Image rewrite therapy: features and operation

There are many therapies offered to treat trauma-related disorders and stressors, particularly focused on treating PTSD, which has been shown to be a high prevalence disorder in the general population.

Among the most recent proposals to treat both PTSD and other disorders related to the memory of traumatic events, we have Image rewrite therapy, A therapy little known in the Hispanic world but which seems to gain popularity over the next decade.

Below we will find out what this therapy is, for what disorders it has been used and what it has to do with imagination and exposure.

    What is Image Rewrite Therapy?

    Imaging rescript therapy is an effective treatment to psychotherapeutically treat trauma-related disorders and stressors, particularly post-traumatic stress disorder (PTSD). The purpose of this technique is to change memories or mental representations which are aversive to the subject, and which are at the origin of a source of psychological distress.

    The importance of the development of image rewriting therapy lies in the main disorder to which it is directed. In recent decades, research targeting PTSD has been increasing, driven by the fact that the disorder has a high prevalence in the general population, close to 4%, and among people who have been exposed to a traumatic event, such as that sexual. abuse, terrorist attack or natural disaster, around 6%.

    PTSD has been associated with high levels of social, occupational and physical disability, implying high economic and health costs. For this reason clinical psychology and psychiatry have put a lot of effort into trying to find cures to improve the quality of life of people diagnosed with this disorder, or any other disorder related to trauma and stressors.

    This technique is fairly recent, having its methodological structure in the 90s. with various groups of researchers. However, their origins are quite classic, possibly in the figure of Pierre Janet (1919), an author who himself used what was called “Imaging substitution” with hysterical patients. However, the current version has its origins in the work of Arntz and Weerman in 1999, in which this technique was already applied with traumatic memories, and Smucker, Dancu, Foa and Niederée (1995) who had used the technique with a population who had been abused in childhood.

    Disorders in which it is used

    Although research has mainly focused on applying this technique to patients diagnosed with PTSD, the truth is that has been shown to be helpful with other psychological disorders.

    This therapy can be applied, both independently and in the form of therapeutic packages, for the treatment of various disorders, among which we can find personality disorders, specific phobias, mood disorders, social phobia, suicide attempts and obsessive-compulsive disorder (OCD).

      The therapeutic importance of the imagination

      The main feature of this therapy is examine the use of the imagination, including it in its English translation of “mental Imagery”. That is, to imagine images (but not necessarily only in their visual sense) in the mind. The imagination has been a component widely used in psychotherapy throughout its history, although it is only relatively recently that the emphasis has started on its theoretical basis.

      Imagination or “mental imagery” could be defined as mental representations accompanied by sensory experiences without a direct external stimulus causing them. In other words, it is to feel something without having to perceive objectively. For example, if we imagine that we are eating a cake, it would be the action of seeing the cake with the eyes of the spirit, of smelling it with the nose of the spirit, of touching it with the hands of the spirit , and to taste with the language of the mind. It is to imagine and “live” the action in the mind.

      Because the imagination can be a really powerful tool leading us to experience unreal but very vivid situations, it is not uncommon that it has become important in the application of psychological therapies. We can see that the imagination it makes it possible to bring about changes in the therapeutic process at the emotional, cognitive and behavioral level.

      In the techniques of using the imagination, we could speak of two types. On the one hand, we have those who seek to change a negative image for a more positive one, ie “repaint the situation in a more pleasant way”, while on the other hand, we would have those who seek to see a situation from another point of view. Image rewrite therapy could be included in both categories.

      How is it applied?

      While applying image rewrite therapy specific memories of past experiences associated with current issues are addressed in the life of the patient. This therapy aims to get the patient to think of a memory or mental representation as vividly as possible, as if they were experiencing it where and at the time it is currently. The idea is then to modify the chain of imagined events in the desired direction and to change the result, in addition to reducing the feeling of anxiety.

      Image rewrite therapy is particularly useful with PTSD. Indeed, this treatment emphasizes modifying memory patterns, based on the idea that this disorder has an important basis in memory, in that the focus of discomfort is rebirth, in flash- back, of the traumatic event. It allows you to change the traumatic memories that reside in the patient’s memory.

      While it may seem that imagining the traumatic situation is not, technically, a revelation, the truth is that it can be considered as such. The individual has to remember the problematic memory, which is the most similar way to be exposed to the stressful event, as it cannot be reproduced in real life. To understand this, arachnophobia can work the patient’s spider phobia by carrying a spider and trying to accept its presence. On the other hand, we cannot expose a rape victim to this event again, mainly because it is unethical.

      General structure of therapy

      The application of image rewrite therapy is not homogeneous, as there are different protocols depending on the psychological problem to be treated. In its original design, this therapy was proposed to treat trauma, although protocols have now been developed for the treatment of different psychopathologies, as we have discussed above. The protocol may also vary depending on the therapeutic objective to be achieved.

