Lack of Imagery Doesn't Protect From Trauma

Reduced Visual Imagery Vividness as a Risk Factor for PTSD: Implications for Aphantasia and Imagery-Based Treatments

Diane Swick, Sandy J. Lwi & Jary Larsen, 2026

The Question

Some researchers have proposed that vivid mental imagery makes PTSD worse, because a stronger ability to generate mental pictures might mean stronger, more intrusive flashbacks. Under that theory, people with aphantasia should be protected from PTSD. This study tested that idea directly in a large sample of military Veterans, including a small group who have aphantasia.

The Discovery

Researchers gave 312 Veterans two questionnaires, one measuring how vivid their mental imagery is and one measuring PTSD symptoms. The result ran opposite to the protection theory. Veterans with less vivid imagery reported significantly more severe PTSD symptoms and this was true across all symptom clusters measured, including intrusive memories, avoidance, negative mood and cognition, and hyperarousal. The strongest connection was with negative thoughts and mood, not with flashbacks specifically.

Eight Veterans in the study met the criteria for aphantasia. Their PTSD scores ranged from 8 to 60 on a scale where 33 or above is considered clinically significant. Five of the eight scored above that line. Two of the highest scorers on intrusive symptoms in the entire study were among the participants who reported no visual imagery at all. Aphantasia did not protect them.

A more specific pattern emerged when the researchers looked at trauma type. Among men whose trauma involved combat, more vivid imagery was strongly linked to milder PTSD symptoms. Among women whose trauma involved military sexual trauma, there was no relationship between imagery and symptom severity at all.

The Catch

Only 8 of the 312 participants had aphantasia, which is a small number to draw firm conclusions from. The researchers are careful to frame this as consistent with but not proof of, two earlier independent studies that found the same pattern. The study is also cross-sectional, meaning everyone was measured at a single point in time. That makes it impossible to tell whether less vivid imagery makes someone more vulnerable to PTSD, or whether having PTSD for a long time gradually reduces a person’s imagery through avoidance and emotional numbing. Everything is self-reported, including both the imagery questionnaire and the PTSD checklist.

The Insight

The theory that aphantasia might shield someone from PTSD treats visual flashbacks as the central problem. This research suggests the picture is more complicated. PTSD symptoms show up through emotional, physical, and cognitive channels that do not require a mental picture at all. A person with aphantasia can still feel intense physical reactions to trauma reminders, carry harsh beliefs about themselves and the world, and avoid situations that feel unsafe, all without a single visual flashback. The absence of pictures does not mean the absence of trauma's grip.

The One Thing to Remember

A person with aphantasia who has been through something traumatic may not describe what is happening to them as flashbacks, because they may not be having any. They may describe it as a wave of physical dread, a conviction that the world is unsafe, or a persistent low mood they cannot name a cause for. A parent, teacher, or therapist working with someone who has aphantasia should not rule out trauma just because the person says “I don't really picture it” or “I don't get flashbacks.” The trauma may still be there, working through a different channel.

I think it is important to remember that this is a VERY small sample size. But it is interesting that we tend to think of PTSD as "flashback" when then the trauma could be held in the body and show up in a way that is not immediately connected to the PTSD.

The Connection

The guide's appendix for counselors raises the concern that imagery-based therapies like guided visualization may not work well for people with aphantasia. This research adds weight to that caution from a different angle. If imagery-based exposure therapies rely on the patient generating a vivid mental image of the traumatic event, and a person with aphantasia cannot generate that image, the standard tool may not just be ineffective. It may be the wrong tool entirely for reaching where the trauma actually lives in that person's experience. That said, the study only suggests this possibility, it does not directly test treatment outcomes.

The Source

You can read the full paper by clicking here.

I feel like saying it one more time. Very small sample size. It is why for most of these summaries I add in the numbers. Please don't take any of the results as the final answer.