Behaviour Research and Therapy 195 (2025) 104913

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Behaviour Research and Therapy

journal homepage: www.elsevier.com/locate/brat

Imagery Rescripting: an update of the treatment protocol

Arnoud Arntz a,b,*
a
Department of Clinical Psychology, University of Amsterdam, the Netherlands
b
Academic Center for Trauma and Personality, Amsterdam, the Netherlands

A R T I C L E I N F O A B S T R A C T

Keywords: Imagery Rescripting (ImRs) is a transdiagnostic technique to treat aversive memories of real (traumatic) expe­
Imagery Rescripting riences, or of aversive fantasies, such as nightmares and future projections. ImRs is getting increasingly popular,
Trauma and can be used either as a standalone treatment or as part of treatment packages consisting of different tech­
Post-traumatic stress disorder
niques. It has been more than 25 years ago that a detailed treatment protocol of Imagery Rescripting (ImRs) was
Treatment
Psychotherapy
published (Arntz, A., & Weertman, A. (1999). Treatment of childhood memories; theory and practice. Behaviour
Early memories Research and Therapy, 37(8), 715–740). New clinical and research insights have led to changes in the protocol,
and large scale studies are based on this updated protocol. The most important changes include that it is now
strongly recommended that the therapist does the rescripting in the first sessions, while the patient does the
rescripting during the later sessions; and that the rescripting should start at the most difficult moment of the
memory (the “hotspot”). Moreover, a standard series of questions helps to deepen the emotional processing,
while specific ingredients of the rescripting help to increase the impact of the corrective experience offered by
the technique. This paper presents and discusses the updated protocol as it has been developed and tested in the
treatment of childhood trauma. It also offers solutions for possible problems that can be encountered in clinical
practice, and discusses variations of the technique, including how to apply it to adulthood trauma’s, to night­
mares, and to a range of disorders and clinical problems, including pathological grief, and feared future catas­
trophes. It is explained that the working mechanism does not rely on installing false memories, and how
therapists can prevent that false memories are installed. Finally, the paper provides a set of practical appendices
including a treatment rationale and a handout that can be given to patients.

1. Introduction ways in which ImRs can be done. Moreover, there is no universally

accepted definition of which imaging techniques can be considered
Imagery Rescripting (ImRs) is a transdiagnostic technique by which ImRs, and which cannot. It is beyond the scope of this paper to address
aversive memories of real (traumatic) experiences, or of aversive fan­ this issue. However, some imagination techniques are generally
tasies, such as nightmares and future projections can be processed so considered to be a form of ImRs, are protocolized, and have been tested
that their emotional meaning changes. In short, in ImRs the patient in several studies. Some of them are stand-alone treatments, others part
imagines the aversive experience as if it happens in the here and now. At of a more extensive treatment. Box 1 explains how the ImRs protocol
the most difficult moment, called the “hotspot”, the patient imagines that is the topic of the present paper differs from the most important
that an intervention takes place that changes the course of events in such other protocols. The present paper focuses on a specific protocol,
a way that the patient’s needs are met. This imagination of a new sce­ without claiming that it is the only or the ultimate way to apply ImRs.
nario leads to emotional and cognitive processing of the emotional Another disclaimer is that the present author did not “invent” ImRs,
(trauma) memory, changing the meaning of the experience from rather he learned the technique from various sources and co-developed a
dysfunctional to more functional. protocol that could tested in clinical trials. For scientific reasons, it is
ImRs has a long history, with roots in ancient healing practices and important for researchers to be transparent about which technique they
used in various forms of psychodynamic and experiential therapies, as have investigated. To facilitate this, published protocols are needed, and
well as hypnotherapy (Edwards, 2007). But it was mainly through this article provides such a protocol.
Gestalt therapy that ImRs entered CBT (Edwards, 2007). There are many Our current understanding of the mechanism underlying ImRs is that

* Department of Clinical Psychology, University of Amsterdam, the Netherlands.

E-mail address: [email protected].

https://doi.org/10.1016/j.brat.2025.104913
Received 14 January 2025; Received in revised form 11 August 2025; Accepted 5 November 2025
Available online 10 November 2025
0005-7967/© 2025 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
A. Arntz Behaviour Research and Therapy 195 (2025) 104913

the technique leads to a transformation of the emotional meaning of the studies into mechanisms of change in ImRs support the hypothesis that
memory representation. Apparently, although the change in the changes in emotional meaning underly the effects (Assmann et al., 2024;
sequence of events is fantasized, the vivid imagery of the change offers a Kunze et al., 2019; Rameckers et al., 2024). In conditioning theory this
corrective experience. This is probably related to the capacity of most phenomenon can be conceptualized as a form of UCS-revaluation (Arntz,
people to imagine so vividly that there is little difference in brain acti­ 2012). UCS-revaluation refers to the phenomenon that later experiences
vation compared to a real experience, except for the posterior brain with the unconditioned stimulus (UCS) can change the evaluation
parts, where the primary and secondary visual sensory input is pro­ (meaning) of the UCS, in turn leading to a change in the conditioned
cessed, as demonstrated in fMRI studies (e.g., Ganis et al., 2004). Thus, response. What is unclear, however, is whether the emotional meaning
although the person is aware that the rescripting is a procedure based on part of the original memory representation can disappear by being
fantasy, the impact can be similar to a real corrective experience. Recent replaced by the new meaning, or whether the new meaning constitutes

BOX 1

Important differences between Imagery Rescripting as presented in the present paper (denoted here as ImRs*) and other protocols.
Imagery Rescripting and Reprocessing Therapy (IRRT; Smucker et al., 1995 ab; Grunert et al., 2007) compared to ImRs*

1. IRRT starts with imaginal exposure to the complete trauma memory. With ImRs* the memory activation part stops when the hotspot is
reached (or, if hotspot is late in the memory/is after the trauma, trauma memory activation can start just before the hotspot). Exposure to the
complete trauma memory is not part of ImRs*.
2. In IRRT, the rescripting starts when the molestation starts. In a later version for non-interpersonal trauma, the rescripting starts when the
subjective distress reaches its peak (Grunert et al., 2007). In contrast, in ImRs* the rescripting starts at the hotspot.
3. In IRRT, the patient’s adult self (current self) performs the rescripting. In ImRs*, therapists rescript in the initial phase of treatment.
4. In IRRT, focus is on mastery by the current self, not so much on the needs of the child (or the past self), as in ImRs*.
5. In IRRT the patient’s perspective during rescripting is the adult’s (current) self. In ImRs*, patients stay in the child perspective in the early
phase of therapy, when therapists rescript. In the later phase of therapy, patients switch back to the child perspective after they completed
rescripting by their adult (current) self.
6. In IRRT there is prolonged post-imagery “re-processing”, described as “linguistic processing of the just-completed imagery session, while
reinforcing the alternative positive representations (visual and verbal) created during the mastery imagery” (Grunert et al., 2007, p. 322). In
ImRs*, such a re-processing phase is not prescribed. Although it is allowed to reflect with the patient on the ImRs* just completed, the idea is
that the experiential elements of the technique do most of the job.
7. In IRRT, patients are requested to listen to audio-recordings of the sessions as daily homework. This is not done in ImRs*.

Important differences between British applications and ImRs*

1. The British tradition is to identify core dysfunctional interpretations of the traumatic experience or encapsulated beliefs, to challenge these
with cognitive therapy techniques, to formulate a more functional interpretation, and to prepare the way rescripting has to be done in detail.
A next session, the prepared rescripting is applied (e.g., Wild & Clark, 2011). In ImRs* there is little preparation, the technique relies on what
is developing during the process of applying it.
2. Relatedly, the focus of the imagery rescripting is more to “update the trauma memory” with current and functional insights, than to meet the
needs of the child (or, the past self) as in ImRs*.
3. In general, in the British application, the patient rescripts, rather than the therapist.

Important differences between imagery rescripting as used in Schema Therapy (ST) and ImRs*

1. In the ST applications proposed (and modeled) by Young (Young et al., 2003), there are usually frequent switches between current self and
child perspectives. In ImRs* the perspective remains the same during each phase. This deepens the emotional processing and leads to less
confusion about the perspective the patient takes.
2. The ST applications as proposed (and modeled) by Young are usually shorter and don’t deepen the process by repeatedly posing the standard
questions as used in the ImRs protocol.
3. However, an important similarity is that both focus on needs that were insufficiently met.

Important differences between Imagery Rehearsal Therapy (IRT; Albanese et al., 2022) for nightmares and ImRs*

1. In IRT, the patient writes down how they want to change the nightmare, so that it would become a positive dream. In ImRs* there is usually
no writing assignment given to patients to prepare the rescripting.
2. In IRT, the new script does not necessarily involve changing the ending. In ImRs* the rescripting usually implies a new ending.
3. In IRT, patients daily rehearse the new script. In ImRs* there is no repeated mental rehearsing of the new script.
4. In IRT, the new script is mentally rehearsed without activation of the nightmare memory. In contrast, in ImRs* the new script is linked to the
emotional memory.

