Imagery rescripting of traumatic memories for panic disorder: an exploratory study

Abstract

Imagery rescripting (ImRs) is a psychological intervention designed to change the meaning of images and associated memories and reduce emotional distress. Recent studies have shown that ImRs can be successfully applied to many psychological problems and disorders; however, little has been reported on the application of ImRs for panic disorder (PD). Consequently, we explored the therapeutic effects of ImRs on patients with PD. Fifteen patients with PD received 16 individual cognitive behavioural therapy (CBT) sessions weekly, including one ImRs session. Early traumatic memories associated with recurrent images in panic situations were identified and rescripted to alleviate maladaptive encapsulated beliefs. ImRs ratings (vividness and distress of the images and memories and conviction degree of encapsulated beliefs) were measured prior to and after ImRs. Self-negative contents not directly related to symptoms of panic attack were observed as common themes in the worst meaning of the image, the memory, and in the encapsulated belief. Whilst five (33%) patients had anticipatory anxiety, 10 (67%) patients had other self-negative beliefs. ImRs significantly reduced distress from images, memories and encapsulated beliefs; however, it did not change the vividness of images and memories. There was no significant correlation between the reduction in PD severity over the CBT program and the change in each ImRs rating. The results of this study are promising for certain aspects of panic disorder. However, further research is needed to overcome the limitations of this study.

A plea for more attention to mental representations

“…Whereas beliefs and schemas should be viewed as semantic memories, as they represent general rules, research into imagery rescripting demonstrated that addressing specific episodic (adverse) memories leads to strong reductions in dysfunctional beliefs (e.g., Cooper, Todd, & Turner, 2007;Lee & Kwon, 2013;Reimer & Moscovitch, 2015;Ritter & Stangier, 2016;Shibuya et al, 2018;Veale, Page, Woodward, & Salkovskis, 2015;Weertman & Arntz, 2007;Wild, Hackmann, & Clark, 2007. At first sight, this seems puzzling, as originally semantic and episodic memory were considered to be different systems with no (direct) mutual influence.…”

Integrated cognitive behavioral therapy for chronic pain

“…Based on our previous studies to develop our new CBT program for panic disorder [ 13 – 15 ] and for major depressive disorder [ 16 , 17 ] based on the Clark and Wells model for social anxiety disorder, [ 18 – 20 ] we incorporated the following 4 sessions that have not been used in CBT protocols for chronic pain (Table 1 ).…”

Cognitive behavioral therapy for postpartum panic disorder: a case series

“…This process overwrites the implications of the event and attributes a more positive meaning to a panic attack. The patients had reduced mental defeat and increased cognitive flexibility, through “imagery re-scripting,” so that they came to be able to manage the meaning of images and memories associated with the first panic attack situation [39]. Modifying pre- and post-event processing: By reflecting on behaviors during and results after a panic attack, a patient tries to confirm the correctness of their safety behaviors as ritual actions.…”

“…This process overwrites the implications of the event and attributes a more positive meaning to a panic attack. The patients had reduced mental defeat and increased cognitive flexibility, through “imagery re-scripting,” so that they came to be able to manage the meaning of images and memories associated with the first panic attack situation [39].…”