Scientific research
Scientific research into imagery rescripting (ImRs) is rapidly increasing. New insights are constantly being gained, and new research questions are formulated. On this page, you will find information about current research projects, an overview of the most important basic literature on ImRs from science and practice, and relevant events. You can also subscribe to the newsletter to be kept informed. Previous newsletters can be consulted in our archive.
Research agenda
The ImRs research agenda is revised annually by an international consortium for ImRs in which researchers and therapists work together. The following themes are on the agenda for 2025:
- Unravelling the mechanisms of ImRs (for example, the attribution of meaning or memory effects)
- Research into ImRs for various psychological conditions (e.g. obsessive-compulsive disorder and depression)
- Research into ImRs for various target groups (e.g. youth and autism)
- Research into various forms of ImRs (e.g. online)
Current projects
Research into ImRs is growing rapidly and focuses on a variety of topics. Below is an overview of websites with information about registered projects on ImRs.
On Onderzoek met mensen (Research with people), you will find medical scientific research (WMO) being conducted in the Netherlands. This link will take you directly to the term ‘Imaginaire Rescripting’. You can enter other terms in the website’s search bar and filter more specifically. For example, you can select by registration date, recruitment status, ethical assessment, disorder, type and research phase.
Clinical Trials provide an overview of internationally registered studies. This link provides a list of studies with the term ‘Imagery Rescripting and Treatment’. You can modify search terms and filter by specific conditions, study status, inclusion and exclusion criteria, study population and specific outcome measures.
OSF is a platform where researchers can preregister studies and hypotheses. These are not only clinical studies, but also other types of research and secondary analyses. Researchers also share documents and data related to their projects here. You can find results for the search term’ Imagery Rescripting’ on this link. The search can be further specified, but the options are somewhat more limited than those of the websites mentioned above.
The ISRCTN registry is also a platform for registering planned, ongoing and completed studies. The link provides an overview of studies using the search term’ Imagery Rescripting’. You can further customise and filter the search, similar to the other platforms and websites.
Basic literature
Below, you will find important scientific and clinical articles that provide a good basic knowledge of ImRs. We recommend searching for ImRs literature for a complete overview and the most recent publications. This can be done in Google Scholar; for example, if you type ‘filetype: pdf’ after your search term, you will immediately find articles that are freely accessible (‘open access’). You can also download the open access extensions Unpaywall or Open Access Button for your browser to help filter for freely accessible publications.
Meta-analyses and systematic reviews
This is a meta-analysis of ImRs for psychological complaints associated with aversive memories. Relevant publications were collected from the Medline, PsychInfo and Web of Science databases. The search identified 19 trials (including seven randomised controlled trials) with 363 adult patients with post-traumatic stress disorder (eight trials), social anxiety disorder (six trials), body dysmorphic disorder (two trials), depression (one trial), bulimia nervosa (one trial) or obsessive-compulsive disorder (one trial). ImRs were administered in an average of 4.5 sessions (1-16). Effect size estimates suggest that ImRs are largely effective in reducing symptoms from pre-treatment to post-treatment and follow-up in the total sample (Hedges’ g = 1.22 and 1.79, respectively). The comparison of ImRs with passive treatment resulted in a large effect size (g = 0.90) after the treatment. Finally, the effects of ImRs on comorbid depression, aversive images and encapsulated beliefs were also large. Most of the analyses concerned pre-post comparisons, and the findings were limited by the small number of randomised controlled studies. The findings indicate that ImRs are a promising intervention for psychological complaints related to aversive memories, with significant effects obtained in a small number of sessions.
This is a meta-analysis based on randomised controlled trials (RCTs) into the efficacy of ImRs for psychological disorders associated with aversive memories. Medline, PsycInfo and Web of Science were searched until May 2023. Seventeen studies were included with a total of 908 participants (417 in the ImRs condition) who have post-traumatic stress disorder, anxiety disorders, depression or eating disorders. Random-effect models yielded an overall effect of g = 0.68 (95% CI 0.18 to 1.18; k = 7) compared to passive controls (usually a waiting list). The effect compared to (long-term) exposure, cognitive restructuring, and EMDR was not significant (g = -0.01; 95% CI -0.18 to 0.15; k = 11). Follow-up evaluations indicated a long-term treatment effect. The results suggest that ImRs can be used to effectively treat a variety of psychological disorders with comparable impacts to evidence-based interventions. Limitations include the limited number of trials included for each psychological disorder.
