Imagery Rescripting with or without preceding Cognitive Restructuring: a randomized clinical trial

Previous research has shown treatment efficacy of imagery rescripting (ImRs)
for several disorders both as part of a treatment package and as a stand-alone
treatment. This technique, which is focused on imagining aversive memories and
changing its course fulfilling the needs of the individual, is used to change
the meaning or encapsulated belief and emotional valence people deduce from
childhood memories of adverse events. Additionally, ImRs is thought to alter
the vividness and distress of this memory. However, little is known regarding
necessity of specific ingredients for the ImRs to be efficient. For instance,
in some protocols within a treatment session ImRs is preceded by cognitive
restructuring (CR) whether other protocols only provide ImRs. CR is a common
therapeutic technique aimed at challenging maladaptive beliefs in a verbal way.
Some researchers have suggested that it is a necessary prerequisite for ImRs to
be successful as it prepares an adult perspective in phase 2 of ImRs (where the
adult intervenes in the averse childhood memory). However, others argue against
this by claiming that ImRs is powerful enough as a stand-alone technique and CR
is not needed to add to the ImRs procedure. The validity of CR as a preceding
element in the ImRs protocol has not been systematically studied yet.

This research project examines whether there are differences in effects between
application of ImRs preceeded by CR and ImRs as a stand-alone treatment
technique on the so-called encapsulated beliefs, cognitive beliefs based on the
aversive childhood memory. Secondary aims focus on differences in effects
between aforementioned conditions with respect to the memory vividness and
distress of the aversive childhood memory addressed, overall symptomatology,
anxiety and depression symptoms, concepts related to positive psychology such
as self-compassion, patient experiences of the techniques and differences of
which emotional states are triggered and with what intensity.

This study is a randomized placebo-controlled clinical trial with a single
session intervention and a one-week follow-up session.

This research project will employ the following conditions focused on the
application of ImRs on an aversive childhood memory 1) CR preceding ImRs, 2)
therapist attention placebo and ImRs 3) double therapist attention placebo. The
therapist attention placebos are common treatment elements not to be effective
to treat the complaints, but will be used as a placebo for therapist attention
of CR and ImRs.

There are no direct risks involved in the interventions. Every participant will
receive or already receives their regular treatment, thus none of the
participants will be without adequate treatment for their condition.
Participants can get emotional during retrieval of the aversive memories. The
benefit is some reduction of symptoms. Assessment 1 takes approximately 2,5
hours, including a 10-minute break. Assessment 2 has a duration of max. 45 min.