Mental Imagery Research Articles

The Effect of Visual Mental Imagery Developing in Improving Pragmatic Language Among Children with Autism Spectrum Disorder

The Effect of Visual Mental Imagery Developing in Improving Pragmatic Language Among Children with Autism Spectrum Disorder

The Impact of Mental Imagery Instructions on Patients' and Therapists' Positive Affect and Strength-Based Behaviours Within Psychotherapy Sessions: A Randomized Controlled Process Study.

Increased attention has recently been paid to the well-being and flourishing of patients in psychotherapy. This study investigated the occurrence of positive affect (PA) and strength-based behaviours within psychotherapy sessions contrasting positive versus neutral imagery instructions. This is a secondary analysis of a randomized controlled trial. Seventy-eight sessions of cognitive behavioural therapy involving 26 patients (69.23% female; Mage = 40.31) treated by 13 therapists were selected. PA and strength-based behaviours of patients and therapists were coded on a minute-by-minute basis with the Resource-Oriented Microprocess Analysis. Each session started with a brief mental imagery instruction. Data were analysed using multilevel modelling. Mild levels of PA were very common, whereas stronger expressions were occasional, especially at the beginning and end of sessions. Strength-based behaviours were employed in one-fifth of the videos analysed. Therapists in the positive imagery instruction showed more strength-based behaviours in the beginning phase of sessions, p < 0.05. The two imagery instructions significantly differed in the session trajectories of PA, p < 0.05. A quadratic trend with higher initial values and a sharper decline in PA were found in the positive instruction, whereas the neutral instruction showed a flatter trend. Patients and therapists experience PA and discuss strengths in psychotherapy sessions despite patients' distress. The positive imagery instructions potentially induced a positive focus at baseline for therapists but had a negligible effect on the subsequent session progression. ClinicalTrials.gov identifier: NCT03767101 (registered December 6, 2018).

The Mental Image in the Poetry of Fawzi Al-Saad (Selected Models)

This study examines the poetry of Fawzi Al-Saad to highlight his ability to create mental imagery intertwined with ascending patterns, which is one of his most important expressive tools. This ability stems from the evolving and integrated ideas and visions within him. Through this integration, the poet dissolves the familiar and rewrites it mentally according to his vision born from the thrill of risk. By means of imagination, which is both unfettered and disciplined by reason that transcends the mind of the recipient, pure mental and dreamlike images are formed. These images carry aesthetic gestures, imbued with significant depth, revealing the poet's experience.

Cognitive Dissonance Equilibrium: Local Product Stigma in the "Filosofi Pete" Ad Narrative Flow

Following the 1998 reform in Indonesia, advertising has undergone significant expansion, leveraging enhanced communication accessibility and media proliferation to shape public perceptions of promoted goods. Presently, media channels are inundated with commercial campaigns showcasing both domestic and international products. Within this landscape, Tokopedia, a key player in the e-commerce sector, employs diverse media platforms such as YouTube to engage consumers amid intensifying market rivalry. This study delves into Tokopedia's approach via the "Filosofi Pete" advertisement, exploring its endeavors to combat stereotypes surrounding local products. Drawing parallels between domestic goods and petai a culturally stigmatized item the research highlights the heightened stigma amid globalization, where foreign products often enjoy elevated prestige and perceived quality standards. Through the lens of cognitive dissonance theory and Todorov's narrative analysis, the analysis reveals Tokopedia's strategic narrative framework aimed at reshaping perceptions towards local products. By dissecting the advertisement's storyline, narrative structure, and visual elements, the study unveils Tokopedia's nuanced tactics for challenging entrenched biases. Through compelling storytelling and visual imagery, Tokopedia endeavors to reframe the discourse around local products, fostering a more favorable consumer outlook. This research sheds light on the intricate interplay between advertising strategies, cultural perceptions, and consumer behavior, offering insights into how brands navigate evolving market dynamics to carve out a competitive edge.

Experiences of imagery-based treatment for anxiety in bipolar disorder: A qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial.

