Imagery Rescripting Versus Cognitive Restructuring for Social Anxiety: Treatment Effects and Working Mechanisms.

Background: Negative mental images in social anxiety are often linked to memories of distressing social experiences. Imagery Rescripting (ImRs) has been found to be a promising intervention to target aversive memories, but mechanisms underlying ImRs are largely unknown. The present study aimed (a) to investigate the effects of ImRs compared to cognitive restructuring (CR) on social anxiety symptoms and (b) to extend previous research by examining whether ImRs works by fostering reappraisal of negative emotional self-beliefs. Method: Highly socially anxious individuals (N = 77) were randomly allocated to ImRs, CR, or no intervention control (NIC). A speech task was performed at baseline and at 1-week follow-up. Results: Only CR significantly reduced social anxiety symptoms from baseline to follow-up. Decreases in negative appraisals and emotional distress in response to the speech task did not differ between conditions. Regarding working mechanisms, ImRs led to stronger increases in positive emotions than CR and NIC. Both CR and ImRs yielded short-term reductions in emotionally anchored idiosyncratic self-beliefs, but CR was superior to ImRs at follow-up. Conclusions: The present study provides evidence for the efficacy of a single-session of CR for social anxiety symptoms. As one specific version of ImRs was applied, it is conceivable that other or optimized versions of ImRs might be more effective.

Improving imagery rescripting treatments: Comparing an active versus passive approach.

BACKGROUND AND OBJECTIVES: In imagery rescripting (ImRs), aversive mental images are modified to reduce symptoms in a variety of psychological disorders. However, uniform guidelines on how to optimally implement ImRs do currently not exist. It remains unclear whether therapists should stimulate patients to imagine themselves to actively intervene within the new image, or whether they may imagine helpers to change the situation. We aimed to compare these two variants of ImRs within an analogue experimental setting. METHODS: After having watched an aversive film, one-hundred participants were randomly assigned to active ImRs (ImRs-A), passive ImRs (ImRs-P), imagery rehearsal (IRE), or no-intervention control (NIC). Participants were either instructed to rescript the film by imagining themselves intervening in the new script (ImRs-A) or encouraged to imagine helpers to intervene in the imagined situation (ImRs-P). RESULTS: Both ImRs increased mastery and elicited less distress than IRE with ImRs-P being experienced as less distressing than ImRs-A. Only ImRs-A led to a stronger increase in positive affect than IRE, whereas groups did not differ with respect to negative affect and self-efficacy. Conditions did not differ regarding the number of film-related intrusive memories. LIMITATIONS: As a convenience sample was investigated, results cannot be generalized to clinical samples. CONCLUSION: Even though differences regarding symptomatic outcome could not be detected, ImRs-P was experienced as less distressing than ImRs-A. Results suggest that both ImRs lead to different processes during the intervention than mere exposure. Compared to IRE, ImRs increases mastery with ImRs-A and ImRs-P being equally effective.

Effects of imagery rescripting on consolidated memories of an aversive film.

BACKGROUND AND OBJECTIVES: Imagery rescripting (ImRs) is a promising intervention targeting emotional memory. Previous analogue studies have mainly investigated effects of ImRs during memory encoding and consolidation; experimental research on the effects and mechanisms of change in ImRs targeting consolidated memories is largely missing. The present study aimed to investigate effects of ImRs on consolidated memories using a multiple-day trauma film paradigm. METHODS: Eighty-eight participants were randomly assigned to either ImRs, imagery rehearsal (IRE), or no intervention control (NIC). In Session 1, participants watched an aversive film. In Session 2 (24 h after Session 1), the analogue trauma memory was reactivated and the intervention took place. Participants reported intrusive memories of the aversive film for one week and then returned to the laboratory for a follow-up (Session 3). RESULTS: Compared to IRE, ImRs was experienced as less distressing and elicited less negative emotions. In addition, ImRs accelerated the decline of intrusive memories when compared to NIC. However, ImRs, IRE, and NIC did not differ with respect to the total number of intrusive memories during the week following the intervention. LIMITATIONS: There was a floor effect of intrusive memories, which may have obscured a potential superiority of the active interventions over NIC. CONCLUSIONS: Adding to the current literature on ImRs as an intervention for emotional memories, the current study underscores that a multiple-day trauma film paradigm can be used to investigate the short-term efficacy and working mechanisms of ImRs, but also points toward useful modifications to the paradigm.