Sad man experiences anxious intrusive thoughts in bed and can't sleep. Loud thoughts depicted as squiggly lines that hang over the man lying in bed

Imagery Rescripting: The Best Therapy Skill You Haven’t Heard of…Yet 

By Richard Brouillette, LCSW, author of Your Coping Skills Aren’t Working

If you’re struggling with intrusive disturbing images coming into your head, either from a phobia, or anxiety, or post-traumatic stress disorder (PTSD), or nightmares, it’s urgent you get relief fast. Images are intense: they grab all of your attention, they are powerful, and they can be disturbing and stay with you in unsettling ways. But how do you stop that image if it’s just popping into your head unexpectedly? It turns out the trick is not to try and prevent intrusive thoughts or images, but to change them. The skill you can use to make this change is called imagery rescripting, or ImRs. As the technique has become more popular, it’s showing more potential to help treat a broad set of problems, including anxiety, obsessive-compulsive disorder (OCD), social phobia, health anxiety, childhood abuse and trauma, grief, and even more intense conditions such as personality disorders. In fact, some studies show that ImRs achieves clinical goals faster than traditional cognitive behavioral therapy (CBT) methods in these areas.  

So, how does it work? 

ImRs as a skill is pretty simple: in the therapy setting, the therapist guides the client to pull up a particular image into their mind’s eye (usually with closed eyes, but not necessarily). The next step is to change the image. If the image is simple, such as a particular image from a traumatic car accident, this means an image depicting a different outcome, such as an airbag deploying safely. The therapist and client may practice drawing this image in mind together over a few sessions, with the client practicing regularly on their own and sharing regular feedback. The idea is that you select the most disturbing recurring image, and, using ImRs, morph that image into something different—and by practicing, you alter the image the next time it pops into your head. You have cleared neural pathways to make that image different. Sounds deceptively simple, right? That’s the thing: it’s simple and it works.  

A more complex version works with images that tell a story. Kind of like moving from working with a still image to a scene from a movie. Very often, the scene derives from a memory. This approach can work with an obsessive worry (the scene of a bad thing happening), or a stressful social interaction, a memory that fuels depression, or a traumatic childhood memory. The ImRs skill to address a scene is to change the ending of the story. For example, a client brings a traumatic childhood memory to session, a scene of the child version of the client being yelled at by a demeaning father. Client and therapist, each with eyes closed, can go into the image together and change the ending by having the adult version of the client confront the father, or simply remove the child from the scene to protect him and offer care and encouragement. This altered ending—however fantastic and not really part of history—still becomes part of the brain’s record of the time, including the change in self-esteem related to the rescripting. 

Using Magic and the Full Creative Freedom of the Imagination 

The fun part of ImRs is that you get to use your imagination. In fact, imagination is an important tool for success, no matter how fantastic, as long as it works. I call this the “Jedi” or “Willy Wonka” or “Harry Potter” part of ImRs. If you are rescripting an intimidating person in your image, you can turn them into a character from “The Office,” or Elmer Fudd. If you are revisiting a childhood memory with an abusive adult, you can turn the child into a confident giant who can speak his mind to the adult. If a more low-key tone is appropriate, you can just imagine a bubble of safety around the child. You don’t need to obey the laws of physics in order for the magic to work.  

Neurological Changes

Over the last thirty years, neuropsychologists using functional magnetic resonance imaging (fMRI) have studied the effects of trauma on the brain, as well as the changes that happen with different therapeutic interventions, including repeating the traumatic story, writing a narrative, and using ImRs. Results have been exciting, and indicate that neural pathways related to the source of fear and stress response from a traumatic memory are actually altered with rescripting. In this sense, you actually can change the past. You may not be changing the actual historical events, but you can change the meaning of the event, so that it is less traumatic.  

Promising Applications of Imagery Rescripting

By combining ImRs with other methods, such as gestalt and chairwork, self-talk, expressive writing therapy, and mindfulness meditation, it’s possible to bring the power of ImRs into the self-help world—as I do in my book Your Coping Skills Aren’t Working. Here’s an example I use from my book: suppose you finish a stressful meeting with your boss, and are feeling let down, hopeless, and ashamed, even though the meeting wasn’t as bad as it feels. You might take yourself for a mindful walk, focus on that inner child who is feeling demeaned just as she was as a child at home, and remind her that you are an adult now and can take good care of her. This way, you are able to gain some distance from the intensity of the feeling, place it in history, and practice self-soothing. This will also help you be less triggered and more in control when you need it.  

Keep in Mind

If you would like to do ImRs with a therapist, make sure they have training and supervision in the method, such as a certified schema therapist.  

Richard Brouillette, LCSW, is a certified schema therapist who works with entrepreneurs, creatives, and activists seeking to overcome anxiety, find fulfillment, and improve their relationships. He has written for The New York Times, and is an expert opinion blogger for Psychology Today

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