Trauma-focused and personality disorder treatment for posttraumatic stress disorder and comorbid cluster C personality disorder: a randomized clinical trial.

Background: Posttraumatic stress disorder (PTSD) is associated with high rates of cluster C personality disorders (PD), which may negatively affect PTSD treatment. It is unknown whether concurrent treatment for PTSD and comorbid PD leads to superior treatment effects, compared to standard trauma-focused treatment.Objective: The objective was to test the efficacy of adding personality disorder treatment (group schema therapy; GST) to individual trauma-focused treatment (imagery rescripting; ImRs).Method: A two-arm randomized clinical trial (1:1 allocation ratio) was conducted between 2018 and 2023 at two sites of a mental health institution in the Netherlands. Raters were blind to treatment allocation. Adult outpatients with PTSD and comorbid cluster C personality disorders were randomized to receive either ImRs (12-18 sessions) or ImRs + GST (12-18 ImRs + 52-58 GST). The main outcome was PTSD severity one year after start of treatment measured with the Clinician-Administered PTSD Scale for DSM-5.Results: Of 130 patients (mean [SD] age = 40.6 [11.2], 110 [85%] females), 66 were assigned to ImRs and 64 to ImRs + GST. At 12 months, there were large decreases in PTSD severity (dImRs = 2.42, 95%CI = 1.97-2.87; dImRs + GST = 2.44, 95%CI = 1.99-2.90), but there was no significant difference between conditions (d = 0.02, 95%CI = -0.33-0.36, p = .944). Reductions in personality disorder symptoms and all other secondary outcomes were observed in both conditions. There were no significant differences between conditions on any of the secondary outcomes at 12 months.Conclusion: The more intensive concurrent trauma-focused and personality disorder treatment (ImRs + GST) was not superior to trauma-focused treatment alone (ImRs) for patients with PTSD and comorbid CPD. This suggests that trauma-focused treatment is the preferred primary treatment in patients presenting with both internalizing personality disorder and PTSD, reserving the stepping up to more intensive psychotherapy aimed at the personality disorder as a second line of treatment.Trial registration: ClinicalTrials.gov identifier: NCT03833531.

Concurrent trauma-focused and personality disorder treatment was not superior to only trauma-focused treatment for patients with posttraumatic stress disorder (PTSD) and comorbid cluster C personality disorders.Large reductions in PTSD severity and medium-to-large reductions in all secondary outcomes, including personality disorder symptoms, were observed in both treatment arms.These findings are remarkable, given the higher therapy dosage and specialized treatment for personality disorder comorbidity in the combined treatment arm.

Testing an Imagery Rescripting Exercise Targeting Fear of Self.

A feared possible self refers to the unwanted characteristics that a person may possess or develop. We tested an experimental paradigm to target fear of possible self using imagery rescripting. A student sample (n = 91), with moderate obsessive-compulsive disorder symptoms, engaged in written and audio-guided exercises to evoke episodic future mental imagery that represented their feared possible self. Participants were then randomized between imagery rescripting or neutral imagery control tasks. The results revealed no difference between conditions in fear of self or general obsessional beliefs following the manipulation. State anxiety and the urge to neutralize the imagery reduced more in the control condition than in the rescripting condition. These findings suggest that the current paradigm is emotionally engaging but not effective at addressing fear of self as measured. Methodological improvements such as removing a written component of the rescripting task and idiosyncratic measuring of fear of self are proposed.

The Effectiveness of Imagery Rescripting Interventions for Military Veterans With Nightmares and Sleep Disturbances: A Systematic Review and Meta-Analysis.

Imagery rescripting (ImRs) interventions have been found effective in improving sleep outcomes, although research has mostly focused on civilian, rather than military, samples. The aim of this review was to estimate the overall effectiveness of ImRs interventions for military veterans on primary outcomes of nightmare frequency and sleep quality. A systematic search was conducted in CINAHL, MEDLINE, PsycArticles, PsycINFO, Psychology and Behavioural Sciences Collection and the PTSDpubs database and was completed on 1 November 2021. Randomised controlled trials, nonrandomised trials and pre-post studies of ImRs interventions in veterans with sleep disturbances or nightmares were included. The methodological quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) tool, and meta-analysis was performed using Stata. Nineteen articles from 15 empirical studies were included in the review, and data from the 15 studies (involving 658 participants) were included in the meta-analysis. Meta-analysis findings indicated that ImRs interventions are associated with significant positive changes from pretreatment to posttreatment for nightmare and sleep quality. Significantly greater improvements were found in ImRs interventions compared to control groups for sleep quality (Hedges' g = -0.65, 95% CI [-1.20, -0.10]) but not for nightmare frequency (Hedges' g = -0.10, 95% CI [-0.34, 0.14]). Overall, the meta-analysis included a relatively small number of studies with poor methodological quality and considerable heterogeneity; therefore, findings should be cautiously interpreted. Further research should focus on veteran participants with larger samples and from a broader range of sources to determine effectiveness more confidently.