      The fact that this therapy is so versatile is a big advantage, Especially in cases where the patient has high comorbidity, as typically occurs in many anxiety and personality disorders. For example, if the therapeutic goal is to change the patient’s source of stress, this therapy can be applied following the same protocol used for PTSD patients. However, if you want to work on the beliefs rooted in the patient, the most practical is to apply a protocol similar to that applied in personality disorders.

      In the particular case of PTSD, whatever the source of the disorder (for example, it is not the same to have been the victim of child sexual abuse to have experienced a natural disaster), Rewriting Therapy of Images seeks to achieve the following three objectives.

      The first is rework and integrate traumatic memories into the context in which they occurred. The second is to work on the dysfunctional evaluations that continue to be made on the event. traumatic. Finally, the goal is to eliminate dysfunctional coping strategies that perpetuate the problem. These strategies can include avoidance, self-harm, drug use, the implementation of various risky behaviors …

      Therapy begins with the exploration phase of the traumatic event. It is at this moment that the exhibition will begin the traumatic event, the goal is to bring the memory of the trauma to be able to work on it. The usual and most recommended at this point is that the patient closes their eyes, encouraging them to speak in the first person and in the present tense (“I see who wants to hurt me …”), expressing in as much detail as possible what it feels like emotionally and sensorially.

      This phase of treatment can take a long time, as it is clearly very aversive to patients. They are experiencing in their mind what they have experienced in their own skin, which has hurt them. It is for this reason that, if the psychotherapist deems it appropriate, certain modifications can be incorporated in the future, such as recalling the patient with his eyes open. This prevents you from dissociating yourself and ceasing to be aware that you are in a safe and secure place, just like the consultation with the therapist.

      It is essential that a strong therapeutic alliance is established before the arrival of this phase of treatment. Although this therapy can be applied on its own, it is preferable to have a good therapeutic basis through exploration in the patient, know where he came from, where he is going, which led him to undergo therapy in the beginning.

      In some cases, it is important that the imagination of the traumatic event is not fully realized, that is, the patient does not have to remember the full experience of the aversive event. This is especially recommended for cases where the traumatic moment was particularly severe, such as a child sexual abuse case. The patient must be warned just in time for the worst to happen.

      From there, the therapist and the patient should reflect on and discuss the hot spots of the traumatic file. A hot spot is understood to mean at the moment of the traumatic event in which the individual suffered the most, the moment which “froze” in his memory the aversive memory. In addition to understanding and discovering what these moments of particular suffering are, the associated meanings and interpretations need to be explored.

      Although image rewrite therapy is only just beginning at this point, the patient may begin to exhibit spontaneous cognitive changes. An example of this is that you may realize that the only place where your memory is harmful is in your memory. It does not involve physical harm and does not transport you to the moment you experienced the traumatic event, but it is evil that originates from your own mind.

      Once the imagining of the traumatic event has been realized, the actual rewriting phase occurs. The aim is to introduce new information, to change the course of the event in the imagination of the patient, and ultimately to make the mental material less harmful.

      The patient will remember the event until they reach the hot spots, at which point the therapist will try to promote guided discovery of how he would like the memory to change.

      For example, instructions are given to the patient so that he can engage in memory, but this does not impose a certain direction or a certain narrative on him. However, there may be cases in which the therapist must directly suggest what would be the best direction to rewrite the story.

      Once it has been verified that the proposed rewrites serve to aid the patient, practice thereof should be performed until it is verified that the suffering is decreasing and the dysfunctional beliefs are corrected. That much, it is useful to record successful rewrite sessions so that the patient can repeat the task at home.

      Bibliographical references:

      • Miguel-Álvaro, Alejandro and Crespo, Maria. (2019). Rewriting images for the treatment of post-traumatic stress disorder: analysis and review. Clinic and health, 30 (3), 137-146. Online publication October 21, 2019
      • Arntz, A. (2012). The description of images as a therapeutic technique: review of clinical trials, basic studies and research agenda. Journal of Experimental Psychopathology, 3, 189-208. jep.024211
      • Janet, P. (1919). Psychological drugs: historical, psychological and clinical studies of methods of psychotherapy (vol. 1-3). Paris, France: Alcan.
      • Morina, N., Lancee, J. and Arntz, A. (2017). Rewriting of images as a clinical intervention of aversive memories: a meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 6-15. https: // doi. org / 10.1016 / j.jbtep.2016.11.003
      • Smucker, MR, Dancu, CV, Foa, EB and Niederee, JL (1995). Rewriting Images: A New Treatment for Child Sexual Abuse Survivors Suffering from PTSD. Journal of Cognitive Psychotherapy: An International Quarterly, 9, 3-17. https: // doi. org / 10.1891 / 0889-8391.9.1.3

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