A systematic literature review identified 23 studies involving 805 adult patients, 15 of which were set up as randomised controlled trials (RCTs) with patients with the following diagnoses: Social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), bulimia nervosa, borderline personality disorder, obsessive-compulsive disorder, nightmares, test anxiety, health anxiety and generalised anxiety disorder. Most studies (14) consisted of a single treatment session. Effect size estimates indicate that ImRs are very effective in reducing clinical symptoms associated with mental images from pre- to post-treatment (g = 1.09, 95% CI = [0.64; 1.53]), as well as from pre- to follow-up (g = 1.90, 95% CI = [1.02; 2.77]). Comparing the ImRs intervention with a passive control group showed large effect sizes after treatment (g = -0.99; 95% CI = [-1.79; -0.20]), but comparing IR with an active control group resulted in a small effect (g = -0.05; 95% CI = [-0.43; 0.33]). Finally, significant effects of ImRs were found for comorbid depressive symptoms in the SAD and PTSD groups. ImRs is a promising and short technique for the treatment of clinical symptoms associated with aversive prospective and retrospective mental images.
Review articles
This review discusses clinical studies into the effects of ImRs, possible processes underlying ImRs, and laboratory studies investigating these underlying processes. Although research into ImRs is still in its infancy, and many studies have methodological limitations, the results are promising. Therefore, a research agenda is outlined with suggestions for the following clinical and basic research steps.
This review article describes the clinical application of ImRs in anxiety disorders and obsessive-compulsive disorder (OCD). Variations in ImRs implementation, clinical evidence and theories about possible mechanisms of change are discussed. Finally, the authors propose an agenda for future research.
Papers on ImRs treatments
This article discusses two methods: (i) imagery rescripting and (ii) role-play. Protocols are provided both as guidelines and to encourage standardisation so that this new field can open up to experimental research. Theoretical views are discussed as to why these methods could be so effective in treating chronic problems that originate in childhood.
This is a special edition of collected papers on ImRs in the context of cognitive therapy, with the aim of (a) presenting research and clinical applications of ImRs in problematic mental images, (b) considering problematic images as transdiagnostic symptoms that can be treated with ImRs (including new areas such as fear of contamination), (c) to investigate ImRs in the treatment of PTSD, as well as depression, social phobia and snake phobia, and (d) to stimulate research into ImRs in other clinical disorders.
This special edition focuses on when and how ImRs should be applied for post-traumatic stress disorder, social phobia, depression, eating disorders and personality disorders. The edition contains five articles with a detailed manual on how ImRs can be applied for the relevant disorders and advice on tackling problems that may arise.
This paper illustrates how ImRs can be used in the treatment of grief disorder.
Examples are given of the application of ImRs in clinical cases for various central themes in grief: (1) Unfulfilled responsibilities, self-reproach and guilt; (2) Third-party mistakes, blaming others and anger; (3) Unfinished business, brooding and regret; (4) Unsatisfactory farewell moments; (5) Emotional loneliness; (6) Shattered self-identity and reduced self-clarity.
This article presents clinical experiences of clinicians and clients who have worked with online ImRs and describes clinical considerations and recommendations.
Clinical studies in different populations
In this RCT, patients with chronic PTSD (eventually n = 67) were randomly assigned to either imaginal exposure or imaginal exposure with ImRs. The treatment consisted of 10 weekly individual therapy sessions, and the treatment was evaluated after the treatment and at a follow-up of 1 month. The PTSD symptoms were reduced compared to a waiting list condition. More patients dropped out of the imaginal exposure treatment than the imaginal exposure with ImRs (51% versus 25%). The treatments did not differ significantly in the reduction of symptoms. Imaginal exposure with ImRs was more effective for anger control, expressions of anger, hostility and feelings of guilt, especially during follow-up. Less significant effects were found on shame and internalised anger. Therapists tended to prefer the combination of imaginal exposure with ImRs because it reduced their feelings of helplessness compared to imaginal exposure alone.