Emotional Changes during Imagery Rescripting of Aversive Social Memories in Social Anxiety Disorder: A Randomized Controlled Trial.

INTRODUCTION: Imagery rescripting (ImRs) is a psychotherapeutic intervention targeting aversive memories. During the three-phase intervention, patients reexperience their aversive memory (phase 1), observe the scene from their adult perspective, and intervene to help their former selves (phase 2), and reexperience it again with the positive changes (phase 3). Previous studies have rarely investigated emotional and regulatory processes taking place during the intervention. OBJECTIVE: This randomized controlled trial investigated self-reported affective and physiological responses during ImRs. METHODS: Seventy-seven patients with social anxiety disorder (SAD) were randomly assigned to a single session of ImRs or a control intervention (recall and discussion of the memory) targeting an aversive social memory. Heart rate (HR) and heart rate variability (HRV) were assessed during and post hoc ratings of positive and negative feelings after baseline and the intervention phases. RESULTS: Relative to the control intervention, ImRs resulted in an initial increase in negative feelings from baseline to phase 1 and a following larger (phase 1 to phase 2) and more stable (phase 2 to phase 3) decrease in negative feelings/increase in positive feelings. On the physiological level, during ImRs compared to the control intervention, mean HR was significantly higher during phase 1 and HRV during phase 3, each compared to baseline. CONCLUSIONS: These results provide further information about the specific sequence of emotional responses on different response levels during ImRs, being consistent with known theories of emotional processing and supposed mechanisms of ImRs.

Attenuating conditioned fear using imagery-based interventions: An overview.

A growing literature has sought to include mental imagery in fear conditioning studies. Imaginal extinction and imagery rescripting are mental imagery-based interventions that reduce conditioned fear. In the current study, we reviewed the recent findings on the efficacy of imaginal extinction and imagery rescripting as interventions to attenuate conditioned fear responses among healthy individuals. In accordance with the PRISMA guidelines, we conducted a literature search in four databases, PubMed, Scopus, Science Direct, and Web of Science to find published original empirical articles involving imagery-based interventions using a fear conditioning paradigm. The inclusion criteria were (i) use of an imagery-based intervention (either imaginal extinction or imagery rescripting), and (ii) use of a differential fear conditioning paradigm. 13 original articles reporting 15 experimental studies were included in the review. The review revealed that imagery-based interventions are effective in reducing conditioned fear. Although studies have shown that imaginal extinction and standard extinction have comparable effects in fear extinction, many studies have not been conducted to confirm the findings, or explore the underlying mechanisms. We also found the need for a standardized intervention protocol to enhance experimental control in intervention-based fear conditioning studies.

Imagery-Focused Therapy for Visual Hallucinations: A Case Series.

INTRODUCTION: Visual hallucinations (VH) are more common than previously thought and are linked to higher levels of distress and disability in people with a psychotic illness. Despite this, scant attention has been given to VHs in the clinical literature, and the few therapy case series of cognitive behavioural therapy (CBT) published to date have not demonstrated reliable change. In other areas of clinical research, problematic mental imagery has been found to be more strongly related to negative affect in psychological disorders than negative linguistic thinking, and imagery focused techniques have commonly been found to improve the outcomes in CBT trials. Given VHs have many similarities with visual mental imagery and many of the distressing beliefs associated with VHs targeted in CBT are maintained by accompanying mental imagery (i.e., imaging a hallucinated figure attacking them), it seems plausible that an imagery-focused approach to treating VHs may be most effective. METHODS: The current study is a multiple baseline case series (N = 11) of a 10-session imagery-focused therapy for VH in a transdiagnostic sample. RESULTS: The study had good attendance and feedback, no adverse events and only one [seemly unrelated] drop-out, suggesting good feasibility, safety and acceptability. The majority of clients reported reduction on both full-scale measures (administered at 3 baselines, midtherapy, posttherapy and 3-month follow-up) and weekly measures of VH severity and distress, ranging from medium to large effect sizes. CONCLUSIONS: The case series suggests that an imagery-focused approach to treating VHs may be beneficial, with a recommendation for more rigorous clinical trials to follow.

Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes.

Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.

You're not alone: imagery rescripting for adolescents who self-harm.

Introduction: Non-suicidal self-injury (NSSI), which refers to the deliberate act of causing harm to one's own body without the intent to commit suicide, occurs in 20% of youth. Interestingly, approximately 90% of individuals who engage in self-harm report intrusive mental imagery thereof shortly prior to the act of NSSI. Previous research has demonstrated that imagery rescripting (IR) is an effective technique to treat intrusive mental images and associated clinical symptoms, such as emotion dysregulation, in various psychiatric disorders. However, there is no research on IR for adolescents who self-harm. Therefore, the present study aims to investigate the efficacy and feasibility of a two-session short-intervention using IR to reduce NSSI and associated clinical symptoms in adolescents. The intervention was supported by an app-based digital health intervention (DHI). Methods: A single case series A-B design with three post-assessments (1 week, 1 month, and 3 months post-intervention) was implemented. Seven adolescents received two treatment sessions of IR, supported by a DHI between sessions. NSSI (SITBI), emotion regulation (ERQ), emotional distress (BDI-II, STAI-T), self-efficacy (WIRKALL_r), and treatment satisfaction (BIKEP) were evaluated. Results: There was an increase in adaptive emotion regulation strategies up to 3 months post-intervention. Furthermore, patients improved regarding their self-efficacy, depressiveness, anxiety, and NSSI symptomatology. The developed DHI was described as a helpful and supportive tool. Conclusion: The intervention has shown initial evidence to be feasible and beneficial for adolescents conducting NSSI. The DHI has demonstrated to be a valuable tool in the treatment of self-harming youth.

Imagery rescripting and extinction: Effects on US expectancy, US revaluation, and the generalization of fear reduction.

Exposure therapy consists of exposing patients to their fears and thereby diminishing their harm expectancies (i.e., extinction or expectancy learning). Although effective for many anxiety patients, its long-term success depends on the generalization of these harm expectancies to other stimuli. However, research shows that this generalization of extinction is limited. Besides decreasing harm expectancies, fear reduction may also be achieved by changing the meaning of an aversive memory representation (US revaluation). Imagery rescripting (ImRs) may be more successful in generalizing fear reduction because it allegedly works through US revaluation. The current experiment aimed to test working mechanisms for ImRs and extinction (revaluation and expectancy learning, respectively), and to examine generalization of fear reduction. In a fear conditioning paradigm, 113 healthy participants watched an aversive film clip that was used as the US. The manipulation consisted of imagining a script with a positive ending to the film clip (ImRs-only), extinction (extinction-only), or both (ImRs + extinction). Results showed enhanced US revaluation in ImRs + extinction. US expectancy decreased more strongly in the extinction conditions. Generalization of fear reduction was found in all conditions. Our results suggest different working mechanisms for ImRs and exposure. Future research should replicate this in (sub)clinical samples.

Working mechanisms of imagery rescripting (ImRs) in adult patients with childhood-related PTSD: a pilot study.

Background: Imagery rescripting (ImRs) has shown to be an effective treatment for posttraumatic stress disorders (PTSD) resulting from childhood-related trauma. The current theory is that the change of meaning of the trauma memory is central to the treatment. Several authors have suggested that the expression of needs, feelings and actions may act as potential healing factors, but little specific research aimed at (in)validating this hypothesis has been done so far.Objective: In this study we investigated to what extent the expression of inhibited action tendencies and the fulfilling of needs lead to the reduction of PTSD symptoms in clients with early childhood trauma.Method: Recordings of 249 therapy sessions of 24 ImRs treatments were rated with an observation instrument developed for this purpose, after which the scores were related to pre and posttreatment symptoms, assessed with the Impact of Events Scale-Revised (IES-R).Results: Scores on the IES-R decreased from pretreatment to posttreatment. The two subscales of the NATS (At-scale and N-scale)significantly predicted the posttreatment scores on the IES-R after controlling for the influence of pretreatment IES-R scores: the better the expression of inhibited action tendencies and the better the fulfilling of needs, the lower the symptoms after treatment.Conclusions: This pilot study on the underlying mechanisms of ImRs in PTSD treatment has shown that the expression of action tendencies and fulfilling basic needs during ImRs are associated with a decrease in PTSD symptoms after treatment, and that actions and basic needs cannot be viewed separately. Follow-up research could focus on which of the six domains of the Needs and Action tendencies Scale (NATS) has the greatest effect on the reduction of PTSD symptoms. With this information we can further improve the ImRs protocol.

