Mervin Smucker. Overview of imagery Rescripting

Imagery Rescripting is an imagery-focused treatment originally designed to alleviate posttraumatic stress symptomatology and alter trauma-related beliefs and schemas (e.g. powerlessness, unloveability, inherent badness, abandonment) of adults who experienced childhood trauma.  The therapy combines imaginal exposure (visually recalling and re-experiencing the traumatic images, thoughts, and associated affect) with imaginal rescripting (replacing traumatic imagery with mastery imagery), and self-nurturing imagery.  Through the rescripting process, the internalized victimization images are altered and the traumagenic beliefs and schemas can be identified and challenged.  The use of imagery allows these trauma-related schemas to be visually activated through the eyes of the “traumatized child” and challenged, modified, and reprocessed through the eyes of the empowered “adult self.”

The standard treatment program consists of eight sessions (plus two follow-up sessions) ranging in length from 1-2 hours each. Imagery Rescripting sessions are best held on a weekly or bi-weekly basis.  It is generally preferable to meet more often (e.g., once a week) in the beginning of treatment, and then meet less frequently in the latter part of treatment (e.g., once every two weeks).  Audio-recordings are made of each Imagery Rescripting session and given to the client as homework for daily listening.  A minimum of two follow-up sessions are recommended at one month and three months post-treatment.

Mervin Smucker

An Interview with Mervin Smucker, PH.D.

Dr. Mervin Smucker is an internationally renowned clinician, consultant, and trainer in the field of trauma. Dr. Mervin Smucker has conducted training seminars around the world on imagery rescripting, an application of cognitive behavior therapy, which has proven effective in cases of trauma and (PTSD).

Question: What is imagery rescripting?

Dr. Smucker: Imagery rescripting is an original treatment that I developed with colleagues in the early 1990s as an effective form of cognitive behavior therapy (CBT). Clients with PTSD often see repeated upsetting images of their original trauma in their minds. Such image-rich scenarios can play out vividly, engaging all of the senses and appearing as a scenario in the present rather than in the past. Imagery rescripting helps clients to move beyond these repeat multi-sensory experiences by providing a new script or modification that enables them to replace victimization images with mastery images, and to develop self-compassionate imagery by means of visualizing oneself as a competent, capable individual today calming, soothing, nurturing, and reassuring one’s “traumatized self” back then.

Question: Please describe the process.

Dr. Smucker: A session may last 60 to 90 minutes and includes three phases. In the first phase, we have the client visualize and describe the distressing imagery, including all of the sensations and emotions that accompany it. We call this imaginal reliving. In the second phase, the client develops mastery imagery by challenging, confronting, modifying, and replacing the distressing images with coping/empowering images. Finally, in phase three the client visualizes him-herself as a competent, empowered individual today calming, soothing, comforting the “traumatized self” back then.

Question: Can you give an example of this?

Dr. Smucker: Suppose a childhood abuse victim is reliving experience through repeated flashbacks. The client may see herself as an adult today entering the abuse scene and confronting (physically, verbally) and disempowering the perpetrator, and then visualizing taking the CHILD to safety where the ADULT can visually offer nurturance and reassurance to the CHILD.

Question: How long does the process take to work?

Dr. Smucker: The standard treatment is eight sessions. However, it may only take a few sessions, depending on the type of trauma. We encourage the client to listen to audio recordings of the session every day until their next session. This helps to reinforce the newly-created mastery images from the previous session.

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Mervin Smucker. Different types of flashbacks.

Though the term „flashback“ is typically referred to in a general sense as pertaining to the re-experiencing of a traumatic memory or event, there are several different types of „flashbacks“ that individuals may experience.

Replay Flashback – involves a complete re-living of a traumatic event in a film-like fashion;

Appraisal Flashback – a snapshot image at the peak of a trauma (the worst or most frightening moment), which is typically photographic in nature;

Projected Flashback – involves experiencing vivid images of traumatic „events“ that never occurred (a false memory)

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Mervin Smucker. When Change is not on Time – Troubleshooting Protocol-Based Treatment of PTSD

Smucker, Mervin, Borge, Finn-M., Nore, Gro, & Langkaas, Tomas. When Change is not on Time – Troubleshooting Protocol-Based Treatment of PTSD. Symposium presented at the 37^th Annual Congress of the European Association for Behavioural & Cognitive Therapies, Helsinki, Finland.

Recurring and distressing thoughts and images of a traumatic event are key characteristics of posttraumatic stress disorder (PTSD). The disorder leads to significant distress and loss of functioning for those who suffer from it. Developing effective treatment for PTSD has received increased interest in the CBT field in recent years, and several protocol-based CBT approaches now exist.  However, employing a treatment protocol on a specific case does not always lead to the desired change and expected progress, and a significant proportion of PTSD clients in naturalistic settings fail to respond to our CBT treatments. The central theme for this symposium is “How to progress with protocol-based PTSD treatment when change does not happen as expected?”

The speakers of this symposium present case examples undergoing different protocol-based PTSD treatments that failed to progress as expected.  Various attempts to troubleshoot these cases are discussed.

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Mervin Smucker. Using Imagery Rescripting to Enhance Successful Emotional Processing of Trauma with Individuals experiencing Posttraumatic Stress Disorder (PTSD)

From an information-processing perspective, PTSD results from inadequate emotional processing of traumatic events, and PTSD will abate once adequate or successful emotional processing has occurred. As such, it is one’s response to trauma – and not the traumatic events themselves – that produces a PTSD syndrome.

