Imagery Rescripting of Early Traumatic Memories in Social Phobia
Open accessAbstract
Negative self-images appear to play a role in the maintenance of social phobia and research suggests they are often linked to earlier memories of socially traumatic events. Imagery rescripting is a clinical intervention that aims to update such unpleasant or traumatic memories, and is increasingly being incorporated in cognitive behavioral therapy programs. In previous research, we have found that imagery rescripting was superior to a control condition in terms of its beneficial effects on negative beliefs, image and memory distress, fear of negative evaluation, and anxiety in social situations. In this article, we describe our imagery rescripting procedure. We consider the importance of updating negative imagery in social phobia, the theoretical basis for imagery rescripting, directions for future research, and how to conduct imagery rescripting, including potential problems and their solutions.
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Preliminary research has shown promising results of clinical interventions that specifically focus on threat imagery in anxiety disorders, such as imagery rescripting or EMDR therapy.
“Preliminary research has also shown promising results of clinical interventions that specifically focus on threat imagery in anxiety disorders, such as imagery rescripting [34–37] or EMDR therapy [38–40].”
Individuals with anxiety disorders are often bothered by intrusive thoughts and images.
“Individuals with anxiety disorders are often bothered by intrusive thoughts and images.”
From Changes in perceived centrality of anxious events following cognitive behavioral therapy for social anxiety disorder and panic disorder (2018) · cites this paper as Wild & Clark, 2011
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“…preliminary benefits of a technique called imagery rescripting that involves engaging with negative autobiographical memories while inserting novel imagery and emotional experiences (Knutsson et al., 2019; Langkaas et al., 2017; Nilsson et al., 2012; Reimer & Moscovitch, 2015; Wild & Clark, 2011).”
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“A next session, the prepared rescripting is applied (e.g., Wild & Clark, 2011).”
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Kredlow, M. A., de Voogd, L. D., & Phelps, E. A. (2022) · Perspectives on Psychological Science · doi:10.1177/17456916211039852 · Cited by 24 · see citing works
“Imagery-rescripting procedures vary somewhat depending on the diagnosis and protocol (Arntz & Weertman, 1999; Hackmann, 2011; Wild & Clark, 2011) but generally include the following components.”
BackgroundNew Developments in Cognitive-Behavioral Therapy for Social Anxiety Disorder
Stangier, U. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0667-4 · Cited by 20 · see citing works
Moscovitch, D. A., White, K., & Hudd, T. (2023) · Clinical Psychological Science · doi:10.1177/21677026231195792 · Cited by 20 · see citing works
“A single 90-min session of IR has been shown to improve social anxiety (SA) symptoms in patients with SAD and to achieve its effects, at least in part, through the process of “memory updating” (Wild & Clark, 2011).”
O'Toole, M. S., Watson, L. A., Rosenberg, N. K., & Berntsen, D. (2016) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.09.008 · Cited by 18 · see citing works
Recurrent involuntary imagery in people who stutter and people who do not stutter
Tudor, H., Davis, S., Brewin, C. R., & Howell, P. (2013) · Journal of Fluency Disorders · doi:10.1016/j.jfludis.2013.06.003 · Cited by 19 · see citing works
“Therefore, the negative self-imagery experiences are thought to contribute to the maintenance of social anxiety and suggest an area to be addressed in treatment (Wild & Clark, 2011).”
