Wednesday, December 29, 2010

Imagery Rescripting and Reprocessing Therapy

"Imagery rescripting and reprocessing therapy (IRRT) was originally developed in the mid-1990s for treating adult survivors of childhood sexual abuse (Smucker & Dancu, 1999). The treatment has now been expanded to other traumatic events such as industrial and motor vehicle accidents and violent assaults (Smucker & Boos, 2005).

IRRT includes four main components of treatment:

(1) imaginal exposure, which is utilized to activate the trauma memory along with distressing emotions and related maladaptive cognitions;

(2) imagery rescripting, during which the trauma memory is modified to replace victimization/traumatic imagery with mastery and coping imagery;

(3) self-calming/nurturing imagery, during which clients visualize themselves as an ADULT (today), calming, comforting, and reassuring the traumatized CHILD (back then); and

(4) linguistic processing, which involves transforming the traumatic imagery and emotions into a verbal narrative while simultaneously challenging related maladaptive beliefs (Grunert et al., 2003; Smucker, 1997; Smucker & Boos, 2005; Smucker & Dancu, 1999).

The goal of IRRT is to decrease PTSD and related symptoms through emotional processing of the trauma memory and to modify maladaptive schemas while increasing the survivor’s ability to self-soothe (Grunert et al., 2003).  

Maladaptive secondary beliefs, such as powerlessness, mistrust, guilt/shame, and incompetence, are challenged during the mastery and self-nurturing imagery rescripting phases (Smucker, Dancu, Foa, & Niederee, 1995).

Socratic questioning during the imagery rescripting reportedly helps the survivor identify, challenge, and modify maladaptive beliefs while empowering them to take mastery of the imagery (Grunert et al.; Smucker & Boos, 2005; Smucker & Dancu, 1999).

As noted by Grunert et al. (2003), imagery rescripting employs imaginal exposure “not for habituation, but for activating the images, emotions, and beliefs associated with the traumatic memories” (p. 344). This distinction may be particularly appropriate for adult survivors of child abuse with PTSD who are unable or unwilling to process their childhood traumas through intensive prolonged imaginal exposure and for whom nonfear emotions (e.g., guilt, shame, anger) are predominant (Smucker, Grunert, & Weis, 2003). Through active cognitive restructuring, imaginal rescripting allows for transformation of the traumatic memory to an adaptive one and an emphasis on positive, corrective cognitive changes to negative secondary beliefs and pathogenic schemas (Grunert et al.; Smucker & Niederee, 1995).

A number of case studies and anecdotal reports—along with an unpublished randomized pilot study with adult survivors of childhood sexual abuse suffering from PTSD (Dancu, Foa, &Smucker, 1993)—suggest that IRRT is effective in reducing PTSD symptoms and modifying trauma-related beliefs. Randomized, controlled trials, however, are needed to further empirically validate IRRT’s clinical usefulness with traumatized populations."


Imagery Rescripting in the Treatment of Posttraumatic Stress Disorder
Mary E. Long, MS, PhD
Randal Quevillon, PhD
Journal of Cognitive Psychotherapy: An International Quarterly, Volume 23, Number 1
© 2009

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