Imagery Rescripting as a Therapeutic Agent for Post-Traumatic Stress Disorder, by Mervin Smucker, Ph.D.
August 9, 2011
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Mervin Smucker, Ph.D. pioneered the field of imagery restructuring as a component of cognitive behavior therapy. In the following, Dr. Mervin Smucker discusses imagery rescripting as a therapeutic agent for post-traumatic stress disorder (PTSD).
Mental imagery often plays a key role in anxiety disorders. While clients seeking treatment for anxiety disorders such as PTSD often share verbal thoughts, they may leave out mental imagery unless prompted by their therapists. However, these mental images are present in all anxiety disorders and the images that patients see often relate to their main fears as a result of the disorder. For instance, in PTSD, intense mental imagery occurs during flashbacks of the precipitating event. Dr. Smucker emphasizes that imagery is important because it has a powerful effect on negative emotion, and cognitive behavior studies show it actually has more of an impact than verbal processing.
In cognitive behavior therapy, which has proven effective for treating PTSD, imagery rescripting is often used to help clients overcome the negative images they may experience via flashbacks and/or nightmares. In imagery rescripting, the existing trauma-related images and their meanings are transformed into mastery/coping images that help the client to feel more empowered and in control. In order for this approach to be effective, therapists must first establish a trusting environment in which the client feels safe. Once the safe environment is established, the therapist guides and accompanies the client through the upsetting imagery via three phases: (1) Imaginal Reliving – visually activating and verbally describing the upsetting images in vivid detail (including the entire memory network and associated affect), (2) Mastery Imagery – replacing victimization imagery with mastery/coping imagery via challenging, confronting, and modifying the distressing images, (3) Self-Compassionate Imagery – visualizing oneself as an empowered individual today nurturing, soothing, comforting, reassuring the “traumatized self” back then.
Imagery rescripting benefits the client in many ways, which includes facilitating expression and organization of feelings, enabling the client to reach closure, decreasing flashbacks, nightmares, and other PTSD-related anxiety symptoms, and improving overall post-trauma adjustment.