Intrusive mental imagery is associated with anxiety in bipolar disorder (BD) and presents a novel treatment target. Imagery-based treatments show promise in targeting anxiety and improving mood instability. This qualitative study explored experiences of receiving up to 12 sessions of a brief structured psychological intervention: Image-Based Emotion Regulation (IBER), which targets maladaptive mental imagery in the context of BD with an aim to modify the emotional impact of these images. A qualitative study embedded within the Image Based Emotion Regulation (IBER) feasibility randomised controlled trial. Semi-structured interviews were conducted with 12 participants in the treatment arm of the trial who received IBER + treatment as usual. Data were analysed using thematic analysis. Despite some initial scepticism about imagery-focused treatment, all participants expressed broadly positive accounts of treatment experiences. High levels of engagement with imagery modification techniques, beneficial use of techniques post treatment and improvements in anxiety management and agency were described by some. Three sub-groups were identified: those who reported a powerful transformative impact of treatment; those who embedded some new techniques into their daily lives, and those who felt they had techniques to use when needed. No participants reported overall negative experiences of the IBER treatment. Findings from this study highlight the value for treatment recipients of modifying the underlying meanings associated with maladaptive imagery, and the personalised skills development to manage anxiety within bipolar disorders. Findings can inform treatment refinements and further trial-based evaluations.

Fostering EFL university students’ motivation and self-regulated learning in writing: A socio-constructivist approach

Research acknowledges that learners’ motivation and self-regulation benefit their academic growth, and it applies to writing development. However, limited research has investigated how learners are supported to foster motivation and cultivate self-regulated learning strategies in writing classrooms. Drawing upon data from semi-structured interviews, self-reflections, and developing drafts, this qualitative case study examined how six first-year EFL university students with previous exam-focused writing experience developed motivation and employed self-regulated learning strategies in writing in a year-long English writing course designed based on the socio-constructivist approach. Analysis revealed that the participants experienced positive changes in writing motivation, including enhanced task interest, clarified outcome expectations, refocused goal orientation, and increased self-efficacy in writing, as they engaged in interrelated social and collaborative writing activities. They also used various self-regulated learning strategies, including cognitive strategies, goal setting, self-evaluative standards, self-selected models, and mental imagery, to improve writing skills and navigate writing. The study provides implications for researchers and practitioners in EFL writing within exam-oriented contexts.

Motor Intentions Decoded from fMRI Signals.

Motor intention is a high-level brain function related to planning for movement. Although studies have shown that motor intentions can be decoded from brain signals before movement execution, it is unclear whether intentions relating to mental imagery of movement can be decoded. Here, we investigated whether differences in spatial and temporal patterns of brain activation were elicited by intentions to perform different types of motor imagery and whether the patterns could be used by a multivariate pattern classifier to detect such differential intentions. The results showed that it is possible to decode intentions before the onset of different types of motor imagery from functional MR signals obtained from fronto-parietal brain regions, such as the premotor cortex and posterior parietal cortex, while controlling for eye movements and for muscular activity of the hands. These results highlight the critical role played by the aforementioned brain regions in covert motor intentions. Moreover, they have substantial implications for rehabilitating patients with motor disabilities.

Analysing the Mental Imagery Training to Improve the Ability of Petanque Sport Shooting Game: Literature Review

Objective. The purpose of this study was to determine the role of biomechanical mental imagery training analysis in improving the ability of Petanque Sports Shooting Game. Materials and methods. This review study was performed following the PRISMA standards for systematic reviews and meta-analyses. The studies were required to have been published within the previous four years, from January 2020 to July 2023. (1) petanque shooting; (2) mental imagery analysis were the keywords used in the search process. To conduct the study, the database Scopus and SINTA (Science and Technology Index) were used. Results. The findings of the literature review yielded a final sample comprising 7 relevant articles. Specifically, 3 articles focused on imagery training for enhancing petanque shooting results, while 4 articles examined the effects of petanque shot improvement on the shooting game abilities of this sport. Conclusions. This study revealed that mental imagery exercise analysis significantly improved the performance of petanque athletes in the match phase, enhancing their performance, motivation, and concentration, making it a valuable method for achieving positive effects on physical and mental performance in petanque athletes.