BackgroundPile, V., Smith, P. A., Leamy, M. C., Blackwell, S. E., Meiser‐Stedman, R., Stringer, D., Ryan, E., Dunn, B. D., Holmes, E. A., & Lau, J. Y. F. (2018) · Pilot and Feasibility Studies · doi:10.1186/s40814-018-0287-3 · Cited by 19 · see citing works
Guilt, Shame and Compassionate Imagery in War: Traumatized German Soldiers with PTSD, a Pilot Study
Alliger‐Horn, C., Zimmermann, P. L., & Schmucker, M. (2016) · Journal of Clinical Medicine · doi:10.3390/jcm5100090 · Cited by 17 · see citing works
Warnock‐Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., & Clark, D. M. (2022) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x22000496 · Cited by 16 · see citing works
“However, if memories or feelings from the past continue to intrude then we have found that imagery re-scripting, as described by Wild and Clark (2011), can be useful to change the meaning patients have attached to early socially traumatic memories, to put these in the past and achieve further…”
BackgroundSelf-citationImagery re-scripting for PTSD: session content and its relation to symptom improvement
Brown, G. P., Salter, C., Parker, E., Murray, H., Looney, K., El‐Leithy, S., Medin, E., Nováková, B., & Wheatley, J. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465822000479 · Cited by 14 · see citing works
“There is considerable variation among different ImRs approaches in terms of the length of the rescript, how rescripting is explained, at what point the memory is targeted, and how much input and guidance is provided by the therapist (Arntz andWeertman, 1999; Hackmann, 2011; Smucker and Niederee, 1995; Wild and Clark,…”
Poerio, G. L., Kellett, S., & Totterdell, P. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01231 · Cited by 16 · see citing works
Ahn, J.-K., & Kwon, J. (2018) · Cognitive Therapy and Research · doi:10.1007/s10608-018-9918-5 · Cited by 16 · see citing works
“Indeed, it has been demonstrated that IR reduced social anxiety and the distress and vividness of early memories as well as current NSIs, changed the core beliefs of self and others, and enhanced the state of self-esteem and positive affect (Çili et al. 2017; Lee and Kwon 2013; Nilsson et al. 2012; Norton and Abbott 2…”
BackgroundGren‐Landell, M., Aho, N., Carlsson, E., Jones, A., & Svedin, C. G. (2012) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-012-0336-z · Cited by 16 · see citing works
“Addressing the unifying characteristics and components commonly seen in the treatment of PTSD could thus be of value in the treatment of SAD like exposure not only to real events but also to memories of past events [41].”
Backgroundvan den Berg, K. C., Voncken, M. J., Hendrickson, A. T., Houterman, S., & Keijsers, G. P. J. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.098 · Cited by 15 · see citing works
Updating versus Exposure to Prevent Consolidation of Conditioned Fear
Pile, V., Barnhofer, T., & Wild, J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0122971 · Cited by 16 · see citing works
“It is important in this context to see that the verbal updating used in the current study differs significantly from debriefing techniques that advertently or inadvertently elaborate trauma memories, and instead is aimed at containing meaning and changing it in a more benign direction, akin to the mechanisms of memory…”
Self-citationSosin, L. S., & Rockinson‐Szapkiw, A. J. (2016) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2016.1251370 · Cited by 16 · see citing works
“The technique has been effective for the treatment of childhood abuse survivors (Smucker, Dancu, Foa, & Niederee, 1995; Wild & Clark, 2011) and adolescents who experienced trauma (Heyes, Lau, & Holmes, 2013).”
MethodNorton, A. R., Abbott, M. J., Dobinson, K. A., Pepper, K. L., & Guastella, A. J. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10221-9 · Cited by 15 · see citing works
“Each IR session followed the published protocol laid out by Wild and Clark (2011), and used in previous studies of IR for SAD (e.g., Norton & Abbott, 2016b; Wild et al., 2007).”
MethodRomano, M., Hudd, T., Huppert, J. D., Reimer, S. G., & Moscovitch, D. A. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10149-6 · Cited by 15 · see citing works
“2019; Wild and Clark 2011).”
BackgroundInfluentialPatients’ perspectives on imagery rescripting for aversive memories in social anxiety disorder
Takanashi, R., Yoshinaga, N., Oshiro, K., Matsuki, S., Tanaka, M., Ibuki, H., Oshima, F., Urao, Y., Matsuzawa, D., & Shimizu, E. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000493 · Cited by 14 · see citing works
“Although Wild and Clark (2011) indicated that socially aversive memories would have a similar theme, such as rejection or humiliation, and the effect of the work with one memory can be generalized to the others, this does not necessarily follow for all cases.”
