Imagery Rescripting as a Stand-alone Treatment for Depression: a Pilot Study.
Phase: NA
Conditions: Major Depressive Disorder, Persistent Depressive Disorder
Sponsor: University of Amsterdam

 
 
 
 
Study protocol ImRs for depression 
 
 
 
 
 
 
STUDY PROTOCOL  
 
Title: 
Imagery rescripting as a stand-alone treatment for depression: a pilot study.  
 
Authors: 
Bonnie Noordegraaf, Drs., Psyq Amsterdam, the Netherlands 
Arnoud Arntz, PhD., University of Amsterdam, the Netherlands 
 
Date: 
July 27, 2023 
 
NCT number: not yet assigned 

 
 
 
 
Study protocol ImRs for depression 
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1. INTRODUCTION AND RATIONALE 
“Just to hold an image in mind is a more emotionally charged experience than verbal processing of the 
same material (Holmes et al., 2007)”  
 
In light of this quote it comes as no surprise that Imagery Rescripting (ImRs) is becoming an increasingly 
popular therapeutic intervention in clinical practice.  
It is a technique that aims to reduce the distress associated with memories of past events by modifying 
the content of pre-existing unpleasant memories into more benign images (Holmes et al., 2007). Patients 
are instructed to retrieve a painful memory and imagine it as vividly as possible -as if it were happening 
in the here and now. Next, either the patient or (in case of higher degrees of severity and complexity) 
the therapist continues to “rescript” the imagined event by imagining intervening and thus creating a 
different (more favorable) turn of events.  
The aim is to modify related dysfunctional core beliefs and fulfill unmet (childhood) needs that are 
associated with the image, ideally resulting in processing psychological traumas, so that they are of less 
influence on the patient’s functioning, and  in an improved sense of connection to one’s emotional needs 
in the here and now and being better equipped to (adequately) connect action to emotions.  
 
Originally embedded in a comprehensive treatment, such as cognitive behavior therapy or schema 
therapy, a growing amount of research also shows promising results of ImRs as a stand-alone treatment. 
It has proved to be successful in reducing symptoms and complaints in a relatively short amount of time 
(on average 4.5 sessions) (Morina et al., 2017). Since negative mental images are a transdiagnostic 
feature of a number of mental conditions it is not surprising that ImRs can successfully be applied to a 
wide range of disorders among which: posttraumatic stress disorder, social anxiety disorder, body 
dysmorphic disorder, bulimia nervosa, obsessive-compulsive disorder, and depression (Morina et al., 
2017). It must be noted however, that the use of ImRs is not solely restricted to visual intrusions or 
memories that are associated to intrusions. It also addresses negative core beliefs and (childhood) 
memories underlying current problems (Arntz, 2012). 
 
Taking a closer look at depression, we find that working with imagery seems to have been relatively 
neglected in standard evidence-based screening and treatment, such as Cognitive Behavior Therapy 
(CBT) which appears to be more verbally based and oriented. This is somewhat remarkable considering 
depressive symptoms are frequently accompanied by intrusive images (almost as often as in Post-
Traumatic Stress Disorder), which are also believed to be an important perpetuating factor (Holmes et 
al., 2016). These negative intrusive images are reported in 44%-96% of depressed patients and 
commonly manifest themselves as imagery of past negative events or so-called flash forwards of suicide 
or self-harm (van der Wijngaart, 2020). The content is often linked to critical life events or traumas and 
typically involves topics such as illness, death, or interpersonal problems; causing feelings of sadness, 
anger, guilt or hopelessness (Weßlau & Steil, 2014). This kind of mental imagery is of great 
significance in the pathogeneses of depression and is often associated with experiential avoidance, 
typically involving ineffective coping styles like rumination and worry (Yuen-ting, 2017). In addition to 

 
 
 
 
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this, negative core beliefs or cognitive schemas (as a result of the aforementioned unmet core emotional 
needs) represent key vulnerability factors to depression (Malogiannis et al., 2014) and adverse 
childhood experiences have been found to be an important factor predicting relapse (Nanni et al., 2012). 
In sum, we see that multiple studies support both the significance of mental imagery, negative core 
beliefs and adverse childhood experiences in the etiology and the manifestations of depression; as well 
as the therapeutic potential of ImRs when targeting these areas.  
 
