Imagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda - summary of an article by Arntz (2012)

Imagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda
Arntz, A. (2012)
Journal of Experimental Psychopathology, 3(2), 190-208.

Abstract

Imagery rescripting (ImRs) is a therapeutic technique addressing specific memories of earlier experiences associated with present problems. By imagining that the course of events is changed in a more desired direction, powerful therapeutic effects have been found.

Introduction

ImRs is a technique used to change the meaning of emotional memories and images. With ImRs, the individual is instructed to image the memory or image as vividly as possible, as if it really happens in het here and now. Next, the individual must imagine that the sequence of events is changed in a direction that the person desires. When the patient is incapable of imagining a good outcome, the therapist rescripts the sequence, whilst the patient imagines this.

The use of ImRs is not restricted to intrusions (unwanted images) or memories that are associated with intrusions.

Treatment studies

PTSD

ImRs seems to have been studied most in the context of PTSD, and the results are positive. But there seems to be a lack of studies investigating ImRs alone by comparing it to other effective treatments.

Social phobia

ImRs is an effective therapeutic technique for social phobia. But, studies didn’t test whether ImRs could be a complete treatment of social phobia.

Simple phobia

With simple phobia, ImRs is effective when applied alone and might enhance the effects of exposure in vivo.  

OCD

ImRs might be an effective treatment for therapy-resistent OCD.

Depression

One pilot studies has promising results.

Bulimia Nervosa (BN)

ImRs might bring about a larger decrease in urges to restrict than control conditions. But, only immediate effects are known.

Nightmares

ImRs  is helpful in combination with exposure, relaxation and rescripting therapy. ImRs is has not yet been addressed without the other components.

Personality disorders

ImRs is used in combination with other techniques. Dismantling studies are necessary to determine the degree to which ImRs contributes to the strong effects therapy seems to have.

Conclusions from treatment studies

ImRs can be successfully applied to any psychological problems and disorders. One session of ImRs is more effective than exploring and discussing the memories. ImRs also seems to bring about changes in a broader area than exposure.

From a methodological point of view the evidence for the effectiveness of ImRs is limited. Few studies used randomized designs.

Studies into mechanisms

Imagined stimuli might have effects comparable to real stimuli, both with respect to psychological and brain responses. They can act as conditioned and unconditioned stimuli with effects approaching those of real stimuli. Imagery causes much stronger emotional effects than verbal processing, which holds for both negative and positive emotions.

ImRs compared to other regulation techniques

ImRs has more effects than distraction. Even when the extent of rescripting is rather limited.

Does ImRs change the meaning of unconditioned stimuli?

One of the mechanisms underlying ImRs might be UCS-revaluation, the change in meaning of the representations of the original aversive event.

Fear memories can be changed. There are indicators that if a fear memory is reactivated it gets in a labile state in which it can be reduced, strengthened, changed, and perhaps even ereased. Perhaps ImRs is a psychological way to modify the fear memory so that it is reconsolidated with a different meaning, no longer giving rise to the strong fear responses.

ImRs, the processing of traumatic events, and effects on intrusions, meaning and memory

ImRs might be a powerful early intervention after trauma to prevent the development of PTSD. It does not lead to forgetting the factual details of the original aversive event, but factual memory might be enhanced. ImRs works through changing the meaning of the original experience.

Another explanation for the intrusion-reducing effects of ImRs is that ImRs enhances contextualization of perceptual memories more than imaginal exposure.

Research agenda

There is a shotage of controlled studies that investigate ImRs­ as a standalone treatment and there is not yet a underlying theory for ImRs.