BackgroundCharacterising Negative Mental Imagery in Adolescent Social Anxiety
Chiu, K., Clark, D. M., & Leigh, E. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10316-x · Cited by 13 · see citing works
“Indeed, in Cognitive Therapy for SAD (CT-SAD; Clark et al., 2003), negative observerperspective self-imagery is already addressed using video feedback with verbal preparation (Warnock-Parkes et al., 2017) and imagery rescripting (Wild & Clark, 2011).”
MethodSelf-citationMemory representation of aversive social experiences in Social Anxiety Disorder
Seinsche, R. J., Fricke, S., Neudert, M. K., Zehtner, R. I., Walter, B., Stark, R. M., & Hermann, A. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102669 · Cited by 12 · see citing works
The Relationship Between Negative Self-imagery and Social Anxiety in a Clinically Diagnosed Sample
Dobinson, K. A., Norton, A. R., & Abbott, M. J. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10051-w · Cited by 13 · see citing works
Kognitive Therapie bei körperdysmorpher Störung
Ritter, V., & Stangier, U. (2013) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000214 · Cited by 13 · see citing works
Pajak, R., & Kamboj, S. K. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00182 · Cited by 12 · see citing works
“Similar brief imagery-based interventions have been successfully implemented for social anxiety (19, 20), depression (21), and specific phobia (12).”
BackgroundZhou, Y., & Wade, T. D. (2021) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2020.11.005 · Cited by 13 · see citing works
Treatment Options for Fear of Blushing
Drummond, P. D., Shapiro, G. B., Nikolić, M., & Bögels, S. M. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-01152-5 · Cited by 12 · see citing works
Emotional Memory, Psychopathology, and Well‐Being
Salmon, K., & O’Kearney, R. (2013) · Wiley eBooks · doi:10.1002/9781118597705.ch33 · Cited by 11 · see citing works
Lechner-Meichsner, F., Boelen, P., & Hagenaars, M. A. (2024) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2024.100435 · Cited by 11 · see citing works
van den End, A., Beekman, A. T. F., Dekker, J., Aarts, I., Snoek, A., Blankers, M., Vriend, C., van den Heuvel, O. A., & Thomaes, K. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2382652 · Cited by 12 · see citing works
Imagery rescripting of traumatic memories for panic disorder: an exploratory study
Shibuya, T., Seki, Y., Nagata, S., Murata, T., Hiramatsu, Y., Yamada, F., Yokoo, M., Ibuki, H., Minamitani, N., Tanaka, M., et al. (2018) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000028 · Cited by 11 · see citing works
“Since then, the application of ImRs to many psychiatric disorders has been studied and practised: social anxiety disorder (SAD) (Wild et al., 2007, 2008; Wild and Clark, 2011; Nilsson et al., 2012; Lee and Kwon, 2013; Frets et al., 2014; Reimer and Moscovitch, 2015; Norton and Abbott, 2016), PTSD (Arntz et al.”
InfluentialSapach, M. J. N. T., & Carleton, R. N. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102225 · Cited by 11 · see citing works
Imagery Rescripting for Reducing Body Image Dissatisfaction: A Randomized Controlled Trial
Ghaderi, A., Welch, E., Zha, C., & Holmes, E. A. (2022) · Cognitive Therapy and Research · doi:10.1007/s10608-022-10295-z · Cited by 11 · see citing works
“They used a very brief online imagery intervention based on previous work on traumatic events in social phobia (Wild & Clark, 2011).”
