The role of mental imagery in worry: Insights from aphantasia

Worry is characterised by thinking about prospective negative future outcomes, and is a key cognitive feature of anxiety. The influential Cognitive Avoidance Model suggests that worry involves visual imagery (mental pictures in the mind's eye) of negative potential outcomes, followed by the attempt to avoid such imagery due to its potentially aversive nature (e.g., by worrying in words instead). Here, we examine the role of imagery in worry by testing people with and without aphantasia - a profound weakness or absence of visual imagery. We show that although aphantasics (n = 59) are no different than imagers (n = 92) in their self-reported levels of day-to-day worry and anxiety, they possess a number of protective qualities: they are less likely to catastrophise in a catastrophising interview, and self-report being less threatened by their worries (in concern or cost), and less likely to cognitively avoid worrisome thoughts. Additionally, when their imagery deficit extends to all senses (dysikonesia), aphantasics are also better able to stop-worrying on command in a stop-worry task. Additionally, we examined the phenomenology of worry. We show that aphantasics report being less likely to worry via verbal-linguistic thought, nor visual imagery, or imagery of any kind (e.g., tactile, taste, smell, etc). Instead, aphantasics experience their worries as somatic symptoms, and abstract conceptual thought. Together, our findings demonstrate that while imagery is not required for worry, imagery plays an influential role, and lacking imagery provides a level of protection against certain worry traits.