___
*ImRs as described in the present paper, that is not imagery rescripting in a more general meaning.

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an alternative memory trace that inhibits the activation of the original when applying the technique. First, the standard ImRs protocol as
meaning (Arntz, 2012; Brewin, 2006; Dibbets et al., 2012). In contrast, it developed for the PTSD due to childhood trauma (ch-PTSD) studies
is clear that the memory of the factual details remains intact, hence the (Boterhoven de Haan et al., 2020; Wibbelink et al., 2021; later extended
mechanism is not based on inducing a false memory in which the person to PTSD in general, Lortye et al., 2021, 2025) is presented and discussed.
believes (see section 6. Preventing false memories for further discussion). Then, several problems that can be encountered and how they can be
There is evidence that the new meaning is the most effective thera­ tackled are addressed. Next, applications to other types of aversive
peutically when linked to the core of the original emotional memory emotional memories and other disorders than PTSD are described. How
representation, i.e. the most distressing and painful part (Dibbets & to prevent that false memories are installed is discussed next. Lastly, a
Arntz, 2015). Therefore, ImRs should start after this part of the short conclusion is offered.
emotional memory has been activated. In clinical practice, this means This paper focuses on ImRs as offered to adults. Applications for
that rescripting starts at the hotspot, i.e. when the most difficult part of children and adolescents have been developed, but are not the subject of
the emotional memory has been reached and emotionally experienced. this paper. Moreover, the focus is on processing memories of adverse
Moreover, the better the person’s needs as experienced during the experiences. Consequently, applications of ImRs to positive memories/
process are met, the better the treatment effects are (Koetsier et al., mental representations, that play a role in appetitive problems such as
2024). This supports the assumption underlying ImRs, that meeting the addiction, are not treated.
person’s needs (as experienced during the activation of the trauma
memory activation) is a corrective experience, leading to a change in the 2. Main changes in the imagery rescripting protocol for
emotional meaning of the original experience. A last insight into childhood memories
working mechanisms is that positive effects of ImRs applied to a specific
memory spread to other associated memories (in line with spreading Compared to the protocol as previously published (Arntz & Weert­
activation theory, Anderson & Pirolli, 1984). People are generally able man, 1999), some important changes were made. The first study that
to indicate the degree to which memories are associated, which predicts investigated this updated protocol was the IREM-study (Boterhoven de
the degree to which the emotional meaning of the associated memories Haan et al., 2020), followed by the IREM-Freq study (Wibbelink et al.,
are affected by rescripting the target memory (Rijkeboer et al., in 2021), and the TOPA-study (Lortye et al., 2025). The changes are now
preparation). listed and explained.
Because emotional memories underlie many clinical problems, ImRs
has a wide range of applications. Moreover, whether or not the memory 2.1. Standard rationale
is based upon a real experience, or upon a fantasy, makes little difference
for the technique. There is no a priori reason why emotional memories of In 1999 we felt less certain about the rationale, mechanisms, and
past events should be treated differently than emotional memories of empirical support for ImRs as an effective technique than nowadays. We
fantasies (including nightmares and negative future expectations), and have now developed a standard rationale that can be used to explain the
we have to keep in mind that memories are subjective anyway, espe­ treatment to patients, as well as a handout that can be given to the pa­
cially when it comes to their emotional meaning. Indeed, studies showed tient, to explain the technique. This is important because ImRs is
good effects of ImRs for nightmares and negative future expectations initially a strange technique for many people, as it raises the question of
(Kroener et al., 2023; Kunze et al., 2017). how fantasizing about something that should have happened but didn’t
Quite some fundamental, subclinical, and clinical studies have been in reality can be useful. Part of the explanation is based on fundamental
done so far, nevertheless many questions remain (see Hagenaars et al., brain imaging research, demonstrating that there is little difference in
this issue, for a research agenda). But although the research agenda has brain activation between imagining something vs. seeing it projected on
not been completed, clinical studies have demonstrated the effectiveness the screen in the scanner. Thus, although we are aware that we imagine
and the high acceptability (low treatment dropout) of ImRs for a wide something, the brain activation is for a large part as if we experience it in
range of clinical problems, ranging from simple phobia to complex reality. The major differences in activation patterns are found in the
disorders such as borderline personality disorder and psychosis. Meta- primary sensory areas in the back of the brain, which makes sense as
analyses support the empirical basis of the effectiveness of ImRs (Kip there is no input from sensory organs (here the eyes), although even
et al., 2023; Kroener et al., 2023). On the other hand, the evidence for there activation is found (e.g., Ganis et al., 2004). The rationale and the
disorders other than PTSD is still limited, although Kroener et al. (2023) handout are provided in appendices A and B.
reported separate meta-analyses of studies on prospective mental im­
agery and social anxiety disorder in addition to a meta-analysis of PTSD 2.2. The therapists starts with rescripting
studies. Nevertheless, there is a clear need for more (multicentre) studies
on a wider range of disorders, reporting not only the effectiveness, but Whereas the original protocol stated that patients should imagine to
also the treatment retention, and safety of the technique. It should also enter the image as their current self, we now prescribe that the initial
be noted that meta-analyses did not show that ImRs is more effective rescripting should be done by the therapist. The first reason for this is
than other evidence-based treatments. that, especially with more severe psychopathological problems, we have
ImRs is getting increasingly popular, and can be used either as a found that patients were often unable to intervene and fell back on their
standalone treatment or as part of treatment packages consisting of feelings as children, as it were, overwhelmed by the threat they faced. In
different techniques, such as in cognitive therapy (Clark et al., 2006; other cases, patients began to blame and punish the child. In both cases,
Ehlers et al., 2005) and schema therapy (Arntz & Jacob, 2017; Arntz and instead of providing a corrective experience, this leads to a reinforce­
van Genderen, 2020; Young et al., 2003). It has been more than 25 years ment of the original memory representation, which is obviously not
ago that a detailed treatment protocol of ImRs was published (Arntz & what we want to achieve with ImRs. Thus, we now prescribe that
Weertman, 1999). In the meantime new clinical and research insights therapists step in the image and lead the rescripting. By this, they offer a
have led to changes in the protocol. Recent large scale studies were corrective experience, for example, that the perpetrator is no longer
based on this updated protocol (e.g., the IREM-study, Boterhoven de invincible and has all the power, and that not the child is to blame, but
Haan et al., 2020; the TOPA-study, Lortye et al., 2025; the the perpetrator. Secondly, the therapist offers a functional model how to
IREM-Freq-study, Wibbelink et al., 2021), and it is important to inform intervene to stop the threat and how to take care of further needs of the
clinicians and researchers about the update. Hence, the aim of this paper child, which patients will use in the later phase of therapy when they
is to share the updated ImRs protocol, as well as our current view on how step in the image to help their younger self and develop their own ways
to deal with specific situations and challenges that one might encounter of rescripting. Thirdly, the experience that somebody else stands up for

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you is a corrective experience in itself, especially important for patients 2.4. Use standard questions to deepen the process
who experienced neglect or rejection of their needs. Qualitative studies
confirmed that patients value these aspects of therapists rescripting, for The emotional and cognitive processing is enhanced by guiding the
example they value that somebody else stood up for them, and took care patient through the process by a set of standard questions, that help the
of their further needs, and that therapists offer a model. But they also patient to become aware of different aspects. This is important, because
value the phase when they have to do the rescripting, as this empowers the technique is primarily experiential, thus the experience needs to be
them and they learn to take care of themselves (Bosch & Arntz, 2023; deepened. Therapists should not be afraid that the process is too lengthy
Menninga et al., in preparation). Thus, in the 12-session ImRs protocol or gets boring, as we know from participants that a lot happens in their
therapists rescript the first 6 sessions, while, patients rescript from their subjective experience. Although the original protocol advised “It can be
current perspective during the last 6 sessions. helpful to ask the type of questions familiar to CBT therapists who use
imaginal exposure: ask for sensory experiences (what do you see, smell, hear,
feel, etc.), for emotions (what do you feel?), for thoughts (what is going
2.3. Start rescripting at the hotspot through your mind?), for behaviour, for what is happening, etc.” (Arntz &
Weertman, 1999, p. 720; see also Table 2, p. 721), it didn’t prescribe this
Previous descriptions of ImRs emphasized that the imagined inter­ nor was it clear how to use this while the therapist rescripts. Moreover,
vention should start before the trauma proper happens. However, a lab although in the case examples questions asking the child what they need
study yielded convincing evidence that starting the rescripting at the are given, questions asking for needs missed in the proposed standard
most difficult moment has much better effects (Dibbets & Arntz, 2016). questions. In developing a standard protocol for the RCTs, we under­
This is understandable from current memory theories, indicating that lined that therapists should cycle through a standard set of questions,
the core of the emotional memory should be activated before the essence and that from the hotspot moment on, the question “What do you need
of it is open for change (Faliagkas et al., 2018; Kindt & Soeter, 2023). (now)?” has to be added, also during the rescripting phase. This question
Hence, therapists should ask before they start with ImRs of a specific helps patients to become aware of their needs, and to verbalize them – a
memory what the most difficult moment in the memory is, to know capacity that is often underdeveloped in more severe forms of psycho­
when they have to start the intervention, c.q. when they have to instruct pathology, but is necessary for reaching a higher degree of wellbeing.
the patient to start the intervention (in the second phase of treatment). Moreover, the answer informs therapists what to address in the
There might be multiple hotspots, for example with sexual abuse, when rescripting. Note that this question is not asked before the hotspot is
one hotspot is located within the actual abuse, whereas another hotspot reached, as it might tempt therapists to start rescripting too early, and
is when the child tries to share what has happened with a parent, but doing nothing while an explicit need is expressed is rather painful. Some
finds the parent to respond in a punitive and rejecting way (e.g.., “Stop patients are initially unable to answer the need question. In such cases
saying such dirty things about your uncle, he is such a good man, go and therapists should reassure the patient and suggest what they might need,
wash your mouth, and never say such terrible things again”). In such then start rescripting, and check what the effects of the first round of
cases, both hotspots need to be addressed with ImRs, sometimes in rescripting are. By trial and error, the actions needed will be found.
different sessions. If it is not possible to discuss what the hotspot is be­ Lastly, feedback from therapists informed us that adding a question
forehand, for instance when a affect-bridge technique is used to find an about how the emotion is experienced in the body helps patients to
early memory, therapists can ask patients to give a sign (e.g. raise their deepen the emotional experience. Table 1 presents the standard ques­
hands, or tell them “This is the most difficult moment”) so that the tions of the current protocol, both for the phase where the therapist
rescripting can start at the right moment. If it takes too much time to rescripts, and for the phase where the patient rescripts.
reach the hotspot and/or waiting for the hotspot to come leads to an
(unnecessary) lengthy exposure to all horrible details of the abuse, the
therapist should instruct the patients to fast forward to the hotspot. ImRs 2.5. Actively reattribute shame and guilt
should not end in prolonged exposure, as the (assumed) working
mechanism is not based on extinction by prolonged exposure to all We learned from patient feedback that it is important to actively tell
frightening details, but change of the (often complex and interpersonal) them, when the therapist rescripts, that they are not to blame, but that
meaning of what happened. the perpetrator is responsible and should be ashamed for doing this to a

Table 1
Main questions used in imagery rescripting.
When patient takes the child (former) perspective
What is happening? What do you see, hear, smell, (taste) feel?
What are you emotionally feeling? Where do you feel this in your body?
What are you thinking?/What is going through your mind?
(From the hotspot on): What do you need (now)?

