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Bipolar disorder (BD) is a severe mood disorder characterized by episodes of depression and hypomania or mania. Despite its primarily biological roots, the onset and course of the disorder have also been related to psychosocial factors such as early adverse experiences and related maladaptive schemas. Several researchers proposed a schema therapeutic model to treat patients with BD. In this paper, we further develop the theoretical model and elaborate on seven elements that were found effective in the psychosocial interventions with individuals with BD: monitoring mood and early symptoms of relapse, recognizing and management of stressful situations and interpersonal conflicts, creating a relapse prevention plan, stabilizing the sleep/wake cycle and daily routine, encouraging the use of medication, and reducing self-stigma and substance use. Apart from that, we describe the elements of the schema work with patients who suffer from BD. Illustrative clinical cases accompany the theoretical framework. The research of the schema therapy with patients with severe mental illnesses has only recently started developing. The presented paper also aims to encourage further research in this area and highlight potentially beneficial research goals.

Investigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for this population. The purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD. We conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly. A total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up. ImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.

Abstract Background In psychosis spectrum disorders, maladaptive mental imagery is associated with auditory verbal hallucinations (AVHs). This study evaluates the feasibility, acceptability, and effectiveness of the following 4 imagery techniques in targeting mental imagery and AVHs severity: Imagery Rescripting (ImRs), Promoting positive Imagery de novo (Pos-Im), Metacognitive Imagery techniques (Meta-Im), and playing Tetris. Study Design Four replicated single-case series experimental designs were used. Participants were randomized to 1 of the 4 treatment conditions. Primary, we measured the severity of mental imagery and AVHs thrice daily on an 11-point VAS scale during a 2-week baseline, throughout 3 weeks of therapy, and during a 2-week follow-up phase. Randomization tests were used to examine whether daily severity levels of momentary mental imagery and AVHs decreased post-therapy. Secondary, questionnaires assessing the severity of AVHs, mental imagery characteristics, and levels of mood, anxiety, and functioning were administered at baseline, before, and posttreatment. Results Twenty-eight participants completed all treatment sessions. Mental imagery significantly decreased after ImRs (P < .001, d = 1.13) and Pos-Im (P = .039, d = 0.22), with no significant effects observed following Meta-Im or Tetris. AVHs significantly decreased with all treatment conditions, with largest effects for ImRs (P = .001, d = 1.39) and Pos-Im (P < .001, d = 1.99). Secondary results demonstrated reductions in the severity of AVHs, mood, anxiety, imagery frequency, and appraisals. Conclusions Imagery techniques appear feasible and acceptable for addressing mental imagery and AVHs in the psychosis continuum and may be valuable additions to current treatment for AVHs.

Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets memories of distressing formative events linked to negative self-imagery (NSI). IR is thought to update unhelpful schema by addressing the needs of the younger self within the memory. An accumulating body of evidence indicates that by modifying NSI, IR can significantly affect distressing imagery, memory appraisal, and beliefs about the self. This systematic review aims to critically evaluate and synthesise literature investigating the existing research on the effects IR has on NSI in SAD. A systematic electronic search of Academic Search Complete, ProQuest, Medline, Scopus and PubMed was performed in February 2021 using pre-defined criteria. Ten studies met the inclusion criteria and were selected for review. Analysis of the reviewed articles' findings identified three main themes: Changes to negative self-images, Memories linked to images and Encapsulated beliefs. IR was associated with significant decreases in image distress, image vividness, memory vividness, memory distress, and encapsulated beliefs. Although reductions were found with image frequency, they were non-significant. Interpretation of results is limited by the small number of studies. IR appears to effectively alter images, memories and beliefs in SAD in as little as a single session. The findings indicate that IR could be utilised as a cost-effective intervention for SAD. However, additional studies and longer-term follow-ups are needed.

Background: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent meta-analysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas. Aims: The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms, and (2) voice frequency and distress in voice hearers. Method: We used a single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered in sessions 1–8, post-intervention, and at 3-month follow-up) and longer measures (administered pre-, mid- and post-intervention) were administered. Mixed regression analysis was used to analyse the results. Results: There was one treatment drop-out. Results of the weekly measure showed significant linear reductions over time in all three primary variables – voice distress, voice frequency, and trauma intrusions – all with large effect sizes. These effects were maintained (and continued to improve for trauma intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress. Conclusions: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices.

