Image Re-scripting and Reprocessing

The therapy involves visually recalling and reexperience the traumatic images, thoughts, and feelings experienced during a flashback (or nightmare) in a safe and controlled setting. Initially the entire memory is visualized in imagery as remembered . Then the entire memory is visualized in imagery as remembered again and this time the imagery is changed, or rescripted, to create a better outcome, resulting in feeling more empowered and in control. The aim is to replace victimization images with mastery images responding to the trauma no longer as a victim, but as an empowered individual. This, of course, does not change the traumatic events themselves, but it can change the lingering images, thoughts, feelings, and beliefs about the trauma.


  • faciliate the expression and labeling of feelings
  • make the thoughts and feelings about the event more organized
  • reach some degree of peace and closure about the trauma
  • decrease anxiety associated with the trauma
  • decrease uncontrollable thoughts about the trauma
  • improve overall adjustment


One study examined the results of adding an imagery-based, cognitive restructuring component (imagery rescripting and reprocessing therapy, IRRT) to the treatment of 23 Type I trauma victims suffering from PTSD, all of whom failed to improve with PE alone. With the added treatment component, 18 of 23 clients showed a full recovery from their PTSD symptoms, and no longer met criteria for PTSD after 1-3 sessions of IRRT. It was noteworthy that non-FEAR emotions (e.g., guilt, shame, anger) were found to be predominant for all 23 PE failures examined in this study, suggesting that a simple habituation model (on which PE is based) is not sufficient to address non-FEAR emotions in PTSD. By contrast, IRRT, a cognitive restructuring treatment, was much more effective in PTSD symptom reduction for these clients. It was proposed that more detailed, individualized trauma assessments be conducted for each patient that focus on (1) identifying the predominant trauma-related emotions and cognitions that maintain the PTSD response, and (2) finding the best CBT “treatment fit” for the specific trauma characteristics of each patient.

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