Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis

Morina, Nexhmedin; Lancee, Jaap; Arntz, Arnoud

doi:10.1016/j.jbtep.2016.11.003

Cited by 197 publications

(187 citation statements)

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“…Instead, the key mechanism of change could be to develop alternative memory representations, through whatever means, that have the retrieval advantage over distressing representations (Brewin, 2006). For example, there are indications that imagery rescripting may be beneficial in PTSD, even though it does not involve fully recontextualising the perceptual memory representation, and instead focuses on encoding a new, less distressing representation (Morina et al, 2017). Interestingly, two recent trials of trauma-focused therapy for PTSD in psychosis found that exposure and EMDR, but not cognitive restructuring, were effective in reducing posttraumatic stress.…”

Section: Discussionmentioning

confidence: 99%

“…Following this, it appears imagery modification purely aiming to elaborate contextual representations in Tanya’s episodic memory, as in traditional exposure approaches, may not be helpful because her memory is already contextualized (Foa et al, 2007). Instead, it may be more useful to focus on developing new episodic representations of her intrusive memories, using techniques such as competitive memory training and imagery rescripting (Steel et al, 2015; Morina et al, 2017). …”

Section: Pathways From Victimization To Psychosis: Vignettesmentioning

confidence: 99%

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Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

2017

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In recent years, empirical data and theoretical accounts relating to the relationship between childhood victimization and psychotic experiences have accumulated. Much of this work has focused on co-occurring Posttraumatic Stress Disorder or putative causal mechanisms in isolation from each other. The complexity of posttraumatic stress reactions experienced in psychosis remains poorly understood. This paper therefore attempts to synthesize the current evidence base into a theoretically informed, multifactorial model of posttraumatic stress in psychosis. Three trauma-related vulnerability factors are proposed to give rise to intrusions and to affect how people appraise and cope with them. First, understandable attempts to survive trauma become habitual ways of regulating emotion, manifesting in cognitive-affective, behavioral and interpersonal responses. Second, event memories, consisting of perceptual and episodic representations, are impacted by emotion experienced during trauma. Third, personal semantic memory, specifically appraisals of the self and others, are shaped by event memories. It is proposed these vulnerability factors have the potential to lead to two types of intrusions. The first type is anomalous experiences arising from emotion regulation and/or the generation of novel images derived from trauma memory. The second type is trauma memory intrusions reflecting, to varying degrees, the retrieval of perceptual, episodic and personal semantic representations. It is speculated trauma memory intrusions may be experienced on a continuum from contextualized to fragmented, depending on memory encoding and retrieval. Personal semantic memory will then impact on how intrusions are appraised, with habitual emotion regulation strategies influencing people’s coping responses to these. Three vignettes are outlined to illustrate how the model accounts for different pathways between victimization and psychosis, and implications for therapy are considered. The model is the first to propose how emotion regulation and autobiographical memory may lead to a range of intrusive experiences in psychosis, and therefore attempts to explain the different phenomenological associations observed between trauma and intrusions. However, it includes a number of novel hypotheses that require empirical testing, which may lead to further refinement. It is anticipated the model will assist research and practice, in the hope of supporting people to manage the impact of victimization on their lives.

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Section: Discussionmentioning

confidence: 99%

Section: Pathways From Victimization To Psychosis: Vignettesmentioning

confidence: 99%

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

2017

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“…IMRS has typically been one component of a broader cognitive-behavioural intervention, with research supporting the effectiveness of the intervention as a whole (Arntz, 2012;McEvoy et al, 2015). However, in a recent metaanalysis by Morina, Lancee, and Arntz (2017), 19 trials of IMRS as a standalone intervention were reviewed. The trials targeted a range of disorders, including post-traumatic stress disorder (n = 8), social anxiety (n = 6), body dysmorphic disorder (n = 2), depression (n = 1), bulimia (n = 1), and obsessive-compulsive disorder (n = 1).…”

Section: Imagery Rescriptingmentioning

confidence: 99%

The essential role of mental imagery in cognitive behaviour therapy: What is old is new again