Imagining flying increases jumping performance in volleyball players: A pilot study

ObjectiveThe study aimed to examine the effect of mental imagery on sports performance. Specifically, it was tested whether imagining flying (i.e., air travel) increases jumping performance in a group of female volleyball players. MethodsThe study included 46 female young athletes (mean age = 15.23 years; standard deviation = 2.4) divided into two groups: the experimental group viewed a three-dimensional video that simulated a flying experience, while the control group watched neutral footage. The jump performance of both groups was measured before and after viewing the videos, using the Vertec Like® instrument to assess jump height. Participants were assessed for their flow disposition, mental imagery skills, and image vividness. ResultsComparing pre-post jump performance scores, the experimental group showed a significant improvement over the control group, with a medium-large effect size (d = 0.634). There was no significant association between flow disposition, mental imagery skills, image vividness, and pre-post jumping performance differences (respectively: β = −0.107, p = .484; β = −0.008, p = .957; β = 0.024, p = .913). ConclusionsThese findings suggest that the experience of imagining flying, enhanced with an immersive video, has a positive effect on jumping performance in a one-session study with young female volleyball players. This effect does not appear to be associated with pre-existing characteristics or the vividness of the image itself.

Vividness of visual imagery is associated with the effect of relaxation response meditation training in elderly people with nonorganic insomnia: A randomized, double-blind, multi-center clinical trial

BackgroundThis study aims to explore the efficacy of Relaxation Response Meditation Training (RRMT) on elderly individuals with different levels of vividness of visual imagery. MethodsIn this randomized controlled, double-blind, multi-center clinical trial, we recruited a total of 136 elderly individuals who were over 60 years with nonorganic sleep disorders to participate in a 4-week RRMT intervention from October 2020 to October 2022. The intervention occurred twice a week, totaling eight times. These individuals were divided into high and low groups based on the vividness of visual imagery, and then randomly assigned to either the control or intervention groups, as follows: low-visualizers intervention group (LI group); low-visualizers control group (LC group); high-visualizers intervention group (HI group); high-visualizers control group (HC group). Their social and psychological parameters were assessed before and after the intervention by the Pittsburgh Sleep Quality Index (PSQI), the Revised Piper's fatigue scale (RPFS), General well-being scale (GWB), and Satisfaction rating. The alpha waves of patients were also collected through electroencephalogram to assess their level of relaxation. ResultsCompared to the LI group, the HI group had a greater reduction rate in the PSQI score [25.2 % (18.8 % to 31.7 %), P < 0∙001], shorter sleep latency (P = 0.001), lower frequency of sleep medication (P < 0.001), lower PSQI scores (P < 0.001), and higher GWB scores (P < 0.001). There were significant differences in all indicators in the HI group vs. HC group and in the LI group vs. LC group. In the first five relaxation training sessions, there was no statistically significant difference in the proportion of α waves between the LI group and the LC group; however, from the sixth session onward, we observed a statistically significant difference (t = 2.86, P = 0.019)，while The HI group and HC group showing significant differences in the first relaxation training session (t = 4.464, P < 0.001). There was a statistically significant difference in subjective satisfaction between the intervention group and the control group (x2 = 49.605, P < 0.001). ConclusionIn this study, we found that most elderly people benefitted from RRMT regardless of their vividness of visual imagery. However, low-visualizers experienced slower and less effective results, so these patients may benefit more from alternative approaches.

The Impact of Using the Trainings of Mental Visualization on Learning Crawl Swimming

Objectives: The study aimed to investigate the impact of using mental imagery exercises in teaching crawl swimming. Methods: The experimental approach was adopted for its suitability to the nature of the study. The study sample consisted of 30 male students enrolled in the swimming course (1) for the second semester of the academic year 2020-2021 at the College of Sports Sciences, Mu'tah University. They were purposefully selected and randomly assigned to two equally matched groups. The experimental group, comprising 15 students, utilized a proposed educational program accompanied by mental imagery exercises, while the control group, also consisting of 15 students, followed a standard educational program. The implementation of the educational program lasted for 8 weeks, with two instructional sessions per week and a total of 16 instructional units. Results: There were statistically significant differences at a significance level (≥ α 0.05) in teaching crawl swimming between the two groups in dimensional measurement, in favor of the experimental group, indicating the impact of using mental imagery exercises in teaching prone crawl swimming compared to the control group. The effect size ranged from 25.31% to 15.77%. The results also showed no statistically significant differences at a significant level (≥ α 0.05) between the two groups according to the "arm movements" test. Conclusions: It is recommended to incorporate mental imagery exercises into the instructional program for teaching the front crawl swimming technique, as they have a positive impact on improving and expediting the learning process. The use of mental visualization exercises for motor skills requiring more precise motor coordination and conducting studies and scientific research on different types of swimming and more complex skills, is recommended.

