Effects and working mechanisms of Imagery Rescripting and Imaginal Exposure on image distress and event-related emotions.
Creators: name: Grabow, Jessica
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Clinical Psychology
subject: Experimental Analysis of Behavior
subject: Social and Behavioral Sciences
subject: Psychology
subject: FOS: Psychology

description: Distressing childhood memories play an important role in the development of PTSD (Frans et al., 2005; Kessler et al., 2018). Specifically, memories of early shaming experiences are considered to possess characteristics of traumatic memories like unwanted intrusion, avoidance and hyperarousal symptoms (Dinis et al., 2015; Matos &amp; Pinto-Gouveia, 2010; Robinaugh &amp; McNally, 2010). Saraiya and Lopez-Castro (2016) conclude in a review about the role of shame in PTSD that addressing shame in the course of the treatment might be “fundamental to recovery” (S. 169); the same applies to maladaptive guilt cognitions (Pugh et al., 2015). This raises the question whether classic CBT, developed to change pathological fear structures, is most effective when other event-related emotions are involved. Some studies suggest that Imagery Rescripting and Reprocessing Therapy (Arntz &amp; Weertman, 1999; Schmucker &amp; Köster, 2017; Weertman &amp; Arntz, 2007) might have an advantage over exposure-based treatments in tackling non-fear emotions such as shame and guilt in PTSD-patients (Arntz et al., 2007; Grunert et al., 2007) while others found no differential effects (Langkaas et al., 2017; Øktedalen et al., 2015). Also, little is known about the working mechanisms through which effects of Imagery Rescripting are being delivered. Arntz (2012) hypothesizes that imagery rescripting leads to a revaluation of the UCS (Davey, 1989) whereas exposure-based treatments aim to change the link between the CS and the CR (change of contingency expectation). Kunze et al. (2019) aimed to identify mediating variables in an exposure- and a rescripting-based treatment for nightmares. An increase in feelings of mastery (i.e. feeling in control of the nightmare content) revealed as the only significant mediator in the rescripting-group indicating that UCS revaluation might have taken place. In the exposure-group however, an increase of tolerance for negative emotions mediated treatment success. Strohm et al. (2019; Strohm et al., 2021) sought to replicate these findings in an analogue experimental design using distressing biographical memories. However, mastery revealed as a significant mediator only in one of two similarly designed studies (2019). Results of a prior pilot study (Grabow et al., 2021) where we compared two mini-interventions based on imagery rescripting (IR) and imaginal exposure (IE) to a control condition (CC) cautiously hint towards a better performance of IR for feelings of anger, fear and positive emotions when compared to IE. Additionally, levels of mastery increased only in the IR condition. For shame and guilt, we did not find our hypotheses corroborated. This might partly be due to measurement difficulties (strong floor effect for self-conscious emotions) that we want to address by altering the experimental procedure and improving our interventions as well as by including image distress as additional dependent variables in the present study (Norton &amp; Abbott, 2016; Strachan et al., 2020; Wild et al., 2008).