The Influence of Anger and Imagery on the Maintenance and Treatment of PTSD

Research on post-traumatic stress disorder (PTSD) has burgeoned since its introduction in DSM-III in 1980. PTSD is conceptualised as a disorder of recovery and has been regarded as intrusion-driven, disordered, anxiety. However, recently there has been a call for explanatory theories of PTSD that better capture the complexity of the condition. Problematic anger is now recognised as an important aspect of PTSD in most sufferers. It is a key predictor of the development, maintenance and severity of PTSD and may be the principal impediment to successful treatment. Nevertheless, the psychological mechanisms underlying the relationship between PTSD and anger are not well understood. This chapter reviews evidence that imagery is an important mechanism within this relationship and is fundamental to the experience of traumatic stress reactions. Imagery is directly related to the prevalence of intrusions in PTSD and is highly correlated with posttraumatic anger. Further, visual imagery with angry content has profound psycho-physiological effects, magnifies the intensity of experienced anger and, ultimately, mediates the experience of PTSD itself. This review elucidates the linkages between angry imagery and PTSD symptomatology and offers propositions for adapting imagery-based PTSD interventions to the treatment of anger-affected PTSD.