Words and images: the effects of verbalization and imagery on intrusions

Intrusive memories represent a core symptom of posttraumatic stress disorder (PTSD). Accordingly, experimental, and clinical research has heavily focused on advancing our understanding of intrusions, and by doing so tried to develop approaches to reduce them, with visual and verbal processes being key targets in this context. This narrative review presents an overview of both visual and verbal approaches aiming at manipulating intrusion frequency. Specifically, tasks are described that either facilitate or interfere with verbal or visual processes, and results of these manipulations in analogue and clinical studies are summarized. Overall, results showed that facilitating verbal processes can reduce the frequency of intrusions, while facilitating visual processes can lead to both increases and decreases in intrusion frequency. Visual interference tasks can also reduce intrusions, however the specific task used seems to be important. Studies on verbal interference tasks, however, present a rather heterogenous picture. Based on these results, possible mechanisms underlying reductions or increases in intrusions in response to these tasks are discussed, e.g., (re)consolidation, rumination, (re)appraisal, and suggestions for (mechanism-driven) follow-up research in both experimental and clinical settings as well as recommendations for clinical interventions are presented.