When patient takes the adult (current) perspective and rescripts

What is happening? What do you see, hear, smell, (taste) feel?
What are you emotionally feeling? Where do you feel this in your body?
What are you thinking?/What is going through your mind?
What do you want to do (or say)?
Therapist prompts the patient: okay, do that! (Or: say that!)

When the patient takes the child perspective and imagines the adult self intervening
What is happening? What do you see, hear, smell, (taste) feel?
What are you emotionally feeling? Where do you feel this in your body?
What are you thinking?/What is going through your mind?
(At the end of the new script): What do you need (now)?/Is there something else you need?
Therapist prompts the patient: okay, ask big ≪ patient’s name≫!

Note. The first set of questions is repeated until the hotspot is reached. Then, the question about needs is added, after which the rescripting starts. Then the full set is
repeated, interspersed with rescripting interventions, until the patient’s former self feels okay.

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child (Raabe et al., 2022). Therapists reassure the child that they are a the day of the sessions. People need to recuperate from intensive trauma
good and nice child (person), and that they don’t deserve the abuse or processing, hence their agenda should allow them to do this. Lastly,
neglect, etc. Especially if a parent is the perpetrator, therapists abstain benzodiazepines and alcohol (and probably other street drugs as well)
from making character attributions. Rather they attribute the behaviour interfere with memory consolidation during sleep. They should not be
to emotional problems and mental health issues of the parent. Nobody used 24 h after a treatment session. In our present PTSD studies, we
wants to be the child of an inherently bad father or mother, and un­ require stopping benzodiazepines before entering the trial.
derstanding that parents misbehaved because of their own issues, and
not because the child was a bad child and deserved or even caused 3.1. Preparation: rationale and creating a list of memories to be addressed
maltreatment, is very helpful for patients. Hence, the protocol now
prescribes active reattribution, and further psychoeducation, even when Usually this preparation takes a single session, but complex cases
the patient doesn’t actively asks for this. This is usually done shortly might need several sessions, though this phase should not result in
after the immediate threat has stopped and it is sufficiently safe for the dysfunctional postponing the trauma processing work. In this phase the
child. rationale of Imagery Rescripting is explained, and questions and doubts
of the patient are addressed. Therapists can use the written out rationale
2.6. End with a positive emotional experience (Appendix A) and give the patient a copy of the handout (Appendix B).
Reassure the patient that the technique has a good evidence base, with
Recent lab research has confirmed the practice to end the rescripting studies showing strong effects, especially in the long-term, and high
with letting the child (person) imagine doing something nice. In a acceptability (low treatment dropout). Then, a list of (trauma/aversive)
nonclinical lab study it was found that ending rescripting with imag­ memories is created, with at least some indication of the severity of each
ining engaging in an activity that leads to a positive emotion leads to memory. No details are needed yet, however age, perpetrator(s), repe­
enhanced effectiveness of ImRs on positive emotions at follow-up titions, and some contextual information is helpful. Explain the patient
(Geschwind et al., 2024). that the list is flexible: memories can be added later, and the order in
which memories are addressed is also flexible. Also explain that with
2.7. Developing a satisfying script is based on trial and error successful rescripting often the impact of other memories also reduce,
when these memories are associated. This means that it might not be
It cannot be predicted what (fantasized) interventions will work. The necessary to address all memories on the list. Which memory to address
basis for deciding whether the imagined interventions were satisfying is when is decided together by patient and therapist on a session-by-
in how the patient experiences them, and here there can even be a dif­ session basis, keeping in mind that rescripting the most severe (index)
ference between the short-term and the long-term. For example, the trauma should not be postponed and should preferably be done in both
patient might imagine after a parent is asked to comfort the child that the therapist and the patient rescripting phases. At the end of the session
the parent does this. However, at the next session the patient might a pilot ImRs can be done with a memory of a minor negative experience,
report that this doesn’t match with how the parent is and therefore re­ so that the patient understands the technique.
jects the imagined change in the parent. This means that a new script has
to be tried out. Thus, therapists (and patients alike) should liberate 3.2. Imagery rescripting with the therapist rescripting
themselves from the idea that they should beforehand know how to
intervene. They should accept that developing a satisfying script is a After the preparation session(s) the first proper ImRs session starts.
matter of trial and error. Therapists are recommended to model this, by The ImRs consists of two steps, with a subdivision of step 2, see Table 2.
responding when the patient says that an intervention doesn’t work with The therapists asks what memory from the list the patient wants to
“no problem, then I will try out something else”. Of course, this requests address in the session, and asks the patient to shortly describe what
creativity and a basic trust of therapists that they will be able to find an happened during the experience. Age, context, and perpetrator(s)
intervention that does the job. Therapists should built up resilience in should be clear. Ask the patient to indicate what the hotspot is, that is
dealing with patients rejecting their interventions as ineffective or not the most difficult moment in the memory is (i.e., what is still the most
impossible. For instance, patients might initially reject interventions troublesome). If there are multiple hotspots, decide together with the
that try to control a dangerous perpetrator who is, in their view patient which to focus on in this session. This should take only a few
almighty. It often takes several attempts before the perpetrator is minutes, after which the therapist instructs the patient to sit comfort­
controlled, and it seems that perseverance of the therapist is the most able, close the eyes, and imagine the situation from the start (i.e., not yet
important. It is important for therapists to develop this capacity, e.g. by at the hotspot). Patients are instructed to imagine the remembered sit­
training and supervision. uation as vividly as possible, using all the senses, from the “I perspec­
tive” of the child that is in the situation, and using present tense. Gently
3. The updated imagery rescripting protocol correct them if they use past tense by repeating what the patient says in
the present tense (P: “I was in the kitchen where my mother was cooking”;
The treatment protocol consists of three major phases: (1) prepara­ T: “I am in the kitchen where my mother is cooking”). The therapist uses the
tion; (2) therapist rescripts; (3) patient rescripts; which are now dis­ standard questions (Table 1; Appendix C, first page). At the hotspot, the
cussed. The complete treatment protocol as used in the IREM-Freq study therapists adds the question “What do you need (now)?” and gives the
can be found in Appendix E. In the IREM and the IREM-Freq studies, the patient some time to reflect on that if necessary. If patients say they
session duration was maximum 90 min, to match the duration to what is don’t know, even after stimulating them to try to find out, therapists
desired in EMDR. However, these studies found that for ImRs sessions, might give suggestions, and see how the patient reacts. If they still don’t
usually 60 min suffice. know, or if the emotional arousal is very high and the patient is in need
Before treatment really starts, it should be clear that the patient
agrees with trauma-processing, and that the patient commits to a 12 (or
Table 2
other number) session treatment in a restricted period. It might well be The two steps of Imagery Rescripting when the therapist rescripts.
the case that a specific period is not suitable for an intensive trauma
Step 1. Memory activation up to and including the hotspot
treatment (e.g., the patient has to undergo a major surgery; a holiday is
Step 2. Therapist rescripts
planned; there are exams taking place, etc.). This should be explicitly a. Therapist stops the threat
checked, and it might be a wise decision to postpone treatment to a later b. Therapist meets further needs of the child
moment. Other issues that need to be checked are the days and time of