Motor imagery ability of children with duchenne muscular dystrophy: Reliability and validity of kinesthetic and Visual Imagery Questionnaire-10, and its association with cognitive status

PurposeTo investigate validity and reliability of the Kinesthetic and Visual Imagery Questionnaire-10 (KVIQ-10) in children with Duchenne Muscular Dystrophy (DMD), to compare the motor imagery (MI) ability with age-matched controls, and to examine the relationship between MI ability and cognitive status. MethodsThe research involved 38 children who were diagnosed with DMD, as well as 20 healthy controls aged between 7 and 18 years. The KVIQ-10 was assessed for its test-retest reliability, internal consistency, construct and concurrent validity. The Motor Imagery Questionnaire for Children (MIQ-C) was selected as the gold standard test for concurrent validity. Cognitive function was assessed using the Modified Mini Mental Test (MMMT) and Montreal Cognitive Assessment (MoCA). ResultsKVIQ-10 showed excellent test-retest reliability (ICC>0.90) and high internal consistency (Cronbach's alpha>0.70). A moderate-to-strong association was found between KVIQ-10 and MIQ-C subscales (p < 0.001). KVIQ-10 and MIQ-C subscores were statistically lower in the DMD group (p ≤ 0.05). A correlation was found between MoCA and KVIQ-10 in children with DMD (p ≤ 0.05). ConclusionsThe KVIQ-10 is a reliable and valid measure to assess the MI ability of children with DMD whose imagery ability was determined to be impaired. Clinical trial registration number and urlNCT05559710 (https://classic.clinicaltrials.gov/ct2/show/NCT05559710?term=NCT05559710&draw=2&rank=1)

Brain regions supporting retrieval of words drawn at encoding: fMRI evidence for multimodal reactivation.

Memory for words that are drawn or sketched by the participant, rather than written, during encoding is typically superior. While this drawing benefit has been reliably demonstrated in recent years, there has yet to be an investigation of its neural basis. Here, we asked participants to either create drawings, repeatedly write, or list physical characteristics depicting each target word during encoding. Participants then completed a recognition memory test for target words while undergoing functional magnetic resonance imaging (fMRI). Behavioural results showed memory was significantly higher for words drawn than written, replicating the typical drawing effect. Memory for words whose physical characteristics were listed at encoding was also higher than for those written repeatedly, but lower than for those drawn. Voxel-wise analyses of fMRI data revealed two distributed sets of brain regions more active for items drawn relative to written, the left angular gyrus (BA 39) and bilateral frontal (BA 10) regions, suggesting integration and self-referential processing during retrieval of drawn words. Brain-behaviour correlation analyses showed that the size of one's memory benefit for words drawn relative to written at encoding was positively correlated with activation in brain regions linked to visual representation and imagery (BA 17 and cuneus) and motor planning (premotor and supplementary motor areas; BA 6). This study suggests that drawing benefits memory by coactivating multiple sensory traces. Target words drawn during encoding are subsequently remembered by re-engaging visual, motoric, and semantic representations.

Neural mechanisms of psychedelic visual imagery.

Visual alterations under classic psychedelics can include rich phenomenological accounts of eyes-closed imagery. Preclinical evidence suggests agonism of the 5-HT2A receptor may reduce synaptic gain to produce psychedelic-induced imagery. However, this has not been investigated in humans. To infer the directed connectivity changes to visual connectivity underlying psychedelic visual imagery in healthy adults, a double-blind, randomised, placebo-controlled, cross-over study was performed, and dynamic causal modelling was applied to the resting state eyes-closed functional MRI scans of 24 subjects after administration of 0.2 mg/kg of the serotonergic psychedelic drug, psilocybin (magic mushrooms), or placebo. The effective connectivity model included the early visual area, fusiform gyrus, intraparietal sulcus, and inferior frontal gyrus. We observed a pattern of increased self-inhibition of both early visual and higher visual-association regions under psilocybin that was consistent with preclinical findings. We also observed a pattern of reduced inhibition from visual-association regions to earlier visual areas that indicated top-down connectivity is enhanced during visual imagery. The results were analysed with behavioural measures taken immediately after the scans, suggesting psilocybin-induced decreased sensitivity to neural inputs is associated with the perception of eyes-closed visual imagery. The findings inform our basic and clinical understanding of visual perception. They reveal neural mechanisms that, by affecting balance, may increase the impact of top-down feedback connectivity on perception, which could contribute to the visual imagery seen with eyes-closed during psychedelic experiences.

