Mental imagery and its role in the psychopathology and treatment of obsessive-compulsive disorder: A systematic review and narrative synthesis

This review examined the features of intrusive mental imagery in obsessive-compulsive disorder (OCD), and evaluated the literature of imagery-based therapies such as EMDR and Imagery Rescripting (ImRs) in treating symptoms.

Article Abstract

“Whilst intrusive mental images are recognised within diagnostic descriptions of obsessions in OCD, research remains limited, with most work focusing on intrusive thoughts. Moreover, it has been suggested that mental imagery might represent a distinct form of OCD symptomatology and could potentially be harnessed to treat symptoms. We performed a systematic review, adopting a two-phased approach, to examine the role of mental imagery in both the psychopathology and treatment of OCD. First, we explored the characteristics and pathological features of intrusive imagery in OCD. Second, we evaluated literature examining imagery-based interventions, i.e., Imagery Rescripting (ImRs) and Eye Movement Desensitisation and Reprocessing (EMDR), in treating symptoms. Findings from the included studies suggest that distressing mental imagery is a clinically relevant feature of OCD for a substantial proportion of affected individuals. Intrusive imagery in OCD was commonly characterised as vivid, distressing, predominantly visual images often accompanied by bodily sensations. Compared to other anxiety disorders, intrusive imagery in OCD appeared to occur more frequently and was associated with appraisals involving fears of having a “dangerous self” or being a threat to others. Up to 89% of OCD patients reported experiencing intrusive imagery, with 70–79% of these also reporting that the intrusions related to adverse or traumatic events.

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Article Access

Open Access

Zenoni, M., Badaoui, A., Brewin, C. R., Milton, A. L., Archer, S., Bloomfield, M. A. P., & Bisby, J. A. (2026). Mental imagery and its role in the psychopathology and treatment of obsessive-compulsive disorder: A systematic review and narrative synthesis. Journal of Anxiety Disorders, 122: 103206. https://doi.org/10.1016/j.janxdis.2026.103206

About the Journal

“Journal of Anxiety Disorders is an interdisciplinary journal that publishes research papers dealing with all aspects of anxiety disorders for all age groups (child, adolescent, adult and geriatric).”

—Description from publisher