Imagery Rescripting: an update of the treatment protocol

Abstract

Imagery Rescripting (ImRs) is a transdiagnostic technique to treat aversive memories of real (traumatic) experiences, or of aversive fantasies, such as nightmares and future projections. ImRs is getting increasingly popular, and can be used either as a standalone treatment or as part of treatment packages consisting of different techniques. It has been more than 25 years ago that a detailed treatment protocol of Imagery Rescripting (ImRs) was published (Arntz, A., & Weertman, A. (1999). Treatment of childhood memories; theory and practice. Behaviour Research and Therapy, 37(8), 715-740). New clinical and research insights have led to changes in the protocol, and large scale studies are based on this updated protocol. The most important changes include that it is now strongly recommended that the therapist does the rescripting in the first sessions, while the patient does the rescripting during the later sessions; and that the rescripting should start at the most difficult moment of the memory (the "hotspot"). Moreover, a standard series of questions helps to deepen the emotional processing, while specific ingredients of the rescripting help to increase the impact of the corrective experience offered by the technique. This paper presents and discusses the updated protocol as it has been developed and tested in the treatment of childhood trauma. It also offers solutions for possible problems that can be encountered in clinical practice, and discusses variations of the technique, including how to apply it to adulthood trauma's, to nightmares, and to a range of disorders and clinical problems, including pathological grief, and feared future catastrophes. It is explained that the working mechanism does not rely on installing false memories, and how therapists can prevent that false memories are installed. Finally, the paper provides a set of practical appendices including a treatment rationale and a handout that can be given to patients.