The purpose of this international multicentre RCT was to compare the effectiveness of ImRs and EMDR for the treatment of PTSD with childhood abuse. Participants received up to 12 90-minute sessions of ImRs or EMDR every two weeks. A total of 155 participants were included in the final intent-to-treat analysis. The dropout rates were low, namely 7.7%. PTSD symptoms decreased significantly for both ImRs (d = 1.72) and EMDR (d = 1.73) 8 weeks after treatment. There were no significant differences between the two treatments after treatment and follow-up.
Ten patients with severe depressive disorder and intrusive memories received an average of 8.1 ImRs sessions. Significant treatment effects were maintained at a one-year follow-up. Seven patients showed reliable improvement, and six patients showed clinically significant improvement. Spontaneous changes in beliefs, worrying and behaviour were also observed.
Twelve patients with OCD with intrusive images were given an A1BA2CA3 design with periods of measurement only (A), a control intervention of talking about the images (B) and a single session of ImRs (C). The control intervention led to minimal changes. Three months after ImRs, there was a significant decrease in symptoms. Reliable improvement was achieved in 9 of the 12 participants, and clinically significant change was observed in 7 of the 12 participants at a 3-month follow-up.
High percentages of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent meta-analysis of trauma interventions in psychosis showed only small improvements in PTSD symptoms and voices. The primary objectives of this study were to investigate whether ImR reduces (1) PTSD symptoms and (2) voice frequency and stress in voice-hearers. Twelve voice-hearers with previous traumas that were thematically related to their voices participated. Short weekly measurements (taken in sessions 1-8, after the intervention and at follow-up after 3 months) and longer measurements (taken before, halfway through and after the intervention) were taken. There was one dropout during the treatment. Results showed significant and large decreases in voice problems, voice frequency and trauma intrusions. These effects were maintained (and continued to improve for trauma intrusions) at the 3-month follow-up.
The current study reports an initial evaluation of the application of ImRs for six adult outpatients with social anxiety disorder. After a baseline period without treatment, ImRs were administered weekly, and the patients were re-measured after 3 and 6 months. Substantial decreases were found for all patients on all outcome measures after treatment, and the gains were largely maintained at the 6-month follow-up.
Test anxiety in the participants (final n = 59) was diagnosed as a social or specific phobia according to DSM-IV. Participants were randomised into three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or ImRs were applied. Students received test anxiety treatment in groups in weekly three-hour sessions over five weeks. Treatment outcome was assessed before and after treatment, as well as in a six-month follow-up. There was a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups.
In this RCT, ImRs and imaginal exposure were compared with a waiting list (WL) condition. One hundred and four patients with a primary DSM-5 diagnosis of nightmares disorder were randomly assigned to three weekly individual sessions of either ImRs imaginal exposure, or waiting list. Both interventions effectively reduced nightmare frequency and distress compared to the waiting list. The effects were comparable to those of other psychological treatments for nightmares. The effects persisted at 3- and 6-month follow-ups.
This is a multiple-baseline single-case study in which ImRs are tested on six people with BDD. The effect of the intervention was measured with daily self-reporting of the severity of the symptoms (preoccupation with appearance, appearance-related control behaviour, appearance-related discomfort, and the strength of the conviction that their most important problem is their appearance) and standardised clinical assessments of the severity of BDD (Yale-Brown Obsessive Compulsive Scale adapted for BDD). Four of the six participants responded positively to the intervention, with a clinically significant improvement. The improvements began within the first week after the ImRs intervention.
This study compared ImRs, in vivo exposure therapy and their combination in treating snake phobia. The imagination capacity for the treatment was correlated with avoidance prior to the treatment. People with snake phobia were randomly assigned to cognitive therapy with ImRs, in vivo exposure, a combination of the two or a relaxation exercise as a control intervention. All active treatment groups improved significantly more than the control group in both fear and avoidance behaviour. The active treatment groups had no significant differences, although the combined treatment was slightly more effective.
Mechanisms of change in ImRs
This study investigated mediators of the treatment effects of ImRs and imaginal exposure (N = 104). Outcome measures were taken before and after treatment. The mediators were measured between treatment sessions. Higher ‘mastery’ over the nightmare content mediated the effect of ImRs. Imaginal exposure was mediated by an increased tolerance of the negative emotions that nightmares evoke. ImRs and imaginal exposure seem to address different underlying processes in nightmares.
Sixty-five patients were included in this RCT. Patients with a higher level of shame and guilt at the start of treatment had more PTSD symptoms during treatment. Changes in shame and guilt predicted PTSD symptoms three days later. There were no significant differences between imaginal exposure alone and imaginal exposure with ImRs from session to session.
Patients (N = 155) with PTSD due to childhood trauma received 12 sessions of EMDR or ImRs. The vividness, distress and dysfunctional cognitions related to the index trauma and the severity of the PTSD symptoms were measured. EMDR initially led to stronger changes in all predictors, but only for distress did this remain the case until the last measurement. No evidence was found for vividness as a predictive variable for EMDR. However, changes in distress and cognitions did predict changes in PTSD symptoms during ImRs.
Experimental studies on ImRs
In a three-day online trauma film study, a healthy sample (N = 267) was used to investigate whether specific instructions during ImRs increase the risk of memory distortions. In addition, the study examined whether the completeness of the original memory moderates these instructional effects. A sensory focus during ImRs was associated with higher memory accuracy in a recognition task, independent of the quality of the original memory. These results suggest that ImRs does not degrade memory, even when the quality of the original memory is poor and when rich imagination is specifically encouraged.
One hundred participants watched an aversive film and were then randomly assigned to one of four experimental conditions: ImRs including the aversive scenes (Late ImRs), ImRs without the aversive scenes (Early ImRs), Imaginal exposure (IE) or a control condition (Cont). Participants in the IE condition reported the highest stress levels during the intervention; Cont resulted in the lowest self-reported stress levels. For the intrusion frequency, only the Late ImRs resulted in fewer intrusions compared to the Cont condition; Early ImRs produced significantly more intrusions than the Late ImRs or IE condition. Finally, the intrusions of the Late ImRs condition were experienced as less vivid than in the other conditions.
Participants (n = 105) were randomly assigned to either a standard ImRs condition, an ImRs condition with an added positive component focused on joy (ImRs+), or a non-intervention control condition (NIC). Participants watched a trauma film on day 1, received the intervention on day 2 and completed measurements of positive and negative affect on day 3. Participants also registered intrusions from the trauma film. Compared to standard ImRs and NIC, ImRs+ significantly increased positive affect. This increase related to medium and high, but not to low arousal positive affect. No significant differences between the groups were found for negative affect or intrusion outcomes.
Seventy-six participants were randomly assigned to one of three conditions: ImRs, imaginary reliving (IRE) and positive imagination (PI). All participants watched an aversive film, had a 30-minute break and then received a 9-minute intervention (IRS, IRE or PI). They indicated subjective distress during the intervention, noted intrusive memories of the film for 1 week and completed a questionnaire on post-traumatic cognitions and a memory test for one week. The ImRs group developed fewer intrusive memories than the IRE and PI groups and fewer negative cognitions than the IRE group. In contrast, memory improved in the ImRs and IRE groups compared to the PI group. ImRs and PI groups experienced less distress during the intervention than the IRE group.
This study investigated whether rewriting images focused on a feared social situation prepares participants to engage in this feared situation. Sixty healthy individuals were asked to formulate a behavioural experiment to test negative beliefs about a feared social situation. They were divided into one of two groups: ImRs focused on the feared outcome of the behavioural experiment or no ImRs (i.e. a break). Before the behavioural experiment, the condition with ImRs, compared to the control condition, showed a reduced expected likelihood and severity of the feared outcome, a lower level of fear and helplessness and a greater willingness to perform the behavioural experiment.
Healthy participants watched a trauma film and were randomly assigned to four conditions: ImRs, written rescripting (WRs), just thinking back to the film (ImRE), or no manipulation (NM). The participants then recorded the intrusion frequency and the discomfort of intrusions for a week, after which they performed a visual interference task (VIT) with still images from a neutral and the trauma film to activate the implicit emotional memory. ImRs and WRs resulted in fewer intrusions than NM, with no differences between the two rescripting conditions. There was no effect on intrusion distress and the VIT.
