Change it while it is hot? Mechanisms of change in Imagery Rescripting for distressing memories in depression

• Applicant: Fritz Renner, Ph.D.
• Subject Area: Personality Psychology, Clinical and Medical Psychology, Methodology
• Term: since 2025
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 556121245

Depression is a major global health problem. Psychological treatments for depression, such as Cognitive-Behavioural Therapy (CBT), are effective but about half of the patients do not improve in treatment. Traditionally, CBT for depression involves verbal restructuring of negative thoughts and/or behavioural activation. These therapeutic techniques target dysfunctions in the underlying cognitive and behavioural aspects of depression. The fact that many patients with depression do not improve in treatment suggests that current treatments do not adequately target all key-clinical features of depression. Distressing memories are a common clinical feature of depression, predictive of depressive relapse and not addressed sufficiently in current treatments. Imagery Rescripting (ImRs) is a therapeutic technique that targets distressing memories by imagining the distressing event as vividly as possible in a “hot-cognition” state, thereby drawing upon the emotion activating properties of mental imagery. Subsequently, the sequence of imagined events is changed in a more desirable direction. Recent innovations in psychotherapy research have stressed the importance of eliciting and transforming emotions in addition to cognitions and behavior. Basic research from psychology and neuroscience has shown that mental imagery processing has a greater impact on emotion than verbal processing. Hence, ImRs aims to take the edge of the emotional impact of the memory by changing the (emotional) meaning of the memory representation, i.e. by changing the emotional-schema while it is “hot”. While there is a large body of evidence demonstrating that ImRs is an effective intervention for a range of mental disorders, little is known about why or how it works, i.e. what the treatment mechanisms are. The overall aim of this project is to test if ImRs for depression works through the hypothesized mechanism of change in underlying emotional schemas facilitated by emotional arousal (hot-state cognition). In addition to this mechanistic question, the project aims to test the effects of ImRs for distressing memories on depressive symptoms and other relevant outcomes. Towards these aims, an experimental study in a clinical sample of patients with depression (N = 105) will be conducted, comparing a 3-session ImRs intervention to two control conditions, an Imaginal and Emotional Activation (IEA) condition and a Cognitive Restructuring (CR) condition. Experimentally controlling the putative mechanisms underlying ImRs (emotional activation: ImRs vs. CR; changing emotional schemas: ImRs vs. IEA) offers a direct test of the hypothesized mechanism. By testing ImRs for depression along a mechanistic pathway, this study will provide compelling evidence for the effectiveness of ImRs for depression and shed light on the underlying mechanisms through which this intervention might work.

• DFG Programme: Research Grants