association AP. APA (2000). Diagnostic and statistical manual of mental disorders 2003; 4.
  • 9 Hackmann A, Holmes EA. Reflecting on imagery: a clinical perspective and overview of the special issue of memory on mental imagery and memory in psychopathology. Memory 2004; 12 (04) 389-402.
  • 10 Schuster C, Hilfiker R, Amft O, Scheidhauer A, Andrews B, Butler J. et al. Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines. BMC Med 2011; 09: 75.
  • 11 Pascual-Leone A, Nguyet D, Cohen LG, BrasilNeto JP, Cammarota A, Hallett M. Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. J Neurophysiol 1995; 74 (03) 1037-45.
  • 12 Honeycutt JM, Ford SG. Mental imagery and intrapersonal communication: A review of research on imagined interactions (IIs) and current developments. Annals of the International Communication Association 2001; 25 (01) 315-45.
  • 13 Theiler AM, Lippman LG. Effects of mental practice and modeling on guitar and vocal performance. J Gen Psychol 1995; 122 (04) 329-43.
  • 14 Hall JC. Imagery practice and the development of surgical skills. Am J Surg 2002; 184 (05) 465-70.
  • 15 Gollwitzer PM. Implementation intentions – Strong effects of simple plans. Am Psychol 1999; 54 (07) 493-503.
  • 16 Carroll JS. Effect of imagining an event on expectations for event – interpretation in terms of availability heuristic. J Exp Soc Psychol 1978; 14 (01) 88-96.
  • 17 Libby LK, Shaeffer EM, Eibach RP, Slemmer JA. Picture yourself at the polls: visual perspective in mental imagery affects self-perception and behavior. Psychol Sci 2007; 18 (03) 199-203.
  • 18 Conway MA. Sensory–perceptual episodic memory and its context: Autobiographical memory. Philosophical Transactions of the Royal Society of London B: Biological Sciences 2001; 356 1413 1375-84.
  • 19 Knäuper B, McCollam A, Rosen-Brown A, Lacaille J, Kelso E, Roseman M. Fruitful plans: Adding targeted mental imagery to implementation intentions increases fruit consumption. Psychology and Health 2011; 26 (05) 601-17.
  • 20 Birtel MD, Crisp RJ. Psychotherapy and social change: Utilizing principles of cognitive-behavioral therapy to help develop new prejudice-reduction interventions. Frontiers in psychology 2015; 6.
  • 21 Murphy S, Nordin SM, Cumming J. Imagery in sport exercise and dance. In: Horn T. (ed.) Advances in sport and exercise psychology. Publications; 2008
  • 22 Knäuper B, Roseman M, Johnson PJ, Krantz LH. Using mental imagery to enhance the effectiveness of implementation intentions. Current Psychology 2009; 28 (03) 181-6.
  • 23 Paivio A, Smythe PC, Yuille JC. Imagery” versus” meaningfulness of nouns in paired-associate learning. Canadian Journal of Experimental Psychology 1968; 22: 427.
  • 24 Kane MJ, Bleckley MK, Conway AR, Engle RW. A controlled-attention view of working-memory capacity. Journal of Experimental Psychology 2001; 130 (02) 169.
  • 25 Kosslyn SM. On cognitive neuroscience. J Cogn Neurosci 1994; 06 (03) 297-303.
  • 26 Williams J. et al. Cognitive psychology and emotional disorders. Chichester: John Wiley; 1997
  • 27 Pictet A, Coughtrey AE, Mathews A, Holmes EA. Fishing for happiness: the effects of generating positive imagery on mood and behaviour. Behav Res Ther 2011; 49 (12) 885-91.
  • 28 Holmes EA, Mathews A, Mackintosh B, Dalgleish T. The causal effect of mental imagery on emotion assessed using picture-word cues. Emotion 2008; 08 (03) 395.
  • 29 Holmes E, Hackmann A. A healthy imagination? Editorial for the special issue of memory: Mental imagery and memory in psychopathology. Memory 2004; 12 (04) 387-8.
  • 30 Holmes EA, Mathews A, Dalgleish T, Mackintosh B. Positive interpretation training: effects of mental imagery versus verbal training on positive mood. Behav Ther 2006; 37 (03) 237-47.
  • 31 Mathews A, MacLeod C. Induced processing biases have causal effects on anxiety. Cognition Emotion 2002; 16 (03) 331-54.
  • 32 Holmes EA, Lang TJ, Shah DM. Developing interpretation bias modification as a” cognitive vaccine” for depressed mood: imagining positive events makes you feel better than thinking about them verbally. Journal of abnormal psychology 2009; 118 (01) 76.