Saulsman

McEvoy

2019

Australian Psychologist

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Objective: The aim of this review is to highlight the important role of mental imagery in contemporary cognitive behaviour therapy (CBT). Method: In this narrative review, we define mental imagery based on cognitive science research, present the rationale for the incorporation of mental imagery within CBT, and outline four key applications of mental imagery within CBT practice (i.e., imagery-enhanced thought records, imagery-enhanced behavioural experiments, imaginal facilitation of behaviour change, and imagery rescripting), including emerging research supporting these varied applications. Results: Mental imagery is highly relevant to CBT practice because (a) it is a transdiagnostic cognitive maintaining factor of psychopathology; (b) it promotes cognitive specificity when working with clients; and (c) the emotional amplification properties of mental imagery, and its impacts on motivation and behaviour, make imagery a powerful facilitator of cognitive, affective, and behavioural change. Emerging research is promising regarding the potential for imagery to enhance treatment outcomes. However, further research is required to guide clinicians regarding how to best facilitate imagery interventions to maximise outcomes. Conclusions: Imagery-focused interventions are an essential part of a CBT practitioner's therapeutic repertoire. Mental imagery has the capacity to bring CBT to life, facilitating conditions important for engaging and effective psychotherapy. K E Y W O R D Sbehaviour change, behavioural experiments, cognitive behaviour therapy, imagery rescripting, mental imagery, thought records

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“…Notwithstanding, the growing evidence suggests ImRs is an efficacious treatment [21, 39]. Recent research has also supported its effectiveness in treating complicated PTSD.…”

Section: Introductionmentioning

confidence: 99%

“…ImRs in the context of adverse childhood memories has been successfully applied to the treatment of disorders such as social anxiety, simple phobias, bulimia nervosa and depression, showing good treatment effects [39]. Taken together, the evidence supports ImRs as an efficacious treatment for PTSD and for addressing aversive childhood memories.…”

Section: Introductionmentioning

confidence: 99%

Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design

et al. 2017

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BackgroundPost-traumatic stress disorder (PTSD) that originates from childhood trauma experiences can develop into a chronic condition that has lasting effects on an individual’s functioning and quality of life. While there are evidence-based guidelines for treating adult onset PTSD, treatments for adults with childhood trauma-related PTSD (Ch-PTSD) are varied and subject to ongoing debate. This study will test the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR) in participants with Ch-PTSD. Both have been found effective in treatment of adult PTSD or mixed onset PTSD and previous research indicates they are well-tolerated treatments. However, we know less about their effectiveness for treating Ch-PTSD or their underlying working mechanisms.MethodsIREM is an international multicentre randomised controlled trial involving seven sites across Australia, Germany and the Netherlands. We aim to recruit 142 participants (minimum of n = 20 per site), who will be randomly assigned to treatment condition. Assessments will be conducted before treatment until 1-year follow-up. Assessments before and after the waitlist will assess change in time only. The primary outcome measure is change in PTSD symptom severity from pre-treatment to 8-weeks post-treatment. Secondary outcome measures include change in severity of depression, anger, trauma-related cognitions, guilt, shame, dissociation and quality of life. Underlying mechanisms of treatment will be assessed on changes in vividness, valence and encapsulated belief of a worst trauma memory. Additional sub-studies will include qualitative investigation of treatment experiences from the participant and therapists’ perspective, changes in memory and the impact of treatment fidelity on outcome measures.DiscussionThe primary aims of this study are to compare the effectiveness of EMDR and ImRs in treating Ch-PTSD and to investigate the underlying working mechanisms of the two treatments. The large-scale international design will make a significant contribution to our understanding of how these treatments address the needs of individuals with Ch-PTSD and therefore, potentially improve their effectiveness.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12614000750684. Registered 16 July 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1330-2) contains supplementary material, which is available to authorized users.

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Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis

Abstract: Our findings indicate that ImRs is a promising intervention for psychological complaints related to aversive memories, with large effects obtained in a small number of session.

Cited by 197 publications

References 48 publications

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

The essential role of mental imagery in cognitive behaviour therapy: What is old is new again

Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design

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