Imagery Rescripting Effective as Childhood Abuse-Related PTSD Treatment

Imagery Rescripting (ImRs) therapy is a potential stand-alone treatment for childhood abuse (CA)-related posttraumatic stress disorder (PTSD), according to study results published in Journal of Behavior Therapy and Experimental Psychiatry.

Researchers from the University of Amsterdam in the Netherlands recruited individuals with CA-related PTSD from 2 mental health clinics between 2011 and 2015. Patients (N=61) were randomly assigned in a 1:1:1 ratio to receive Skills training in Affective and Interpersonal Regulation (STAIR) plus ImRs (n=20), ImRs alone (n=21), or waitlist placement (n=20). The waitlist cohort was randomly assigned in a 1:1 ratio to receive STAIR plus ImRs (n=10) or ImRs (n=10) at week 8.

The STAIR intervention comprised 8 weekly hour-long sessions following the STAIR manual. The ImRs intervention comprised 16 twice-weekly 90-minute sessions and was based on a previously published ImRs procedure. The primary outcome was the change in PTSD symptoms.

The study population included patients (89% women) aged mean 35.9 (SD, 10.7) years, of whom 53% experienced sexual and physical abuse, 31% experienced sexual abuse, and 16% experienced physical abuse, respectively.

Study patients received an average of 13 ImRs treatment sessions, and 19% of the ImRs and 13% of the STAIR plus ImRs cohorts discontinued treatment early.

Clinician-administered PTSD scale scores decreased from baseline to posttreatment among the STAIR (mean, 75.6 vs 64.1 points), ImRs (mean, 78.2 vs 45.6 points), and waitlist (mean, 70.5 vs 63.7 points) groups, respectively.

For only the pooled active treatment groups, clinician-administered PTSD scale scores decreased from 69.9 points at baseline to 26 points at the 12-week follow-up among the STAIR plus ImRs group. Comparatively, clinician-administered PTSD scale scores decreased from 75.2 points to 36.1 points for the ImRs alone group.

Significant effects were observed for ImRs compared with waitlist (β, -26.54; P =.003) and ImRs compared with STAIR (β, -21.23; P =.017) for the change in clinician-administered PTSD scale score. Similarly, significant changes to the posttraumatic diagnostic scale (PDS) scores, PDS guilt scores, PDS shame scores, PDS anger scores, and to sensitivity analyses were observed for ImRs compared with both the waitlist (all P ≤.010) and  STAIR (all P ≤.031).

The major limitation of this study was the small sample size.

Study authors concluded, “This study demonstrates that ImRs as stand-alone treatment is an effective and tolerable method for the treatment of CA-related PTSD and can be relatively easily implemented in routine clinical care. A sequential treatment (STAIR/ImRs) may not lead to superior effects, but this question may need further investigation in a larger sample.”