Purpose of Review This review describes imagery rescripting (ImRs) and its clinical application to anxiety disorders and obsessive-compulsive disorder (OCD). Variations in ImRs delivery, clinical evidence, and theories of potential mechanisms of change are also reviewed. Finally, we propose a future research agenda. Recent Findings There is some evidence that ImRs affects memory processes and schemas. ImRs is associated with reductions in cognitive-affective, physiological and behavioural symptoms of social anxiety disorder and reductions in OCD-related distress and OCD symptoms. ImRs for other anxiety disorders has not been evaluated. Summary While ImRs appears to be an effective intervention for social anxiety disorder and OCD, more research is needed to (a) systematically compare ImRs to established interventions, (b) evaluate ImRs for other anxiety disorders, (c) test theorized mechanisms of change, and (d) evaluate the impact of moderating factors and treatment variations on therapeutic outcomes.

Misophonia, a disorder of decreased sound tolerance, can cause significant distress and impairment. Cognitive behavioural therapy (CBT) may be helpful for improving symptoms of misophonia, but the key mechanisms of the disorder are not yet known. This case series aimed to evaluate individual, formulation-driven CBT for patients with misophonia in a UK psychology service. A service evaluation of one-to-one therapy for patients with misophonia ( =19) was conducted in a specialist psychology service. Patients completed an average of 13 hours of therapy with a focus on the meaning applied to their reactions to sounds and associated behaviours. Primary outcome measures were the Misophonia Questionnaire (MQ) and the Amsterdam Misophonia Scale (A-MISO-S). Repeated measures -tests were used to compare scores from pre-treatment to follow-up, and reliable and clinically significant change on the MQ was calculated. Scores significantly improved on both misophonia measures, with an average of 38% change on the MQ and 40% change on the A-MISO-S. From pre-treatment to follow-up, 78% of patients showed reliable improvement on the MQ and 61% made clinically significant change. Limitations included a lack of control group, small sample size, and the use of an outcome measure that had not been thoroughly validated for a treatment-seeking sample. These results suggest that one-to-one, formulation-driven CBT for misophonia is worth exploring further using experimental design. Potential mechanisms to explore further include feared consequences of escalating reactions, the role of safety-seeking behaviours and the impact of early memories associated with reactions to sounds.

BackgroundBrief, innovative, mechanistically-driven psychological treatments for body dissatisfaction are needed. We aimed to explore the occurrence of body-related mental images among females reporting a subjective sense of body dissatisfaction (study 1), and to investigate the potential efficacy of a single session of imagery rescripting (ImRS) to reduce body dissatisfaction (Study 2: pilot; Study 3 randomized controlled trial).Methods and ResultsIn study 1 (n = 31), participants reported occurrence of both positive and negative body-related mental imagery. Frequency of body-related mental imagery and negative valence of such images were significantly related to body dissatisfaction. The pilot trial (n = 63) indicated feasibility, whereby ImRS of a distressing body-related mental image significantly reduced the believability, vividness, negative affect and distress of the image within-session and one-week post-session versus an active placebo condition (Expressive writing about body related thoughts and emotions). However, ImRS did not result in significant changes in body dissatisfaction. Study 3 was a randomized controlled trial (n = 113) with 3 conditions—ImRS, Expressive writing, and wait-list control. ImRS resulted in a significant reduction of vividness, controllability and negative affect caused by the image compared to Expressive writing condition, after the intervention. However, there were no significant reductions in body dissatisfaction from baseline to 1-week assessment, nor in post-hoc analyses at the 1-month follow-up. Findings suggest that a single session of imagery rescripting seems to alleviate the negative properties of the image (i.e., has proximal effects as hypothesized in our mechanistic account), but does not bring about a significant change in body dissatisfaction (i.e., transfer downstream to more distal effects).ConclusionsGiven some promising effects of ImRS on negative body-related emotions, but lack of a downstream effect on body dissatisfaction itself, further investigation of the format, dose and focus of ImRS in this context is warranted.

BackgroundIntrusive re-experiencing of trauma is a core symptom of posttraumatic stress disorder. Intrusive re-experiencing could potentially be reduced by ‘rewinding’, a new treatment approach assumed to take advantage of reconsolidation-updating by mentally replaying trauma fast-backward.MethodsThe present analogue study was the first to investigate ‘rewinding’ in a controlled laboratory setting. First, 115 healthy women watched a highly aversive film and were instructed to report film-related intrusions during the following week. Twenty-four hours after film-viewing, participants reporting at least one intrusion (N = 81) were randomly allocated to an intervention (fast-backward, or fast-forward as active control condition) or a passive control condition. Intervention groups reactivated their trauma memory, followed by mentally replaying the aversive film either fast-backward or fast-forward repeatedly.ResultsResults indicate that replaying trauma fast-backward reduced intrusion load (intrusion frequency weighted for intrusion distress) compared to the passive group, whereas replaying fast-forward did not. No above-threshold differences between fast-backward and fast-forward emerged.ConclusionPresent findings strengthen the view that ‘rewinding’ could be a promising intervention to reduce intrusions.

[This corrects the article DOI: 10.3389/fnhum.2019.00192.].[This corrects the article DOI: 10.3389/fnhum.2019.00192.].