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for immediate help, therapists say what they think the child needs and became aware of. However, rely on that the experiential work done is
start the rescripting. It is important that patients stay in the child the primary source of change. In other words, there is (usually) no need
perspective during internally exploring what they need, with the eyes for extensive discussions of what happened during the rescripting, and
closed. If they open their eyes, gently tell them to close their eyes and be what the implications are. Help the patient to calm down a bit before
the child in the adverse situation. ending the session. If necessary, the patient can sit in the waiting room to
Therapists then tell the patient that they are now in the image with further calm down.
the patient. They describe where they are (e.g., “I am now standing be­ Returning to the step where the therapist begins to intervene, the
tween you and your mother”) and check whether the patient can see them. level of forcefulness and aggressiveness of the intervention needs some
Next they describe how they intervene (e.g., “I tell you mother the reflection. Therapists are recommended to tailor the intervention to the
following (therapist speaks angrily): “Madam, your daughter needs your situation. E.g., when the hotspot is in the middle of brutal physical or
attention now, you cannot just threaten her with locking her up if she doesn’t sexual abuse, a forceful intervention is appropriate, including physically
stop asking for attention. She was severely bullied at school and she needs you pulling the perpetrator away from the child. For other types of negative
to help her and calm her down, she is very upset. Stop with threatening her childhood experiences, however, a firm but less (physically) aggressive
and give her what she needs!”“). After the first intervention, the therapist intervention is appropriate. Exaggeration can frighten the patient and is
asks the patient how the person addressed by the therapist responds, especially problematic if the child has an ambivalent relationship with
using the first type of standard question again (“What is happening now? the perpetrator, for example when the perpetrator is also a source of love
How is your mother responding?“), followed by the other standard ques­ and recognition. Also, a firm and clear but polite verbal confrontation
tions. After the needs question, the therapists continues the intervention, can have a surprising effect on the perpetrator, in the patient’s experi­
informed by how the image developed in the patient’s fantasy, and the ence. So a safe approach is to start with an intervention of an intensity
emotions, thoughts, and needs of the patient. It is recommended to that seems appropriate, and scale it up if it does not work.
incorporate psychoeducation into the texts spoken against the offender Box 2 presents a case example of the therapist rescripting.
(s), not so much to convince the offender, but to help the patient change
the meaning of what happened. (e.g., “What is wrong with you that you 3.3. Imagery rescripting with the patient rescripting
cannot give your daughter what she needs? It is perfectly normal and healthy
for children to ask their parent for being calmed down when they are upset. Later in treatment, patients rescript themselves. In the first session
Why can’t you give this to your child? It is very bad for children to be pun­ when patients start to rescript themselves, patients are given a short
ished for being emotional and for seeking reassurance with their parent.“). instruction and are reassured that the therapist will help them
In case the patient is not satisfied with the intervention, which will throughout the process: “We are now going to let you do the rescripting. Let
become clear from the answers to the standard questions, try out me explain shortly. We start as usual, by you imagining an adverse (trau­
something else. It is not a problem to rewind the image if necessary (e.g., matic) experience as vividly as possible. At the hotspot, I will instruct you to
the perpetrator was killed, but the patient doesn’t like that on second imagine that you enter the scene as your current self. Your task is to help your
thoughts) and try out another intervention. After all, ImRs is a fantasy little self, and you can use anything that is necessary to accomplish this. Keep
technique, so one can try out any intervention, until the patient (from in mind that you are in control and can do whatever is necessary. If you are
the child perspective) is satisfied. not satisfied with an intervention, no problem, you can try out something else.
After the immediate threat is taken away, the therapist reassures the When you have finished the rescripting, we will rewind the image, and I will
child, and provides psycho-education: “I want you to know that it is not instruct you to be little ≪ patient’s name >> again and experience the in­
your fault that this happened. There is something wrong with terventions by big ≪ patient’s name>>. At the end you can ask big ≪ pa­
<<perpetrator>> that (s)he behaves like this. You should not feel tient’s name >> for additional actions that you need. This is a rather long
ashamed, you should not feel guilty, but <<perpetrator>> should feel explanation, but there is no need to remember everything. I will guide you
ashamed, <<perpetrator>> does wrong things.” In case of parents don’t through the process. Do you have any questions?”
make character attributions, rather attribute to dysfunctional The process thus consists of three steps, summarized in Table 3.
(emotional) states, while maintaining that the parent is responsible, and As with the previous phase, when the therapist rescripted, a memory
point out underlying emotional/mental health problems, not as an is chosen. Then the patient closes the eyes, and imagines the start of the
excuse but as an explanation, while underlining the need that the parent adverse/traumatic event as vividly as possible, using the standard
should change, e.g. get proper treatment (e.g., “you mother must have questions (Table 1). At the hotspot, patients are instructed to keep their
some emotional problem that she reacts like this, and I am going to arrange eyes shut, switch perspective to their current self, and step in the image.
that she gets a proper treatment for that because it is not acceptable how she The therapist reminds them shortly that that they are in control and have
treats you”). all the power to do what is necessary to help their little self. Next, the
The last part, often the most extensive part, is to take care of further therapist continues with the standard questions, starting with asking
needs of the child. Again, the sequence of the standard questions what they see, etc. However, instead of asking for their needs, the
(Table 1) is used: standard questions – intervention by therapist – therapist now asks for action tendencies: “What do you want to do (or
standard questions – intervention by therapists, etc. Further needs say)?“. If the patient has expressed an action tendency, the therapist
usually include: being comforted (which can involve being calmed down gives a prompt: “Okay, do that!” (or: “Okay, say that!“). If patients don’t
through imagined bodily contact, such as holding the child’s hand, describe what they do, or speak out what they say in the image, the
giving the child a hug, etc.), taking measures to prevent repetition (e.g., therapist should ask them to do. This increases the impact of the
giving the child a pager to alarm the therapist when needed, who re­ rescripting. After the first intervention by the current self, the standard
assures to fly in immediately in to intervene and protect the child; questions are repeated, leading to a new intervention. This continues
bringing the child to another family where it is safe and where there is a until the patient’s current self is satisfied. The therapist might remind
caring and happy atmosphere); and doing something pleasurable at the the patient of explaining the child why they are not guilty and should not
end (e.g., playing with other children, eating favourite food (pancakes, feel ashamed. In case the therapist sees that the patient’s current self
ice cream), watching a favourite movie, being read a favourite story). If switches into a state of powerlessness, the therapist should remind the
the child doesn’t ask for doing something nice at the end, actively pro­ patient that they are in control and can use anything that is necessary
pose it: this helps to strengthen the effects of the technique. End the (including calling in others to help) to achieve what should be done.
ImRs when the child feels fine and no further needs are to be met. In the third step of the process, while the patient has still the eyes
Following the ImRs, the experience can be shortly discussed, and the closed, the therapist instructs the patient to rewind the image to just
patient can be helped to integrate the different aspects the patient before the hotspot, and be little ≪ patient’s name ≫ again. The standard

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Box 2
Case example of ImRs by therapist

Context: patient Emmy chooses for today an early memory of sexual abuse by father. In the list of memories there are other instances of sexual
abuse by her father, but also physical violence by her father to her, her brother, and her mother; and memories of emotional neglect by mother,
who was absorbed by her own emotional problems, including abandonment fears.

Step 1. Trauma memory activation up to and including the hotspot

T: can you shortly describe what the situation was that you choose to address today? Where took it place, what age were you, who was involved?
What was the most difficult moment, the hotspot?
P: I was 7 years, and asleep, in my bedroom. I woke up, feeling that my vagina was touched, somebody trying to penetrate it. Then I realized that
it was my father. That was the most difficult moment, discovering it was my father.
T: Okay, can you then sit comfortably, and close your eyes? Be little Emmy and imagine the situation as if it is happening in the here and now.
You are lying in bed just before you feel asleep. Can you imagine that?
P: Yes.
T: Can you feel the sheets and the pillow? Do you have a cuddly toy with you?
P: Yes, I feel the sheets and I feel I hold Fluffy against my chest.
T: Can you describe what you hear?
P: I hear some noise from the kitchen below, and some people talking in the street.
T: Is there anything you smell?
P: I smell food, my mother is preparing something, soup or something.
T: And what do you see?
P: Nothing, it is dark, and I have my eyes closed.
T: How do you feel now, emotionally?
P: I feel calm and relaxed.
T: Where do you feel that in your body?
P: (P points at her shoulders and stomach).
T: What is going through your mind now?
P: How I played with my friend, after school.
T: What happens next? What do you see, hear, smell, feel in your body?
P: I’m sleeping but I feel something between my legs, trying to enter my vagina, I wake up but I still don’t fully understand what is happening ….
Then I hear breathing and I smell … sweat and breath smelling of smoke. I suddenly realize it is my father!
T: How do you feel now emotionally?
P: I panic. I feel very unsafe, and confused. What is happening?
T: Where can you feel this in your body?
P: Here (holds her hands on her breastbone).
T: What are you thinking now?
P: What is going on? What is dad doing?
T: What do you need right now?
P: That he stops!

Step 2a. Therapist stops the threat

T: Okay, I am now with you in the room. I turn on the light and I am now standing behind you dad. Can you see me?
P: Yes.
T: Okay, I now pull you father away from you, and tell him (speaks with angry and loud voice): “Stop with this, are you out of your mind? What
are you doing with your daughter? You cannot do this! This is very inappropriate and not good for children. You should take care that your
daughter is safe, not frighten her. Never, never do this again.” (To P in a softer tone of voice) How is your father responding?
P: He looks embarrassed, and surprised that you are here. He doesn’t say anything. Now I see him trying to leave the room.
T: How do you feel now, as little Emmy?
P: Much better, I feel relief … But I’m also afraid that he will come back later and punish me for letting you stop him, and doing it again.
T: Can you feel that fear in your body?

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P: Yes (holds her hand on her chest and stomach).

T: What are you thinking now?
P: What if you are away?
T: What do you need now?
P: that you make sure this never happens again, and dad is not going to punish me …
T: Okay, I tell your dad: “Don’t leave now. We need to talk. First of all, you are not going to punish your daughter for the fact that I am here. This
is my decision and I am here because you did something wrong, and not your daughter. If you try to do this ever again, or punish your daughter, I
will be back again together with the police and you will be arrested. So don’t be stupid. Secondly, I want you to apologize to your daughter. You
should feel ashamed of what you did, and not your daughter. So say sorry to her and promise her to never do this again” (To little Emmy) What is
your dad doing now? How does he respond?
P: He gets very angry at you and starts to hit you.
T: What do you feel now, emotionally, as little Emmy?
P: I get very afraid now.
T: Where do you feel that in your body?
P: Here (P taps her chest).
T: What are you thinking now?
P: He is going to beat you up.
T: What do you need now?
P: That he is stopped, that he goes away.
T: Okay, I call in the two police officers that are waiting at the corridor. They now enter the room. They grab him, and take him to the police
station. Can you see this?
P: (Nods affirmatively).
T: How do you feel now?
P: Much better. But I am still afraid about what will happen when he returns.
T: Where do you feel that in your body?
P: (Puts her hand on her breastbone).
T: What are you thinking now?
P: That he is going to be angry and aggressive when he returns.
T: What do you need?
P: That he shouldn’t return unless he is the nice dad that he also can be.
T: Okay, I’m going to arrange with child security services that your father can’t come back if he can’t behave himself. And that he gets treatment,
because it’s clear that there’s something wrong with him if he behaves like that. Compulsory treatment. So he won’t come back, unless he has
resolved his problems. And I will keep an eye on that.

Step 2b. Therapist addresses further needs of the child

T: How do you feel now?