Available research on the application of ImRs in the specific area of depression is still limited, but 
promising. Wheatley et al. (2007) and Brewin et al. (2009) offered ImRs as a brief stand-alone treatment 
to 10 depressed patients in an exploratory study and found a significant reduction of symptoms in an 
average of 8.1 sessions with treatment effects well maintained at one year follow-up. Both studies were 
aimed specifically at patients reporting intrusive memories. An extensive meta-analysis conducted by 
Morina et al. (2017) showed large effects of ImRs on co-morbid depression. To our knowledge Yuen-
ting (2017) conducted the first RCT comparing ImRs with another renowned intervention (cognitive 
restructuring (CR)); randomly assigning 41 patients to either one of the two treatment conditions. ImRs 
proofed to be superior in even as few as three sessions. Although CR was comparable in reducing 
depressive symptoms, ImRs led to a greater magnitude of change and yielded continuous treatment 
effects at 2 month follow-up, contrary to CR. Lastly Moritz et al. (2018) showed that ImRs can also be 
successfully applied as a self-help intervention, as long as the use-at-home treatment manual is not too 
brief and allows for enough repetition and redundancy. In their RCT 127 participants were randomly 
allocated to either two intervention subgroups (brief vs long version of the treatment manual), or to a 
wait-list control group (equal chance). The long version manual proofed superior to both the brief version 
and the wait-list control group and was successful in reducing depressive symptoms and improving self-
esteem and quality of life. Unfortunately no follow-up measurements were included in this study, thus 
preventing insight in the sustainability of the effects.  
 
Globally the total number of people with depression was estimated to exceed 300 million in 2015, 
equivalent to 4.4% of the world’s population (World Health Organization; 2017). Shifting the focus to a 
more local angle shows us that depression is the most common mental disorder among patients in the 
Netherlands. About 797.000 people (including youth from the age of 13 and the elderly) suffer from 
depression each year (GGZ Standaarden, 2018). Approximately 50% of patients with depression do not 
respond to treatment and about half of the patients reporting a first depressive episode will experience 
relapse within 2 years after initial recovery reached in psychological therapy (Holmes et al., 2016). 
 
These numbers create a certain sense of urgency and underline the strong need for treatment 
innovations of all sorts that can be easily implemented as well as help to prevent relapse after treatment. 
As explained earlier, ImRs appears to be an obvious candidate for this since it can intervene on 
important underlying mechanisms (negative mental imagery, unmet emotional needs, dysfunctional core 
beliefs) which seem to be addressed notably less in the prevailing treatments - generally based on a 
more complaint/symptom-oriented approach.  

 
 
 
 
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Based on the presented findings the idea of the current study is to further explore the efficacy of ImRs 
as a brief stand-alone treatment for patients suffering from depression. A clear treatment manual is to 
be formulated ensuring that the patients feelings, thoughts and needs are addressed. A protocol that 
meets these criteria has been described by Arntz & Weertman (1999) 
 
 
2. OBJECTIVES 
The primary aim of the study is to examine the effects of ImRs as a stand-alone treatment for patients 
with depression (Major Depressive Disorder (MDD), according to DSM-5 criteria) on the decrease of 
dysfunctional core beliefs and depressive symptoms.  
 
Hypotheses: 
1. The slopes of improvement as expressed in a decrease in dysfunctional core beliefs measured with 
the VAS for beliefs) are significantly stronger during ImRs than during control conditions (pre- & post- 
baseline; post-preparation; post-treatment and at follow-up).  
2. The slopes of improvement as expressed in a decrease in depressive symptoms (measured with the 
PHQ-2) are significantly stronger during ImRs than during control conditions (pre- & post- baseline; post-
preparation; post-treatment and at follow-up).  
 
The secondary aim of this study is to examine the effects of ImRs as a stand-alone treatment on two 
areas that represent key factors in the pathogenesis of MDD: rumination and worrying.  
 
Hypotheses: 
3. A significant reduction of Rumination (compared to baseline) is expected at post-treatment and at 
follow-up. No significant changes (compared to baseline) are expected post-wait and post-preparation. 
4. A significant reduction of Worrying (compared to baseline) is expected at post-treatment and at 
follow-up. No significant changes (compared to baseline) are expected post-wait and post-preparation.  
 
Lastly, the final aim of the study is to gain insight into the patients’ experience and qualitative evaluation 
of this treatment. At post-treatment a brief qualitative interview will be conducted among participants to 
gain insight in their experience.  
 
