Imagery Rescripting for Patients With Posttraumatic Stress Disorder: A Qualitative Study of Patients’ and Therapists’ Perspectives About the Elements of Change☆

Cognitive and Behavioral Practice

Marion Bosch, Arnoud Arntz


Imagery rescripting (IR) has been proven effective in several studies applied to different disorders. It is unclear, however, what the elements of change are according to patients and therapists and whether they agree on this. In this study, we examined the perspectives of patients and therapists and their degree of agreement regarding the elements of change in IR for posttraumatic stress disorder due to childhood trauma. Patients who showed a substantial decrease in symptoms on the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) after a maximum of 12 sessions of IR, as well as their therapists, were approached. Ten patients and nine therapists provided in-depth interviews about the elements of change in the treatment they had received or conducted. A qualitative analysis of the results was used. One element of change was mentioned by all but one interviewee—namely, caring for the child by the therapist when the therapist rescripts the traumatic event. All except two interviewees mentioned that when the therapist rescripts, speaking up to the perpetrator was important. Both aspects were also important when patients did the rescripting themselves. All patients mentioned the positive connection they had with the therapist and the encouragement they received from him or her was important. There was only moderate agreement between patient and therapist regarding the most important element of change, although overall both patients and therapists believed the same elements were of importance. To our knowledge this is the first study in which the elements of change viewed by patients and therapists are investigated in relationship to one another. Despite the fact that this study does not provide definite answers of what works, the perspective of patients and therapists needs to be taken into account when IR for posttraumatic stress disorder is further developed.

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