P: Much better. Relieved.
T: Where do you feel that in your body?
P: (Puts her hands on her shoulders).
T: What are you thinking now?
P: Where is my mother?
T: What do you need?
P: My mum.
T: Okay, I’ll get you mother in a moment. But before that, I just want to reassure you that you are not guilty of what happened, and you shouldn’t
be ashamed about it. Your father has a problem, that makes him do these things, and he should be ashamed for what he did. Sometimes adults do
these weird things when they have a problem, but you didn’t deserve this at all. You are a good girl and there is nothing wrong with you. It is just
sad that this happened to you, and you didn’t do anything wrong. Do you understand a bit what I am saying?
P: (Nods affirmatively).
T: How are you feeling now?
P: Better, more relieved.
T: Where do you feel that in your body?

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P: (First punts her hand on her shoulders, next on her stomach).

T: What are you thinking now?
P: That it is not my fault.
T: You said you need your mum, what do you want her to do?
P: To sooth me.
T: Okay, let me get her. She is now with us, can you see her? (P: Nods affirmatively) I tell your mother the following: “Mother of Emmy, can you
sooth your daughter and reassure her that it is not her fault and that you will protect her so that it will never happen again?” How is your mother
responding?
P: She holds me, but she is also crying and says that she doesn’t know what to do now that dad is taken away by the police.
T: What do you feel now, emotionally, as little Emmy?
P: Anger.
T: Where do feel that in your body?
P: In my arms and fists.
T: What are you thinking now?
P: Mum is only concerned with herself. She doesn’t really care about me.
T: What do you need now?
P: That she stops and takes care of me … But I don’t feel she is able to do that …
T: Is there anybody else who could take care of you, and where it is safe?
P: (Nods affirmatively): grandma and granddad.
T: Okay, I tell your mother the following: “Listen madam, at this moment you don’t seem to be capable of giving Emmy what she needs. It is
completely normal that she needs to be comforted now, after what happened, but you are so overwhelmed by your own fears that you cannot
give your daughter what she needs. And that is not good for children, children need protection, love, and being taken care of. That’s why I am
taking Emmy to her grandparents now, because they can take care of her. I am also going to make sure you get therapy, because you are so
preoccupied with your own problems and the fear of being left by your husband that you are unable to protect Emmy and take good care of her.”
(To Emmy) How is your mother responding?
P: She seems to understand and even a bit relieved.
T: What are you feeling now?
P: Happy with the idea to go to Grandpa and Grandma’s.
T: Where do you feel this in your body?
P: (Points at her mouth, which shows a smile).
T: What are you thinking now?
P: I want to take Fluffy with me!
T: Of course! Anything else you need?
P: (Nods no).
T: Okay then we drive now to your grandparents. Meanwhile I tell you the following: “I want you to understand that there is nothing wrong with
you that your mother is not capable to properly protect you and give you what you need. It is perfectly normal that you need to be comforted by
your mother, and I am very sorry that your mother suffers so much from her own problems that she is not capable to do this. You are a lovely girl
and you didn’t deserve this. Maybe you sometimes doubt whether you are good enough to be taken care of by your mother. I understand that you
can have that doubt, but I am here to tell you that you are not the reason for this. Your mother suffers from severe emotional problems, and you
should not think that you are the cause of that. So that’s why I now bring you to your grandparents, because you deserve to be taken care of. Do
you understand a little bit what I mean? (P nods affirmatively).
We arrive there, we stand in front of the door and I ring the bell. Do you see and hear that? (P. nods affirmatively) They open the door and I ask
them: “Dear grandparents of Emmy, I have a request. Can Emmy stay with you? Right now it is not safe at her home. Her father harassed her and
the police have taken him away. Her mother is so preoccupied with her own emotional problems that she cannot take care of her. They both need
therapy, but that takes time. Can she stay with you in the meantime? I know you are taking very good care of her and she feels very safe with
you.” (To Emmy) What do they say? What is happening now?
P: They say “yes, of course”, and invite us in. They give me a hug. We walk to the living room, and their dog Robby is welcoming me. He is very
nice and playful.
T: How are you feeling now?
P: I feel much lighter now. It’s always nice with them.
T: Where do you feel that in your body?
P: In my stomach and in my face (points at her mouth smiling).
T: What are you thinking now?
P: I am so happy to be here.

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T: Is there anything else you need?

P: (Nods no).
T: If there isn’t anything else you need, is there something nice you would like to do now?
P: Yes, I would like to get my favourite lemonade and lie on the couch, with my head on grandma’s lap, holding Fluffy, and Robby lying next to
me. Watching my favourite TV program. Grandma caressing my hair.
T: Okay, imagine that as vividly as you can. Feel you are lying on the couch, feel Fluffy, and feel Robby next to you. And feel your grandma’s
hand over you hair. Can you smell and taste the lemonade? See and hear the TV program?
P: (Nods affirmatively and smiles).
T: How do you feel now?
P: Good.
T: Where do you feel that in your body?
P: Over my whole body, relaxed (moves her hand over her body).
T: What are thinking now?
P: It is nice here.
T: If there is anything else you need, you can just tell me. If not, enjoy the experience for a few moments and then slowly open your eyes and
return to the here and now.
P: (After some time opens the eyes).
Note. The case is fictional and any resemblance with a real person is accidental.

as this can help to choose the memory that has to be addressed in the
Table 3
session, or the focus of the rescripting (e.g., more on the issue of shame).
The three steps of Imagery Rescripting when the patient rescripts.
In principle, patients choose what memory to address in the session.
Step 1. Memory activation up to and including the hotspot However, therapists propose to address the index trauma rather soon in
Step 2. Patient rescripts from current self
the phase where therapists rescript, and in the phase where patients
a. Patient stops the threat
b. Patient meets further needs of the child rescript. Thus, the index trauma is rescripted both by the therapist and
Step 3. Patient experiences the interventions from child perspective and asks adult self by the patient. Other memories can, but don’t need to be rescripted by
for additional interventions, if needed both the therapist and the patient. Therapists keep an eye on the choice
of memories, to prevent that specific difficult issues are avoided or
postponed too much. Lastly, if patients report an increase of specific
questions are used again (Table 1). At the hotspot, when the child has
emotions or symptoms, it is explored to which memory this is related,
expressed the needs, the therapist tells that the patient’s adult self is now
and that memory can then be addressed in the session.
in the image, and asks the patient to describe what the adult self is doing
(saying). After the description of the first intervention(s), the standard
questions are repeated – but without the need question. It is important to 3.3.1.2. End of session. At the end of the session, there is a short
postpone the need question to the end of the new script, as otherwise the debriefing, therapists ask patients what they think of the session and
script might deviate from the script as developed by the patient’s adult give them the opportunity to ask questions or make comments.
self, which creates confusion. In case patients forget to imagine impor­
tant aspects of the new script as developed by their current self, they are 3.3.2. Additional techniques
reminded of what the adult self did. Note that there is no need to go
through all the details of the new script, however, the emotionally 3.3.2.1. Using changes in symptoms/emotions. Changes in symptoms or
important parts should be experienced by the child. At the end the emotions can be used to inform therapist and patient about what
therapist adds the needs question (“What do you need (now)?“; or: “Is memory to choose to be addressed in a session, or what should be spe­
there anything else that you need (now)?“). Give patients time to reflect on cifically focused upon in the rescripting. In the IREM study patients
that. When they express an additional need, the therapist prompts the filled out the PCL-5 (PTSD symptom severity) and a list of emotions
patient to ask their adult self: “Okay, ask big ≪ patient’s name>>“. Again before the session, and handed this to the therapist. Increases in for
let patients say this out loud, this will enhance the effect. Then return to instance nightmares, intrusions, guilt, or anger feelings were used to
the standard questions (“What is happening now? How is big ≪ patient’s finetune the choice of memory and the rescripting. For instance, a
name >> responding?“). Continue through the standard questions (and particular nightmare may be thematically linked to a specific traumatic
the imagined interventions by the patient’s adult self) until the child is experience, which can be addressed in the session. As another example,
fine. However, if at the end there isn’t an emotionally positive activity, an increase in anger can indicate that the ImRs should focus on anger
ask the child whether they would like to do something nice, and then expression.
instruct them to ask their big self for that.
3.3.2.2. Use of the affect bridge. A technique known as the affect bridge
3.3.1. General guideline for start and end of each session can be used to find early memories related to emotional problems in the
present. This technique is usually not necessary for PTSD, a disorder in
3.3.1.1. Start of the session. ImRs sessions generally start with asking which the memories themselves are in the foreground. For many other
patients what the effects of the last ImRs were, and whether they have disorders, the access to memories of experiences that underlie sensitivity
any thoughts about it. Patients might have developed new insights, wish to respond in a dysfunctional way in the present is not that simple. Pa­
the rescripting to take a different course, or want a memory to be added tients might be unaware of the early experiences that contributed to
to the list. The therapist also asks for changes in symptoms or emotions, their current problems, or might block or otherwise avoid their

