The Visual Salience Model of PTSD (VSM-PTSD)
A Framework for Understanding Trauma as a Disorder of Visual Representation
Executive Summary
Post-traumatic stress isn’t just about fear or memory, it’s about images that refuse to let go.
The Visual Salience Model of PTSD (VSM-PTSD) explains why.
When trauma strikes, the brain doesn’t only record what happened, it locks onto what was seen. A flash of light. A weapon. A face. A scene froze in time. These visual fragments often bypass the normal pathways that would integrate them into narrative memory. Instead, they remain raw, sensory-bound, and dominant.
That’s why PTSD feels like being ambushed by your own mind. Intrusive images and flashbacks arrive without context, hypervigilance locks onto visual cues, and the past plays out as if it were happening now. VSM-PTSD reframes post-traumatic stress as not just a disorder of fear conditioning, but as a disorder of maladaptive visual representation.
This model suggests a new way forward: if trauma resides in images, then healing must also directly engage those images. Interventions that rescript, integrate, or reprocess visual memory aren’t secondary because they’re central to recovery.
The Visual Salience Model of PTSD (VSM-PTSD) is a theoretical framework that emphasizes the central role of visual representations in the encoding, storage, and retrieval of traumatic memories. Drawing from cognitive neuroscience, dual representation theory, and clinical observation, it posits that trauma-related imagery is often stored in a sensory-bound format, poorly integrated with contextual and narrative memory systems.
Academic Summary
This persistent visual dominance contributes to hallmark PTSD symptoms:
Intrusive Imagery
Involuntary, recurring visual representations of trauma.
Flashbacks
Vivid re-experiencing driven by sensory memory loops.
Hypervigilance to Visual Cues
Heightened threat detection anchored to environmental triggers.
Moderating factors include individual differences in imagery ability, attentional bias, and cultural norms that influence how visual material is encoded and recalled.
NOVELTY
To our knowledge, this is the first theoretical model to conceptualize PTSD primarily as a disorder of maladaptive visual representation, rather than as solely a memory or fear disorder.
Future Research Directions
Neuroimaging studies:
Investigate visual-cortical and amygdala connectivity during intrusive imagery and flashback episodes.
Experimental paradigms:
Manipulate visual salience to test its role in trauma encoding and retrieval.
Clinical trials:
Assess the efficacy of therapies that directly modify visual memory (e.g., imagery rescripting, EMDR, VR-based exposure).
Cross-disciplinary applications:
Apply the model to performance psychology, resilience training, and cultural trauma studies to test how visual dominance varies across contexts.
Developmental studies:
Explore how visual encoding in childhood and adolescence shapes vulnerability or resilience to trauma-related disorders.
Downloads & References
Reference Note:
Gregory, C. H. (2025). The Visual Salience Model of PTSD: A Theoretical Framework for Understanding and Targeting Visual Representations in Trauma Memory. Copyright © 2025 by Carl H. Gregory. All rights reserved.
ORCID ID: 0009-0007-8200-8207
Foundational Sources
Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). Dual representation theory of posttraumatic stress disorder. Psychological Review.
Van der Kolk, B. (2014). The Body Keeps the Score. Viking.
Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review.
Krystal, J. H. (2020). Neurobiology of PTSD: Imaging, networks, and new interventions. Biological Psychiatry.
Van den Broek, M., et al. (2025). Imagery Rescripting for PTSD. PTSD UK.
Wang, L., et al. (2025). Working mechanisms of imagery rescripting (ImRs) in human sleep. PNAS.
Zreik, G., et al. (2025). Cultural psychological factors in posttraumatic symptom expression. PMC.
These works inform the conceptual foundation of VSM-PTSD, but the framework itself is original to Carl H Gregory.