Mental Imagery and Anxiety: What the Research Says

Mental imagery isn't neutral. It can help us plan, remember, and create—and it can also feed into anxiety, worry, and intrusive images. Research increasingly shows that vivid visual imagery is involved in the development and maintenance of anxiety and mood disorders, while imagery-based interventions are used to treat them. Many people also ask whether aphantasia—low or no voluntary visual imagery—changes the picture. Here's what the evidence says so far, with the important caveat that this is an overview, not medical advice. If you struggle with anxiety or intrusive imagery, a qualified professional can help.

How Imagery and Anxiety Are Linked

Studies find a bidirectional relationship between mental imagery and anxiety. Increases in mental imagery can predict later rises in anxiety, and anxiety can in turn strengthen intrusive or distressing imagery—an "emotional amplifier" pattern where imagery intensifies anxiety and helps maintain symptoms. Temporal network models have quantified these lagged links between mental imagery, anxiety, and mood instability. So imagery isn't just a side effect; it's part of the loop.

Intrusive visual imagery is especially relevant. In anxiety and mood disorders, unwanted or repeated mental images often play a core role in maintaining symptoms. Systematic reviews confirm that visual mental imagery influences how these disorders persist, including trauma-related intrusions where anxiety bridges the imagery and the distress. The content of imagery—and how we appraise it (e.g. negative interpretations)—can heighten anxiety and fuel worry cycles, though the exact worry–imagery links are still being clarified. So both the presence of vivid imagery and the way we respond to it matter.

Imagery-Based Interventions

Because imagery is part of the picture, targeting it in treatment makes sense. Interventions that work with mental imagery alongside verbal or cognitive approaches can improve outcomes in psychosis, anxiety, and related conditions. For example, addressing both the imagery and the verbal interpretations of symptoms (e.g. voices, intrusive thoughts) can refine cognitive models and support psychosocial treatments. So imagery is not only a risk factor; it's also a lever—therapists may use imagery to expose people to feared scenarios in a controlled way, or to build alternative, calming or supportive images. If you're interested in imagery-focused work, a mental health provider can discuss what's appropriate for you.

Aphantasia and Anxiety: Preliminary Findings

A recurring question is whether people with aphantasia experience anxiety or intrusive imagery differently. By definition, they have little or no voluntary visual imagery, so the kind of intrusive visual images that show up in anxiety or PTSD might be reduced or absent—but they can still have verbal worry, auditory intrusions, or other forms of distress.

One recent study (provisionally accepted at the time of writing) compared people with aphantasia to those with vivid imagery. It found that people with aphantasia reported lower anxiety and less intrusive imagery. In emotional tasks (e.g. romantic emotion), the aphantasia group showed muted neural responses (e.g. smaller P3 amplitudes, shorter late positive potentials, less alpha suppression) and muted autonomic responses (minimal heart rate increase, less heart-rate-variability suppression)—suggesting weaker emotional "embodiment" when imagery isn't there to carry it. The authors suggest that aphantasia may buffer some imagery-driven anxiety or intrusions.

Those findings are preliminary. The study is a single report; there is no direct data yet on clinical anxiety disorders, generalized worry, or long-term mental health in aphantasia. So we should not conclude that aphantasia "protects" against anxiety or that people with aphantasia never experience intrusive thoughts—they can have verbal rumination, mental "noise," or other forms of anxiety. The takeaway is that the visual channel of intrusion may work differently when visual imagery is absent; the rest of the picture is still open.

What This Means in Practice

• If you have vivid imagery and anxiety or intrusions: You're not imagining it—research supports that imagery and anxiety interact. Imagery-based interventions exist and can be part of treatment. Speaking with a therapist or doctor is the right step.
• If you have aphantasia: You may experience less visual intrusive imagery, and one study suggests you might report lower anxiety and fewer intrusions overall. Don't assume that means you're immune to anxiety or that you don't need support if you're struggling. Anxiety can show up in many forms.
• Knowing your imagery profile can help you and a clinician understand which channels (visual, auditory, verbal) matter most for you—and which interventions might fit.

See Your Imagery Profile

The Imagination Index assessment measures visual, auditory, and other senses. It's not a mental health screen—it's a way to see how you imagine. If you're curious how your imagery compares across senses, the profile can give you a baseline. The core assessment is free and takes about 12 minutes.

Further reading: Imagery, anxiety, and symptom maintenance – PMC; Mental imagery and mood instability – Wiley; Aphantasia and emotional response – Frontiers; Intrusive imagery in disorders – SAGE.