The pilot study of working mechanisms of imaginary rescripting shows that the NATS is a reliable research tool for observing expressed action tendencies and fulfilled needs.The better the action tendencies are expressed during treatment and the better the needs are fulfilled, the lower posttreatment symptoms.It seems useful if practitioners are specifically trained during the ImRs training in performing actions that lead to the fulfilment of basic needs.

Coping with test anxiety using imagery rescripting: A two-session randomized controlled trial.

BACKGROUND: Up to 55 % of students experience test anxiety (TA), which is characterized by intense physiological and psychological symptoms before or during exams, such as anxiety, fear of failure, sweating, or increased heart rate. Furthermore, TA increases graduation times and can result in discontinuance of the graduate program all together. Previous research demonstrated the beneficial effects of combining cognitive behavioral therapy with imagery rescripting, however, treatment programs are comparably long. Hence, they do not account for the students´ time-sensitive schedules. Therefore, the present study investigates a two-session short-intervention using imagery rescripting to treat TA. METHODS: 44 students and pupils were randomly assigned to either the two-session imagery rescripting intervention (22 participants) or the waitlist-control condition (22 participants). One week before the intervention clinical interviews were conducted and self-report questionnaires on TA, self-efficacy, symptoms of depression, and intrusive prospective images were completed (T1). The same questionnaires were completed one week (T2) and six months after the intervention (T3). RESULTS: Test anxiety significantly decreased from T1 to T2, as well as from T1 to T3 within the intervention group. Furthermore, there were medium to large within and between group effects for situational test anxiety, self-efficacy, symptoms of depression, as well as prospective intrusive images, showing significant improvements for the intervention group at six months follow-up. LIMITATIONS: The study is limited to the comparably small sample size, as well as the sole usage of self-report measurements. CONCLUSIONS: The presented short-intervention provides a feasible treatment technique, which can be easily applied within school and university counseling centers.

Mechanisms of therapeutic change after psychedelic treatment in OCD.

Novel treatments are required for the 30-50% of individuals with obsessive-compulsive disorder (OCD) who remain resistant to first-line pharmacological and psychotherapeutic treatments. Recent pilot data suggest benefit from psilocybin-assisted psychotherapy (PAP) and from imagery rescripting (ImRs). We explore psychological mechanisms of change underpinning both interventions that appear to allow for reprocessing of negative emotions and core beliefs associated with past aversive events. A next critical step in PAP is the development of psychotherapeutic frameworks grounded in theory. We propose that basing PAP on an ImRs framework may provide synergistic benefits in symptom reduction, modification of core beliefs, and value-based living.

Imagery rescripting and cognitive restructuring for inpatients with moderate and severe depression - a controlled pilot study.

BACKGROUND: This controlled pilot study investigates the effect of the combined use of cognitive restructuring (CR) and imagery rescripting (IR) compared to treatment as usual among inpatients with moderate and severe depression. Alongside expert ratings and self-report tools, fitness wristbands were used as an assessment tool. METHODS: In addition to the standard inpatient care (SIC) program, 33 inpatients with moderate and severe depression were randomly assigned to an intervention group (two sessions of IR and CR) or an active treatment-as-usual (TAU) control group (two sessions of problem-solving and build-up of positive activity). Depression severity was assessed by the Hamilton Depression Rating Scale-21 (HDRS-21), the Beck Depression Inventory-II (BDI-II), and as a diagnostic adjunct daily step count via the Fitbit Charge 3™. We applied for analyses of HDRS-21 and BDI-II, 2 × 2 repeated-measures analysis of variance (ANOVA), and an asymptotic Wilcoxon test for step count. RESULTS: The main effect of time on both treatments was η2 = .402. Based on the data from the HDRS-21, patients in the intervention group achieved significantly greater improvements over time than the TAU group (η2 = .34). The BDI-II data did not demonstrate a significant interaction effect by group (η2 = .067). The daily hourly step count for participants of the intervention group was significantly higher (r = .67) than the step count for the control group. CONCLUSIONS: The findings support the utilization of imagery-based interventions for treating depression. They also provide insights into using fitness trackers as psychopathological assessment tools for depressed patients. TRIAL REGISTRATION: The trial is registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien) under the registration number: DRKS00030809.