  • 33 Heyes SB, Pictet A, Mitchell H, Raeder S, Lau J, Holmes E. et al. Mental imagery-based training to modify mood and cognitive bias in adolescents: Effects of valence and perspective. Cognit Ther Res 2016; 1-16.
  • 34 Hackmann A, Clark DM, McManus F. Recurrent images and early memories in social phobia. Behav Res Ther 2000; 38 (06) 601-10.
  • 35 Foa EB, Steketee G, Turner RM, Fischer SC. Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers. Behav Res Ther 1980; 18 (05) 449-55.
  • 36 Wolpe J. Psychotherapy by reciprocal inhibition. Cond Reflex 1968; 03 (04) 234-40.
  • 37 Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T. et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychia 2006; 63 (06) 649-58.
  • 38 Edwards D. Restructuring implicational meaning through memory-based imagery: Some historical notes. J Behav Ther Exp Psychiatry 2007; 38 (04) 306-16.
  • 39 Weertman A, Arntz A. Effectiveness of treatment of childhood memories in cognitive therapy for personality disorders: a controlled study contrasting methods focusing on the present and methods focusing on childhood memories. Behav Res Ther 2007; 45 (09) 2133-43.
  • 40 Arntz A, Tiesema M, Kindt M. Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting. J Behav Ther Exp Psychiatry 2007; 38 (04) 345-70.
  • 41 Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther 2000; 38 (04) 319-45.
  • 42 Ehlers A, Clark DM. Early psychological interventions for adult survivors of trauma: A review. Biol Psychiat 2003; 53 (09) 817-26.
  • 43 Arntz A, Sofi D, van Breukelen G. Imagery Rescripting as treatment for complicated PTSD in refugees: A multiple baseline case series study. Behav Res Ther 2013; 51 (06) 274-83.
  • 44 Grunert BK, Weis JM, Smucker MR, Christianson HF. Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury. J Behav Ther Exp Psychiatry 2007; 38 (04) 317-28.
  • 45 Kindt M, Buck N, Arntz A, Soeter M. Perceptual and conceptual processing as predictors of treatment outcome in PTSD. J Behav Ther Exp Psychiatry 2007; 38 (04) 491-506.
  • 46 Alliger-Horn C, Zimmermann P, Mitte K. Vergleichende Wirksamkeit von IRRT und EMDR bei kriegstraumatisierten deutschen Soldaten. Trauma und Gewalt 2015; 09 (03) 204-15.
  • 47 Duffy M, Gillespie K, Clark DM. Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: randomised controlled trial. BMJ 2007; 334 7604 1147.
  • 48 Brewin CR, Wheatley J, Patel T, Fearon P, Hackmann A, Wells A. et al. Imagery rescripting as a brief stand-alone treatment for depressed patients with intrusive memories. Behav Res Ther 2009; 47 (07) 569-76.
  • 49 Wheatley J, Brewin CR, Patel T, Hackmann A, Wells A, Fisher P. et al. “I’ll believe it when I can see it”: Imagery rescripting of intrusive sensory memories in depression. J Behav Ther Exp Psychiatry 2007; 38 (04) 371-85.
  • 50 Frets PG, Kevenaar C, van der Heiden C. Imagery rescripting as a stand-alone treatment for patients with social phobia: A case series. J Behav Ther Exp Psychiatry 2014; 45 (01) 160-9.
  • 51 Lee SW, Kwon JH. The efficacy of imagery rescripting (IR) for social phobia: a randomized controlled trial. J Behav Ther Exp Psychiatry 2013; 44 (04) 351-60.
  • 52 Wild J, Hackmann A, Clark DM. When the present visits the past: Updating traumatic memories in social phobia. J Behav Ther Exp Psychiatry 2007; 38 (04) 386-401.
  • 53 Wild J, Hackmann A, Clark DM. Rescripting early memories linked to negative images in social phobia: a pilot study. Behav Ther 2008; 39 (01) 47-56.
  • 54 Somerville K, Cooper M, Hackmann A. Spontaneous imagery in women with bulimia nervosa: An investigation into content, characteristics and links to childhood memories. J Behav Ther Exp Psychiatry 2007; 38 (04) 435-46.
  • 55 Ohanian V. Imagery rescripting within cognitive behavior therapy for bulimia nervosa: An illustrative case report. International Journal of Eating Disorders 2002; 31 (03) 352-7.
  • 56 Speckens AE, Hackmann A, Ehlers A, Cuthbert B. Imagery special issue: Intrusive images and memories of earlier adverse events in patients with obsessive compulsive disorder. J Behav Ther Exp Psychiatry 2007; 38 (04) 411-22.
