Imagery re-scripting for PTSD: session content and its relation to symptom improvement

Abstract

Imagery rescripting (ImRs) is a therapy technique that, unlike traditional re-living techniques, focuses less on exposure and verbal challenging of cognitions and instead encourages patients to directly transform the intrusive imagery to change the depicted course of events in a more desired direction. However, a comprehensive account of how and in what circumstances ImRs brings about therapeutic change is required if treatment is to be optimised, and this is yet to be developed. The present study reports on the development of a coding scheme of ImRs psychotherapy elements identified in the literature as potential ImRs mechanisms. The codes were assessed in relation to short-term outcomes of 27 individuals undergoing ImRs for post-traumatic stress disorder. The timing of the change in the image, degree of activation of the new image and associated cognitive, emotional and physiological processes, self-guided rescripting, rescript believability, narrative coherence and cognitive and emotional shift were identified as being related to symptom change and so are potentially important factors for the re-scripting process.

Voice hearers' explanations of trauma‐related voices and processes of change throughout imagery rescripting: A qualitative exploration

“…Additionally, we found that appropriate and fair treatment of perpetrators may also be important, which could suggest that ImRs facilitates a deeper understanding of the complex contextual factors surrounding one's trauma, beyond ‘secondary’ self‐ and other trauma‐related appraisals. Like Brown et al (2023), who found that believable and compelling rescripts were associated with stronger shifts in the perceived meaning of memories, we found that the genuineness of the therapist during rescripts may support self‐expression and reprocessing of trauma experiences.…”

“…Similar to our study, participants in past qualitative studies experienced emotional release during ImRs (Bosch & Arntz, 2021). While it is possible that the expression of responses that were suppressed at the time of trauma may be a maintaining factor that is modified during ImRs (Dibbets & Arntz, 2016), recent ImRs studies suggest that activation of cognitions and emotions linked to the original event are less therapeutically important than activation of new cognitive processes and emotions (Brown et al, 2023). Thus, ImRs may interrupt a prolonged pattern of expressive suppression more generally, which may facilitate the development of cognitive re‐appraisal strategies.…”