Imagery rescripting: The value of an added positive emotion component.

BACKGROUND AND OBJECTIVES: Imagery Rescripting (ImRs) aims to reduce trauma-related negative emotions and intrusions. Positive emotions during ImRs may aid coping with the consequences of trauma, but protocols vary in the extent to which they explicitly target such positive emotions. We used a multiple-day design with a trauma film paradigm to investigate whether adding an explicit positive emotion component to ImRs improved intervention effects in a non-clinical sample. In addition, we explored potentially differential effects on high, medium, and low arousal positive affect. METHODS: Participants (n = 105) were randomly assigned to either a standard ImRs condition, to an ImRs condition with an added explicit positive emotion component targeting joy (ImRs+), or to a non-intervention control (NIC) condition. Participants watched a trauma film on day 1, received the condition-specific intervention on day 2, and completed additional post-assessments of positive and negative affect on day 3. In addition, participants recorded intrusions from the trauma film from day 1 until day 3. RESULTS: Compared to standard ImRs and NIC, ImRs + significantly increased positive affect. Exploratory analyses showed that this increase concerned medium and high, but not low arousal positive affect. No significant between-group differences were found for negative affect and intrusion-related outcomes. LIMITATIONS: Floor effects for intrusions and negative affect limited our ability to fully investigate the potential benefits of targeting positive affect. CONCLUSIONS: Adding a positive emotion component to ImRs reliably improved positive affect. More research is needed to determine whether explicitly targeting positive affect improves efficacy of ImRs for intrusion-related outcomes.

When does imagery rescripting become a double-edged sword? - Investigating the risk of memory distortion through imagery rescripting in an online Trauma film study.

Imagery Rescripting (ImRs) has proven effective in reducing involuntary emotional memories. However, it is unclear whether and when it may lead to reduced accuracy of voluntary memory. Although previous analogue studies suggest that ImRs does not pose a general risk regarding memory distortion, it can not be ruled out that ImRs could cause memory impairment under certain risk conditions. In our three-day online trauma film study we investigated in a healthy sample (N = 267) whether specific instructions during ImRs as typically provided in clinical practice (i.e., detailed imagery with a sensory focus) increase the risk of memory distortions. Additionally, we examined whether the completeness of the original memory moderates these instruction effects. Contrary to our expectations, a sensory focus during ImRs was associated with higher memory accuracy in a recognition task, independently of the quality of the original memory. These results extend previous findings by suggesting that ImRs does not even impair memory performance when the quality of the original memory is poor and when the production of sensory-rich images is specifically encouraged. Our results question current practices employed to assess witness statement credibility, which are partly based on concerns that trauma-focused interventions like ImRs undermine memory accuracy.

The working mechanisms of imagery rescripting and eye movement desensitization and reprocessing: Findings from a randomised controlled trial.

We studied the mechanisms of eye movement desensitization and reprocessing (EMDR) and imagery rescripting (ImRs). We hypothesized that EMDR works via changes in memory vividness, that ImRs works via changes in encapsulated beliefs (EB), and that both treatments work via changes in memory distress. Patients (N = 155) with childhood-related posttraumatic stress disorder (Ch-PTSD) received 12 sessions of EMDR or ImRs. The vividness, distress, and EB related to the index trauma were measured with the Imagery Interview. PTSD severity was assessed with the Impact of Events Scale-Revised and the Clinician-Administered PTSD Scale for DSM-5. We conducted mixed regressions and Granger causality analyses. EMDR led to initially stronger changes in all predictors, but only for distress this was retained until the last assessment. No evidence for vividness as a predictive variable was found. However, changes in distress and EB predicted changes in PTSD severity during ImRs. These findings partially support the hypothesized mechanisms of ImRs, while no support was found for the hypothesized mechanisms of EMDR. Differences in the timing of addressing the index trauma during treatment and the timing of assessments could have influenced the findings. This study provides insight into the relative effectiveness and working mechanisms of these treatments.

Treating emotion dysregulation in patients with borderline personality disorder using imagery rescripting: A two-session randomized controlled trial.

