Content of Visual Mental Imagery in Mood and Anxiety Disorders: A Qualitative Systematic Literature Review

Mental imagery is an internal representation of perceptual experiences without external sensory input. Visual mental imagery plays a recognized role in the development and maintenance of anxiety and mood disorders. In this systematic literature review, we explored the kind of visual mental imagery content, its emotional impact, and possible recurrent visual mental imagery patterns (i.e., specific theme/content type) in individuals with mood and anxiety disorders. The mood disorders included in the review were Major Depressive Disorder (MDD), bipolar disorder, suicidal behavior (attempts) and ideation, or non-suicidal injury (NSSI), as per the DSM-V. The Anxiety disorders included were post-traumatic stress disorder (PTSD) and social anxiety (SA) as per the DSM-IV and DSM-V. Electronic searches of five databases between January 2000 and April 2024 were undertaken to identify relevant publications, including qualitative, qualitative, and mixed-methods studies, with a final list of 17 studies eligible for review. The studies were synthesized using thematic synthesis. The results suggest that recurrent visual imagery content patterns across different mental health conditions include visualizing interpersonal interactions such as fighting with a spouse or another family member, suicide or self-harm-based imagery, and crossing one's boundaries by another. In addition, although individuals with anxiety and mood disorders are more prone to experience negative visual visual mental imagery, they can also experience positive visual mental imagery. In conclusion, the content of visual mental imagery can be objectively positive and negative, but ultimately, an individual's appraisal is the driving factor behind the emotional impact of visual mental imagery.