ArticleLiterature Review

Treatment of childhood memories: Theory and practice

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Abstract

With the growing interest of cognitive behaviour therapy in early developed psychopathology like personality disorders there is an increased need for therapeutic methods for more directly treating pathogenic schemas. Exploring and reinterpreting memories of early childhood experiences that are assumed to have contributed to the pathogenesis are more and more viewed as a promising way to modify core schemas. Experiential methods seem to be the most effective. This article discusses two main forms of these methods: (i) imagery with rescripting and (ii) role play, both of childhood interactions with key figures. For both, protocols are provided as guidelines for clinicians and to stimulate standardization so that this new field can be opened for experimental research. Theoretical views are discussed as to why these methods might be so effective in treating chronic problems that originated in childhood.

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... It involves activating an early memory or image associated with the current psychological problem and imagining a more helpful course of events. This way, the individual can address their unmet needs (Arntz & Weertman, 1999). It has been proposed that ImRs enables the modification of core beliefs by mentally imagining, and thereby experiencing a corrective experience, which reduces the associated emotional response (Arntz, 2012). ...
... Then, they are invited to think about what goes through their mind on such occasions (e.g., a mix of thoughts, mental images, and emotions). Focusing their attention on the emotions and sensations, they are then asked to imagine themselves as a child having the same feelings and see whether a spontaneous memory comes to their mind (c.f., diagnostic imagery using the emotional bridge technique; Arntz & Weertman, 1999). Next, they are asked to describe the memory in detail and rate it on vantage perspective, vividness, valence, and anxiety as in the SIQ. ...
... Imagery Rescripting Procedure The ImRs procedure was identical for the autobiographical memory (ImRs-Memory) and intrusive image (ImRs-Image) conditions. Our ImRs procedure differed from the conventional clinical protocol (Arntz & Weertman, 1999), in that participants were not specifically instructed to experience the image from the adult or the child perspective, given that intrusive images do not necessarily involve a child perspective, and we primarily aimed to keep the experimental instructions as constant as possible for both conditions. ...
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Background This study compared the effect of imagery rescripting (ImRs) of early autobiographical memories to ImRs of intrusive images and a no task control condition on eating disorder (ED) related core beliefs and ED symptoms in individuals at risk of developing an eating disorder. We qualitatively explored the content of ImRs scripts. Method Participants ( N = 66, 87.8% females) were allocated to one of three conditions: ImRs of autobiographical memories, ImRs of intrusive images, or a no task control condition. Participants in the ImRs conditions received a 9-min self-guided ImRs intervention in the lab and practiced ImRs daily for the next 6 days online. Participants in the no task control condition took a 9-min break and did not do any further tasks. All participants attended a follow-up testing 1 week after the lab session. Results Both ImRs manipulations resulted in greater reductions in negative core beliefs and ED symptoms compared to the no task control group. However, there were no differences among the two ImRs groups. The most widely used rescripting strategy was self-compassion, followed by unhealthy, ED-confirming strategies. No significant associations were found between the ImRs strategies and any of the outcome measures. Conclusion ImRs may be a promising intervention for individuals with disordered eating and both early memories as well as intrusive images may be useful targets.
... Two psychotherapeutic methods with different mechanisms proposed to reduce PTSD symptoms are EMDR and Imagery Rescripting IR [25][26][27]. Both share similarities with exposure techniques such as recalling the trauma memory with related images, emotions, and cognitions, and providing corrective information. ...
... IR patients do not have to relive the whole trauma in detail as exposure with habituation and extinction is not the primary goal. The predominant explanation for the underlying mechanism is that IR works by facilitating change in the original meaning of the trauma, which results in changes in patients' core belief systems and behaviors [25,28]. During EMDR, patients recall their trauma experience in brief sequential doses while simultaneously focusing on an external bilateral stimulus such as therapist directed lateral eye movements or hand-tapping. ...
... It was possible to conclude treatment in less than twelve sessions provided that the participant, therapist, and site coordinator agreed the participant had recovered. Both treatment conditions followed standardized treatment manuals [25,27], and all sessions were either video-or audiotaped. ...
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Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.
... This approach is used in schema-focused (e.g. Arntz & Weertman, 1999) and compassion-focused (e.g. Lee & James, 2011) therapies. The second approach focuses on identifying the most distressing meaning associated with the trauma memory, and developing new appraisals that are less distressing, more adaptive and in line with what the individual would like to believe. ...
... In Ison et al. (2014), ImRs was delivered to four people with psychosis who heard voices over two sessions. Memories either directly or indirectly related to the voice were targeted using Arntz & Weertman's (1999) protocol. Reductions in distress, negative affect, and conviction in the image-related beliefs were found in three of the four participants at 1-week and 1-month follow-up. ...
... Paulik et al. (2019) reported case series investigating ImRs for voice hearers, although only 67% had a psychosis diagnosis. They rescripted trauma memories related to voice hearing over eight sessions, also using the Arntz and Weertman (1999) protocol. They reported significant improvements in PTSD symptoms, and voice hearing frequency, distress and malevolence. ...
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Background and objectives There has been limited investigation of therapies targeting trauma-related psychological mechanisms hypothesised to play a role in post-traumatic and psychosis symptoms. Imagery rescripting (ImRs) is a therapeutic technique which involves transforming images, such as episodic memories, to modify associated distressing beliefs. This study is the first ImRs study for psychosis to incorporate experimental controls. We used a novel ImRs protocol, targeting present-focused, self-referential distressing meanings associated with intrusive trauma memories. A multiple baseline case series design investigated whether the protocol was feasible, safe, acceptable and effective. Methods 12 participants with a psychosis diagnosis and intrusive trauma memories were assessed and randomised to a monitoring period (one, two or three weeks), followed by three ImRs sessions (over three weeks), a further two-week monitoring period with a post-therapy assessment a week after completing therapy. Memory phenomenology was assessed daily during monitoring. Post-traumatic stress symptoms and wellbeing were assessed pre and post therapy. Results ImRs was feasible, safe and rated as highly acceptable. No participants dropped-out of the brief, targeted intervention. There were moderate effects on the frequency, distress, controllability and appraisals of trauma memories. Notably, ten participants showed reliable change, and seven clinically significant change, in post-traumatic stress symptoms. Limitations Assessments were not blinded and impact on psychosis was not examined. Conclusions The study indicates that a brief, novel ImRs protocol targeting present-focused, self-referential meanings is a promising intervention for intrusive trauma memories. Future research should investigate its integration into trauma-focused therapy for psychosis and impact on psychosis severity.
... IR is a collection of therapeutic imagery techniques aiming to update negative appraisals encapsulated in memories of painful past events. IR is thought to modify negative mental selfrepresentation by meeting the younger self's unfulfilled needs within a memory (Arntz and Weertman, 1999;Arntz, 2012). IR was first used to treat SAD by Clark et al. (2006) among a subgroup of patients who had a modest response to standard interventions. ...
... When the subjective meaning of the UCS is altered in IR, so is the CR. This theory has been termed US-revaluation (Davey, 1989;Arntz and Weertman, 1999). Alternatively, Brewin's (2006) retrieval competition hypothesis suggests that rather than modifying the negative memory, IR may develop a new adaptive memory that competes with the original memory during instances of subsequent retrieval. ...
... However, multiple studies included in this review show that a single session of IR without CR can significantly reduce negative self-beliefs (Knutsson et al., 2019;Nilsson et al., 2012;Reimer and Moscovitch, 2015;Romano et al., 2020a;Romano et al., 2020b). Therefore, together with previous research, our findings suggest that IR is a powerful and efficient method for accessing, addressing and reducing negative beliefs (Arntz, 2012;Arntz and Weertman, 1999;Stopa, 2009). ...
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Background Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets memories of distressing formative events linked to negative self-imagery (NSI). IR is thought to update unhelpful schema by addressing the needs of the younger self within the memory. An accumulating body of evidence indicates that by modifying NSI, IR can significantly affect distressing imagery, memory appraisal, and beliefs about the self. Aims This systematic review aims to critically evaluate and synthesise literature investigating the existing research on the effects IR has on NSI in SAD. Method A systematic electronic search of Academic Search Complete, ProQuest, Medline, Scopus and PubMed was performed in February 2021 using pre-defined criteria. Ten studies met the inclusion criteria and were selected for review. Results Analysis of the reviewed articles’ findings identified three main themes: Changes to negative self-images , Memories linked to images and Encapsulated beliefs . IR was associated with significant decreases in image distress, image vividness, memory vividness, memory distress, and encapsulated beliefs. Although reductions were found with image frequency, they were non-significant. Interpretation of results is limited by the small number of studies. Conclusions IR appears to effectively alter images, memories and beliefs in SAD in as little as a single session. The findings indicate that IR could be utilised as a cost-effective intervention for SAD. However, additional studies and longer-term follow-ups are needed.
... In ImRs for PTSD, patients are asked to vividly recall a traumatic experience where after patients are asked to imagine that an intervention takes place that changes the course of the original memory into an image in which the needs of the patient are fulfilled (Arntz, 2012;Arntz & Weertman, 1999). In ImRs several therapeutic steps are used to modify the content of traumatic memories into new positive images in order to change the meaning of the trauma memory representation, by adding new and corrective information about the meaning of the event. ...
... (2) Thereafter they are stimulated to intervene in the image and do whatever they think is needed for their own little child. (3) Patients are subsequently asked to experience the interventions by their adult self again from the perspective of the child in order to experience how it feels when needs are fulfilled (Arntz & Weertman, 1999). A recent study investigated the perspectives of patients and therapists regarding the elements of change in IMRS. ...
