Fear of Thoughts, Images, and Trauma Memories

Like Chapter 5 (fear of emotions and bodily sensations), Chapter 7 discusses the treatment of internal threats including thoughts, images, and trauma memories. Imaginal exposure is particularly effective for the treatment of these fears. It has advantages over in vivo exposure because it can be used when in vivo exposure may not be appropriate or feasible (e.g., for combat traumas, contracting a disease, dying alone, harming someone). It can be used alone or in combination with in vivo exposure. When used in combination, it is generally delivered first in therapy (sequentially) or along with in vivo exposure (concurrently). Imaginal exposure therapy steps include identifying the core threat (downward arrow technique) or trauma memory, developing an imaginal exposure script/planning sheet, delivery of imaginal exposure for approximately 30-minutes (recording patient voice, first person, present tense), processing of the imaginal exposure (what was learned/meaning), and assigning home practice (listen to the recording daily). Imaginal exposure can be used as a transdiagnostic approach to reduce fear. In particular, the chapter discusses slight modifications in the cases of generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder.