Search

Trauma-focused imagery-based interventions are suspected to alter or even distort declarative voluntary memory of a traumatic event, especially if they involve the active modification of imagery, e.g., as used in imagery rescripting (ImRs). However, systematic research is lacking so far. To investigate whether ImRs modifies voluntary memory of a standardized autobiographical aversive event (Trier Social Stress Test) (Session 1), healthy participants (N = 100) were randomly assigned to either an intervention condition receiving one session of ImRs or to a no-intervention control condition (NIC) (Session 2). Voluntary memory was examined using a free recall (Sessions 2 and 3) and a cued recall (Sessions 3 and 4). Although voluntary memory tended to deteriorate over time, contrary to expectations, this effect was not associated with ImRs. Remarkably, the number of correct details in free recall even improved in ImRs but not in NIC. This challenges the view that ImRs alters voluntary memory.

Abstract. In clinical psychology, imagery rescripting (ImRs) is a promising intervention to target negative emotional memories after victimization experiences. The present research tested the effects of ImRs in “minor” cases of experienced injustice. After imagining being the victim of an injustice, participants ( N = 272) were randomly assigned to one of four conditions in a univariate design (treatment: active ImRs, passive ImRs; control: pleasant imagery, imagery rehearsal). Dependent variables were positive and negative affect; mediator variables were justice-related satisfaction and empowerment. Both justice-related satisfaction and empowerment increased positive and decreased negative affect, but empowerment was higher in the active than in the passive ImRs condition (while justice-related satisfaction was increased by both ImRs conditions). These results suggest that ImRs can be beneficial even in minor victimization experiences and that these beneficial effects are mediated by both empowerment and justice-related satisfaction.

Background Imagery Rescripting (ImRs) is a promising intervention to reduce symptoms associated with aversive memories, but little is known about its working mechanisms. The present study investigates whether ImRs increases perceived mastery and attenuates emotional reactivity to memory retrieval on a subjective and physiological level. Methods Seventy-nine individuals reporting memories of distressing real-life events were randomly allocated to ImRs, positive imagery (PI), or no-intervention control (NIC). The memory was reactivated before the intervention and at 1-week follow-up to assess subjective measures and physiological reactivity (heart rate [HR], skin conductance level [SCL], and facial electromyography activity [EMG]) during memory retrieval. Results ImRs was superior to PI and NIC on subjective memory distress and helplessness, but not on other emotions. ImRs did not exceed PI and NIC in reducing state stress symptoms or increasing perceived mastery. Physiological reactivity (HR, EMG) decreased from pre-intervention to follow-up with no differences between groups. Conclusions Positive effects of ImRs on helplessness and distress were found. Null findings regarding mastery might result from timing of its assessment or the fact that rather high-functioning participants were included. The lack of between group differences on physiological responses indicates that ImRs did not exceed habituation effects in the present sample.

Introduction Fear of sleep is proposed to contribute to pathogenic processes underlying trauma-related sleep disturbances. The Fear of Sleep Inventory (FOSI) and its short form (FOSI-SF) appear to be suitable instruments to investigate this construct, yet only English versions are currently available. Objective To facilitate the cross-cultural investigation of fear of sleep, this study aimed at providing a German version of the FOSI-SF, and investigating its psychometric properties as well as its associations with clinically significant PTSD and insomnia. Method The German version of the FOSI-SF was generated following the principle of forward-backward translation and administered to a large online sample from the German general population (n = 754), next to measures of PTSD symptom severity, insomnia severity, and sleep quality. Results The German FOSI-SF has good internal consistency (Cronbach's α = .87). The factorial structure remains inconclusive because exploratory and confirmatory factor analysis detected Heywood cases. Convergent validity was confirmed by moderate to high correlations with PTSD symptoms, insomnia severity, and sleep quality (rs = .30 to .47). Participants reporting clinically relevant PTSD symptoms expressed significantly higher fear of sleep than participants without PTSD (ω2 = .053). Furthermore, participants with insomnia reported significantly increased levels of fear of sleep relative to participants without insomnia (ω2 = .011). Conclusion These results indicate that the German FOSI-SF is sensitive to the theoretically-related disorders of PTSD and insomnia. Overall, the German FOSI-SF offers an economic and practicable brief measure of sleep fears that can enhance further insights into trauma-related sleep disturbances.

Imagery rescripting (IR) and imaginal exposure (IE) are two efficacious treatments for nightmare disorder, but their discrete underlying mechanism(s) remain largely unknown. We therefore examined mediators of the treatment effects of IR and IE in a randomized wait-list controlled trial (N = 104). Therapeutic outcomes were assessed at pre- and post-assessment, and mediator assessment took place in between treatment sessions to establish a temporal relationship between mediators and nightmare symptoms (i.e., frequency and distress). In line with the hypothesis, enhanced mastery (or self-efficacy) of the nightmare content mediated the therapeutic efficacy of IR. Furthermore, the treatment effects of IE were mediated by increased tolerability of the negative emotions elicited by nightmares. Even though IR and IE for nightmares seem to produce similar therapeutic effects, the results of this study suggest that IR and IE tap into different underlying processes.

Imagery rescripting (ImRs) has been shown to be a promising intervention for aversive emotional memories, but research on underlying mechanisms is only in its beginnings. Previous analogue studies on ImRs were mainly based on the trauma film paradigm, but the personal relevance of film-induced memories is limited. Therefore, the present study aimed to investigate the effects of ImRs on personally relevant autobiographical memories. Sixty-five participants who had experienced a distressing life-event were randomly assigned to ImRs or no-intervention control (NIC). ImRs led to less intrusive memories than NIC during the 1-week follow-up period, but was not superior in reducing overall event-related stress symptoms. When retrieving the memory after 1 week, ImRs participants reported greater reductions in sadness and distress, and higher feelings of mastery. Findings underline the potential of the paradigm used in this study to test memory processes involved in ImRs. Limitations and modifications of the paradigm are discussed.

The currently best-supported psychological treatment for nightmares is imagery rehearsal therapy. The problem, however, is that not enough trained practitioners are available to offer this treatment. A possible solution is to conduct imagery rehearsal therapy in a guided self-help format. In the current study, 70 participants with nightmares according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders were randomized to either telephone-guided imagery rehearsal therapy (n = 36) or a wait-list condition (n = 34). Participants in the imagery rehearsal therapy condition received three sessions over the course of 5 weeks. Every treatment session was followed by telephone support delivered by postgraduate students. Participants who received imagery rehearsal therapy showed larger improvements on nightmare frequency (d = 1.03; p d = 0.75; p d = 1.12; p

Background Negative mental images in social anxiety are often linked to memories of distressing social experiences. Imagery Rescripting (ImRs) has been found to be a promising intervention to target aversive memories, but mechanisms underlying ImRs are largely unknown. The present study aimed (a) to investigate the effects of ImRs compared to cognitive restructuring (CR) on social anxiety symptoms and (b) to extend previous research by examining whether ImRs works by fostering reappraisal of negative emotional self-beliefs. Method Highly socially anxious individuals (N = 77) were randomly allocated to ImRs, CR, or no intervention control (NIC). A speech task was performed at baseline and at 1-week follow-up. Results Only CR significantly reduced social anxiety symptoms from baseline to follow-up. Decreases in negative appraisals and emotional distress in response to the speech task did not differ between conditions. Regarding working mechanisms, ImRs led to stronger increases in positive emotions than CR and NIC. Both CR and ImRs yielded short-term reductions in emotionally anchored idiosyncratic self-beliefs, but CR was superior to ImRs at follow-up. Conclusions The present study provides evidence for the efficacy of a single-session of CR for social anxiety symptoms. As one specific version of ImRs was applied, it is conceivable that other or optimized versions of ImRs might be more effective.

Nightmares can be effectively treated with cognitive-behavioral therapies. Though it remains elusive which therapeutic elements are responsible for the beneficial effects on nightmare symptoms, imagery rescripting (IR) and imaginal exposure (IE) are commonly identified as active treatment components of nightmare therapies. With this randomized controlled trial, we compared IR and IE as individual treatments to a wait-list (WL) condition to determine whether these particular therapeutic elements ameliorate nightmare symptoms. For this purpose, 104 patients with a primary DSM-5 diagnosis of nightmare disorder were randomly assigned to three weekly individual sessions of either IR or IE, or WL. Results showed that compared to WL, both interventions effectively reduced nightmare frequency (ΔdIR-WL = 0.74; ΔdIE-WL = 0.70) and distress (ΔdIR-WL = 0.98; ΔdIE-WL = 1.35) in a sample that predominantly consisted of idiopathic nightmare sufferers. The effects of IR and IE were comparable to those observed for other psychological nightmare treatments. Initial effects at post-treatment were sustained at 3- and 6-months follow-up, indicating that IR and IE both seem to be efficacious treatment components of nightmare therapies. Additional research is needed to directly compare IR and IE among both idiographic and posttraumatic nightmare sufferers with respect to treatment expectancy, acceptability, and effectiveness.

Background and objectives In imagery rescripting (ImRs), aversive mental images are modified to reduce symptoms in a variety of psychological disorders. However, uniform guidelines on how to optimally implement ImRs do currently not exist. It remains unclear whether therapists should stimulate patients to imagine themselves to actively intervene within the new image, or whether they may imagine helpers to change the situation. We aimed to compare these two variants of ImRs within an analogue experimental setting. Methods After having watched 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 rescript the film by imagining themselves intervening in the new script (ImRs-A) or encouraged to imagine helpers to intervene in the imagined situation (ImRs-P). Results Both ImRs increased mastery and elicited less distress than IRE with ImRs-P being experienced as less distressing than ImRs-A. Only ImRs-A led to a stronger increase in positive affect than IRE, whereas groups did not differ with respect to negative affect and self-efficacy. Conditions did not differ regarding the number of film-related intrusive memories. Limitations As a convenience sample was investigated, results cannot be generalized to clinical samples. Conclusion Even though differences regarding symptomatic outcome could not be detected, ImRs-P was experienced as less distressing than ImRs-A. Results suggest that both ImRs lead to different processes during the intervention than mere exposure. Compared to IRE, ImRs increases mastery with ImRs-A and ImRs-P being equally effective.

Background and objectives Imagery rescripting (ImRs) is a promising intervention targeting emotional memory. Previous analogue studies have mainly investigated effects of ImRs during memory encoding and consolidation; experimental research on the effects and mechanisms of change in ImRs targeting consolidated memories is largely missing. The present study aimed to investigate effects of ImRs on consolidated memories using a multiple-day trauma film paradigm. Methods Eighty-eight participants were randomly assigned to either ImRs, imagery rehearsal (IRE), or no intervention control (NIC). In Session 1, participants watched an aversive film. In Session 2 (24 h after Session 1), the analogue trauma memory was reactivated and the intervention took place. Participants reported intrusive memories of the aversive film for one week and then returned to the laboratory for a follow-up (Session 3). Results Compared to IRE, ImRs was experienced as less distressing and elicited less negative emotions. In addition, ImRs accelerated the decline of intrusive memories when compared to NIC. However, ImRs, IRE, and NIC did not differ with respect to the total number of intrusive memories during the week following the intervention. Limitations There was a floor effect of intrusive memories, which may have obscured a potential superiority of the active interventions over NIC. Conclusions Adding to the current literature on ImRs as an intervention for emotional memories, the current study underscores that a multiple-day trauma film paradigm can be used to investigate the short-term efficacy and working mechanisms of ImRs, but also points toward useful modifications to the paradigm.

BACKGROUND AND OBJECTIVES: We argue that the stimuli used in traditional fear conditioning paradigms are too simple to model the learning and unlearning of complex fear memories. We therefore developed and tested an adapted fear conditioning paradigm, specifically designed for the study of complex associative memories. Second, we explored whether manipulating the meaning and complexity of the CS-UCS association strengthened the learned fear association.METHODS: In a two-day differential fear conditioning study, participants were randomly assigned to two experimental conditions. All participants were subjected to the same CSs (i.e., pictures) and UCS (i.e., 3 s film clip) during fear conditioning. However, in one of the conditions (negative-relevant context), the reinforced CS and UCS were meaningfully connected to each other by a 12 min aversive film clip presented prior to fear acquisition. Participants in the other condition (neutral context) were not able to make such meaningful connection between these stimuli, as they viewed a neutral film clip.RESULTS: Fear learning and unlearning were observed on fear-potentiated startle data and distress ratings within the adapted paradigm. Moreover, several group differences on these measures indicated increased UCS valence and enhanced associative memory strength in the negative-relevant context condition compared to the neutral context condition.LIMITATIONS: Due to technical equipment failure, skin conductance data could not be interpreted.CONCLUSIONS: The fear conditioning paradigm as presented in the negative-relevant context condition holds considerable promise for the study of complex associative fear memories and therapeutic interventions for such memories.

Neuroimaging research on emotional memory has greatly advanced our understanding of the pathogenesis of anxiety disorders. While the behavioral expression of fear at the time of encoding does not predict whether an aversive experience will evolve into long-term fear memory, the application of multi-voxel pattern analysis (MVPA) for the analysis of BOLD-MRI data has recently provided a unique marker for memory formation. Here, we aimed to further investigate the utility of this marker by modulating the strength of fear memory with an α2-adrenoceptor antagonist (yohimbine HCl). Fifty-two healthy participants were randomly assigned to two conditions - either receiving 20 mg yohimbine or a placebo pill (double-blind) - prior to differential fear conditioning and MRI-scanning. We examined the strength of fear associations during acquisition and retention of fear (48 h later) by assessing the similarity of BOLD-MRI patterns and pupil dilation responses. Additionally, participants returned for a follow-up test outside the scanner (2-4 weeks), during which we assessed fear-potentiated startle responses. Replicating our previous findings, neural pattern similarity reflected the development of fear associations over time, and unlike average activation or pupil dilation, predicted the later expression of fear memory (pupil dilation 48 h later). While no effect of yohimbine was observed on markers of autonomic arousal, including salivary α-amylase (sAA), we obtained indirect evidence for the noradrenergic enhancement of fear memory consolidation: sAA levels showed a strong increase prior to fMRI scanning, irrespective of whether participants had received yohimbine, and this increase correlated with the subsequent expression of fear (48 h later). Remarkably, this noradrenergic enhancement of fear was associated with changes in neural response patterns at the time of learning. These findings provide further evidence that representational similarity analysis is a sensitive tool for studying (enhanced) memory formation.

Introduction: About 2-5% of the general population is suffering from nightmare disorder. Nightmares are associated with several negative consequences but can be effectively treated with cognitive-behavioral therapies. Imagery rescripting (IR) and imaginal exposure (IE) are commonly identified as active treatment ingredients of psychological nightmare treatments. However, it remains unclear which specific therapeutic elements are responsible for the beneficial effects on nightmare symptoms. With this randomized controlled trial, we aimed to investigate the isolated therapeutic efficacy of IR and IE for nightmares.Materials and methods: In this trial we randomized 104 patients with a primary DSM-5 diagnosis of nightmare disorder into an IR, IE, or wait-list control group. In the intervention conditions all participants received three weekly 60 minutes individual treatment sessions. The treatment conditions only consisted of IR or IE and did not comprise of treatment elements such as extensive psycho-education, relaxation and safe-place exercises, or nightmare journals.Results: Post-test results showed that compared to WL, both interventions effectively reduced nightmare frequency and distress, as well as other associated symptoms such as the number of nights with nightmares, insomnia complaints, and dysfunctional nightmare beliefs. These results were sustained at three- and six-month follow-up.Conclusions: Given that the observed effects of IR and IE were comparable to those observed in meta-analyses for other psychological nightmare treatments, we conclude that IR and IE both seem to be active treatment components in nightmare therapies. Future research is needed to examine the potential superiority or equivalence of IR and IE in the treatment of nightmares. In a similar vein, future studies should investigate the potential beneficial effects of combining IR and IE.

Background Recurrent nightmares can effectively be treated with cognitive-behavioral techniques such as imagery rehearsal therapy, which involves imagery rescripting (IR) of nightmares, and imaginal exposure (IE) therapy. However, the underlying mechanisms of these treatments remain largely unknown. To investigate this, we identified a number of variables that might mediate the therapeutic effect of rescripting-based and/or exposure-based therapies. Also, to control for the possible confounding influence of (other) treatment components, we designed two stripped-down treatment protocols, which primarily consist of either (1) rescripting of, or (2) exposure to, the nightmare content. In a randomized controlled trial, we aim to investigate the therapeutic efficacy of these stripped-down IR and IE treatments, and explore their working mechanisms. Method Three weekly sessions of either IR or IE will be compared to a waiting-list control group. Ninety participants suffering from nightmare disorder will be included and randomly allocated to one of the three groups. The primary clinical outcome measures are nightmare frequency and distress caused by nightmares. Secondary clinical outcome measures include sleep complaints, dysfunctional beliefs about nightmares, and posttraumatic stress symptom severity. Outcomes will be assessed weekly from week 1 (pre-assessment) to week 5 (post-assessment). Online follow-up assessments will take place at 3 and 6 months after post-assessment. In order to investigate temporal relationships between mediators and outcome, we will measure the proposed mediators of the treatment effect 1 day after each outcome assessment (but not after the follow-ups). Mediators include nightmare distress and valence, mastery of the nightmare content, predictability, controllability, and tolerability of emotions elicited by nightmares, as well as sleep quality. Discussion The proposed trial allows us to investigate the efficacy of IR and IE as intervention techniques for the treatment of nightmares, and to explore mediators of their respective therapeutic effects. The results may advance our understanding of nightmare therapies by identifying possible mechanisms of psychological treatments for chronic nightmares. Moreover, the results of the proposed study might provide useful knowledge about the working mechanism of rescripting-based and exposure-based treatments in general. Trial registration Netherlands Trial Register (NTR4951), registered on 14 December 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1570-3) contains supplementary material, which is available to authorized users.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non‐traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep‐disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence‐based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.