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Background: Despite the growing evidence that trauma-focused treatments can be applied as first-line approaches for individuals with childhood trauma-related PTSD (Ch-PTSD), many therapists are still reluctant to provide trauma-focused treatments as a first-choice intervention for individuals with Ch-PTSD, especially by telehealth. The current manuscript will therefore give an overview of the evidence for the effectiveness of trauma-focused therapies for individuals with Ch-PTSD, the delivery of trauma-focused treatments via telehealth, and a case example on how a specific form of trauma focused therapy: Imagery Rescripting (ImRs) can be applied by telehealth. Method: This article presents a clinical illustration of a blended telehealth trajectory of imagery rescripting (ImRs) Ch-PTSD delivered during the COVID-19 pandemic. Results: The presented case shows that ImRs can be safely and effectively performed by telehealth for ch-PTSD, no stabilization phase was needed and only seven sessions were needed to drastically reduce Ch-PTSD and depressive symptoms, and to increase quality of life. Conclusion: This case report shows the effectiveness of ImRs by telehealth for Ch-PTSD, which gives hope and additional possibilities to reach out to patients with ch-PTDS. Telehealth treatment might have some of advantages for specific patients, especially, but certainly not only, during the pandemic.
... Imagery rescripting procedures vary somewhat depending on the diagnosis and protocol (Arntz & Weertman, 1999;Hackmann, 2011;Wild & Clark, 2011) but generally include the following components. First, the therapist works with the patient to choose an autobiographical memory to target in treatment. ...
... Imagery rescripting explicitly instructs patients to change the narrative of the memory by replacing the negative outcome of the traumatic event with a more favorable one. Although this has been suggested to be akin to UCS devaluation (Arntz & Weertman, 1999), it is also similar to counterconditioning in which an aversive UCS is replaced with an appetitive UCS. Counterconditioning, much like extinction learning, is hypothesized to result in a new CS-appetitive UCS memory that competes for expression with the old CS-aversive UCS memory. ...
Article
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments for emotional disorders and identifying strategies to make treatments more effective. This research has often focused on translation from the laboratory to the clinic. Although this approach has notable successes, it has not been seamless. There are many examples of strategies that work in the laboratory that fail to lead to improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is a failure to focus on translation from the clinic to the laboratory. Here, we discuss potential benefits of translation from the clinic to the laboratory and provide examples of how this might be implemented. We first consider two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that are missing from these analogues, and propose variations to better capture the clinical process. Second, we discuss two clinical procedures that have more recently been brought into the laboratory (eye-movement desensitization and reprocessing and imagery rescripting). We conclude by highlighting potential implications of this proposed shift in focus for translational research.
... One of the most effective technique that could be implemented with the use of VR is the "reference frame shifting approach" (Akhtar, Justice, Loveday, & Conway, 2017;Riva, 2011), that is focused on the reorganization of body-related memories (Osimo, Pizarro, Spanlang, & Slater, 2015;Riva, 2011). This approach involves the VR adaption of the imagery rescripting method, a therapeutic technique, used in the context of CBT, that aims at reducing distress associated with negative memories (Arntz & Weertman, 1999) and changing their meaning (Arntz, 2011). ...
... Secondly our review showed the efficacy of VR in modifying the experience of the body in EDs patients by changing the stored negative memories related to the body and thus reorganizing patients' multisensory integration processes. This approach involves the VR adaption of the imagery rescripting method that aims at reducing distress associated with negative memories (Arntz & Weertman, 1999) by changing their meaning (Arntz, 2011). The re-scripting offers a fresh perspective on events that happened in the past and led to body dissatisfaction low self-esteem or isolation, creating new feelings and meanings to store in memory. ...
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Over the last 25 years, Virtual Reality (VR) has offered innovative solutions for targeting different key symptoms of eating disorders: from craving to negative emotions, from attentional biases to body dissatisfaction. The present narrative review assesses the existing literature in these areas trying to identify their different levels of clinical evidence. Specifically, the review presents four clinical approaches based upon VR and their implications in the treatment of eating disorders: VR cue exposure, VR reference frame shifting, VR for correcting body distortions and attentional biases. In general, existing findings demonstrate the clinical value of VR. On one side, the present review suggests that two VR-based techniques – VR exposure and reference frame shifting – have a significant research support and provide a possible advantage over traditional cognitive-behavioral therapy (CBT) for bulimia nervosa and binge eating disorder. On the other side, two emerging VR applications - multisensory body illusions and the use of VR for the modification of attentional biases - even if supported by preliminary data still need further research.
... The therapist remains largely nondirective and only facilitates the rescripting. Arntz and Weertman (1999) changed the IR method where the present adult self enters the scene to help the past (child) self by adding an extra phase. Their protocol distinguishes three phases in which the patient shifts perspective. ...
... Randomization to treatment condition was based on block randomization per site, to guarantee a balance between conditions per site and over time In this study, patients having received IR and their therapists were asked through a semistructured indepth interview about their view regarding the elements of change in the treatment. The IR treatment was based on the treatment protocol by Arntz and Weertman (1999) and Arntz (2015). However, after one introduction session in the following five sessions the therapist entered the image, and in the last six sessions the patient as the adult self entered the image (see Boterhoven de Haan et al., 2017, 2020. ...
Article
Imagery rescripting (IR) has been proven effective in several studies applied to different disorders. It is unclear, however, what the elements of change are according to patients and therapists and whether they agree on this. In this study, we examined the perspectives of patients and therapists and their degree of agreement regarding the elements of change in IR for posttraumatic stress disorder due to childhood trauma. Patients who showed a substantial decrease in symptoms on the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) after a maximum of 12 sessions of IR, as well as their therapists, were approached. Ten patients and nine therapists provided in-depth interviews about the elements of change in the treatment they had received or conducted. A qualitative analysis of the results was used. One element of change was mentioned by all but one interviewee—namely, caring for the child by the therapist when the therapist rescripts the traumatic event. All except two interviewees mentioned that when the therapist rescripts, speaking up to the perpetrator was important. Both aspects were also important when patients did the rescripting themselves. All patients mentioned the positive connection they had with the therapist and the encouragement they received from him or her was important. There was only moderate agreement between patient and therapist regarding the most important element of change, although overall both patients and therapists believed the same elements were of importance. To our knowledge this is the first study in which the elements of change viewed by patients and therapists are investigated in relationship to one another. Despite the fact that this study does not provide definite answers of what works, the perspective of patients and therapists needs to be taken into account when IR for posttraumatic stress disorder is further developed.
... . Historical role-plays involving the recreation and revision of troubling events from the past (e.g. Arntz & Weertman, 1999). . Internal-symbolic role-plays in which aspects of the client's inner world are enacted, such as the experience of hearing voices (e.g. ...
... If it is not your experience of me, where do these expectations come from?"). Alternatively, historical role-play (Arntz & Weertman, 1999), interviews with her internalised parents (Goulding & Goulding, 1979;Tomm et al., 1998), or empty-chair dialogues for resolving unfinished business (Greenberg & Malcolm, 2002) may have helped resolve the attachment-related injuries underlying her self-dismissal. Indeed, it is not uncommon for distressing parent-child interactions and conflictual relationships between I-positions to be related to one another (Siegel, 2020;Young et al., 2003). ...
Article
Single session therapy (SST) is an increasingly popular approach to mental health treatment that aims to address clients' presenting difficulties in a single appointment. However, experiential approaches to SST are limited. In this paper I describe the theory and practice of "chairwork"-an integrative, action-focused method of intervention centred on the concept of self-multiplicity-and outline how these procedures can be coherently applied in a single-session format. A preliminary protocol for delivering single-session chairwork (SSC) or "brief dialogical psychotherapy" is presented, alongside a case illustration that demonstrates features of this approach. Finally, directions for future research and the continued development of chairwork as a psychotherapeutic modality are considered. ARTICLE HISTORY
... A recent randomized clinical trial (RCT) (IREM) found promising results for two treatments for Ch-PTSD, namely imagery rescripting (ImRs) and EMDR [11]. ImRs involves the patient recalling the start of the traumatic experience and, subsequently, imagining an intervention that changes the course of events to a more positive outcome aimed at satisfying the needs of the patient [12,13]. In EMDR, the therapist instructs the patient to focus on a traumatic memory, composed of images, emotions, cognitions, and physical sensations, while the therapist concurrently provides a form of active distraction (e.g., following the back and forth movements of the finger of the therapist) [14]. ...
... ImRs is delivered based on a modified version of the protocol developed by Arntz and Weertman [13]. In short, the therapist helps the patient to imagine a traumatic event and then a helping figure is introduced and changes the script to a better outcome where the needs of the traumatized person are met. ...
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Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018.
... During ImRs, participants were guided by means of a semistructured ImRs protocol. The first phase of the ImRs protocol closely followed the procedure suggested by Arntz and Weertman (1999) in that participants were instructed to vividly imagine the aversive event as vividly and detailed as possible and if it was happening at the moment. To achieve affective activation, participants were instructed to describe the event in present tense, from a first person perspective, and to focus on all sensory modalities, feelings, and body sensations. ...
... They were encouraged to imagine the new script as vividly as possible and to describe it out loud in detail. During the rescripting of the memory, the following questions were asked to support participants (see Arntz & Weertman, 1999): What would you like to do/ say? Ok, do it/say it! ...
