Image Rewriting Therapy: Characteristics And Operation
There are many therapies proposed to treat disorders related to trauma and stress factors, especially focused on treating PTSD, which has been shown to be a disorder with a high prevalence 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 Rewriting Therapy a therapy that is little known in the Hispanic world but that seems like it could gain popularity in the next decade.
Below we will discover what this therapy consists of, what disorders it has been used for and what relationship it has with imagination and exposure.
Imagery Rescript Therapy is an effective treatment to psychotherapeutically address trauma-related disorders and stress factors, especially Post-Traumatic Stress Disorder (PTSD). The purpose of this technique is to change memories or mental representations that are aversive for the subject, and which are originally a source of psychological discomfort.
The importance of the development of Image Rewriting Therapy lies in the main disorder at which it is directed. In recent decades, research aimed at PTSD has been increasing, motivated by the fact that this disorder has a high prevalence in the general population, close to 4%, and among people who have been exposed to a traumatic event, as can be seen. be sexual abuse, terrorist attack or natural disaster, about 6%.
PTSD has been associated with high levels of social, occupational and physical disability, implying a high economic and health cost. For this reason Clinical psychology and psychiatry have invested much effort in trying to find treatments to improve the quality of life of people diagnosed with this disorder, or with any other disorder related to trauma and stress factors.
This technique is quite recent, having its methodological structuring in the 90s with various groups of researchers. However, its origins are quite classical, and can be found in the figure of Pierre Janet (1919), an author who himself used what he called “imagery 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 Niederee (1995) who had used the technique with a population who He had suffered abuse as a child.
Disorders in which it is used
Although research has focused, above all, on the application of this technique with patients diagnosed with PTSD, the truth is that has been shown to be useful with other psychological disorders
This therapy can be applied, both independently and in therapeutic packages, for the treatment of various disorders, among which we can find personality disorders, specific phobias, mood disorders, social phobia, suicide attempts and disorder. obsessive-compulsive disorder (OCD).
The therapeutic importance of imagination
The main characteristic of this therapy is rely on the use of imagination, understood in its English translation of “mental imagery” That is, imagining images (although not necessarily only in their visual sense) in the mind. Imagination has been an element widely used in psychotherapy throughout its history, although it has not been until relatively recently that focus has begun to be placed on it to understand its theoretical bases.
Imagination or “mental imagery” could be defined as mental representations accompanied by sensory experiences without a direct external stimulus that causes them. That is, it is feeling something without needing to perceive it 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 mind, smelling it with the nose of the mind, touching it with the hands of the mind and tasting it with the tongue of the mind. mind. It is imagining and “living” the action in your mind.
Because imagination can be a truly powerful tool, leading us to experience non-real situations but in a very vivid way, it is not surprising that it has become important in the application of psychological therapies. It is proven that the imagination allows eliciting changes in the therapeutic process at an emotional, cognitive and behavioral level
Among the techniques in which imagination is used, we could talk about two types. On the one hand, we have those that seek to change a negative image for a more positive one, that is, “repaint the situation in a more pleasant way”, while, on the other hand, we would have those that seek to see a situation from another point of view.. Image rewriting therapy could fall into both categories.
How does it apply?
During the application of Image Rewriting Therapy specific memories of previous experiences associated with current problems are addressed in the patient’s life. In this therapy, the aim is to make the patient bring to consciousness a memory or mental representation in the most vivid way possible, as if they were experiencing it in the place and time in which they are currently. The idea is that you then modify the sequence of events that you imagine in the desired direction and change the result, in addition to reducing the feeling of anxiety.
Imagery Rewriting Therapy is especially helpful with PTSD. This is because this treatment emphasizes the modification of memory schemes, based on the idea that this disorder has an important basis in memory, in the sense that the focus of the discomfort is reliving, in the form of of flashbacks, of the traumatic event. Allows changing traumatic memories that reside in the patient’s memory
Although it may seem that imagining the traumatic situation is not, technically, an exposure, the truth is that it can be considered as such. The individual must bring the problematic memory to mind, which is the closest way to exposing oneself to the stressful event, since it cannot be replicated in real life. To understand it, in arachnophobia you can work on the patient’s spider phobia by bringing him a spider and having him try to accept its presence. On the other hand, we cannot expose a rape victim to that event again, basically because it is unethical.
