Stage 4 is "Image Transformation". In this stage, the participant transforms, modifies, or alters the content of generated mental imagery, in such a way as to substitute images that provoke negative feelings, are indicative of suffering and exacerbate psychological pain, or that reaffirm disability or debilitation, for those that elicit positive emotion, and are suggestive of autonomy, ability to cope, and an increased degree of mental aptitude and physical ability.[55]