The Impact of Aphantasia on Mental Healthcare Experiences

Mawtus, Renwick, Thomas & Reeder — Collabra: Psychology, 2024

This study looked at how not having a visual mind's eye affects whether people with aphantasia get accurate diagnoses and helpful treatment. Researchers surveyed over 2,800 people and did in-depth interviews with 22 of them. They specifically looked at how well common therapies like CBT work for people who can't visualize.

People with aphantasia experience mental health conditions just as often as everyone else, but their symptoms look different because the visual stuff is mostly absent. That difference is causing real problems. Many diagnoses rely on imagery-based symptoms like flashbacks in PTSD, and most standard therapies are built around visualization exercises.

When a person with aphantasia can't do the "picture this" part of therapy, some therapists conclude the patient is resistant or not trying hard enough. The therapy that does work is basically the same therapy, just with the visual components removed.

If you remember one thing — CBT can work for people with aphantasia, but only when the therapist drops the visualization exercises and stops assuming everyone's brain works the same way.

If you have read No Picture Needed, here is the connection to the paper...

The guide has a whole section on what happens when the strategy requires a mind's eye. The table that walks through what to do instead of asking someone to visualize a safe place, or picture themselves succeeding, or mentally rehearse a hard thing. This research is why that table exists. These are not hypothetical workarounds. They are what actually works, confirmed now in a study of nearly 3,000 people.

The guide also names something therapists need to hear. When a client can't do the visualization homework, the trained response is often to label them resistant. This study puts a number on that mistake. Aphantasic participants consistently rated imagery-based therapy as ineffective.