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Background Imagery Rescripting (ImRs) is a promising intervention to reduce symptoms associated with aversive memories, but little is known about its working mechanisms. The present study investigates whether ImRs increases perceived mastery and attenuates emotional reactivity to memory retrieval on a subjective and physiological level. Methods Seventy-nine individuals reporting memories of distressing real-life events were randomly allocated to ImRs, positive imagery (PI), or no-intervention control (NIC). The memory was reactivated before the intervention and at 1-week follow-up to assess subjective measures and physiological reactivity (heart rate [HR], skin conductance level [SCL], and facial electromyography activity [EMG]) during memory retrieval. Results ImRs was superior to PI and NIC on subjective memory distress and helplessness, but not on other emotions. ImRs did not exceed PI and NIC in reducing state stress symptoms or increasing perceived mastery. Physiological reactivity (HR, EMG) decreased from pre-intervention to follow-up with no differences between groups. Conclusions Positive effects of ImRs on helplessness and distress were found. Null findings regarding mastery might result from timing of its assessment or the fact that rather high-functioning participants were included. The lack of between group differences on physiological responses indicates that ImRs did not exceed habituation effects in the present sample.
... Then, they were invited to focus on the emotions and physical sensations they experienced along with the image. Focusing on these feelings, they were then asked to imagine themselves as a child having the same feelings and to see whether a memory came to mind (i.e., diagnostic imagery; Arntz & Weertman, 1999). Next, they were asked to describe the memory in detail and rate it as in the SIQ. ...
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This study aimed to assess the characteristics and content of intrusive images in patients with eating disorders, and test the relations between intrusive images, core beliefs and autobiographical memories. As an exploratory aim, patients with anorexia nervosa, bulimia nervosa and binge eating disorders were compared on the level of dissociation associated with intrusive images. Self‐report questionnaire data were collected from 85 patients with an eating disorder. Most participants (91.7%) experienced intrusive images related to body weight and shape and self‐worth, and results confirms that these images were highly distressing and vivid. We found that intrusive images were linked to autobiographical memories, and that negative and distressing intrusive images were positively associated with negative core beliefs. Eating disorder subtypes did not differ on the level of dissociation associated with intrusive images. Our findings point to the potential importance of targeting intrusive images or autobiographical memories in the treatment of eating disorders. This article is protected by copyright. All rights reserved.
... Therapists may also promote cognitive dissonance, by providing comments and reflections that aim to challenge the consistency and coherence of the belief. In cases where patients struggle with emotionally intense memories of traumatic events and/or post-traumatic stress symptoms, engaging in imagery rescripting might help reduce the vividness of the event, as well as reduce the associated feelings of shame and guilt, through a three-phase imagery procedure that aims to create an environment where the adult client takes care of their younger self who experienced the trauma (see Arntz and Weertman, 1999 for a detailed description of imagery rescripting). • Behavioural activation: after clarifying and listing the patient's values and goals, and ascertaining/exploring their links with avoidance patterns of behaviour that have been moving the client away from those same goals, therapists may help TGNC clients engage in previously avoided trans-affirming activities (e.g. ...
Article
In a cisheteronormative culture, gender and sexual minorities (GSMs) may experience additional challenges that get in the way of a meaningful life. It is crucial that clinicians are mindful of these challenges and cognizant about the specificities of clinical work with GSMs. This article points out how societal structure interferes with mental health, and clarifies what clinicians must take into account when using affirmative cognitive behavioural therapy (CBT) interventions. Knowledge of up-to-date terminology and use of affirmative language are the first steps that contribute to clients’ experience of respect, which is paramount for the development of a good therapeutic relationship. Considering a conceptual framework of minority stress to understand vulnerability in GSM, specificities in formulation and key psychological processes are discussed. Moreover, guidelines and practical tools for intervention are presented within a CBT approach. Some reflections on therapists’ own personal biases are encouraged, in order to increase the efficacy of interventions. Key learning aims After reading this article you will be able to: (1) Recognize the uniqueness of gender and sexual minorities (GSM) stressors in broad and specific contexts, and their impact on mental health. (2) Identify the underlying key processes and specificities in therapeutic work with GSMs, from a CBT perspective. (3) Recognize the importance of a culturally sensitive approach in affirmative CBT interventions.
... The imagery rescripting protocol consisted of three phases (Arntz & Weertman, 1999;Frets, Kevenaar, & Van Der Heiden, 2014;Wild & Clark, 2011). In phase one, participants were instructed to relive an aversive event as their younger self. ...
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Background and objectives Negative mental imagery appears to play a role in anxiety disorders and can involve aversive memories or anticipated future threats. Modulating aversive memories through imagery rescripting generally reduces negative memory appraisals and associated anxiety. This pre-registered two-day analog study investigated whether imagery rescripting of aversive memories also reduces negative imagery of future threats. Methods On Day 1, socially anxious individuals (N = 52) were randomly assigned to imagery rescripting of an aversive memory or progressive relaxation (control condition). Before each intervention, they were asked to imagine a feared social situation that may happen in their future and evaluate this situation. They also rated the aversive memory before and after the intervention phase. The feared future situation was again evaluated at follow-up on Day 2. Results Unexpectedly, no group differences were found on the main outcome measures. That is, negative memory appraisals reduced after both interventions. Likewise, in both groups, negative details decreased, and positive details increased in prospective mental imagery, and anxiety and avoidance towards the imagined event decreased. On the exploratory measures, the imagery rescripting group showed increased positive appraisals of memory and future threat, and decreased negative future-threat appraisals, compared to the progressive relaxation group. Limitations No passive control group was included, so potential time or placebo effects cannot be precluded. Conclusions The interventions had similar effects on the main outcomes and influenced mental imagery of future threats. Some differences were found on the exploratory measures that warrant further investigation with a passive control condition.
... Tra questi, centrale è stato in primis il lavoro mirato alla riduzione della sintomatologia depressiva, da un lato mediante interventi di ristrutturazione cognitiva volti alla riduzione degli standard elevati adottati da Sandro e dall'altro, mediante sessioni di Imagery Rescripting (Arntz, 2012;Arntz & Jacob 2017;Arntz & Weertman, 1999) volti alla diminuzione dell'autocritica alle sue vulnerabilità. Questo lavoro congiunto ha reso progressivamente perseguibili gli obiettivi successivi legati alla ripresa delle precedenti attività lavorative abbandonate, dando la possibilità, a Sandro e alla terapeuta, di lavorare "in diretta" sui momenti di impasse ancora presenti mediante interventi di esposizione alle emozioni temute e l'accettazione del rischio del rifiuto nonché della sua "rivalutazione" e contestualizzazione. ...
Article
Sommario L’articolo descrive il caso di un paziente con un Disturbo Narcisistico di Personalità e Depressione Maggiore. Il trattamento è stato progettato per affrontare temi e credenze patogene emersi sia nella ricostruzione della storia di vita del paziente che nella sua interazione con lo psicoterapeuta. Particolare attenzione viene dedicata agli aspetti relazionali emersi nel corso del processo psicoterapeutico e alle difficoltà che possono essere riscontrate dallo psicoterapeuta con i pazienti narcisisti. Viene descritto come alcuni di questi ostacoli siano stati efficacemente superati mediante l’integrazione del modello teorico della Control Mastery Theory all’approccio cognitivo standard, favorendo in ultimo la consapevolezza e la ristrutturazione delle credenze patogene. Parole chiave: CBT, Narcisismo, Alleanza terapeutica, Control Mastery Theory, Test relazionali. Abstract This article describes the case formulation and treatment of a patient with narcissistic personality disorder and major depression. The treatment was designed to address pathogenic themes and beliefs that emerged in both the patient’s life history and interactions with the therapist. Particular attention has been given to the relational processes arising during psychotherapeutic sessions, highlighting typical difficulties that can be encountered by the therapist with narcissistic patients. It is reported how these obstacles were effectively overcome using an integration of standard cognitive-behavioural therapy and control-mastery theory, ultima- tely favouring awareness and restructuring of pathogenic beliefs. Keywords: CBT, Narcissism, Therapeutic alliance, Control-mastery theory, Relational tests.
... Although actual hostility traits were not reduced more strongly in I-CR and CR than in our control condition, we observed sustained reductions in hostile beliefs and aggressive tendencies. Our findings provide convergent data with previous work that evidenced the potential of mental imagery to increase treatment efficacy for psychopathologies (Arntz & Weertman, 1999;Beck, 1985;Edwards, 1990;Ehlers et al., 2005;McEvoy et al., 2015;Smucker et al., 1995). ...
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Background and objectives Cognitive restructuring (CR) is an effective intervention for hostility. However, the number of patients who fail to benefit suggest that the efficacy of CR can be further improved. The present study investigated whether enhancing CR with mental imagery techniques can increase its effectivity. Methods A high hostility sample (28% male, and 72% female) was randomized over one session of imagery enhanced CR (I-CR) (n = 34), traditional CR (n = 32) or an active control session (AC) (n = 21). Changes in hostile beliefs, aggressive tendencies, state anger and hostility traits were assessed pre- and post-treatment, and at one-week follow-up. Results Results showed that both I-CR and CR efficaciously reduced hostile beliefs, aggressive tendencies and anger, to a stronger degree than AC. I-CR was more efficacious and sustainable over time than both CR and AC in reducing hostile beliefs and aggressive tendencies. Limitations This study was conducted using a small, non-treatment seeking sample. Conclusions Findings suggest that implementing imagery techniques in CR for hostile beliefs enhances its’ efficacy.
... To our knowledge, no study has investigated early parent-child memories through diagnostic imagery in patients with eating disorders. Previous studies have applied Imagery Rescripting (IR, Arntz and Weertman, 1999) to early memories as a therapeutic tool in the treatment of clients with anorexia or bulimia nervosa (Ohanian, 2002;Cooper et al., 2007;Cooper, 2011;Deguè et al., 2019;Zhou and Wade, 2021) and binge-eating disorder (Deguè et al., 2019). IR aims to address and change the meaning of adverse childhood events and emotions within the past episode, principally by satisfying the emotional unmet needs of the child, through guided mental visualization. ...