Studies on Emotionally Dysregulated Behavior (EDB) demonstrated that the conduct thereof is associated with emotion dysregulation and preceded by mental imagery of EDB, which can direct future behavior. These findings are specifically important within the context of Borderline Personality Disorder (BPD), where emotion dysregulation and EDB are at the core of the disorder. The present study aims to evaluate the efficacy of imagery rescripting (IR) in treating emotion dysregulation associated with EDB in patients diagnosed with BPD. Forty-eight females diagnosed with BPD were randomly allocated to the IR intervention or treatment-as-usual group. Assessment took place one week before the first treatment session, as well as one week, and twelve weeks after the last treatment session evaluating emotion regulation strategies, borderline-symptomatology, EDB, depressiveness, impulsivity, mental imagery, and illness severity. Within-, and between subject, intention-to-treat-, and per-protocol analysis were conducted. Results showed decreased maladaptive emotion regulation strategies and increased adaptive emotion regulation strategies within the intervention group. Borderline-symptomatology improved immediately after treatment for the intervention group. Additionally, BPD patients within the intervention group improved regarding their impulsivity, depressiveness, and EDB symptomatology in comparison to patients in the TAU group. The presented intervention has proven to be effective in improving BPD-related symptomatology, such as emotion regulation, EDB, depressiveness, and impulsivity. Imagery rescripting could be routinely applied when EDB related images are present. TRIAL REGISTRATION: German Clinical Trials Registry (DRKS) ID: DRKS00010620.

Targeting beliefs and behaviours in misophonia: a case series from a UK specialist psychology service.

BACKGROUND: Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known. AIMS: This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service. METHOD: A service evaluation of one-to-one therapy for patients with misophonia (n=19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures t-tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated. RESULTS: Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change. CONCLUSIONS: Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.

Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse - A randomized controlled trial.

BACKGROUND: Institutional childhood abuse can have a long-term impact on the survivors' mental health, however, treatment for this group is limited and not always accessible. An internet-based intervention was developed, with the aim to reduce psychological sequelae relating to institutional abuse. OBJECTIVE: This study aimed to examine the efficacy of an online imagery rescripting intervention for survivors of institutional abuse, through assessing symptoms of depression, anxiety, PTSD, and CPTSD. PARTICIPANTS AND SETTING: Seventy-two adult survivors of institutional childhood abuse in the former German Democratic Republic were randomized either to the intervention (n = 38) or to the waitlist condition (n = 34). The intervention consisted of 10 modules, based on written imagery rescripting, and involved asynchronous therapist contact. METHODS: Primary outcomes included symptoms of depression (PHQ-9), anxiety (GAD-7), PTSD (ITQ), and CPTSD (ITQ DSO). The intervention condition was assessed at baseline, post-intervention, 3-, and 6-month follow-up. RESULTS: Intention-to-treat analyses revealed a significant symptom reduction from baseline to post-assessment with medium to large effects for all main outcomes (d = 0.45 to d = 0.76), in favor of the intervention condition. Significant interactions between condition (intervention vs. wailist) and time (baseline vs. post-assesment) were revealed for all main outcomes (p < .001 to p = .024). The effects were maintained at follow-up. CONCLUSIONS: The results suggest online writing-based imagery rescripting as a promising treatment option for adults formerly institutionalized in residential care. Future research is needed to explore its effectiveness for other groups of patients suffering from abuse and neglect.

Emotion dynamics of clients with test anxiety before and after an imagery-based treatment.

BACKGROUND AND OBJECTIVES: Imagery-based techniques have become a promising means in the treatment of test anxiety (TA). Although previous studies have demonstrated the effectiveness of imagery-based treatment, not all clients seem to benefit from it. The present study compares clients' pre- as well as post-treatment emotion dynamics between responders and non-responders. Furthermore, it examines treatment-related changes in emotion dynamics in both subgroups. METHODS: The results are based on 44 clients suffering from TA who underwent a six-session imagery-based treatment and include Ecological Momentary Assessment (EMA). Emotions were assessed with the Profile of Mood States four times a day over the course of two weeks before and after the treatment. Temporal networks were computed to index emotion dynamics. RESULTS: Pre-treatment emotion dynamics differed between responders and non-responders. Similarly, post-treatment emotion dynamics differed as well between both groups. Some changes were also observed between pre-treatment and post-treatment networks: for responders, fatigue no longer predicted anger, and depression predicted itself; for non-responders, calmness predicted fatigue, anger, depression, contentment, and anxiety. In addition, fatigue no longer predicted itself and anxiety predicted vigor. LIMITATIONS: The investigation is marked by several limitations: a liberal inclusion threshold of at least a 50% response to EMA prompts, and a relatively homogenous sample. CONCLUSION: These results provide first evidence for the idea that emotion dynamics may be associated with response to treatment for TA. Furthermore, effective imagery-based treatments may be tied to changes within these dynamics.