I’m hurt, annoyed and see things: anger in PTSD and the role of visual imagery

Abstract

This research investigated the role of imagery as a mechanism underlying anger’s relationship to posttraumatic stress disorder (PTSD). Previous research has demonstrated that anger is a strong predictor of PTSD severity and comprehensive reviews have argued for the development of nuanced explanatory models describing the psychological mechanisms underlying this relationship. Research has shown that visual imagery is linked to a range of psychological phenomena and psychopathologies, the clearest case being anxiety disorders. Imagery may also have a strong role in eliciting anger. Exemplifying this is research demonstrating that imagery with angry content has a profound psycho-physiological effect. Dysregulated imagery is the hallmark of PTSD and research has shown that anger in PTSD is directly related to intrusion prevalence. PTSD sufferers with high imagery control have fewer intrusions and less anger, compared to those with low imagery control. The current research program investigated these issues in three separate cross-sectional and longitudinal studies. It aimed to explore the potential moderating and mediating roles of imagery and negative thought as twin dimensions of cognition in anger in PTSD, compared to their roles in anxiety and depression. Participants in Studies One and Three comprised treatment seeking past and present police and military personnel with PTSD (n = 123 and 462 respectively). Study Two explored these issues in an analogue population of university students (n = 197). It was predicted that anger would be more strongly associated with PTSD than anxiety and depression and that imagery and thought would be differentially associated with anger compared to anxiety and depression. It was further hypothesised that the magnitude of imagery and thought and their impact on affect would increase in the context of PTSD via direct and interactive effects and that patterns of effect would vary by PTSD population and the nature of the trauma experienced. Results demonstrated that: (a) anger was strongly predictive of PTSD, (b) different facets of imagery were linked to different negative affects, (c) imagery and thought were linked to anger and mediated its relationship to PTSD, (d) thought mediated the effect of imagery in anger in PTSD and (e) the potency of imagery and thought were increased in PTSD and were reflective of the nature of the trauma involved. These findings demonstrated the powerful role played by imagery and thought in the genesis and maintenance of anger in PTSD. They provide a basis for developing a fuller description and theoretical account of the aetiology and maintenance of anger in PTSD and offer new possibilities for improvements in its treatment.