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Together with socio-cultural components, the family environment and early parent-child interactions play a role in the development of eating disorders. The aim of this study was to explore the nature of early parent-daughter relationships in a sample of 49 female inpatients with an eating disorder. To acquire a detailed image description of the childhood experiences of the patient, we used diagnostic imagery, a schema therapy-derived experiential technique. This procedure allows exploring specific contents within the childhood memory (i.e., emotions and unmet core needs), bypassing rational control, commonly active during direct verbal questioning. Additionally, patients completed self-report measures to assess for eating disorder severity, general psychopathology, and individual and parental schemas pervasiveness. Finally, we explored possible differences in the diagnostic imagery content and self-report measures in two subgroups of patients with anorexia nervosa and bulimia nervosa. The results showed that the most frequently reported unmet needs within the childhood memories of patients were those of safety/protection, care/nurturance, and emotional expression, referred specifically to the maternal figure. Overall, mothers were described as more abandoning, but at the same time particularly enmeshed in the relationship with their daughters. Conversely, patients perceived their fathers as more emotionally inhibited and neglecting. Imagery-based techniques might represent a powerful tool to explore the nature of early life experiences in eating disorders, allowing a more detailed case conceptualization and addressing intervention on early-life vulnerability aspects in disorder treatment.
... The procedure aims to correct dysfunctional meanings attached to trauma memories and restore perceived control. The protocol is based on the ImRs protocol described by Arntz and Weertman [45]. In a minimum of two and a maximum of 5 sessions after the first session, the therapist steps into the image and rescripts, the patient staying in the perspective of their former self. ...
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Background Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. Methods In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. Discussion This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. Trial registration Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.
... The reactivated experience is then "rescripted" (i.e., changed in the imagination in a positive, desired direction) so that the unmet needs of the vulnerable or traumatized self are satisfied, at least in part. To accomplish this, the client is asked to imagine the scene from the perspective of their present self and step into the image to do whatever is necessary to satisfy the needs of their vulnerable selves [6][7][8]. ...
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Imagery rescripting (IR), an effective intervention technique, may achieve its benefits through various change mechanisms. Previous work has indicated that client–therapist physiological synchrony during IR may serve as one such mechanism. The present work explores the possibility that therapist-led vs. client-led synchrony may be differentially tied to clients’ emotional experiences in therapy. The analyses were conducted with data taken from an open trial of a brief protocol for treating test anxiety (86 IR sessions from 50 client–therapist dyads). Physiological synchrony in electrodermal activity was indexed using two cross-correlation functions per session: once for client leading and again for therapist leading (in both cases, with lags up to 10 s). The clients’ and therapists’ in-session emotions were assessed with the Profile of Mood States. Actor–partner interdependence models showed that certain client (but not therapist) in-session emotions, namely higher contentment and lower anxiety and depression, were tied to therapist-led (but not client-led) physiological synchrony. The results suggest that therapist-led synchrony (i.e., clients’ arousal tracking therapists’ earlier arousal) is tied to more positive and less negative emotional experiences for clients.
... Historical role-play is a chairwork technique that can be used to process disturbing memories and address internal attributions of parental actions (Arntz & Weertman, 1999). This method can be integrated into CFT to address introjected messages of criticism and abuse when differentiated from the form of self-criticism targeted above (Table 17.2). ...
Chapter
Chairwork refers to a group of experiential, psychotherapeutic methods that utilize chairs, their positioning, and the client’s movement between them. Chairwork forms an integral part of compassion focused therapy (CFT) and is used to differentiate, integrate, and transform threat-based processes via compassionate relating. This chapter highlights how the core principles and processes of chairwork practice (self-multiplicity, embodiment and personification, and dialogue between internal parts or patterns) can be used to compliment and support the aims of CFT. Core CFT chairwork exercises will be outlined in detail to aid practical application; these exercises include: two-chair self-compassion; chairwork for self-criticism; and ‘multiple-selves’ for addressing threat-based emotions. Novel forms of CFT chairwork will also be introduced and contextualized, including the use of chairwork to explore blocks to compassion and to enhance motivation. Recent research on the therapeutic relationship and process skills in CFT chairwork will be outlined to support clinicians in their delivery of this powerful method.
... Imagery rescripting can be useful to help update the meanings linked to these memories. For example, their older self entering the scene to deliver these messages, comfort the child with a hug and take them to a place of safety (similar to the protocol described by Arntz and Weertman, 1999). ...
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Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for post-traumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common ‘misconceptions’ were identified. These included misconceptions about the suitability of the treatment for some types of trauma and/or emotions, the need for stabilisation prior to memory work, the danger of ‘retraumatising’ patients with memory-focused work, the risks of using memory-focused techniques with patients who dissociate, the remote use of trauma-focused techniques, and the perception of trauma-focused CBT as inflexible. In this article, these misconceptions are analysed in light of existing evidence and guidance is provided on using trauma-focused CT-PTSD with a broad range of presentations. Key learning aims (1) To recognise common misconceptions about trauma-focused CBT for PTSD and the evidence against them. (2) To widen understanding of the application of cognitive therapy for PTSD (CT-PTSD) to a broad range of presentations. (3) To increase confidence in the formulation-driven, flexible, active and creative delivery of CT-PTSD.
... Individuals who worry report more frequent traumas and childhood adversity, including difficult attachments, than non-anxious people [18,19]. Attachment experiences, such as enmeshment and role reversal with childhood primary caregivers [20], may be developmental precursors to interpersonal difficulties associated with worrying. ...
... Explanations of change in ImRs exist at different levels. The most basic level focuses on associative learning processes and places the change in the meaning attached to the targeted memories/images at the heart of its therapeutic effects (1,(16)(17)(18). In this explanation, ImRs allows the reactivation of the distressing memories/images (the unconditioned stimuli), their emotional processing, and subsequent re-evaluation before they are reconsolidated. ...
Article
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Imagery rescripting (ImRs) is increasingly used in cognitive-behavioral therapy (CBT) to change beliefs and meanings about the self associated with negative and traumatic memories. It is quintessentially an imagery intervention that targets the self and autobiographical memory (AM); however, to date most of the research into its effectiveness has focused on symptom alleviation. The mechanisms of change remain unclear. In this article, we outline a narrative identity model of change in ImRs and note the value of the narrative identity literature in helping us understand memory-focused therapeutic interventions.
... One method to update negative or distressing memories is imagery rescripting. This intervention typically consists of three phases (Arntz & Weertman, 1999;Wild & Clark, 2011). In the first phase, patients are asked to relive a negative memory as their younger self. ...
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Distressing mental images are common in anxiety disorders and can make it difficult for patients to confront feared situations. This study examined whether imagery rescripting focused on a feared social situation prepares participants to engage in a feared situation. Sixty healthy individuals were asked to formulate a behavioral experiment to test negative beliefs about a social situation they feared. They were assigned to one of two groups: imagery rescripting focused on the feared outcome of the behavioral experiment or no imagery rescripting (i.e., a break). All participants were then asked to complete ratings scales and to conduct the behavioral experiment. Before the behavioral experiment, the imagery rescripting condition, compared to the control condition, showed reduced anticipated probability and severity of the feared outcome, lower anxiety and helplessness levels, and increased willingness to conduct the behavioral experiment. Imagery-based interventions focused on feared outcomes seem promising to prepare anxious individuals to engage in treatment.
... Their intervention includes (a) reliving the traumatic scene (i.e., prolonged imaginal exposure) and (b) changing the memory using mental imagery (i.e., ImRs). Arntz and Weertman (1999), on the other hand, suggested that prolonged exposure is not necessary because ImRs "is not based on extinction, but on processing new, corrective information about the meaning of the event" (p. 719). ...
Article
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Anxiety disorders are effectively treated with exposure therapy, but relapse remains high. Fear may reinstate after reoccurrence of the negative event because the expectancy of the aversive outcome (unconditioned stimulus [US]) is adjusted but not its evaluation. Imagery rescripting (ImRs) is an intervention that is proposed to work through revaluation of the US. The aim of our preregistered study was to test the effects of ImRs and extinction on US expectancy and US revaluation. Day 1 ( n = 106) consisted of acquisition with an aversive film clip as US. The manipulation (ImRs + extinction, extinction-only, or ImRs-only) took place on Day 2. Reinstatement of fear was tested on Day 3. Results showed expectancy learning in both extinction conditions but not in the ImRs-only condition and no enhanced revaluation learning in ImRs. The combination of ImRs and extinction slowed down extinction but did not protect against reinstatement, which pleads in favor of stand-alone interventions in clinical practice.
... This treatment uses mental imagery to directly modify the content of distressing memories as well as related dysfunctional cognitions (Arntz, 2012;Holmes et al., 2007). As powerful mental images closely resemble real experiences and are superior to verbal processing when it comes to accessing and changing emotions (Holmes & Mathews, 2010), it is hypothesized that ImRs works through changing the meaning of an aversive memory (Arntz, 2012) and entails transformations in core belief systems and implicit associations (Arntz & Weertman, 1999;Holmes et al., 2007). ImRs does not rely on exposure to all details of the traumatic event and has been found to be less distressing than exposure-based treatments (Siegesleitner et al., 2019). ...