Questions / topics to be included:  
How would patients evaluate their experience of undergoing the treatment? What aspects in particular 
did they appreciate? What aspects in particular did they disparage? What aspects do they believe to 
contribute to the outcome? Do they feel the treatment continued to have effects outside of the treatment 
sessions? If so: in what way? In case they have undergone psychological treatment for depressive 
symptoms prior to the current treatment; what treatment was that? If compared to the current treatment, 
do they hold a preference of one over the other and if so: why?  
 

 
 
 
 
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3. STUDY DESIGN 
The study design is a non-concurrent multiple baseline case series design with N=10 patients reporting 
levels of depression as well as ratings of dysfunctional core beliefs on a weekly basis. Patients will be 
randomized over five conditions of baseline length (6, 7, 8, 9, 10 weeks; 2 patients per condition), thus 
isolating time from the consecutive condition so that the effects of treatment can be distinguished from 
that of time per se. After baseline, 5 preparatory sessions will take place followed by 8 to 12 sessions 
of ImRs (according to clinical need). This brings the total amount of sessions to a minimum of 13 and a 
maximum of 17 (5 prep + 8 – 12 IMRS). In addition to the weekly measurements, there will be 6  
moments of assessment: start of baseline, pre-preparation, pre-treatment, post-treatment and two 
follow-ups to assess the stability of the effects (6 and 12 months post-treatment). 
 
 
4. 
STUDY POPULATION 
4.1 
Population 
Patients with a main diagnosis of MDD will be recruited at the Academic Center for Trauma and 
Personality (ACTP) at Amsterdam, the Netherlands. This institute provides state-of-the-art, professional 
treatment for trauma and personality related mental health problems. Male and female patients within 
the age range of 18-65 will be included if they meet the criteria of MDD based on the DSM-5 criteria as 
their primary diagnosis, assessed with the SCID-5-S. 
 
4.2 
Inclusion criteria 
In order to be eligible to participate in this study, a subject must meet all of the following criteria:  
 
- 
Primary diagnosis of MDD as assessed with the SCID-5-S 
- 
Total score of 20* or above on the BDI-II (cut-off score for moderate depression) (Beck et al., 1996). 
(*Based on previous research by Brewin et al. (2009) & Yuen-tin (2017) demonstrating averages of 
BDI-II: 34-35, in their population.) 
- 
Age 18-65 
- 
Dutch or English as a first language (or estimated as sufficient to receive treatment in either of these 
 
languages without interpreter) 
- 
Willingness to participate in the study (signed informed consent) 
 
4.3 
Exclusion criteria 
A potential subject who meets any of the following criteria will be excluded from participation in this 
study:  
 
- 
DSM-5 Bipolar disorder, type 1 (current or past); if there has been no manic episode the last year 
 
patients will be included 
- 
Psychotic disorders (though psychotic features alongside depression will be allowed) 
- 
Organic brain disease 

 
 
 
 
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- 
IQ < 80 
- 
High risk of self-harm or suicide 
- 
Current substance abuse 
- 
Start of new medication within 2 months before beginning the study (medication used for longer  
 
periods can be continued; patients are requested to keep medication stable during the course of the  
 
study) 
- 
Having received ImRs (either as a stand-alone or embedded in a greater treatment such as CBT or  
  
schema therapy) within the last year 
- 
No other evidence-based treatment of MDD is allowed during the study.  
- 
Not able to plan enough time for weekly therapy sessions (45-60 minutes); weekly measurements  
(estimate of 5 minutes) and other measurements (estimate of 20 minutes); and the  qualitative post-
treatment interview (estimate of 60 minutes) during the treatment period. 
 
4.4 
Sample size calculation 
No simple  way to perform power analysis for this type of mixed regression is known to the authors. As 
an approximation we power the study at 80% to detect a large effect size of Cohen’s d = 1 for the change 
from baseline to post treatment at a significance level of .05 (two-tailed)), ten participants are necessary 
for this. Given the effect size d=1.92 reported by Brewin et al (2009), d=1 is a conservative estimate of 
the to be expected effect size. 
 
