From painful memories to present relief: Enhancing CBT efficacy for depression through imagery rescripting in a randomized controlled trial.

INTRODUCTION

Imagery Rescripting (ImRs) is an evidence-based technique for modifying the emotional meaning of distressing autobiographical memories, which are common in depression. This randomized controlled trial examined whether adding three ImRs sessions to ongoing Cognitive Behavioral Therapy (CBT) improves outcomes compared with an active imagery-based control condition.

METHOD: Sixty-six patients with major depressive disorder (MDD) receiving outpatient CBT were randomized to three sessions of either (1) ImRs or (2) guided imagery (GI), both delivered as adjunctive interventions to routine CBT. The primary outcome was depressive symptom severity measured by the Beck Depression Inventory (BDI-II) at baseline, post-intervention, and 4- and 8-week follow-ups. Secondary outcomes assessed emotional-cognitive functioning, dysfunctional core beliefs, and distress linked to autobiographical memories.

RESULTS

Relative to baseline, both groups showed significant reductions in depressive symptoms at post-treatment and follow-up. The condition × time interaction for the BDI-II was not significant. Although effect sizes numerically favored ImRs, these differences were not statistically significant and should be interpreted with caution given the limited statistical power. Regarding the secondary outcomes, ImRs led to significantly greater reductions in emotional distress and perceived memory burden, as well as higher overall participant satisfaction. For the remaining secondary outcomes, interaction effects were not significant, but descriptive patterns again favored ImRs.

DISCUSSION: These findings indicate that both interventions were associated with improvements over time. ImRs showed significantly greater improvements on selected secondary outcomes, whereas remaining outcomes displayed descriptively larger effects for ImRs. However, due to limited statistical power, no conclusions can be drawn regarding the comparative effectiveness of ImRs versus GI. Overall, findings suggest that ImRs is a feasible and promising adjunct to CBT for depression, warranting further investigation in larger trials.