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Posttraumatic stress disorder (PTSD) is among the most prevalent mental disorders in refugees. Imagery Rescripting (ImRs) has gained growing interest as an innovative and effective treatment for several disorders, including PTSD. The technique aims to change the meaning of traumatic memories by asking the patient to imagine a different outcome of a particular memory. As ImRs focuses on meeting individual needs, it can be tailored to patients with different cultural and religious backgrounds and may be a promising intervention for refugees. This case study therefore illustrates the application and challenges of ImRs as a stand-alone treatment for a refugee patient. The patient had experienced multiple traumatic events during flight and met full criteria for PTSD according to the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; total score of 32). The treatment was conducted with the assistance of an interpreter and consisted of 12 100-min sessions, during which the most distressing traumatic events were rescripted. Cognitive restructuring and imagery modification—another imagery-based intervention showing some similarities with ImRs—was applied as an additional intervention to address feelings of contamination. At the end of treatment, symptoms were reduced and the patient no longer met diagnostic criteria for PTSD (CAPS-5 total score of 25); however, only change in self-reported symptoms reached clinical significance. Challenges during treatment included frequent dissociative symptoms that were managed by instructing the patient to use antidissociative skills during ImRs. Findings corroborate ImRs as a feasible approach for the treatment of PTSD in patients with complex trauma histories.
... A parent and partner group was offered five times during clinical admission (psychoeducation about eating disorders, opportunity for support, recognition, understanding and advice).The investigational treatment was IMRS. IMRS is a psychological treatment for processing traumatic experiences[4,5,44,53]. IMRS was given in addition to the regular inpatient treatment program for FED. ...
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Background Eating disorder patients with posttraumatic stress disorder have worse treatment results regarding their eating disorder than patients without posttraumatic stress disorder. Many eating disorder patients with co-morbid posttraumatic stress disorder symptoms are not treated for posttraumatic stress disorder symptoms during an underweight state. We propose that treatment of posttraumatic stress disorder is possible for underweight patients and that their trauma symptoms decrease with the use of Imagery Rescripting. We also investigated whether treatment of trauma influences eating disorder pathology in general and the process of weight gain specifically. Method Ten patients in clinical treatment (BMI 14–16.5) participated. A multiple baseline design was used, with baseline varying from 6 to 10 weeks, a 6-week treatment phase, a 3-week follow-up period and a 3-month follow-up measurement. Data were analysed with mixed regression. Results Evidence was found that Imagery Rescripting had strong positive effects on posttraumatic stress disorder symptoms without interfering with eating disorder treatment. Positive effects were also found on a range of secondary emotional and cognitive measures. Conclusion Imagery Rescripting of traumatic memories is a possible and safe intervention for underweight eating disorder patients. It also had positive clinical effects. Trial registration Netherlands trial register (NTR) Trial NL5906 (NTR6094). Date of registration 09/23/2016. https://www.trialregister.nl/trial/5906.
... Since it shares the same theoretical principles of Imagery Rescripting (IwR) (73)(74)(75), which has recently been used for working on dream scenarios, it is important to conduct further studies to evaluate its efficacy in the specific treatment of nightmares on different clinical samples. This could lead to the development of an integrated intervention that may allow clinicians to intervene effectively even in cases in which there are linguistic communication barriers, as often happens when working with migrants, asylum seekers, refugees, and victims of torture, who need an intervention that can take these difficulties into account. ...
Article
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Besides affecting 8% of the general population, nightmares are one of the most frequent symptoms of traumatized individuals. This can be a significant factor in the treatment of post-traumatic disorders; indeed, several studies demonstrated its strong predictive and prognostic value. Sleep disorders, nightmares in particular, could be very distressing for individuals and need targeted interventions, especially if they are associated with a PTSD diagnosis. To date, the best technique for the treatment of traumatic sleep disturbances seems to be Imagery Rehearsal Therapy (IRT), an empirically supported method. Through a review of the literature on this matter, this article aims to outline the incidence and consequences of nightmares in PTSD, illustrate how IRT could prove useful in their treatment, and investigate its clinical applications.
... Imagery rescripting has been used to impact narrative identity (Singer, 2006) and the characteristics of SDMs (Çili et al., 2017). Imagery rescripting has also been shown to reduce the distress associated with certain early memories (Arntz & Weertman, 1999) and mental health symptoms across various disorders, such as major depression, PTSD, and OCD (Morina et al., 2017). One pilot study reported that, after one session of imagery rescripting, participants reported their adverse SDM as less negative, distressing, and less important to their sense of self (Çili et al., 2017). ...
Article
Background: Self-defining memories (SDMs) are important for identifying one's purpose in life, achieving goals, and overcoming challenging situations. Individual studies have demonstrated differences in the characteristics of SDMs between clinical and non-clinical populations. This systematic literature review aimed to summarise and compare SDM characteristics among those with mental, substance use, cognitive, neurodevelopmental, and physical health challenges. Methods: Peer-reviewed English-language studies were included if they evaluated SDMs in these groups. Results: Thirty-five studies (N = 3123) were included. SDM content across all clinical populations tended to focus on illness themes. SDMs were generally less specific and integrated in those with mental health or substance use disorders as compared to non-clinical populations. SDM specificity and integration findings were more mixed in those with cognitive, neurodevelopmental, and physical health challenges. Conclusions: Specific differences emerged between groups of individuals which may be related to illness characteristics, recovery trajectory, and individual differences in the ability to understand and process difficult life events.
Article
Background: From 1949 to 1990, about 500,000 children and adolescents in the former German Democratic Republic (GDR) were placed in institutional care. Many of these individuals experienced physical and sexual abuse as well as general maltreatment. While this population group is in great need of psychosocial support, few low-threshold interventions aimed at the needs of adult survivors of institutional childhood abuse exist. Objective: This pilot study examines the efficacy of an internet-based imagery rescripting intervention in reducing psychopathological symptoms, within a population of survivors of institutional abuse from state childcare institutions, in the former GDR. Additionally, a case study is presented, depicting the treatment of a woman suffering from PTSD after having been institutionalised in the former GDR. Method: Participants received 10 internet-based writing assignments, based on the principles of imagery rescripting, specifically tailored to the needs of survivors of institutional childhood abuse in the GDR. The participants received personalised feedback on their assignments. Symptoms of posttraumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD), depression, and anxiety were assessed at pre- and post-treatment. Results: A total of 15 participants completed the intervention (mean age 56.2 years; 66.7% female). Paired t-tests showed a significant reduction of PTSD, CPTSD, depression, and anxiety symptoms. Large effect sizes were found for PTSD (d = 1.26), CPTSD (d = .97), depression (d = 1.08) and anxiety (d = 1.20). Conclusion: The results of this pilot study provide preliminary evidence for the efficacy and feasibility of the intervention in treating psychopathological symptoms in survivors of institutional abuse in the GDR. The case study additionally demonstrates the applicability of the intervention. A randomised controlled trial should be applied to further evaluate the intervention and its effects. Trial registration: German Clinical Trials Register identifier: DRKS00020266..
Article
Background Negative mental images in social anxiety are often linked to memories of distressing social experiences. Imagery Rescripting (ImRs) has been found to be a promising intervention to target aversive memories, but mechanisms underlying ImRs are largely unknown. The present study aimed (a) to investigate the effects of ImRs compared to cognitive restructuring (CR) on social anxiety symptoms and (b) to extend previous research by examining whether ImRs works by fostering reappraisal of negative emotional self-beliefs. Method Highly socially anxious individuals (N = 77) were randomly allocated to ImRs, CR, or no intervention control (NIC). A speech task was performed at baseline and at 1-week follow-up. Results Only CR significantly reduced social anxiety symptoms from baseline to follow-up. Decreases in negative appraisals and emotional distress in response to the speech task did not differ between conditions. Regarding working mechanisms, ImRs led to stronger increases in positive emotions than CR and NIC. Both CR and ImRs yielded short-term reductions in emotionally anchored idiosyncratic self-beliefs, but CR was superior to ImRs at follow-up. Conclusions The present study provides evidence for the efficacy of a single-session of CR for social anxiety symptoms. As one specific version of ImRs was applied, it is conceivable that other or optimized versions of ImRs might be more effective.
Article
Background and objectives In Schema Therapy (ST) for Borderline Personality Disorder (BPD) patients the empty chair technique (EC) is often used to diminish the ‘punitive parent mode’ (PP). The present study is a first attempt to assess whether EC is more effective in reducing the PP than a standard Cognitive Behavioral Therapy technique (CT). Methods We utilized a counterbalanced, cross-over design comparing one EC session to one CT session in twenty patients with a primary BPD diagnosis who had started ST. Before and after each intervention we assessed credibility, power, and valence of the PP-associated core belief and how much power patients felt over this core belief (dominance). Patients also completed a working alliance inventory. An interview was conducted to explore subjective views regarding the interventions. Results Both techniques reduced power and credibility of the PP-associated core belief and increased dominance. CT reduced credibility more strongly than EC. Still, patients preferred EC as they felt it was better able to elicit feelings during the session and believed it would be more effective than CT when administered repeatedly. Limitation s: A complex technique was tested early in treatment and only once, effects might be different later in treatment and when applied repeatedly. Moreover, only short-term effects were assessed in a rather small sample. Conclusion Both EC and CT help combat the PP in BPD patients, with CT being more effective in reducing credibility after one session. However, patients preferred EC and suggest multiple sessions might be needed to truly elucidate differences between both techniques.