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activation. The affect bridge technique is based on an uncontrolled, rescripting can be done if they are not completely satisfied with the
associative search process. The patient is instructed to imagine being in a rescripting in the session, visit places associated with adverse/traumatic
recent problematic situation. When the emotions related to the most memories to enhance their reactivation, bring pictures from childhood
difficult moment are activated, the therapist instructs the patient to keep to the session to help reactivation, etc.
the eyes closed, stay with the emotion, but let go of the image, and see
whether an image (memory) from childhood pops up. The therapist 4. Addressing possible problems applying imagery rescripting
explains that the patient should not use a controlled search strategy, but
just see what comes to the mind. The image that comes up is then 4.1. Dissociation
rescripted, in the same way as described above. In the rare times that a
positive childhood memory comes up, the therapist can instruct the As dissociation is a fuzzy (container) construct, and some definitions
patient to let go of that image, and wait until a negative memory comes include reliving and overwhelming emotions, there is not a single
up. Note that initially the association between the recent experience and approach. Here two subtypes of dissociation are discussed. The first type
the early memory might be unclear, but usually it becomes clear when of dissociation that creates problems with applying ImRs is when the
the rescripting is completed. Here, some reflection with the patient at attention to the task is blocked by dissociative responses such as dere­
the end of the session on how the early experience relates to the current alization, depersonalization, (pseudo-)hallucinations, and pseudo-
problem can be helpful to increase patient’s insight and maintain epileptic seizures. First of all, therapists should be aware that control
motivation for the ImRs work. (or power) over the threat is essential. With a growing experience of the
therapist, and later the patients themselves, having control over the
3.3.2.3. Safe place. Some texts advice the use of a safe place image, and threat (usually a perpetrator), dissociative responses disappear. This is
some therapists use it. A safe place image is an image of a situation in understandable by conceiving dissociative responses as automatic sur­
which the patient feels safe. It can be a memory of a real experience, or a vival strategies when confronted with severe, life endangering threat,
fantasy image. The safe place image can be used to start the ImRs work and fight or flight is not possible. Several strategies can be tried. First,
(the patient first imagines the safe place, then the traumatic/adverse severe dissociation before the hotspot is reached is a sign to start the
memory), and/or to end it. Note however that the ImRs should end in a rescripting. Thus, severe dissociative responses constitute an exception
safe situation and a positive emotional experience anyway, hence, it is to the rule that the rescripting should start at the hotspot. Later in
unclear what a safe place image would add here. Moreover, for some treatment, when the dissociative responses have weakened, the hotspot
severe patients the world in total is unsafe, and the search for a safe should be reached before rescripting starts. Second, grounding tech­
place image takes a lot of time and might fail. Thus, there is a risk that niques can be used during ImRs. For instance, patients can stand on a
this search for a (non-necessary) imagery takes a lot of time and results balance board during ImRs. Another option is patients holding a scarf
in a failure experience, reinforcing dysfunctional ideas. Note that to the (or strip of fleece) in their hand, while the therapist holds the other end.1
best of the present author’s knowledge, no research has been done into When the patient starts to dissociate, the therapist gently pulls the scarf,
the positive or negative effects of the safe place. saying “stay with the image”. The scarf can also be used by patients to
inform therapists that they should enter the image and start rescripting
3.3.2.4. Self-help. The version of ImRs in which the patient rescripts can as soon as possible. In this way, control is given to the patient, which in
also be used by the patients outside of the session. Indeed, in a quali­ turn will help to reduce dissociation. It is recommended to practice the
tative study, some patients reported they spontaneously used it after use of the scarf before a memory is addressed with ImRs.
treatment (Menninga et al., 2024). Perhaps this is one of the factors The second type of dissociation is extreme reliving and pseudo-
explaining the increase of effects observed after end of treatment hallucinations. With these the therapist should not stop the ImRs, but
(Boterhoven de Haan et al., 2020; Raabe et al., 2022). On request of start with powerful imaginary interventions that help to establish a
participants in her study of ImRs for voice hearers, Paulik developed a sense of control. For example, when patients are fully reliving severe
short imagery exercise that patients can use to deal with negative feel­ abuse, therapists tell the patient that they are with them, and that they
ings (Paulik et al., 2019). The text is provided in Appendix D. Lastly, stand in between them and the perpetrator, and protect them, and then
Moritz et al. (2018) developed extensive instructions for a self-help form continue rescripting. As an example for pseudo-hallucinations, with a
of ImRs, of which the effectiveness was demonstrated in an RCT (though severe dissociative identity disorder patient who reported seeing flying
effect size tended to be smaller than with treatment provided by a sharp triangles in the therapist’s room, attacking her, the therapist
therapist). responded that he had two laser guns, one of them he gave to the patient
(all in imagination), and that they started to shoot all the triangles out of
3.3.2.5. Homework. In the initial protocol patients were instructed to the air.
listen to audio recordings of the ImRs, in between sessions (Arntz & Note that some patients with severe dissociative problems might
Weertman, 1999). We no longer request patients to do so. It doesn’t want to address the most frightening memories early in therapy, while it
seem to contribute to the effectiveness of ImRs, and many patients don’t might be more helpful for them to start with less overwhelming mem­
like it, don’t do it, or do it in a superficial way (e.g., while doing ories to establish a sense of control.
something else to distract), which leads to the therapist having to discuss
this and trying to convince the patient to do the homework in a proper 4.2. Perpetrator starts to attack therapist and/or interventions don’t work
way. In our experience, this takes a lot of time and doesn’t facilitate the in getting control over perpetrator
therapeutic alliance. We rather focus on the in-session work itself.
However, if patients want to make a recording for their own use, this is In the patient’s imagination, perpetrators might start to physically
allowed, under the condition that they don’t share it with others. It attack the therapist, and/or initial attempts to control the perpetrator,
should be noted that the decision to not request patients to listen to for instance by words, don’t help. When therapists are not prepared for
session recordings is based on clinical observations, including that this, they might feel overwhelmed, not knowing what to do. This leads to
effectiveness remained high after deleting this homework from the a reinforcement of the original representation of the perpetrator as
protocol. However, this has never been tested in an RCT. having all the power, nobody being able to control the perpetrator. It is
Patients can be asked to prepare sessions, for instance by writing therefore important that the therapist wins. Therapists should have
down (aspects of) memories that come to their mind, rethink the list of
trauma’s to be covered, ask them to think about how an alternative
1
Thanks are due to Ida Shaw for suggesting this in a training.

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different measures in their toolkit to address such perpetrators, some of emotions that might be triggered when somebody cares for them. Still
them should be “realistic” (e.g., a taser, calling in the police, etc.) and others might be extremely self-punitive, and feel they are not worth
others “magical” (e.g., shrinking the perpetrator, capturing the perpe­ being defended. Each of these requires a different stance of the therapist,
trator in an impenetrable bubble, etc.). As discussed previously, but in all cases it is recommended to try to reduce the resistance and let
rescripting involves a trial and error process, so different actions by the the therapist do the rescripting, because this means a corrective expe­
therapist might be needed before the perpetrator is controlled. Thera­ rience. Expressing understanding and empathy for the resistance, but
pists should be prepared for this in a training, before they treat patients still pointing out the need to break through it to change the underlying
with these kind of responses. expectations, can be a useful strategy.

4.3. The victimized yet co-responsible parent 4.7. Loyalty problems

A challenging constellation is when in a family where abuse took Patients might struggle with having their parents being confronted
place by one of the parents, the other parent is also victim of abuse, and by the therapist, or doing that themselves in later phases of treatment,
did not take effective measures to protect the child. Usually, the child because of loyalty issues. It is important that therapists understand, and
starts to believe that the victimized parent has no power and feels explain to patients, that there are different forms of loyalty: (1) positive
sympathy for that parent. The complexity increases when the victimized loyalty, that is loyalty to others based on the positive things that others
parent uses that child to find protection or consolation, instead of the do for you, such as love, protection, and care; and (2) negative loyalty,
other way around (see also 4. Parentification in the next subparagraph). that is enforced loyalty by intimidation and threats with punishment and
In most cases the victimized parent suffers from mental health problems, terrible consequences if you are not compliant; and (3) a mixture of both,
such as pathological dependency. It is important to confront this co- where both positive things are provided but there is also the threat of
responsible parent in ImRs, however patients might express resistance, terrible consequences – a tactic well-known to the mafia and to sexual
because the representation of that parent is of a powerless victim, and abusers of vulnerable children. It is the mixture that is the most complex
not as a person that for self-serving purposes decides to not set limits to to process in trauma work, for example the sexual abuse by father who
the abuse of the child. Usually, the patient doesn’t report the need to be gives attention and love, not given by the other parent, while also
protected by co-responsible parent, thus the therapist needs to take the threatening the child that talking about the sex will have as consequence
initiative in the early phase of treatment (“Before we ≪ description of the that father will be put in prison and that the child will then be guilty of
need to be met >> I want to have a chat with your ≪ co-responsible that. In the rescripting, the therapist should explicitly point this out,
parent>> …”). Initial confrontation by the therapist should be rather both in confronting perpetrators – acknowledging the good things they
gentle, but clearly pointing out that the child needs protection and do for the child, but also setting limits to the abuse and the threats made
asking why the co-responsible parent doesn’t offer that, and might by the perpetrator; and in talking with the child expressing empathy for
include the therapist to enforce treatment for the victimized parent. how difficult and confusing this must be for the child, and that it is good
for the child to feel recognized by the love and care of the perpetrator,
4.4. Parentification but that it is not okay to be sexually used and be threatened with con­
sequences for which not the child but the perpetrator is responsible.
Another pathogenic family constellation that is not necessarily Thus, therapists should explain the difficulties the mixed loyalty feelings
immediately clear to the patient is that of parentification, where the create, and support the emotional struggles this creates for the child.
roles of child and parent are reversed. Examples are when an emotion­
ally weak parent uses the child for consolation, sharing of inappropriate
intimate experiences, and using the “healthy” or oldest child to take care 4.8. Patient cannot imagine
of other (ill, disabled) children. Other examples are when the child has
to intervene to prevent or resolve conflicts between parents, or has to A small minority of people are not able to (visually) imagine. When
meet high achievement expectations that are not necessarily in line with patients report that, it should be checked whether this is really a ca­
what the child prefers. pacity problem, or rather the result of avoidance. There might also be
other interfering processes, for instance when patients cannot focus on a
4.5. Not wanting to close the eyes single image, but are flooded by different images. One option to deal
with the inability to imagine (a single image) is to use drama rescripting.
Patients might refuse to close the eyes. As a general rule, the reasons Here drama therapy is used to play out the new script. As multiple
underlying any form of resistance should be explored in an empathic persons are involved, one can either use an empty chair to represent a
way. For example, patients might fear that somebody unexpectedly person (for instance the perpetrator), or one can get others involved to
enters the door and sees them, which might be solved by the patient play roles, e.g. in group therapy. Some patients cannot visualize, but are
sitting with the back to the door. Another example was a patient treated able to use other channels in imagination, for example auditory, and still
by this author, who was distrustful and feared that the therapist would profit from what is said in the rescripting.
make a fool of her when she would cry. She agreed to close her eyes
however, when sitting with the backs to each other. Patients can also 4.9. Neglect instead of abuse
stare at the floor, or at a blank wall, if they refuse to close their eyes, as
long as they are able to visualize. In sum, try to understand what is Many trauma-focused treatments can deal with the presence of
underlying the refusal and try to find a solution. abuse, but the absence of care is more difficult to address. One of the
advantages of ImRs is that experiences of neglect can be easily dealt
4.6. Patient refusing therapist to intervene with. Often, there is not a clear hotspot, nor is there an episodic memory
of a single experience as usually the neglect continued for years. It
Some patients don’t want the therapist to intervene in the image. It is suffices that the patient gets a sort of general memory, for example as a
important to understand what underlies this resistance. For instance, child sitting alone on the bed in the bedroom, nobody else at home,
they might be afraid that the perpetrator will attack the therapist when feeling sad and lonely. When there is emotional activation, the therapist
stepping in the situation. Or, they distrust other people so seriously that steps in the image to start rescripting. Neglecting caregivers can be
they don’t dare to trust the therapist. Still others are afraid of being in a called to account, and as ImRs is a fantasy technique, they can just be
vulnerable position, for instance afraid or ashamed of the vulnerable brought into the image and confronted.

