Information about imagery rescripting for clients and loved ones
On this page, you will find information about the psychological treatment ‘imagery rescripting’ (ImRs). This information is intended for people considering ImRs treatment, their loved ones, and anyone else curious about ImRs. We explain what ImRs is, for which symptoms it is a good treatment, and how the treatment works. You will also find video clips, links to reliable information about ImRs, and personal accounts from clients who have undergone ImRs treatment.
We hope this site will give you a good idea of ImRs and help you decide whether it is a suitable treatment for you.
What is imagery rescripting?
Imagery rescripting (ImRs) focuses on memories of unpleasant events from your past (such as trauma) that are related to the psychological symptoms you are experiencing in the here and now. During the therapy sessions, you will go back in your mind to these unpleasant memories under the guidance of your therapist. You will then use your imagination to vividly imagine a better outcome of the event. For example, you can imagine standing up for yourself, comforting and understanding yourself or letting other things happen that you actually needed at the time. With ImRs, you can take care of your emotional needs that were violated in the unpleasant event or that you missed. This gives the unpleasant memories a different meaning for you and they become less about feeling. For example, you regain a sense of control and more understanding towards yourself and your suffering.
Unpleasant memories take on a different meaning
It may be difficult to imagine exactly what this means. But perhaps you recognize that you sometimes experience something and then think afterwards, ‘Of course, I should have said or done THAT!’. It makes you feel better if you can vividly imagine yourself saying or doing those things. Vividly imagining something feels ‘as if it were real’ to your brain. That is why ImRs can be such a healing experience. This video explains simply how it works in the brain.
For which symptoms is imagery rescripting suitable?
- ImRs is a scientifically proven effective treatment for post-traumatic stress disorder (PTSD)
- A modified form of ImRs is an effective treatment for nightmares. The treatment is then called ‘Imagery Rehearsal Therapy’ (IRT).
- The cognitive behavioural therapy (CBT) treatment for social anxiety disorder sometimes also has a module with ImRs.
- ImRs is also frequently used in schema therapy for personality disorders. In that case, ImRs is not given separately, but at various moments during the treatment. This can vary per session.
- For many other complaints, research is currently being done to determine how well ImRs works. At this time, we do not yet have enough information to immediately recommend ImRs for other complaints. Ask your doctor for further advice.
What does the treatment with imagery rescripting look like?
ImRs looks different depending on the complaint being treated (see ‘For which complaints is ImRs suitable’ above). The ImRs treatment for PTSD has been most researched. This variant has 16 standard 90-minute sessions that occur once or twice weekly. The number of sessions and how they are scheduled can – as with other treatments – vary somewhat depending on the institution/practitioner or the severity of the symptoms.
First, you will receive information about ImRs and get to know your therapist. Together, you will map out your symptoms and most important memories. Some memories will be sufficiently addressed in a single session, while other memories will require more attention. Clinical experience has taught us that treating one memory often affects other memories. So, in principle, it is not necessary to address all memories. In each session, you collaborate with your therapist and decide which memory you will work on and when the treatment has worked sufficiently for you.
The ‘rewriting’ of the memory during an ImRs session consists of the following 3 steps:
1. You will mentally return to the (traumatic) event from the past. You will do this in great detail (what do you feel, smell, hear and see?) to make the memory as vivid as possible, as if it were happening all over again. You will also feel the unpleasant feelings strongly again. This can be emotionally intense. However, in the next step you will immediately do something about it. Below is an example of the first step in which you, as a client, mentally go back to the traumatic event
2. In the second step, you will ‘rewrite’ the memory. For the first few sessions, you will imagine that the therapist comes in and does whatever is necessary to make you feel better about the memory (for example, chasing away or locking up an offender). For the rest of the therapy, you will imagine that you yourself completing what should have happened and what you would have liked to have done. You are looking at yourself in the traumatic memory and helping yourself achieve a better outcome. In your imagination, you are creating a new, more positive story. Below is an example of this second step
3. In the third step, you imagine the new story from beginning to end. This time through the eyes of the ‘you’ from the memory. So, you experience what it is like to be helped by the therapist (in the first sessions) and yourself (in the later sessions). Sometimes, in this step, you feel that you need more or other things to feel better (for example, being comforted after the perpetrator has been chased away). You can then bring this to the screen with your imagination. This often feels like a relief and brings more pleasant emotions. This can be seen in the next part.
Where and from whom can I follow imagery rescripting?
In order to be able to give ImRs, therapists must be trained in a recognized form of psychotherapy (for example, cognitive behavioural therapy or schema therapy). Registered therapists can be found via the websites of professional associations (see, for example, mijn.vgct.nl/vgct-register or www.schematherapie.nl/zoek-een-therapeut). In addition, we recommend doing ImRs with a therapist who has completed recognized training in ImRs (or schema therapy). There is however no listing of who has previously completed ImRs training. That is why it is a good idea to ask whether your therapist has had recognized training in ImRs and has gained experience with ImRs. Ideally, a therapist will also consult with fellow therapists who provide ImRs or supervision (performing ImRs under the guidance of a more experienced therapist). Your general practitioner or referring doctor can also help you find a therapist who meets these requirements.