Article
Background and objectives Posttraumatic stress disorder (PTSD) related to childhood abuse (CA) is associated with high symptom complexity. This study examined the efficacy of Imagery Rescripting (ImRs) as a stand-alone treatment versus a sequenced approach with Skills training in Affective and Interpersonal Regulation (STAIR) followed by ImRs for CA-related PTSD. Methods Outpatients of two mental health clinics with CA-related PTSD (N = 61) were randomly assigned to ImRs (16 sessions; n = 21), STAIR/ImRs (8 STAIR-sessions followed by 16 ImRs-sessions; n = 20), or Waitlist (8 weeks; n = 20). Patients of the waitlist condition were also randomized to the two active conditions for comparison of STAIR/ImRs (total n for this condition = 31) and ImRs (total n for this condition = 30) and started treatment after waitlist completion. Assessments took place at pre-treatment, after each treatment phase and at 12-week post-intervention follow-up. PTSD symptoms and diagnosis were primary outcome measures, and depression, emotion regulation and interpersonal functioning were secondary outcomes. Results ImRs showed greater reduction of PTSD severity (effect sizes [ES] 1.40–1.63) than STAIR (ES, 0.23–0.33) as compared to waitlist. When comparing STAIR/ImRs and ImRs directly, (i.e. including re-randomized Waitlist-patients), PTSD symptoms reduced significantly (within condition ES, 1.64–2.10) and improved further to 12-week follow-up (within-condition ES, 2.33–2.66), with no significant difference between both conditions (between-condition ES, 0.21–0.45). Loss of PTSD diagnosis was achieved by 70% in the ImRs condition and 86% in the STAIR/ImRs condition. Limitations The sample size was relatively small. Conclusions Results show that ImRs is an effective treatment for CA-related PTSD, whereby the current data do not convincingly show an additive effect of STAIR.
Article
Imagery Rescripting ist eine in vielen psychotherapeutischen Richtungen und störungsspezifischen Behandlungsansätzen eingesetzte Technik, die auch im Rahmen der Therapie der Posttraumatischen Belastungsstörung (PTBS) Anwendung findet. Das Grundprinzip besteht in der imaginativen Aktivierung einer traumatischen Erinnerung, die in eine gezielte Veränderung des Geschehens in der Vorstellung mündet. Dieses Grundprinzip wird in verschiedenen Varianten und mit unterschiedlichen Zielen in der Behandlung der PTBS eingesetzt, unter anderem als Stand-Alone-Behandlung im Rahmen der Imagery Rescripting and Reprocessing Therapy (IRRT) sowie dem Imagery Rescripting für PTBS . In der Kognitiven Therapie der PTBS wird es darüber hinaus als spezifischer Baustein zur Aktualisierung der Traumaerinnerung verwendet. Andere Varianten wurden zur Behandlung von Albträumen oder zur Reduktion eines Gefühls des Beschmutzt-Seins nach sexueller Traumatisierung entwickelt. Nach einem vergleichenden Überblick über die unterschiedlichen Einsatzmöglichkeiten werden zusammenfassend Ergebnisse der Wirksamkeitsforschung dargestellt. Der Artikel schließt mit einem Ausblick auf aktuelle Entwicklungen und zukünftige Perspektiven in Bezug auf Indikation, differenzielle Wirksamkeit und Wirkmechanismen von Imagery Rescripting zur Behandlung der PTBS. Zur Illustration der dargestellten Interventionen werden in einem Online-Supplement zwei Fallbeispiele beschrieben.
Article
Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioural therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.
Article
Background Imagery rescripting (IR), an emotion-focused technique for processing dysfunctional core beliefs, is an increasing topic of psychotherapy research; however, the underlying mechanisms of the technique remain unclear. The results of recent studies on physiological synchrony suggest that processes such as co-regulation could play a significant role. In particular, linear associations between physiological synchrony and various process variables during IR have been investigated. Nevertheless, it is questionable whether a linear association always provides the best result.Objective The aim of this study is to investigate whether there is a linear or quadratic association between physiological synchrony in the therapeutic dyad and the emotional processing of clients during IR.Material and methodsThe results are based on 128 therapy sessions with 1926 segments each of 2 min from an imagination-based treatment for test anxiety with 50 clients over the course of 6 sessions. This is a student sample (88% female, mean age 24 years). The group of therapists consisted of psychotherapists in training and Masters students in psychology. The electrodermal activity of clients and therapists was continuously monitored and emotional processing was assessed by external raters using the experiencing scale.ResultsOrdinal regression modelling was used to demonstrate that moderate levels of physiological synchrony were associated with higher emotional processing (linear: b = 7.85, SE = 2.39, p < 0.01; quadratic: b = −16.80, SE = 4.92, p < 0.001).Conclusion The results provide first evidence that during IR the physiological synchrony between clients and therapists could be an important indicator of the depth of emotional processing of clients.
Article
Exposure and response prevention (ERP), a specific type of Cognitive and Behaviour Therapy, is well recognised as the first-line psychological treatment in obsessive-compulsive disorder (OCD), either alone or in combination with selective serotonin reuptake inhibitor pharmacotherapy. However, given that up to half of patients suffering from OCD do not experience a clinically significant reduction in symptoms following ERP, further treatment options for treatment-resistant OCD are needed. Initial research into using ImRs as a psychological adjunct for treatment-resistant OCD has been encouraging. We provide a detailed case study of a 61-year-old male who continued, following ERP treatment, to suffer debilitating OCD symptoms of compulsive checking to prevent making mistakes. Following ERP, the individual received two sessions of ImRs as a therapy adjunct, which resulted in a further reduction of 56% in OCD symptoms. The individual reported associated improvements in mood, life satisfaction, and occupational and interpersonal relationships. This case study describes how ImRs can be incorporated into ERP treatment for OCD. Details of the ERP and ImRs treatment are provided, along with transcript excerpts to highlight the ImRs process. Further research is needed to enhance understanding of mechanisms and optimal deployment of ImRs in treatment sequencing for OCD sufferers.
Article
L'Imagery Rescripting (IR) è una tecnica emotivo-esperienziale, particolarmente applicata nella Schema Therapy, che collega problematiche affettive attuali a memorie infantili dolorose, ri-scrivendo, tramite l'appagamento di bisogni emotivi frustrati nel passato, il loro contenuto doloroso. Diversi studi evidenziano che a seguito dell'applicazione dell'IR in popolazioni cliniche si osserva anche una riduzione dell'intensità delle convinzioni nucleari disfunzionali associate al ricordo traumatico. Scopo dell'attuale ricerca è indagare l'efficacia dell'IR nel ridurre l'intensità di alcune delle principali convinzioni nucleari disfunzionali in un campione non-clinico. Quarantatré psicologi specializzandi in psicoterapia hanno indicato l'intensità con cui si identificavano in venti credenze negative. Quindi, una parte del campione è stata sottoposta a una sessione di IR, mentre l'altra metà rientrava nella condizione di controllo, senza IR. A distanza di uno (t1) e 40 giorni (t2) sono state raccolte ulteriori misurazioni circa l'intensità delle loro credenze. I risultati mostrano una riduzione significativa dell'intensità di metà delle convinzioni nucleari disfunzionali misurate, in t1 e in t2, nel gruppo sottoposto ad IR, a differenza del gruppo di controllo. È emerso, inoltre, un effetto di interazione significativo (gruppo × tempo) per alcune credenze specifiche. I dati evidenziano come l'IR riduca, a breve e a lungo termine, l'intensità di convinzioni nucleari disfunzionali in una popolazione non clinica.
Article
Specific phobia of vomiting (SPOV) can be a severe and debilitating anxiety disorder and affects women in the childbearing years. The perinatal period and early parenthood is a time of increased risk for the onset or exacerbation of anxiety problems, which can have an impact on both the woman and the developing child. There are particular issues pertinent to the physical experience of pregnancy and tasks of early caregiving that women with SPOV may find difficult or distressing to confront, but these are not well documented. Cognitive behavioural therapy (CBT) focused on exposure to vomit cues and processing distressing early memories of vomiting is an effective treatment for SPOV. This paper describes the successful CBT treatment of two young mothers with SPOV, outlining the challenges faced by parents at this time and the need to take this into account in treatment, using illustrative case material. Key learning aims (1) To understand how specific phobia of vomiting (SPOV) affects women in early parenthood. (2) To know how to target and update traumatic early memories of vomiting with imagery rescripting. (3) To know how to design and carry out effective behavioural experiments for perinatal SPOV. (4) To understand how to take mother, baby, and the mother–infant relationship into account in SPOV treatment.
Article
Cognitive-behavioral therapy (CBT) has been shown to have a small to medium effect on chronic pain, necessitating further research to identify which components of CBT work for which type of patient. Previously, we developed a high-intensity individual CBT protocol and conducted a single-arm, uncontrolled feasibility study for chronic pain. In the current study, we explored patients' experiences in CBT sessions, including tactile attention-shift training; memory work using the peak-end rule; mental practice of action using motor imagery rescripting; and video feedback, including mirror therapy. Fourteen patients with chronic pain completed 16 CBT sessions. The tactile attention-shift training was very helpful for two patients and somewhat helpful for five, memory work was helpful for nine, mental practice was very helpful for four and somewhat helpful for three, and visual feedback was very helpful for six patients. Effective methodologies for new chronic pain CBT components should be developed. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Background Imagery Rescripting (ImR) has proved to be effective in the treatment of different mental disorders as an integral part of broader clinical protocols or as a standalone technique. ImR has also been successfully incorporated as part of group Schema Therapy treatment; however, to the best of our knowledge, it has never been assessed as a standalone technique in a group setting.AimIn this study, we focused on ImR delivered via telehealth in groups and we aimed to assess whether group ImR is effective in responding to basic emotional needs, in changing participants’ affective state, and in reducing dysfunctional beliefs. We also wanted to assess whether memory realism is associated with a greater effectiveness of the technique.MethodsA total of 52 participants were presented with 3 ImR sessions on childhood memories related to the current dysfunctional belief that elicited more suffering.ResultsThe technique was effective in facilitating the retrieval of a memory in almost the entire sample (in the range of 92.3–100%). Overall, memory realism values (level of vividness, ability to immerse, and participants’ distance from the images) were high in all three sessions. Almost all participants were reported having their needs met during ImR (89.7%). Importantly, need satisfaction was associated with the ability to immerse in the image. In addition, the intensity of the dysfunctional belief decreased significantly from pre-test to Session 3. The technique also changed the affective state, reducing arousal. Importantly, we also observed a general reduction in shame levels from the first to the third session.ConclusionA telehealth delivered ImR group intervention on childhood memories provides cognitive and emotional improvement. Along with the ability to satisfy the patient’s basic emotional needs, the technique seems to be effective in modifying maladaptive beliefs encapsulated in memory.