 
5. TREATMENT 
5.1 
Investigational treatment 
Eight to 12 sessions (45-60 minutes) of ImRs will be offered to participating patients. The stand-alone 
ImRs treatment will be based upon the protocol described by Arntz & Weertman (1999). (This protocol 
can be modified to tailor the needs of this study more specifically. Possible adaptations shall be based 
upon the manual developed by Brewin and colleagues (2009) for their study of applying ImRs to 
depression.) 
Before patients start the ImRs sessions, they will receive 5 preparatory sessions. During these sessions 
the rationale of ImRs will be explained in more detail and a list of painful (childhood) memories to be 
addressed with ImRs is to be compiled, based on any further input from the patient. During the course 
of treatment other memories that come up during or in between sessions can also be added. There is 
no specific order / hierarchy in which the memories have to be addressed during the sessions, nor do 
they all have to be discussed.  
Patients are allowed to finish treatment before 8 sessions if the patient, therapist, and site coordinator 
agrees that treatment is no longer necessary. In these cases assessments will still be conducted at the 
originally planned time points. Participating therapists are licensed psychologists, psychotherapists, or 
clinical psychologists that have undergone basic training in either cognitive-behavioral therapy or 
schema therapy. An additional 2-day training in ImRs according to the model of Arntz (2011, 2015) is 
required. Therapists will be provided with ongoing peer supervision throughout the study. 
 

 
 
 
 
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5.2 
Use of co-intervention 
Patients may continue taking medication during the course of the study. Start of new medication within 
2 months before beginning the study is listed as an exclusion criterium. Patients are requested to keep 
medication stable during the course of the study. No other psychological therapy is allowed during 
treatment (crisis interventions excluded). 
 
5.3 
Escape medication / treatment 
Patients might start taking medication or another form of treatment/therapy in case of acute crisis during 
the study. The use of these medications or crisis intervention during the study as co-intervention will not 
lead to exclusion from the study, but will be monitored, documented, and reported.  
 
5.4 
Further treatment 
Participation in this study will not affect patients’ access to standard psychological treatment. However, 
they will be asked and advised to withhold such treatment at least until the first follow-up measurement 
has been completed (6 months post-treatment). In the case of patients requesting help during the follow-
up period, an evaluation is required whether the necessity of the request for help should overrule the 
planned treatment-free period.  
 
 
6. METHOD 
6.1 
Main study parameter / endpoint  
The primary outcome measure is a change in the manifestation and the severity of dysfunctional core 
beliefs and depressive symptoms. These will be measured on a weekly basis with the following 
instruments:  
1. The Patient Health Questionnaire (Kroenke et al., 2003). The PHQ-2 consists of the first two items 
of the PHQ-9 and has strong psychometric properties. (Staples et al. (2019) reported an effect size 
of 1.38 (0.95-1.79) and a good internal consistency (α = 0.83)). 
2. The idiosyncratic dysfunctional core beliefs formulated by the patients -> belief ratings will be 
expressed on a Visual Analogue Scale (VAS) ranging from 1 – 100. 
 
6.2 
Secondary study parameters 
The secondary outcome measures consist of the following 3 instruments applied at 6 consecutive time-
intervals* (pre-baseline; post-baseline, post-preparation; post-treatment; follow-up 1 and follow-up 2): 
(*See 6.4.2; table 1 for an overview of the assessment moments) 
 
1. The Beck Depression Inventory-II (Beck et al., 1996). The BDI-II is a 21-item self-report measure of 
depressive symptoms that possesses strong psychometric properties. Items are rated based on 
selecting the best-fitting statement that reflects one’s mood state, with each item ranging from 0 to 3 
in regards to increasing levels of severity of that symptom.  
2. The Ruminative Response Scale; “Brooding” subscale (Nolen-Hoeksema & Morrow, 1991). The RRS 
is a 22-item scale that assesses individuals’ tendency to ruminate in response to depressed mood. 

 
 
 
 
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Items are rated based on a 4-point Likert scale ranging from 1 (“almost never”) to 4 (“almost always”). 
Instead of using the total score (22 items); it has become common practice to focus on a subset of 
10 items (divided into 2 subscales: Reflection & Brooding). For purposes of the current study, only 
the 5-item “Brooding” subscale will be used since these seem to reflect the most maladaptive aspect 
of rumination (Treynor et al., 2003; as cited in Raes & Bijttebier, 2012 ). 
3. The Penn State Worry Questionnaire (Meyer et al., 1990). The PSWQ is a 16-item self-report 
measure of worry phenomena. Items are rated on a 5-point Likert scale ranging from 1 (“not at all 
typical of me”) to 5 (“very typical of me”). 
 