MethodPile, V., Schlepper, L. K., Lau, J. Y. F., & Leamy, M. C. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01902-7 · Cited by 10 · see citing works
Stechler, N., & Henton, I. (2022) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2021.2015871 · Cited by 9 · see citing works
Avşar, V., & Sevim, S. (2022) · International Journal of Assessment Tools in Education · doi:10.21449/ijate.1062613 · Cited by 8 · see citing works
Ng, A. S., & Abbott, M. J. (2014) · Behaviour Change · doi:10.1017/bec.2014.12 · Cited by 9 · see citing works
O'Toole, M. S., Watson, L., Rosenberg, N. K., & Berntsen, D. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.01.007 · Cited by 8 · see citing works
Tanaka, Y., Yoshinaga, N., Tsuchiyagaito, A., Sutoh, C., Matsuzawa, D., Hirano, Y., Nakazato, M., & Shimizu, E. (2018) · Asia Pacific Journal of Counselling and Psychotherapy · doi:10.1080/21507686.2018.1487455 · Cited by 10 · see citing works
“We hypothesized that the daily use of imagery might be related to SAD because negative self-images play an important role in the maintenance of psychopathology of SAD (Wild & Clark, 2011).”
BackgroundThe effect of imagery rescripting on prospective mental imagery of a feared social situation
Landkroon, E., Salemink, E., Meyerbröker, K., Barzilay, S., Kalanthroff, E., Huppert, J. D., & Engelhard, I. M. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101764 · Cited by 8 · see citing works
Waldron, S. M., Maddern, L., & Wynn, A. (2018) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12216 · Cited by 8 · see citing works
You’re not alone: imagery rescripting for adolescents who self-harm
Schmied, E., Hack, L., Connemann, B. J., Sosic-Vasic, Z., & Kroener, J. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1395603 · Cited by 7 · see citing works
A single case series of imagery rescripting of intrusive autobiographical memories in depression
Stavropoulos, A., Brockman, R. N., Hayes, C., Rogers, K. D., & Berle, D. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101854 · Cited by 7 · see citing works
Exploring aspects of self-reported emotional mental imagery in patients with bipolar disorder
van den Berg, K. C., Voncken, M. J., Hendrickson, A. T., Simplicio, M. C. D., Regeer, E. J., Rops, L., & Keijsers, G. P. J. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101861 · Cited by 7 · see citing works
Steel, C. (2015) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465815000508 · Cited by 7 · see citing works
“More recent research has highlighted how trauma-related intrusive images may also play a role in the development and maintenance of a number of other psychological disorders, including social phobia (Wild and Clark, 2011), depression (Patel et al.”
BackgroundChan, E., & Tan, H. J. R. (2020) · Journal for ReAttach Therapy and Developmental Diversities · doi:10.26407/2019jrtdd.1.24 · Cited by 7 · see citing works
Seinsche, R. J., Fricke, S., Neudert, M. K., Zimmer, R. I., Stark, R., & Hermann, A. (2024) · Psychotherapy and Psychosomatics · doi:10.1159/000539402 · Cited by 6 · see citing works
“Changing the memory representation of these experiences to alter mental images has become a goal of psychotherapeutic interventions, such as imagery rescripting (ImRs) [4 – 6].”
Meral, Y., & Vriends, N. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000424 · Cited by 6 · see citing works
“In line with these findings on self-image, recent studies (Lee and Kwon, 2013; McEvoy and Saulsman, 2014; Nilsson et al., 2012; Wild et al., 2007; Wild and Clark, 2011) investigated modifying self-imagery in SAD by using an imagery rescripting technique, which aims to update the meaning of distressing memories and ima…”
ResultGraham, B., Bowes, L., & Ehlers, A. (2022) · Clinical Psychology in Europe · doi:10.32872/cpe.3809 · Cited by 7 · see citing works
“Experiences like these can be socially traumatic (Wild & Clark, 2011) and contribute to the onset and maintenance of anxiety disorders (Norton & Abbott, 2017) including social anxiety (Hackmann et al., 2000).”
BackgroundStrohm, M., Siegesleitner, M., Kunze, A. E., Ehring, T. W., & Wittekind, C. E. (2021) · Clinical Psychology in Europe · doi:10.32872/cpe.5303 · Cited by 5 · see citing works
“The ImRs procedure was based on protocols by Arntz and Weertman (1999) and Wild and Clark (2011).”