  • 57 Veale D, Page N, Woodward E, Salkovskis P. Imagery Rescripting for obsessive compulsive disorder: A single case experimental design in 12 cases. J Behav Ther Exp Psychiatry 2015; 49: 230-6.
  • 58 Farrell JM, Shaw IA, Webber MA. A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. J Behav Ther Exp Psychiatry 2009; 40 (02) 317-28.
  • 59 Ritter V, Stangier U. Seeing in the Mind’s eye: Imagery rescripting for patients with body dysmorphic disorder. A single case series. J Behav Ther Exp Psychiatry 2016; 50: 187-95.
  • 60 Willson R, Veale D, Freeston M. Imagery rescripting for body dysmorphic disorder: A multiplebaseline single-case experimental design. Behav Ther 2016; 47 (02) 248-61.
  • 61 Holmes EA, Crane C, Fennell MJ, Williams JMG. Imagery about suicide in depression – “Flash-forwards”?. J Behav Ther Exp Psychiatry 2007; 38 (04) 423-34.
  • 62 Davis JL, Wright DC. Randomized clinical trial for treatment of chronic nightmares in trauma exposed adults. J Trauma Stress 2007; 20 (02) 123-33.
  • 63 Kunze AE, Lancee J, Morina N, Kindt M, Arntz A. Efficacy and mechanisms of imagery rescripting and imaginal exposure for nightmares: study protocol for a randomized controlled trial. Trials 2016; 17 (01) 469.
  • 64 Morina N, Lancee J, Arntz A. Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. J Behav Ther Exp Psychiatry 2017; 55: 6-15.
  • 65 Arntz A. Imagery rescripting as a therapeutic technique: review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology 2012; 03 (02) 189-208.
  • 66 Smucker MR, Dancu C, Foa EB, Niederee JL. Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy 1995; 09 (01) 3-17.
  • 67 Foa EB, Chrestman KR, Gilboa-Schechtman E. Prolonged Exposure Therapy for Adolescents with PTSD Emotional Processing of Traumatic Experiences. Therapist Guide: Oxford University Press; 2008
  • 68 Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M. Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behav Res Ther 2005; 43 (04) 413-31.
  • 69 Hirsch CR, Clark DM, Mathews A, Williams R. Self-images play a causal role in social phobia. Behav Res Ther 2003; 41 (08) 909-21.
  • 70 James M. Post-event processing: Its role in social phobia and social anxiety: University of Southampton. 2005
  • 71 Clark DM, Ehlers A, Hackmann A, McManus F, Fennell M, Grey N. et al. Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. J Consult Clin Psychol 2006; 74 (03) 568-78.
  • 72 Norton AR, Abbott MJ. The efficacy of imagery rescripting compared to cognitive restructuring for social anxiety disorder. J Anxiety Disord 2016; 40: 18-28.
  • 73 Hunt M, Bylsma L, Brock J, Fenton M, Goldberg A, Miller R. et al. The role of imagery in the maintenance and treatment of snake fear. J Behav Ther Exp Psychiatry 2006; 37 (04) 283-98.
  • 74 Hunt M, Fenton M. Imagery rescripting versus in vivo exposure in the treatment of snake fear. J Behav Ther Exp Psychiatry 2007; 38 (04) 329-44.
  • 75 Wheatley J, Hackmann A. Using Imagery Rescripting to treat major depression: Theory and practice. Cogn Behav Pract 2011; 18 (04) 444-53.
  • 76 Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 2004; 72 (01) 31-40.
  • 77 Holmes EA, Lang TJ, Moulds ML, Steele AM. Prospective and positive mental imagery deficits in dysphoria. Behav Res Ther 2008; 46 (08) 976-81.
  • 78 Williams AD, O’Moore K, Blackwell SE, Smith J, Holmes EA, Andrews G. Positive imagery cognitive bias modification (CBM) and internet-based cognitive behavioral therapy (iCBT): A randomized controlled trial. J Affect Disord 2015; 178: 131-41.
  • 79 Hagenaars MA, Arntz A. Reduced intrusion development after post-trauma imagery rescripting; an experimental study. J Behav Ther Exp Psychiatry 2012; 43 (02) 808-14.
  • 80 Ng RM, Krans J, Holmes EA. Mental imagery and psychopathology: Examples of post-traumatic stress disorder and bipolar disorder. Multisensory imagery. Berlin: Springer; 2013: 365-84.
  • 81 Holmes EA, Geddes JR, Colom F, Goodwin GM. Mental imagery as an emotional amplifier: application to bipolar disorder. Behav Res Ther 2008; 46 (12) 1251-8.
  • 82 Crane C, Shah D, Barnhofer T, Holmes EA. Suicidal imagery in a previously depressed community sample. Clin Psychol Psychother 2012; 19 (01) 57-69.