4. An evaluation of treatment experience. Insight in the way patients will have experienced and how 
they evaluate the treatment will be gathered by means of a brief qualitative interview at post 
treatment. Topics to be included: How would patients evaluate their experience of undergoing the 
treatment? What aspects in particular did they appreciate? What aspects in particular did they 
disparage? What aspects do they believe to contribute to the outcome? Do they feel the treatment 
continued to have effects outside of the treatment sessions? If so: in what way? In case they have 
undergone psychological treatment for depressive symptoms prior to the current treatment; what 
treatment was that? If compared to the current treatment, do they hold a preference of one over the 
other and if so: why?  
 
6.3 
Other study parameters (diagnostic & baseline assessments) 
The Dutch DSM-5 version of the SCID-5-S will be used to assess syndromic disorders during screening.. 
A checklist will be used to assess inclusion and exclusion criteria.  
 
6.4 
Study procedures 
6.4.1 
Screening procedures  
During the screening procedure, the eligibility will be determined according to the aforementioned in- 
and exclusion criteria. The SCID-5-S will be used to asses syndromic disorders. The BDI-II will be used 
to assess the severity of the depression. All participating patients will be asked for their consent, which 
will be documented by a signed consent-form. 
In a (separate) pre-interview conducted by the primary researcher or an assigned research assistant, a 
list of idiosyncratic dysfunctional core beliefs (min.3; max. 5) patients wish to work on will be assembled. 
These can either be a direct appraisal of certain intrusive memories or they can be of a more general / 
diffuse nature. 
6.4.2 
Study Assessment Moments  
The primary outcome measures will take place on a weekly basis during the entire course of baseline; 
the preparation sessions and the ImRs sessions; followed up with 5 weekly measures during week 1-5 
post-treatment. 
 
The secondary measures will take place at 6 allocated time intervals:  
1) Pre-baseline (prior to the allocated waiting time; counted as 0 weeks) 
2) Post-baseline (6 – 10 weeks, depending on the allocated waiting time) 

 
 
 
 
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3) Post-preparation (waiting time + 5 prep. sessions) 
4) Post-treatment (min. week 19 – max. week 27: depending on baseline and ImRs duration) 
5) Follow-up 1 (6  months) 
6) Follow-up 2 (12 months) 
 
Table 1 Overview in time of the study assessment moments 
6.4.3 
Assessment Procedures  
All quantitative measurements as well as the qualitative interview at post-treatment will be conducted 
by either the primary researcher or an assigned research assistant. 
Instrument/Action 
Screening  
 
Weekly 
(Start: pre-
baseline 
End: 5 weeks > 
post-treatment) 
 
Pre-
Baseline 
Post-
Baseline 
Post-Prep. 
Post-treatment:  
(>5 weeks after 
finishing ImRs)  
 
Follow-up 1:  
6 months > 
Post-treatment 
Follow-up 2: 
12 months > 
Post-
treatment  
Diagnostic / 
baseline 
assessments  
 
 
 
 
 
 
 
 
SCID-5-S 
• 
 
 
 
 
 
 
 
Inclusion 
/ 
exclusion criteria  
• 
 
 
 
 
 
 
 
BDI-II 
• 
 
 
 
 
 
 
 
Primary outcomes 
/ weekly measures 
 
 
 
 
 
 
 
 
VAS  
(dysf. core beliefs) 
 
• 
 
 
 
 
• 
• 
PHQ-2 
 
• 
 
 
 
 
• 
• 
Secondary 
outcomes / 
repeated 
measures 
 
 
 
 
 
 
 
 
BDI-II 
 
 
• 
• 
• 
• 
• 
• 
RRS  
(5-item “Brooding” 
subscale 
 
 
• 
• 
• 
• 
• 
• 
PSWQ 
 
 
• 
• 
• 
• 
• 
• 
Secondary 
outcome / single 
measure 
 
 
 
 
 
 
 
 
Qualitative 
interview on 
exp./eval. 
 