Clients’ experiences with ImRs
‘ImRs, how I dreaded it. I had read about it and thought it was weird and strange: a therapist stepping into the image of a memory. I didn’t like the idea and didn’t want to do it. Besides, you can’t change the past, or so I thought. But then I was given schema therapy and it was part of the programme, so in the end I had no choice but to do it. That first time, a bad memory came to the surface in which I felt unseen and worthless. When my therapist asked me to place him in the image, I found it very strange and uncomfortable. But I managed. He stood up for me and said I was not worthless but worthwhile. That I had to be taken care of because I was still so small – that was exactly what I needed! It felt wonderful to be supported like that. Very different from before. My history has not changed, but the ImRs exercises, with ever-changing memories, have ultimately ensured that I no longer let those memories, and especially the associated feelings of loneliness, sadness and insecurity, control my life.’
‘I first underwent Imagery Rescripting therapy (ImRs) with weekly sessions in an outpatient setting. During this ImRs treatment, I would go back in my mind to traumatic memories to give myself what I needed (for example, saying something comforting, encouraging or giving myself a hug). This was somewhat less effective for me. After some time, I was enrolled in an intensive trauma treatment programme in which I received treatment for entire days at a time. First, I received EMDR from various therapists. This did not work well for me. Then I did Imagery Rescripting with the same therapist for three consecutive days. This looked slightly different than my first ImRs treatment. When I reached a certain feeling, image or thought, we would remove it from my memory step by step, wrapping it up and destroying it, for example by burning it. This was done in great detail, which ultimately allowed me to process a large part of my early childhood trauma after many years.’
‘My experience with imagery rescripting is very positive. I had had a number of unpleasant experiences that caused me a great deal of fear and sadness. The memories were related to illness, loss and grief. Together with my therapist, I retrieved these memories and looked at what I needed in those situations. Together, we rewrote these memories one by one, which reduced the fear and sadness considerably and allowed me to accept the situations. At first, I found it scary to go back to the memories, but it helped me enormously. I would definitely recommend imagery rescripting if you want to work through certain events.’
FAQs Frequently Asked Questions
In principle, ImRs is intended to be a short-term treatment. Studies have shown that even one session of ImRs can be useful, but many research protocols have included six or more sessions. At this time, no fixed number of ImRs sessions has been determined. The duration of the therapy depends on the mental health condition and the problem to be treated (with more sessions for more serious complaints). It also depends on whether ImRs is given as a stand-alone intervention or integrated into schema therapy or CBT, in this case, fewer sessions are usually devoted to ImRs than when incorporated into a broader therapeutic approach.
In imaginal exposure, you think back as vividly as possible to the traumatic memory and its most difficult moments. You usually do this with your eyes closed and always in the safe environment of the treatment room. You tell the therapist as many details as possible with the aim of getting used to the emotions associated with thinking back to the trauma. The emotions ‘turn off’, as it were. In the first step of ImRs, you also think back as vividly as possible to the traumatic experience. But then the memory is ‘paused’ at the most difficult moment, and you imagine a different outcome that makes you feel better. In this way, ImRs helps you to pay attention to the emotional needs that were violated during the trauma.
ImRs can be safely applied to clients who are prone to dissociation. There are various ways the therapist can use to reduce or prevent dissociation, for example: discussing in advance what you can do if you dissociate so you can use this during ImRs; discussing the rewriting steps very clearly in advance so you know where you stand; emotion regulation techniques (for example, breathing calmly); spend less time dwelling on the most difficult moments before they are rewritten; the therapist can take more control during the rewriting; grounding techniques, for example by holding on to certain objects during the rewriting; client and therapist can each hold one end of a blanket or scarf, so that the therapist can pull on it if the client does not respond. The therapist can use these techniques while continuing with the rescripting and reassuring the client at the same time (for example: ‘You are safe with me here in the therapy room; this image cannot harm you, and there is no reason to dissociate. Come back to the image …’).
In the early days of Covid-19, therapists often had to offer therapy online. This allowed us to discover whether ImRs could be applied safely and effectively online. Although no controlled studies have been conducted, feedback from clients and therapists indicated that online ImRs were equally effective and safe. The only condition was that the client had sufficient privacy to conduct the online session and that technical problems, such as internet connection and other routines, could be resolved. It will depend on the approach of the institution offering the treatment, whether it will be in person or online.
In conclusion
The Imagery Rescripting Knowledge Platform is an initiative of the International Consortium for Imagery Rescripting and was made possible in part by the Achmea Foundation for Victims and Society. Experts with experience from the MIND Platform have contributed to the content of this page.