BackgroundMethodInfluentialLooney, K., El‐Leithy, S., & Brown, G. P. (2020) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000806 · Cited by 6 · see citing works
Recher, D., Rohde, J., Poian, G. D., Henninger, M., Brogli, L., Huber, R., Karlen, W., Lustenberger, C., & Kleim, B. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03192-4 · Cited by 8 · see citing works
“We used an established clinical ImR procedure adapted from Wild and Clark [51].”
Vernachlässigte Folgen sozialer Traumatisierung
Richter, A.-K. (2018) · Trauma und Gewalt · doi:10.21706/tg-12-4-334 · Cited by 5 · see citing works
Asselbergs, J., Riper, H. M., Engelhard, I. M., Mannes, F., & Sijbrandij, M. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101920 · Cited by 5 · see citing works
Treatment Manual for Cognitive Behavioral Therapy for Social Anxiety Disorder
Yoshinaga, N., & Shimizu, E. (2016) · Anxiety Disorder Research · doi:10.14389/jsad.7.special_issue_42 · Cited by 5 · see citing works
Social Anxiety Disorder: Assessment and Treatment
Ginzburg, D., Schreiber, F., & Stangier, U. (2014) · Wiley eBooks · doi:10.1002/9781118775349.ch47 · Cited by 13 · see citing works
Endhoven, B., De Cort, K., Matthijssen, S. J. M. A., de Jongh, A., van Minnen, A., Duits, P., Schruers, K. R. J., van Dis, E. A. M., Krypotos, A. M., Gerritsen, L., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-022-04320-4 · Cited by 4 · see citing works
Pile, V., Tinch‐Taylor, R., Carter, B., Richardson, J., Rijk, L. D., Leamy, M. C., Blackwell, S. E., Meiser‐Stedman, R., Dunn, B. D., Byford, S., et al. (2025) · Trials · doi:10.1186/s13063-025-08920-9 · Cited by 4 · see citing works
“The protocol was adapted for adolescents based on previous adult literature [47–50].”
Winter, H. R., Norton, A. R., & Wootton, B. M. (2025) · British Journal of Clinical Psychology · doi:10.1111/bjc.70029 · Cited by 4 · see citing works
Janssen, H., van den Berg, K. C., Keijsers, G. P. J., Paulik, G., Newman‐Taylor, K., Taylor, C. D. J., Steel, C., & Marcelis, M. C. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf033 · Cited by 4 · see citing works
“11 Addressing imagery viv-idness in exposure has shown benefits for anxiety and trauma symptoms.”
Schema Therapy: An Experiential Approach to Dealing with Maladaptive Schema Mode
Jing, R. T. H. (2018) · Biomedical Journal of Scientific & Technical Research · doi:10.26717/bjstr.2018.08.001589 · Cited by 4 · see citing works
“[6,7] The process allowed emotions to be processes while providing unmet needs, care and support experientially.”
BackgroundTargeting schema change in social anxiety via autobiographical memory reconstruction
Sheldon, S., Atack, L., Ngo, N., Moscovitch, M., & Moscovitch, D. A. (2024) · Cognition & Emotion · doi:10.1080/02699931.2024.2433516 · Cited by 5 · see citing works
“Several intervention methods for conditions such as SAD are designed to diminish negative schemas by targeting these autobiographical memories, but there has been little research that describes exactly how such schema change emerges through the auto-biographical memory system (Wild & Clark, 2011).”
- Authors
- Wild, J., & Clark, D. M.
- Affiliations
- King's College London (GB)
- Corresponding author
- Wild, Jennifer
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 18
- Issue
- 4
- Pages
- 433-443
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC3267018
- OpenAlex
- W2028662332
- Cited by
- 147
- References
- 43
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 10 · 2023: 11 · 2022: 13 · 2021: 10 · 2020: 13 · 2019: 7 · 2018: 18 · 2017: 4 · 2016: 10 · 2015: 8 · 2014: 7 · 2013: 8 · 2012: 6
- FWCI
- 9.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cognitive and Behavioral Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (069777)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- imagery rescripting, social anxiety disorder, traumatic memory, negative self-concept, cognitive behavioral therapy, fear of negative evaluation, memory updating, anxiety
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