After watching an aversive film, one hundred participants were randomly assigned to active ImRs (ImRs-A), passive ImRs (ImRs-P), imagery rehearsal (IRE), or no-intervention control (NIC). Participants were either instructed to rewrite the film by imagining themselves intervening in the new script (ImRs-A) or encouraged to imagine helpers intervening in the imagined situation (ImRs-P). Both ImRs conditions increased feelings of mastery and led to less distress than IRE, with ImRs-P being experienced as less stressful than ImRs-A. Only ImRs-A led to a stronger increase in positive affect than IRE, while the groups did not differ in terms of negative affect and mastery. The conditions did not differ in terms of the number of film-related intrusions.
This study (n = 106) aimed to test the effects of ImRs and extinction on the expectation of the US (negative event) and the re-evaluation of the US. On day 1, fear acquisition took place with an aversive film clip as the US. The manipulation (ImRs + extinction, extinction alone, or ImRs alone) occurred on day 2. Return of fear was tested on day 3. In both extinction conditions, expectancies were learned, but not in the ImRs-only condition. There was also no change in revaluation in ImRs. The combination of ImRs and extinction slowed extinction but did not protect against return of fear.
Seventy psychology students were subjected to fear conditioning. During acquisition, the CS+ was always followed by the US, while the CS- was never followed by the US. For all groups, acquisition took place in context A. Both CS+ and CS- were presented during extinction, but no US was presented. Extinction was carried out for three groups in a different context, context B (ABA groups). The fourth group underwent extinction in the acquisition context (AAA group) to demonstrate that renewal took place. During extinction, the participants were given either an ImRs instruction (ABAir), an US-unrelated imagination instruction (ABAcont), or no instruction at all (ABAno and AAAno). Subsequently, all groups were tested in acquisition context A. The return of the US expectation was less in the ImRs ABAir group compared to mere extinction (ABAno). ImRs (ABAir) also resulted in the devaluation of the valence of the US.
This study compared the effect of ImRs of early autobiographical memories with ImRs of intrusive images and a passive control condition on eating disorder-related core beliefs and symptoms in individuals at risk of developing an eating disorder. Participants (N = 66, 87.8% women) in the ImRs conditions received a 9-minute ImRs auto-instruction and practised the ImRs daily at home for the next 6 days. Participants in the control condition without a task control took a 9-minute break. Both ImRs manipulations resulted in a decrease in negative core beliefs and symptoms compared to the control group. There were no differences between the two ImRs groups. The most commonly used ImRs strategy was self-compassion.
Qualitative studies
Ten patients and nine therapists gave in-depth interviews about the elements of change in the treatment they had received or carried out. The results were qualitatively analysed. All but one of the interviewees mentioned one element of change, namely the therapist’s care for the child when the therapist re-describes the traumatic event. All but two of the interviewees mentioned that it was important to address the offender when the therapist rewrote the event. Both aspects were also important when patients did the rewriting themselves. All patients mentioned the positive relationship they had with the therapist and the encouragement they received from him or her as important. There was only moderate agreement between patient and therapist about the most important element of change, although in general, both patients and therapists considered the same element important.
The study focused on the first imagination techniques used in preparation for ImRs (diagnostic imagination and safe place imagination). Patients emphasised that more attention should be paid to the emotional impact of imagery exercises. They reported a lack of information, communication, and support during the first imagery exercises. Patients indicated that the duration of the imagery exercises is unpredictable, creating feelings of uncertainty and fear.
Recommended clinical productions
Fine Tuning Imagery Rescripting. Remco van der Wijngaart & Chris Hayes
This audiovisual production contains 35 scenes of ImRs in various phases of therapy. You can also view challenging situations from clinical practice and the application of ImRs in several specialised areas (e.g. obsessive-compulsive disorder).
Imagery rescripting: Theory and practice. (2021). Remco van der Wijngaart.
This book offers an extensive practical description of ImRs as a treatment method for various complaints.
Events
Activities
3 & 4 April 2025
5th international ImRs conference in Amsterdam, deadline for abstracts 15 December 2024; click HERE for more information
Congresses
Below is an overview of professional associations that regularly organise national or international congresses, often including contributions on ImRs. Keep an eye on their news and agenda for the latest information.
The VGCT organises an annual autumn conference.
The VSt organises a national congress every two years.
The EABCT organises a European congress every year.
The WCCBT organises a world congress every four years.
The ISST organises an international congress every two years.