The application of Image Rewriting Therapy is not homogeneous, since there are different protocols depending on the psychological problem to be treated. In its original conception, this therapy was proposed to address trauma, although currently protocols have been developed for the treatment of different psychopathologies, as we have already mentioned previously. The protocol can also vary depending on the therapeutic objective to be achieved.
The fact that this therapy is so multifaceted is a great advantage, especially in cases where the patient shows high comorbidity, as often happens in many anxiety and personality disorders. For example, if the therapeutic objective has to do with changing the patient’s source of stress, this therapy can be applied following the same protocol that is used with PTSD patients. On the other hand, if what you want is to work on the beliefs rooted in the patient, it is most convenient to apply a protocol similar to that applied in personality disorders.
In the particular case of PTSD, whatever the origin of the disorder (e.g., having been a victim of childhood sexual abuse is not the same as having experienced a natural disaster), Image Rewriting Therapy seeks to comply with the following three objectives.
The first is rework and integrate traumatic memories into the context in which they happened The second is to work on the dysfunctional evaluations that continue to be made about the traumatic event. Finally, the aim is to eliminate dysfunctional coping strategies that perpetuate the problem. Among these strategies you can find avoidance, self-harm, drug use, carrying out various risk behaviors…
Therapy begins with the exploration phase of the traumatic event. It is at this moment that the exposure to the traumatic event would begin, the objective of which is to bring the trauma to memory in order to work on it. The usual and most recommended thing at this point is to have the patient close his eyes, encouraging him to speak in the first person and in the present tense (“I’m seeing who wants to hurt me…”), expressing in as much detail as possible how you feel on an emotional and sensory level.
This phase of therapy can be quite time consuming, as it is clearly very aversive for patients. They are living in their minds what they experienced in their own flesh, what hurt them. It is for this reason that, if the psychotherapist considers it appropriate, some modifications can be incorporated into this part, such as having the patient remember with his eyes open. This prevents you from dissociating and ceasing to be aware that you are in a safe and protected place, such as the therapist’s office.
It is essential that a solid therapeutic alliance has been established before this phase of treatment arrives. Although this therapy can be applied on its own, it is most appropriate to have established good therapeutic foundations through examination of the patient, knowing where you come from, where you are going, what led you to go to therapy in the first place
In some cases it is important that the imagination of the traumatic event is not carried out fully, that is, the patient should not be made to remember the complete experience of the aversive event. This is especially recommended for cases in which the traumatic moment was especially serious, such as a case of child sexual abuse. The patient must warn just the moment before the worst comes.
From there, therapist and patient must reflect and discuss what the hot spots of the traumatic memory are. We understand a hot spot as the moment of the traumatic event in which the individual suffered the most, the moment that “froze” the aversive memory in their memory. In addition to understanding and discovering what those moments of special suffering are, the associated meanings and interpretations must be explored.
Although Image Rewriting Therapy has just begun at this point, the patient may begin to manifest spontaneous cognitive changes An example of this is that you may become aware that the only place your memory is harmful is in your memory. It does not involve physical damage or transports you to the moment in which you suffered the traumatic event, but rather it is a damage that comes originally from your own mind.
Once the imagination of the traumatic event has been achieved, the rewriting phase itself arrives. The aim is to introduce new information, change the course of the event in the patient’s imagination, and ultimately make the mental material less harmful.
The patient will remember the event until the hot spots are reached, at which time the therapist will try to promote guided discovery how you would like the memory to be modified.
For example, instructions are given to the patient so that they can engage in remembering, but it does not impose a specific direction or narrative. However, there may be cases in which the therapist has to directly propose what would be the best direction to rewrite the story.
Once it has been proven that the proposed rewritings help the patient, they should be practiced until it is verified that the suffering decreases and the dysfunctional beliefs are corrected. Arrived at this point, It is helpful to record successful rewrite sessions so that the patient can repeat the task at home.