Exploring the evocative qualities of masks' visual imagery and their associations with adversity and trauma.

Studies suggest a relationship between the emotional evocativeness of visual imagery and viewer responses, however, there is limited understanding of these associations, especially as they relate to viewers' personal experiences of adversities. In this exploratory study, we examined the relationship between the visual content of mask images and viewers' responses. In an online survey 699 participants (of n = 1,010 total initial participants) rated 98 masks based on valence, arousal, and personal relevance and completed the Life Events Checklist. The masks included those created by service members (SMs) with traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD), depicting physical, psychological, and moral injuries and matched neutral masks created by creative arts therapists and arts in health scholars. The findings indicated that responses to mask image content (traumatic versus neutral) were associated with viewers' personal history of adversity and trauma. Specifically, images representing injury/trauma provoked stronger reactions on valence and arousal than neutral images. Moreover, participants with personal histories of trauma had heightened emotional responses to distressing imagery. These findings have implications for art therapists as well as for clinical and general populations in that these results highlight the potential impact of distressing imagery particularly for individuals with personal histories of experiencing or witnessing traumatic events.

A qualitative pilot study examining Tibetan bowls and monochord sound meditation with adults with mental health conditions and intellectual disabilities

Tibetan bowls and monochords are millennia-old instruments used for spiritual and therapeutic purposes. In the last few decades, there has been growing interest in the use of these instruments in meditation and therapeutic settings. Nevertheless, they are still rarely used in music therapy in the Western world, either because of technical difficulties or musical or cultural biases. The purpose of this pilot study was to examine the experiences of adults with mental health conditions and intellectual disabilities during sound meditation sessions using Tibetan bowls and a monochord. In this qualitative pilot, a group of six psychiatric inpatients participated in seven weekly sound meditation sessions over eight weeks that implemented Tibetan bowls and the monochord combined with meditation. Semi-structured interviews were conducted after each session to capture participants’ reflections on their experiences. The interview data was analysed using thematic analysis. Three main themes emerged: physical sensations, experiences of emotions, and visual experiences. The sounds of the Tibetan bowls and the monochord helped participants relax and evoked a wealth of emotions and mental imagery. These findings suggest that using these instruments with adults with mental health conditions and intellectual disabilities can foster relaxation, as well as heighten their awareness of physical sensations, feelings, and previous life events. Music therapists can thus integrate Tibetan bowls and the monochord into their skillset and use them during treatment sessions.

Improving prospective memory in persons with multiple sclerosis via telehealth: A randomized feasibility study

BackgroundPersons with multiple sclerosis (PwMS) can experience deficits in prospective memory (PM) or “remembering to remember,” which are associated with functional difficulties. However, no cognitive rehabilitation intervention has specifically addressed improving PM in PwMS. The Telehealth PM Intervention (TPMI) provides a novel combination of two strategies—visual imagery and implementation intentions—that have each been beneficial in other populations. This study aimed to evaluate the feasibility of TPMI and its preliminary efficacy, which could be used to inform future trials. MethodsParticipants (n = 35) were PwMS who were pre-screened and endorsed experiencing problems “remembering places they have to be” and “things they have to do.” After completing a baseline evaluation, which included objective (Memory for Intentions Test; MIST) and subjective (Perceived Deficits Questionnaire; PDQ-PM) measures of PM, participants were randomized to either the active treatment (TPMI; n = 17) or active control group (Control; n = 18). TPMI was offered through remote one-on-one sessions twice a week over a four-week period. Participants were asked about treatment credibility and expectancy during the first session. The MIST and PDQ-PM were repeated at post-treatment, where treatment satisfaction was also captured. Mann-Whitney U and chi-square tests were used to examine the feasibility measures, while repeated measures ANOVAs were used to examine changes in the PM outcomes. ResultsA total of 88.2 % of the TPMI group completed all eight sessions, with moderate-to-high (≥7 out of 10) treatment credibility/expectancy and satisfaction reported by 93.3 % and 86.7 %, respectively. While there were no significant effects on overall PM, the TPMI group had an improvement in objective time-based PM after adjusting for baseline differences (F(1,29) = 4.61, p = 0.040; d = 0.80). Furthermore, the TPMI group had a significant reduction in the number of time-based loss of content errors compared to the Control group, which remained significant after covariate adjustment (F(1,25) = 4.29, p = 0.049; d = 0.83). ConclusionsTPMI is a feasible intervention, with high completion rates and moderate-to-high treatment ratings, that can be delivered remotely. Early evidence shows its potential benefit for improving time-based PM, a particular concern for PwMS, which should be further evaluated in a larger clinical trial.