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Written by internationally recognized experts, this comprehensive CBT clinician's manual provides disorder-specific chapters and accessible pedagogical features. The cutting-edge research, advanced theory, and attention to special adaptations make this an appropriate reference text for qualified CBT practitioners, students in post-graduate CBT courses, and clinical psychology doctorate students. The case examples demonstrate clinical applications of specific interventions and explain how to adapt CBT protocols for a range of diverse populations. It strikes a balance between core, theoretical principles and protocol-based interventions, simulating the experience of private supervision from a top expert in the field.
Chapter
Written by internationally recognized experts, this comprehensive CBT clinician's manual provides disorder-specific chapters and accessible pedagogical features. The cutting-edge research, advanced theory, and attention to special adaptations make this an appropriate reference text for qualified CBT practitioners, students in post-graduate CBT courses, and clinical psychology doctorate students. The case examples demonstrate clinical applications of specific interventions and explain how to adapt CBT protocols for a range of diverse populations. It strikes a balance between core, theoretical principles and protocol-based interventions, simulating the experience of private supervision from a top expert in the field.
Article
Written by internationally recognized experts, this comprehensive CBT clinician's manual provides disorder-specific chapters and accessible pedagogical features. The cutting-edge research, advanced theory, and attention to special adaptations make this an appropriate reference text for qualified CBT practitioners, students in post-graduate CBT courses, and clinical psychology doctorate students. The case examples demonstrate clinical applications of specific interventions and explain how to adapt CBT protocols for a range of diverse populations. It strikes a balance between core, theoretical principles and protocol-based interventions, simulating the experience of private supervision from a top expert in the field.
Chapter
Im folgenden Kapitel geht es um schematherapeutische emotionale Regulation, das zentrale Konstrukt, mit dem wir die Praxis der Verhaltenstherapie erweitern und anreichern wollen. Gemeint ist hierbei nicht primär die konkrete Fertigkeit, bisher unterregulierte Emotionen oder Anspannungszustände regulieren zu lernen oder am Ende der Behandlung „Gefühle im Griff“ (Barnow 2018) zu haben. Vielmehr geht es um den Aufbau einer liebevoll akzeptierenden Haltung und Beziehung zu sich selbst. Das allgemeine SORKC-Modell wird mit dieser im Modusmodell konzipierten Regulationsfertigkeit systematisch verzahnt und eine Entscheidungsheuristik zur Verfügung gestellt, die bei der Indikationsentscheidung für den schematherapeutisch erweiterten Ansatz hilft.
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Imagery rescripting is presented as a new treatment of posttraumatic stress disorder (PTSD) for adult survivors of childhood sexual abuse. A theoretical discussion illustrates the model's consistency with schema theory and information processing models of PTSD, and suggests that the rescripting process may effect change in pathological schemas associated with interpretation of the traumatic event(s). It is proposed that this combination of imaginal exposure, mastery imagery, and cognitive restructuring goes beyond extinction models to alter recurring images of the trauma and create more adaptive schemas. Hypothesized mechanisms for PTSD symptom reduction are presented, implications for cognitive restructuring are noted, and the model's potential for facilitating personal empowerment and self-nurturance are discussed. Preliminary outcome research data are summarized that support the efficacy of imagery rescripting in significantly reducing PTSD symptomatology with this population.
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We present a theory of classical conditioning based on a parallel, rule-based performance system integrated with mechanisms for inductive learning. Inferential heuristics are used to add new rules to the system in response to the relation between the system's predictions and environmental input. A major heuristic is based on "unusualness": Novel cues are favored as candidates to predict events that are important or unexpected. Rules have strength values that are revised on the basis of feedback. The performance system allows rules to operate in parallel, competing to control behavior and obtain reward for successful prediction of important events. Sets of rules can form default hierarchies: Exception rules censor useful but imperfect default rules, protecting them from loss of strength. The theory is implemented as a computer simulation, which is used to model a broad range of conditioning phenomena, including blocking and overshadowing, the impact of statistical predictability on conditioning, and conditioned inhibition. The theory accounts for a variety of phenomena that previous theories have not dealt with successfully. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study investigated whether dichotomous thinking is characteristic of borderline personality disorder (BPD). Patients with BPD (N = 16), control patients with Cluster-C personality disorder (PD; N = 12), and normal controls (N = 15) evaluated personalities from film clips in a structured response format. Film clips were presented with emotional themes, which were hypothesized to be either specific or nonspecific for borderline pathology, and with neutral themes. Dichotomous thinking was operationalized as the extremity of evaluations on a list of visual analogue scales (VASs) with bipolar trait descriptions. Patients with BPD made more extreme evaluations (dichotomous thinking) on BPD-specific film clips, but not on control film clips, than subjects of both control groups. The extreme evaluations of patients with BPD were not either all good or all bad, which indicates that patients with BPD do not engage in unidimensional good–bad thinking (splitting), but are capable of viewing others in mixed, although extreme, terms (multidimensional dichotomous thinking).
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This article describes the application of a guided imagery psychodrama technique to emotionally charged early memories. Such memories provide access to core schemata about the self and social relationships. Two case studies illustrate how the imagery technique enables the therapist to identify and restructure key cognitions out of which the schemata are constructed. The need for techniques to modify developmentally primitive schemata is discussed. Examples are given of ways to assist the patient in confronting the strong affect that may be aroused and in dealing with cognitions that block the process. Effectiveness is discussed in terms of the contribution of a guided imagery session to the overall process of ''learning to learn'' that takes place in cognitive psychotherapy.
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The psychometric properties and validity of the Borderline Personality Disorder Severity Index (BPDSI), a semistructured interview assessing the frequency and severity of manifestations of Borderline Personality Disorder (BPD) during a circumscribed period, were investigated in two studies. In study 1, patients with BPD (n = 15), with other personality disorders (PD; n = 18), and without Axis II disorders (but with Axis I disorders; n = 10) assessed with the SCID were interviewed with the BPDSI (1-yr. version). Patients also filled out a number of questionnaires. A second rater judged taped BPDSI interviews. The BPDSI appeared to yield highly reliable (ICC = .93) and internally consistent (Cronbach's alpha = .85) scores. The BPDSI strongly discriminated BPD patients from other patients, and was not related to other Axis II pathology. Concurrent and construct validity was excellent. In study 2, a version of the BPDSI suitable for use in treatment outcome research was investigated (3-month version) in a sample of 64 BPD patients, 23 Cluster C PD patients, and 20 nonpsychiatric controls. Again, reliability coefficients were excellent (ICC = 0.97; Cronbach's alpha = 0.93), and validity indices were good. Clinical norms were also derived. In a sample of 28 BPD patients, the instrument detected improvement during 6 months of psychotherapy.
Chapter
In the last several years, there has been a growing interest in the study and understanding of personality disorders. Patients with personality disorders have been part of the clinician’s case load since the beginning of the recorded history of psychotherapy; the general psycho­therapeutic literature on the treatment of personality disorders, however, has emerged more recently and is growing quickly. The main theoretical orientation in the present literature is psychoanalytic (Abend, Porder, & Willick, 1983; Chatham, 1985; Goldstein, 1985; Gunder­son, 1984; Horowitz, 1977; Kernberg, 1975, 1984; Lion, 1981; Masterson, 1978, 1980, 1985; Reid, 1981; Saul & Warner, 1982). Millon (1981) is one of the few volumes in the area of personality disorders that offers a behavioral focus, and the volume by Beck, Freeman and associates (1989) will be the first to offer a specific cognitive-behavioral focus. This is of interest, in that leading cognitive therapists have been, and remain, interested in “personality disorder” and “personality change” (Hartman & Blankenstein, 1986). When Beck (1963a,b) and Ellis (1957a, 1958) first introduced cognitive approaches, they drew upon the ideas of “ego analysts,” derived from Adler’s critiques of early Freudian psychoanalysis. Though their therapeutic innovations were seen as radical, their earliest cognitive therapies were, in many ways, “insight therapies” in that the therapy was assumed to change a patient’s overt “personality,” whether or not the therapy changed some hypothesized underlying personality. Although Beck and Ellis were among the first to use a wide array of behavioral treatment techniques, including structured in vivo homework, they have consistently emphasized the therapeutic impact of these techniques on cognitive schemata and have argued in favor of the integration of behavioral techniques into therapy within a broad framework that has some roots in prior analytic practice (Beck, 1976; Ellis & Bernard, 1985); they and their associates have emphasized the impact of treatment for particular types, or styles, of cognitive errors on dysfunctional self-concepts, as well as on presenting focal problems (Beck & Freeman, 1989; Ellis, 1985; Freeman, 1987).