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4.10. Extreme neglect and distrust – rejection of emotional support 4.13. Extreme self-punitiveness

Some patients have a history of extreme neglect and are so Sometimes patients are stuck in extreme self-punitiveness and they
distrustful, that they cannot (yet) tolerate physical proximity. So continue to blame themselves for the traumas, and disagree with at­
whereas it would be normal to sooth children by holding their hand, or tempts of the therapist to point out that the perpetrator was responsible,
holding the child in one’s arms, as physical contact is the primary or that it was bad luck. One of the reasons for extreme self-punitiveness
channel to reduce stress, these patients firmly and sometimes aggres­ can be that the belief that one was responsible maintains a sense of
sively reject any proposal to be touched. Usually these patients have controllability. Indeed, when people have a negative experience, they
emotional intimacy problems, and their attachment has been severely try to learn from it so that they can prevent it from happening again. If
damaged. Therapists should not enforce physical contact, but might try they can attribute the experience at least partially to their own behav­
other ways such as letting the child imagine holding a pet or a cuddly iour, they can change that behaviour to prevent repetition of the trauma.
toy. However, sometimes one was just powerless and it is impossible to find a
way to control. For some people, acknowledging the powerlessness
4.11. ImRs can trigger a period of grief seems almost impossible, and they rather stick with attributing the
trauma to themselves. This kind of counterfactual thinking comes with
Realizing that one’s needs were not met and will never be met by the the costs of ruminating and self-blame. It might help to explain this to
caregivers can install a period of grief. It’s essential for therapists to the child in the ImRs, expressing understanding and normalizing the
acknowledge and normalize this grief without labelling it as patholog­ need to have control, but also pointing out that sadly they didn’t have
ical. Rather, they should provide compassionate support to their pa­ any possibility to control the traumas, in other words they were
tients. Pushing away the realization that important needs were not met powerless. Support the child in the emotional responses that are trig­
and never will be met usually comes with the costs of psychopatholog­ gered with this empathic confrontation.
ical symptoms and relational difficulties. So, it is important that thera­ In other cases there might be early experiences that led to these self-
pists don’t give in to tendencies in the patient (or in themselves) to avoid punitive tendencies (e.g., a parent often excessively blaming the child).
the necessary grief work, and empathically support the patient. Hence, memories of such experiences should be targeted with ImRs.

4.12. Revenge and aggression 4.14. Problematic behaviours don’t change despite successful ImRs

There is a lively debate whether or not patients should be allowed to Sometimes problematic behaviour such as dysfunctional avoidance,
act out aggression and revenge in imagery rescripting. The concern is problematic interpersonal behaviours, addictive behaviours, compul­
that imagining aggression might lower the barrier to act out aggressively sive behaviours, etc. don’t disappear after successful ImRs, despite that
in reality. The fact that repeated visualisation of specific acts might help there is a clear link between the underlying trauma’s/adverse experi­
to perform the specific act in reality (e.g., as used in sport psychology) ences and the development of the problematic behaviours, which served
feeds the concern. On the other hand, many forms of psychopathology as attempts to cope with the adverse experiences. The reason for this is
are characterized by inhibition of anger and aggression, and the idea is that these behaviours became independent from their original cause.
that it helps to experience that it is safe to acknowledge and feel the Such habitual coping can be quite rigid and may need additional
anger and aggressive images. We have generally allowed patients to behavioural therapy (Arntz, 2020).
rescript in aggressive ways (e.g., kill the perpetrator), and didn’t observe
negative effects. On the contrary, one study found faster and deeper 5. More applications
improvements with ImRs allowing this in anger control, experiences of
internal and external anger, and hostility, compared to imaginal expo­ 5.1. Adulthood experiences
sure (Arntz et al., 2007). Experimental studies among nonpatients didn’t
observe any negative effects either, but also didn’t find additional effects ImRs can be easily applied to memories of traumas or other adverse
compared to ImRs without revenge (Seebauer et al., 2014; Watson et al., experiences in adulthood. There are two options. The first is to use the
2016). Apart from the problem to generalize from nonpatients to pa­ protocol for childhood memories and replace “little ≪ patient’s name≫”
tients, these nonclinical studies have the problem that they force all by “former ≪ patient’s name≫“, and “big ≪ patient’s name≫” by
participants in the revenge condition to take revenge in fantasy, even “current ≪ patient’s name≫“. For example, “little John” becomes
when they don’t experience any need for it. In clinical practice, thera­ “former John”, etc. In the first phase of treatment, the therapist can enter
pists are confronted with some, but not all, patients expressing revenge the image and rescript; in the second phase the patient enters the scene
needs which when acted out in rescripting can take violent forms. Thus, from the current perspective and rescripts. The second option is to let the
more research is needed, focusing on this specific subgroup of patients. patient stay in the same perspective as during the traumatic/adverse
Such research should also help clarifying when aggressive rescripting is experience, and let the patient rescript (remind patients that they have
contraindicated. For the time being it is recommended to not forbid all the power to do what they feel should be done). The first option is
patients to engage in aggressive rescripting, especially not in cases probably more suitable for traumas that took place some time ago, while
where there is no history of losing control over aggressive tendencies. If the second option is more suitable for recent traumas. However, no
the therapist is concerned, the patient can be requested to (temporarily) research has been done on what is the best approach.
stop use of alcohol and street drugs (as they might weaken inhibiting
control over aggressive behaviour) and discuss any plans for actual 5.2. Non-PTSD disorders
aggressive acts with the therapist before acting them out. Lastly, ther­
apists should not feel forced to transgress their own standards with ImRs is a transdiagnostic technique, and applications have been
respect to aggressive acts when they do the rescripting in the first phase described and empirically tested for a wide range of disorders (Kip et al.,
of therapy, they can just tell the child, if they are asked e.g. to kill the 2023; Kroener et al., 2023). However, there is an important difference
perpetrator: “Sorry, but I’m not willing to do that. Can you think of another between PTSD and other disorders, that might have treatment implica­
way to punish X?” tions. When patients request treatment for PTSD, this is usually because
they are haunted by explicit memories of traumas, for instance through
spontaneous intrusions, nightmares, or triggered by a range of stimuli.
This means that it is relatively simple to list the memories to be

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addressed with ImRs, and that the patient is highly motivated to process disorders is still limited, except for social anxiety disorder and pro­
the memories if this leads to a reduction of suffering caused by the spective mental imagery, for which Kroener et al. (2023) found enough
memories. In contrast, in many other disorders the access to explicit studies for separate meta-analyses. However, all these trials had small
memories that underlie the disorder can be more complex, patients not sample sizes. Thus, clinicians should be careful in assuming the effec­
necessarily being aware of or willing to share the memories. Often, they tiveness of ImRs when applied to other disorders than PTSD.
have a range of coping strategies to prevent that the memories and the
core emotions associated with them get activated. The task of the 6. Preventing false memories
therapist is then to nevertheless try to get access to these memories, for
instance using a mixture of psycho-education, motivational techniques, Although there is no evidence that ImRs when following the protocol
and empathic confrontation. The affect bridge technique (see above) can induces false memories (Aleksic et al., 2024, 2025; Ganslmeier et al.,
be useful here, in addition to exploring what early experiences lie at the 2023 ab; Hagenaars & Arntz, 2012; Spinhoven et al., 2012), it is good to
root of the formation of negative schemas and/or the start of the dis­ discuss how to prevent the formation of false memories. First, the
order. With depression, the helplessness and motivational problems rescripting phase should be clearly described as active fantasy work.
patients often display might form an additional barrier, and therapists This enhances the chance of appropriate source attribution of the
might need to be quite directive and determined to break through this. memory of the new script, that is to the mental effort of the patients
With psychosis (not in the acute phase), ImRs has been found to be themselves (Aleksic et al., 2024). In the rationale it should be stressed
effective and safe, in several case series studies (e.g., Clarke et al., 2022; that the working mechanism of ImRs is not replacing the original script
Paulik et al., 2019). by a new script, i.e. installing a false memory, but changing the
emotional meaning of the memory, while the memory of factual details
5.3. Nightmares is not changed. Second, in the memory activation phase, therapists
should refrain from suggesting details not reported by the patients.
Nightmares can be rescripted in the same way as traumatic experi­ Instead, they should follow what the patients share with them. Third,
ences from adulthood (see 5.1 above; Kunze et al., 2017). Another op­ they should not reify (aspects of) memories, and keep in mind that by
tion is to use a rescripting technique originally developed for the nature memory is (re)constructive. When patients want to hear from the
treatment of nightmares, Image Rehearsal Therapy (IRT). IRT has a solid therapist whether a memory (detail) is the truth, therapists should
evidence-base (Gill et al., 2023). In IRT, patients first write down the explain that they are neither able to do so, nor that it is their task. They
nightmare, next write down an alternative ending, i.e. rescript (usually should explain that for the effectiveness of the technique, it doesn’t
in which control replaces flight or passivity), and then repeatedly ima­ make a difference, using the example of the treatment of nightmares. For
gine the alternative script. If nightmares don’t disappear during the instance, images of satanic sexual abuse can be treated with ImRs, but
course of ImRs treatment focusing on memories of traumatic/adverse therapists should abstain from whether or not this abuse took place, or
experiences, they should be directly addressed with ImRs or IRT. Note might express their doubts, and explain that horrible fantasies can
that research demonstrated that rescripting nightmares is effective even develop into repeated intrusive and invalidating mental images – which
when there are other major disorders (Gill et al., 2023). can be treated with ImRs. It should be noted that we know less about the
risks of the affect bridge technique with regard to inducing false mem­
5.4. Future images ories, although I personally have never heard of patients claiming to
have recovered a memory, i.e. a memory they were previously unaware
Negative images of future events can be rescripted too. Especially of, through the affect bridge. This is not to say that patients may come to
with anxiety (disorders), rescripting of negative expectations can be realize that specific memories triggered by the technique were related to
helpful. When patients don’t report to suffer from (intrusive) images, but aversive experiences which can be seen as forms of child abuse or
nevertheless worry about the future, the therapist instructs the patient to neglect, e.g. parentification or neglect. But this is not recovering a
form an image of the feared future event. Usually, the option that pa­ memory, but a change in evaluation of childhood experiences. Clearly,
tients imagine to act differently without a perspective change is used. more research is needed into whether the affect bridge can induce false
Keep in mind that the standard questions should be used (from per­ memories.
ceptions via emotions and cognitions to needs and action tendencies),
and that various scripts can be tried out. 7. Conclusion