 
 
 
 
• 
 
 

 
 
 
 
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Self-report instruments will be filled out by patients themselves, either at home or at the research site; 
digitally or in paper. This applies to all instruments that are used, with the exception of: the Scid-5-S, the 
list of in- and exclusion criteria and the qualitative interview at post-treatment.  
To assess treatment integrity, all ImRs sessions will be recorded (audio or video) and a random sample 
will be drawn to be rated by independent trained judges for treatment adherence. The recordings may 
also be used to study other issues that might arise during the course of treatment and can be discussed 
in the peer supervision for this purpose. Recordings will be destroyed 5 years after publication of the 
main findings.  
The results of the screening assessment will be given to the assigned therapist to help them focusing 
the ImRs; e.g. a list of the idiosyncratic dysfunctional core beliefs. 
 
6.4.4 
Withdrawal of individual subjects 
Patients can leave the study at any time for any reason if they wish to do so without any consequences. 
Their right for treatment at the participating centre will remain intact. Patients may provide their 
reasons(s) for leaving the study, but this is not required. The responsible clinician can decide to withdraw 
a patient due to urgent clinical reasons, after consultation with the primary investigator.  
 
 
7. STATISTICAL ANALYSIS 
7.1 
Primary study parameter(s) 
There will be two  primary outcomes: (1) the idiosyncratic negative beliefs and (2) the PHQ-2.  (2). Total 
scores will be used for the PHQ-2, and the mean score of the idiosyncratic belief ratings. These scores 
will be analyzed by mixed regression (Arntz et al., 2013; Videler et al., 2018). Either AR1 or ARMA11 
will be chosen for the repeated part, depending on what covariance structure has the best fit. For the 
fixed part, condition (baseline, preparation, treatment, post-treatment, FU1 and FU2), as well as 
centered time per condition (except for FU1 and FU2, which are single assessments) will be included, 
with baseline as reference. Nonsignificant time-within-condition effects will be stepwise deleted from the 
model. It is expected that the change in the primary outcomes stronger is during treatment than during 
baseline, and that preparation does not lead to a stronger change than baseline. Furthermore, it is 
expected that during post-treatment and follow-up results are maintained, or show further improvement. 
The final model will be compared to a model with only time as fixed effect by a fit test, to test whether 
the hypothesized model (treatment being responsible for the changes) explains the data better than an 
effect of time only. If the data are not normally distributed, appropriate other distributions will be chosen 
for analysis with generalized linear mixed models (GLMM) (e.g. negative binomial or gamma regression 
with log-link in case of skewed distribution). 
 
7.2 
Secondary study parameter(s)  
There will be three secondary outcomes: the BDI-II; the RRS 5-item “Brooding” subscale and the 
PSWQ. Total scores will be used for analysis by mixed regression or GLMM (Arntz et al., 2013; 

 
 
 
 
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Videler et al., 2018). The approach is the same as with the primary outcome, except that no time-
within-condition are part of the model. 
 
The brief qualitative interview conducted post-treatment will not be statistically, but qualitatively, 
analyzed. Answers will solely be used to gain insight in patients’ experience and as helpful tool to give 
direction to possible further research and / or development of treatment. Answers will be not be used 
to draw conclusions from, nor will they be presented as proof to confirm or discard any of the aims of 
this study. 
 
 
8. Dissemination, Implementation, Future Studies 
The results of the study will be disseminated in the scientific community by publication of an article in a 
scientific journal and presentation(s) at (a) scientific conference(s). Clinicians will be informed by 
presentations at conferences attended by clinicians (e.g., the national and international conferences). 
Trainings in ImRs for colleague clinicians will be organised, as well as supervision possibilities. Among 
participating therapists are teachers (e.g., courses in ST) and supervisors, which will facilitate 
dissemination. Implementation will be stimulated by offering in-company training and supervision. As 
this study is a pilot, evidence in favour for the effectiveness of ImRs as a stand-alone treatment for 
depression can be seen as an invitation for further research on the subject.  
 
 
9. Time schedule 
August 2023: start of recruitment of patients, assessment of in/exclusion criteria, first assessments. 
 
Autumn 2023: start of first treatments, data are centrally stored, checked and prepared for analysis  
 
Summer 2026: last treatment and post-treatment assessments completed 
 
Summer 2027: last 1 year follow-up assessments completed; analyses of outcome data, reports of 
results (article, conference(s)). Start of dissemination & implementation activities. 
 
 
10. Participating Sites 
At this moment the following site committed to participate: 
ACTP Amsterdam (website: https://actp.nl) 
 
 

 
 
 
 
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