Patients with social phobia experience negative ‘observer-perspective’ images that represent their inner fears. Earlier aversive social experiences ( ” ghosts from the past”) may be the foundation for these fears. Negative self imagery contributes to maintain the social fear. Changing the self imagery is valuable in treating social phobia. Would imagery rescripting, a technique effectively used to help survivors of childhood trauma, be useful in social phobia as well?
Petra. G. Frets , Ciska Kevenaar & Colin van der Heiden from Netherlands report the successful use of imagery rescripting in this aricle.
Three stages of Imagery Rescripting:
1. Trauma reliving stage: This is the stage asking the patient to relive the original trauma. Patient close their eyes and relive a problematic recent social event in as much detail and as vividly as possible. Patient is then guided to the earlier experience associated with that feeling and ask the patient to relive that i.e. as if it is happening now, in their imagination.
2. Mastery stage: In this stage, along with reliving, patient is visualising the events from the perspective of their current age observing the events and then entering the situation to help their younger self. Therapist guides the patient to find what needs to be done to help their younger self. (”What would need to happen in the image for the younger self to feel better?” or “Is there anything you as the adult would like to do?”)
3. Compassionate stage: This is the last stage where patient relives the rescripted scene from the perspective of their younger self. Aim here is to replace victimization imagery with coping imagery. The adult at this stage is compassionate with affection and soothing words that may enhance the patient’s feeling of being accepted.
The represent study is a case series ( single case design) outlining the application and the effect of imagery rescripting in social phobia as a stand alone treatment.
This preliminary case series suggest that IR as a stand alone treatment is an effective intervention . Number of sessions required varied very much, some requiring 14 or more sessions. It might be more effective in those who report intrusive memories.
This is a small case series, suggesting that imagery rescripting can be beneficial in social phobia. Further rigorous approaches required to confirm the efficacy.
Summary of the article.
Frets PG, Kevenaar C, van der Heiden C. J Behav Ther Exp Psychiatry. 2014 Mar;45(1):160-9