Imagery Rescripting in the Treatment of Posttraumatic Stress Disorder

By Long, Mary E. Ms, PhD; Quevillon, Randal PhD | Journal of Cognitive Psychotherapy, April 1, 2009 | Go to article overview

Imagery Rescripting in the Treatment of Posttraumatic Stress Disorder


Long, Mary E. Ms, PhD, Quevillon, Randal PhD, Journal of Cognitive Psychotherapy


The use of imagery in psychotherapy has received surprisingly little attention from researchers despite its long history in psychology and the significance of imagery in a number of psychological disorders. One procedure warranting increased attention is imagery rescripting, an imagery technique in which an image is modified in some way to decrease distress. Imagery rescripting is relatively new with a small but growing empirical base. This article briefly reviews hypothesized mechanisms for therapeutic change via imagery techniques, emphasizing imagery rescripting, and how they might be relevant in the treatment of posttraumatic stress disorder (PTSD). We review studies employing imagery rescripting as a component of treatment, followed by recommendations for future direction.

Keywords: PTSD; intrusive images; treatment; nightmares; cognitive-behavioral therapy

Imagery rescripting is a unique imagery technique in which a distressing image is modified in some way in psychotherapy to change associated negative thoughts, feelings, and/or behaviors. The use of imagery rescripting to treat psychological problems such as nightmares, posttraumatic stress disorder (PTSD), bereavement, intrusive images, and eating disorders has been described in the literature for several decades (Arntz & Weertman, 1999; Bishay, 1985; Davis & Wright, 2007; Edwards, 1990; Fidaleo, Proano, & Friedberg, 1999; Forbes et al., 2003; Germain et al., 2004; Grunert, Smucker, Weis, & Rusch, 2003; Kellner, Irogoyen-Rascon, & Singh, 1991; Krakow, 2004; Marks, 1978; Melges & DeMaso, 1980; Ohanian, 2002; Rusch, Grunert, Mendelsohn, & Smucker, 2000; Smucker & Boos, 2005; Thompson, Hamilton, & West, 1995). Only the study of treatment of nightmares, however, has a base of empirical support beyond anecdotal descriptions or case studies. This article will briefly discuss the historical background of imagery rescripting and then discuss several potential putative mechanisms for therapeutic change via imagery techniques that have special relevance in the treatment of PTSD. The evidence base for using imagery rescripting to treat PTSD, including studies employing imagery rescripting as a component of trauma-related nightmares treatment, will then be examined, and recommendations for future directions will be provided.

BACKGROUND

Inducing images via hypnosis or other means has been a part of dynamically based therapeutic practices since their inception (Beck, Emery, & Greenberg, 1985). The earliest clinical applications of imagery were noted in the late 19th century by Janet, a French clinician in Paris, who used a technique called "imagery substitution" to replace distressing images with nondistressing images in "hysteric" patients (Janet, 1889, 1898). Since the 1950s, imagery has been employed by behaviorists in anxiety reduction treatments based on counterconditioning and habituation models. Behavioral treatment techniques using imagery components include systematic desensitization, flooding, covert conditioning, coping imagery, stress-inoculation training, induced anxiety, and guided imagery (Anderson, 1980; McMahon & Sheikh, 2003; Munroe-Chandler & Hall, 2004-2005; Sipprelle, 1967; Wolpe, 1958). Another technique, imagery rescripting, has garnered increased recent attention and shows promise enough to warrant further investigation.

Imagery rescripting is a cognitive-behavioral technique most often used as a component of nightmare treatments, such as imagery rehearsal therapy (IRT) or, more recently, Exposure, Relaxation, and Rescripting therapy (ERRT) (Davis & Wright, 2005; Krakow, 2004; Krakow et al., 2004; Marks, 1978). IRT is currently the most commonly used technique to treat trauma-related nightmares (Davis & Wright, 2005). The effectiveness of IRT has been typically examined in a group setting over one to three sessions (Krakow, 2004). The session(s) generally include psychoeducation and cognitive skills training regarding insomnia and nightmares, an imagery rescripting component, and follow-up to discuss progress and review concerns/experiences (Krakow et al. …

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