Ocular working memory signals are flexible to behavioral priority and subjective imagery strength.

The pupillary light response was long considered a brainstem reflex, outside of cognitive influence. However, newer findings indicate that pupil dilation (and eye movements) can reflect content held "in mind" with working memory (WM). These findings may reshape understanding of ocular and WM mechanisms, but it is unclear whether the signals are artifactual or functional to WM. Here, we ask whether peripheral and oculomotor WM signals are sensitive to the task-relevance or "attentional state" of WM content. During eye-tracking, human participants saw both dark and bright WM stimuli, then were retroactively cued to the item that would most likely be tested. Critically, we manipulated the attentional priority among items by varying the cue reliability across blocks. We confirmed previous findings that remembering darker items is associated with larger pupils (vs. brighter), and that gaze is biased toward cued item locations. Moreover, we discovered that pupil and eye movement responses were influenced differently by WM item relevance. Feature-specific pupillary effects emerged only for highly prioritized WM items but were eliminated when cues were less reliable, and pupil effects also increased with self-reported visual imagery strength. Conversely, gaze position consistently veered toward the cued item location, regardless of cue reliability. However, biased microsaccades occurred at a higher frequency when cues were more reliable, though only during a limited post-cue time window. Therefore, peripheral sensorimotor processing is sensitive to the task-relevance or functional state of internal WM content, but pupillary and eye movement WM signals show distinct profiles. These results highlight a potential role for early visual processing in maintaining multiple WM content dimensions.NEW & NOTEWORTHY Here, we found that working memory (WM)-driven ocular inflections-feature-specific pupillary and saccadic biases-were muted for memory items that were less behaviorally relevant. This work illustrates that functionally informative goal signals may extend as early as the sensorimotor periphery, that pupil size may be under more fine-grained control than originally thought, and that ocular signals carry multiple dimensions of cognitively relevant information.

The epistemic role of vividness

Abstract The vividness of mental imagery is epistemically relevant. Intuitively, vivid and intense memories are epistemically better than weak and hazy memories, and using a clear and precise mental image in the service of spatial reasoning is epistemically better than using a blurry and imprecise mental image. But how is vividness epistemically relevant? I argue that vividness is higher-order evidence about one’s epistemic state, rather than first-order evidence about the world. More specifically, the vividness of a mental image is higher-order evidence about the amount of first-order information one has about its subject matter. When vividness is sufficiently low, it can give one reason to doubt the epistemic basis of the mental image and thereby act as a defeater. This account has important implications for theorizing about the epistemic roles of memory, imagination, mental imagery and phenomenal consciousness.

Effects of motor imagery using virtual reality on pain sensitivity and affect in healthy individuals: a prospective randomized crossover study.

Exercise induces a hypoalgesic response and improves affect. However, some individuals are unable to exercise for various reasons. Motor imagery, involving kinesthetic and visual imagery without physical movement, activates brain regions associated with these benefits and could be an alternative for those unable to exercise. Virtual reality also enhances motor imagery performance because of its illusion and embodiment. Therefore, we examined the effects of motor imagery combined with virtual reality on pain sensitivity and affect in healthy individuals. Randomized crossover study. Laboratory. Thirty-six participants (women: 18) were included. Each participant completed three 10-min experimental sessions, comprising actual exercise, motor imagery only, and motor imagery combined with virtual reality. Hypoalgesic responses and affective improvement were assessed using the pressure-pain threshold and the Positive and Negative Affect Schedule, respectively. All interventions significantly increased the pressure-pain threshold at the thigh (P < .001). Motor imagery combined with virtual reality increased the pressure-pain threshold more than motor imagery alone, but the threshold was similar to that of actual exercise (both P ≥ .05). All interventions significantly decreased the negative affect of the Positive and Negative Affect Schedule (all P < .05). Motor imagery combined with virtual reality exerted hypoalgesic and affective-improvement effects similar to those of actual exercise. The study was enrolled in the UMIN Clinical Trials Registry (registration number: UMIN000046095). The website for registration information is https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052614.