Delivering Imagery Rescripting via Telehealth: Clinical Concerns, Benefits, and Recommendations.

PURPOSE OF THE REVIEW: Delivery of psychological therapies via telehealth has increased with the emergence of the COVID-19 pandemic. Therapists may be hesitant in moving to telehealth when delivering therapies targeting memories of traumatic experiences. This paper collates the clinical experiences of clinicians and clients who have delivered or received imagery rescripting, respectively, via telehealth across a range of clinical presentations, and describes key clinical considerations and recommendations. RECENT FINDINGS: It is important to consider perceived and real safety; practical and technological issues; therapeutic alliance; depth of emotional processing; and dissociation. There was support for the delivery of imagery rescripting via telehealth being no less effective than face-to-face delivery; however, telehealth delivery was not a viable option for many clients during COVID-19 lockdowns who were living in high density housing, old houses with thin walls, or with some complex disorders.

Imagery rescripting as an adjunct clinical intervention for obsessive compulsive disorder.

Novel adjunct psychological techniques are needed for the large number of patients with OCD who remain symptomatic despite the effective implementation of standard evidence-based treatments. The aim of this study was to examine the efficacy of imagery rescripting (ImRs), an established technique for the treatment of traumatic stress, as a treatment for OCD symptoms that were not responsive to standard exposure and response prevention (ERP). Thirteen patients completed a baseline assessment followed by a control intervention that involved discussion of an aversive memory linked with the onset of OCD symptoms. Treatment then involved provision of 1-6 ImRs sessions; ImRs continued until patients achieved a 35% reduction in symptoms, as measured using the Y-BOCS one week after each treatment. Patients were followed up one and three months after the treatment completion. Twelve out of thirteen patients achieved ≥35% improvement in Y-BOCS. Of these patients, six required only a single ImRs session, while the remaining six patients required 2-5 ImRs sessions to achieve a clinically significant change. Lower baseline Y-BOCS predicted improvement after a single treatment session. ImRs may be a useful adjunct for treatment-resistant OCD associated with past aversive experiences, especially when symptomatology remains within the mild-moderate range after standard ERP.