5.5. Symbolic feelings New insights necessitated an update of the Arntz and Weertman
(1999) protocol. This will help researchers with replication and exten­
When patients have general dysfunctional ideas that cannot be sion studies, and clinicians to apply ImRs according to the current in­
directly related to specific experiences, one can still address them with sights. The protocol will probably continue to develop, there are many
ImRs. The patient is then asked to close the eyes and form a visual image issues on the research agenda (Hagenaars et al., 2025), and new findings
of the idea, and subsequently change the image in a desired direction. will inevitably lead to new updates. The research agenda includes the
need for more RCTs with sufficient statistical power into the treatment
5.6. Pathological grief of disorders other than PTSD, related to adverse (childhood) experi­
ences, such as (persistent) depression. Moreover, we need to deepen our
Another application is pathological grief. Often, patients feel guilty if understanding of the working mechanisms of ImRs. More specifically, is
they do not constantly remember the deceased person, leading to con­ there indeed a link with the needs that the person experiences? Does this
stant mourning and a taboo on resuming normal life. Patients can mean that when the need for safe attachment has been frustrated, a
imagine to visit the deceased person in heaven, and ask the person different rescripting is indicated than when the person needs someone to
permission to remember them once a week with a short ceremony and to stand up for them? Still another issue is, whether it is possible to defi­
resume life. The deceased person (usually) agrees with that, and often nitely replace the original meaning of the experience, and if so, what the
the image of the deceased in a peaceful heaven is also comforting. Of necessary conditions are, or whether the technique always relies on
course, patients can express and discuss other issues as well with the forming a competing memory trace. Other issues are whether the pro­
deceased. A broad range of ImRs applications for pathological grief is cedure can be shortened without loss of effectiveness, and how impor­
discussed by Lechner-Meichsner et al. (2024). tant emotional activation of the trauma memory is. While some research
It should be noted however that the evidence base for non-PTSD questions can be addressed by direct experimental (dismantling) tests (e.

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g., whether or not the phase in which patients in the child perspective Arntz, A., Tiesema, M., & Kindt, M. (2007). Treatment of PTSD: A comparison of imaginal
exposure with and without imagery rescripting. Journal of Behavior Therapy and
experience rescripting by their current self), others can only be
Experimental Psychiatry, 38, 345–370.
addressed by mediation or Granger causality analysis, when it is Arntz, A., & van Genderen, H. (2020). Schema therapy for borderline personality disorder
impossible to experimentally manipulate the mechanism in isolation. (2nd ed.). Chichester, West Sussex: Wiley.
See Hagenaars et al. (this issue) for an extensive discussion of the Arntz, A., & Weertman, A. (1999). Treatment of childhood memories; theory and
practice. Behaviour Research and Therapy, 37(8), 715–740.
research agenda. Assmann, N., Rameckers, S. A., Schaich, A., Lee, C. W., Boterhoven de Haan, K.,
Despite the many possible topics on the research agenda, the current Rijkeboer, M. M., Arntz, A., & Fassbinder, E. (2024). Childhood-related PTSD: The
protocol has been tested in a series of studies across different disorders, role of cognitions in EMDR and imagery rescripting. European Journal of
Psychotraumatology, 15(1), Article 2397890. https://doi.org/10.1080/
and hence offers an up-to-date evidence-supported approach for pro­ 20008066.2024.2397890
cessing traumatic and other adverse memories. The basics of ImRs can Bosch, M., & Arntz, A. (2023). Imagery rescripting for patients with posttraumatic stress
be easily trained, and the current manuscript offers a guideline for disorder: A qualitative study of patients’ and therapists’ perspectives about the
elements of change. Cognitive and Behavioral Practice, 30(1), 18–34. https://doi.org/
trainers and practitioners. Thus, it is hoped that the dissemination and 10.1016/j.cbpra.2021.08.001
implementation of ImRs is facilitated with the current paper. Boterhoven de Haan, K., Lee, C., Fassbinder, E., Van Es, S., Menninga, S., Meewisse, M.,
… Arntz, A. (2020). Imagery rescripting and eye movement desensitisation and
reprocessing as treatment for adults with post-traumatic stress disorder from
Video examples and explanations childhood trauma: Randomised clinical trial. British Journal of Psychiatry, 217(5),
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Brewin, C. R. (2006). Understanding cognitive behaviour therapy: A retrieval
Therapist rescripts
competition account. Behaviour Research and Therapy, 44(6), 765–784.
Patient rescripts Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006).
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randomized controlled trial. Journal of Consulting and Clinical Psychology, 74,
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568–578.
When Aggression Shows Up in Imagery Rescripting — What Should Clarke, R., Kelly, R., & Hardy, A. (2022). A randomised multiple baseline case series of a
You Do? novel imagery rescripting protocol for intrusive trauma memories in people with
https://youtu.be/4Y-aVxqpyGI psychosis. Journal of Behavior Therapy and Experimental Psychiatry, 75, Article
101699. https://doi.org/10.1016/j.jbtep.2021.101699
How to Handle Dissociation During Imagery Rescripting (Step-by- Dibbets, P., & Arntz, A. (2016). Imagery rescripting: Is incorporation of the Most aversive
Step Guide) scenes necessary? Memory, 24(5), 683–695. https://doi.org/10.1080/
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Declaration of competing interest Edwards, D. (2007). Restructuring implicational meaning through memory-based
imagery: Some historical notes. Journal of Behavior Therapy and Experimental
Psychiatry, 38(4), 306–316.
The authors declare the following financial interests/personal re­ Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive
lationships which may be considered as potential competing interests: therapy for posttraumatic stress disorder: Development and evaluation. Behaviour
Research and Therapy, 43, 413–431.
Arnoud Arntz reports receiving grants from the Netherlands Organisa­ Faliagkas, L., Rao-Ruiz, P., & Kindt, M. (2018). Emotional memory expression is
tion for Health Research and Development and the Stichting tot steun misleading: Delineating transitions between memory processes. Current Opinion in
VCVGZ, as well as receiving reimbursements for presentations, train­ Behavioral Sciences, 19, 116–122. https://doi.org/10.1016/j.cobeha.2017.12.018
Ganis, G., Thompson, W. L., & Kosslyn, S. M. (2004). Brain areas underlying visual
ings, books, and chapters on imagery rescripting and related subjects.
mental imagery and visual perception: An fMRI study. Cognitive Brain Research, 20
The reimbursements go to the University of Amsterdam to support (2), 226–241.
research and aren’t personal income. Ganslmeier, M., Ehring, T., & Wolkenstein, L. (2023a). Effects of imagery rescripting and
imaginal exposure on voluntary memory. Behaviour Research and Therapy, 170,
Article 104409. https://doi.org/10.1016/j.brat.2023.104409
Appendices A–F. Supplementary data Ganslmeier, M., Kunze, A. E., Ehring, T., & Wolkenstein, L. (2023b). The dilemma of
trauma-focused therapy: Effects of imagery rescripting on voluntary memory.
Psychological Research, 87, 1616–1631. https://doi.org/10.1007/s00426-022-01746-
Supplementary data to this article can be found online at https://doi. z
org/10.1016/j.brat.2025.104913. Geschwind, N., Keasberry, E., Voncken, M., Lobbestael, J., Peters, M., Rijkeboer, M., &
van Heugten-van der Kloet, D. (2024). Imagery rescripting: The value of an added
positive emotion component. Journal of Behavior Therapy and Experimental
Data availability Psychiatry, 84, Article 101958. https://doi.org/10.1016/j.jbtep.2024.101958
Gill, P., Fraser, E., Tran, T. T. D., De Sena Collier, G., Jago, A., Losinno, J., & Ganci, M.
No data was used for the research described in the article. (2023). Psychosocial treatments for nightmares in adults and children: A systematic
review. BMC Psychiatry, 23(1), 283. https://doi.org/10.1186/s12888-023-04703-1
Grunert, B. K., Weis, J. M., Smucker, M. R., & Christianson, H. F. (2007). Imagery
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