Article
Contends that loyalty to one's parents is important to the understanding of and the intervention in the handing down of unresolved problems from one generation to another, particularly with respect to family violence. Two case studies are presented of (1) an adult female who, beaten during childhood by an authoritarian father, gave up her false parental loyalty and (2) an adult female, with an incestuous father and a sadistic, psychotic mother, who could not give up her loyalty to her mother. It is suggested that the major therapeutic task is to help the client come to terms with the fact that the abuse was not because of any intrinsic flaw and see the parent as both good and bad. Techniques include letting the client see the therapist as mostly "good" but sometimes "bad," relabeling the client and the client's family system, dispelling old shameful feelings related to victimization, and enabling the expression of anger. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Many women who seek help from psychologists, psychiatrists, social workers, counsellors and nurses, have been sexually abused in childhood. These women frequently complain of a wide range of mood disturbances, interpersonal difficulties and sexual dysfunctions that appear to be related to their earlier abuse and its surrounding circumstances. Consequently these contributory factors often need to be addressed in therapy. This book offers a systematic and comprehensive approach to the assessment and treatment of the psychosocial problems that are commonly encountered in this client group. These problems are described, and detailed guidelines are provided for practitioners who wish to implement and develop the author's intervention package. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This is the first comprehensive practitioner's guide to using cognitive therapy techniques for patients diagnosed with Borderline Personality Disorder. It covers all the important facets of advanced cognitive therapy in detail. Combining developmental perspectives with here-and-now intervention techniques, the authors discuss methods of conceptualizing borderline cases and developing treatment plans, techniques for establishing a collaborative therapeutic relationship with borderline patients, ways to apply standard cognitive techniques in their treatment, and advanced schema-focused strategies developed specifically for use with patients exhibiting borderline characteristics. In addition, they provide five extensive, engrossing case studies that illustrate the conceptualization and treatment process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This book discusses schema-focused therapy, an integrative approach . . . to treat characterological patients including borderline, narcissistic, avoidant, dependent, obsessive-compulsive, passive-aggressive, and histrionic personality disorders. . . . [This] model is [an] integration of cognitive behavior therapy with gestalt, object relations, and psychoanalytic approaches. It expands on conventional cognitive behavior therapy by placing more emphasis on the therapeutic relationship, affective experience, and the discussion of early life experiences. In addition to presenting the rationale, theory, and practical techniques of schema-focused therapy, this book includes an extended case example, and revised editions of the Schema Questionnaire, Client's Guide, and schema listings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Although low self-esteem is common in clinical populations, a cognitive conceptualization of the problem and an integrated treatment programme deriving from that conceptualization are as yet lacking. The paper proposes a cognitive model for low self-esteem, deriving from Beck's model of emotional disorder. It outlines a treatment programme which integrates ideas and methods from cognitive therapy for depression, anxiety and more recent work on schemas or core beliefs. The model and treatment are illustrated with an extended case example.
Article
A history of sexual abuse is reported by a large proportion of women with psychological disorders. Cognitive approaches to therapy for this group aim to change the dysfunctional cognitions that are associated with abusive experiences, but often lack a clear model of the psychological processes that might be involved. This study examines the relationship between the overt cognitive correlates of sexual abuse (self-denigratory beliefs) and the covert correlates (information-processing bias). Women with psychological disorders who reported a history of sexual abuse had greater levels of self-denigratory beliefs and of information-processing bias than women who had a history of abuse but had no psychological disorder. The difference in overt self-denigratory cognitions was partly explained by the clinical women's higher level of covert information-processing bias. The information-processing bias appears to reflect a specific schema, which involves beliefs about the individual having been “contaminated” by the abusive experience. Therapeutic implications are discussed, including targets for treatment and evaluation. Further research is needed, to allow these cognitive correlates to be understood in relation to different psychological syndromes and symptoms.
Article
Schemas are core beliefs which cognitive therapists hypothesize play a central role in the maintenance of long-term psychiatric problems. Clinical methods are described which can be used with clients to weaken maladaptive schemas and construct new, more adaptive schemas. Guidelines are presented for identifying maladaptive and alternative, more adaptive schemas. Case examples illustrate the use of continuum methods, positive data logs, historical tests of schema, psychodrama, and core belief worksheets to change schemas. Specification of therapeutic methods for changing schemas can lead to the development of treatment standards and protocols to measure the impact of schema change on chronic problems.
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There is consistent agreement that guilt has both affective and cognitive dimensions. We describe a conceptualization of event-related guilt in which cognitive elements play a crucial role. Factors posited as primary cognitive components or determinants of guilt include perceived wrongdoing, acceptance of responsibility, perceived lack of justification, and false beliefs about preoutcome knowledge caused by hindsight bias. Each cognitive component can be manifested as an irrational belief or faulty conclusion that can vary in magnitude. Numerous errors of logic that can lead trauma victims to draw faulty conclusions about their role in traumatic events are identified. Within the proposed model, correcting these thinking errors is considered the best way to alleviate guilt and is the primary task of cognitive therapy for trauma-related guilt (CT-TRG). With each guilt issue, a debriefing/imaginal exposure exercise precedes cognitive therapy. CT-TRG proper involves considerable psychoeducation and collaborative examination of each guilt component. Procedures are described for teaching clients to distinguish what they knew “then” from what they know “now” and to reassess perceptions of responsibility, justification, and wrongdoing in light of beliefs held and knowledge possessed when the trauma occurred. Several issues regarding applicability of the treatment model are discussed.
Book
There are few topics so fascinating both to the research investigator and the research subject as the self-image. It is distinctively characteristic of the human animal that he is able to stand outside himself and to describe, judge, and evaluate the person he is. He is at once the observer and the observed, the judge and the judged, the evaluator and the evaluated. Since the self is probably the most important thing in the world to him, the question of what he is like and how he feels about himself engrosses him deeply. This is especially true during the adolescent stage of development.
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Recent developments in the study of Pavlovian conditioning in humans have suggested that the strength of a conditioned response (CR) is affected not only by associative processes that link the conditioned stimulus (CS) with the unconditioned stimulus (UCS), but also by processes which lead the individual to revalue the UCS itself. These latter processes can frequently lead to dramatic changes in CR strength independently of any experience with the CS-UCS contingency. This paper discusses a number of ways in which UCS revaluation can be effected in human subjects, and discusses their implications for conditioning models of acquired fears.
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A working definition of the concept of emotional processing is presented, with the aim of integrating a set of clinical and experimental observations. If successful, the concept may help to unify such apparently unrelated events as obsessions, the return of fear, abnormal grief reactions, nightmares, treatment failures, and so on.Factors that may facilitate or impede emotional processing are presented, and some circumstances that may give rise to initial difficulties in processing are mentioned. A number of theoretical problems are posed, and some methodological innovations offered.
Article
A 12-week self-control therapy program based on the self-control model proposed by Rehm was added to the routine program for depressed patients in a psychiatric day-treatment center. It was hypothesized that addition of the self-control therapy would accelerate the recovery of depressed patients. Twenty-five depressed patients were randomly assigned to either standard treatment or standard treatment plus the self-control therapy program. At post-test, patients in the self-control condition showed significant improvement with regard to self-control, self-esteem, depression, depressed mood and frequency and potential enjoyability of pleasant events, whereas the control patients did not. On 5 of 6 measures the differences between the groups were significant in the hypothesized direction. Although at the 13-week follow-up the positive effects of the self-control therapy were maintained, between-group differences were no longer significant, except for self-control.
Article
Patients with so-called Borderline Personality Disorder are generally considered as extremely difficult to treat. Until recently, conceptualizations of this severe disorder on which cognitive-behavioural therapy could be based were underdeveloped. The present paper presents a cognitive formulation based on previous cognitive and behavioural conceptualizations, and on empirical evidence pertaining to the relationship between childhood traumas and Borderline Personality Disorder. It is assumed that chronic traumatic abuse or neglect in childhood has led to the development of almost unshakeable fundamental assumptions about others (dangerous and malignant), about one's own capabilities (powerless and vulnerable) and upon one's value as a person (bad and unacceptable). These are assumed to underlie the complex symptomatic presentation of borderline patients. A treatment protocol is described, which takes 1.5-4 years, and consists of 5 stages: (1) construction of a working relationship; (2) symptom-management (gaining more control over symptoms); (3) correction of thinking errors; (4) emotional processing and cognitive re-evaluation of the childhood trauma and schema changes; and (5) termination. A case example is presented, and a call for research into the efficacy of this approach is made.
Article
The clinical cognitive approach assumes that emotional reactions are mediated through the meanings given to events. Cognitive therapy aims to change emotion by changing meanings. It focuses on specific level meanings, evaluating the truth value of particular beliefs. Bower's science-driven associative network theory of cognition and emotion is also primarily concerned with specific meanings. This focus on meaning at a specific level causes problems, e.g. the contrasts between 'intellectual' and 'emotional' belief, between 'cold' and 'hot' cognition, and between explicit and intuitive knowledge. These problems are resolved in the Interacting Cognitive Subsystems (ICS) approach. ICS distinguishes between a specific and a more holistic, intuitive, level of meaning. In contrast to alternative approaches, ICS suggest that holistic level meanings are of primary importance in emotion production. Representations at this level consist of schematic mental models, encoding high-order inter-relationships and prototypical patterns extracted from life experience. The ICS approach to meaning is described and its implications for understanding and treating emotional disorders discussed, together with relevant empirical findings. ICS suggests a therapeutic focus on holistic rather than specific meanings, a role for 'non-evidential' interventions, such as guided imagery, and a rational basis for certain experiential therapies.
Article
The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.
The Personality Disorder Beliefs Questionnaire (short version)
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