Successful emotional processing is generally thought to have occurred when the trauma victim is able to talk about, see, listen to or be reminded of the traumatic events without experiencing distress.  However, many trauma victims use denial, numbing, amnesia, or other dissociative strategies as protection from information overload and the emotional distress associated with their trauma.  While the use of such avoidance responses may have been adaptive survival responses at the time of the traumatic events, and perhaps for a period of time thereafter, their continued, long-term post-trauma use is often a maladaptive avoidance strategy that thwarts or delays successful emotion processing.

In Imagery Rescripting, four conditions are essential for successful emotional processing of traumatic material to occur:  (1) visual and verbal activation of the trauma-related memory, including cognitive, affective, and primary sensory stimuli (visual, auditory, kinesthetic, tactile), (2) transformation of the traumatic imagery into coping/mastery imagery, (3) development of self-calming, self-soothing imagery, and (4) linguistic processing of the transformed imagery and its meaning.

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Mervin Smucker. Neuroscience Trauma Research Findings.

In a neuroscience research study conducted by Lanius et. al. (2004), traumatic imagery vs. neutral imagery was measured by fMRI functional connectivity analyses to determine if differences existed between patients with and without PTSD.

• Scripti-Driven Imagery was used with 24 trauma patients
  – 11 had PTSD (6 sexual assault, 5 motor vehicle accidents)
  – 13 no PTSD (5 sexual assault, 8 motor vehicle accidents)
• All subjects scanned the traumatic and neutral imagery 3 times while instructed to
  – (30 seconds) Lie still and focus on script of a traumatic or neutral event that they had experienced as the script of the event was being read to them;
  – (60 seconds) Remember olfactory, auditory, somato-sensory, visual sensations as soon as the script was heard;
  – (120 seconds) Lie still, breathe through nose, and let go of traumatic imagery
  – Above script was repeated two times

Results of fMRI analyses yielded the following differences between PTSD vs. non-PTSD patients.

• PTSD Patients Experienced:
  – Trauma memories as affect-laden memories in flashback form (e.g., reported feeling „I was back at the scene of the trauma“
  – Increased heart rate during the script-driven imagery
  – Increased right hemispheric activity consistent with a non-verbal pattern of memory retrieval
• Non-PTSD Patients Experienced:
  – Trauma memories recall as non-affect-laden, autobiographical memories (in narrative form)
  – Increased left-hemispheric activation consistent with verbal pattern of memory retrieval
  – No increase in heart rate during script-driven imagery

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Mervin Smucker: Panic Symptom Questionnaire

Below is a list of physiological symptoms that people sometimes experience when they are feeling anxious or panicky.  Please rate on the line next to each item how fearful you are of these symptoms using the numbers from 0 to 3 below.  Please rate each item.

• N/A  –   Symptom not present
• 0 – Not at all fearful
• 1 – Somewhat fearful
• 2 – Quite  fearful
• 3 – Extremely fearful

____   1.  Lightheadedness / dizziness

_____ 2.  Shortness of breath

_____ 3.  Wobbliness in legs

____   4.  Nausea

____   5.  Blurred / distorted vision

____   6.  Tingling in fingertips

____   7.  Numbness in arms or legs

____   8.  Heart palpitations

____   9.  Pressure / heaviness in chest

____ 10.  Knot in stomach

____ 11.  Lump in throat

____ 12.  Dry throat

____ 13.  Sweating

____ 14.  Disorientation / confusion

____ 15.  Sense of disconnectedness from body

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Mervin Smucker. Conceptualization of Abandonment Panic

Clinical observations suggest that a state of „abandonment panic“ may be triggered in borderline and narcissistic individuals when a here-and-now threat of abandonment is associated with earlier experiences of abandonment depression. The fear of abandonment depression is sufficient to trigger a panic response, as the individual feels the threat of being overwhelmed by the traumatic affect associated with memories and experiences of early abandonment. Thus, when borderline or narcissistic individuals experience the threat or signal of abandonment depression, they are often propelled to activate their seemingly dysfunctional, acting-out behaviours, in order to ward off the overwhelming feelings of abandonment depression (e.g., by outbursts of rage, suicide gestures or other self-injurious actions) which may then lead them to re-connect with care-givers, therapist, or significant others (e.g., via hospitalization, emergency therapy session) and a temporary remittance of the abandonment panic.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker. The essentials goals of cognitive therapy.

Cognitive therapy is based on the underlying rationale that the way in which individuals interpret and structure their experiences determine in large how they think, feel, and act. The therapy involves teaching individuals a blend of verbal, visual, and behavioural modification techniques designed to help them to identify, reality-test, and correct their own distorted cognitions and the maladaptive beliefs underlying them. When a person is able to think and act more realistically and adaptively to here-and-now issues, problems, and situations, an amelioration in mood and overall functioning generally ensues. Thus, the primary goals of cognitive therapy are to:

• alleviate the emotional distress of patients by identifying and modifying their cognitive distortions, misinterpretations, self-defeating behaviors, underlying dysfunctional beliefs and maladaptive schemas.
• have patients learn to incorporate the therapeutic techniques of the therapist so that they can, in effect, become their own cognitive therapist; that is, they learn to alleviate their own negative moods by becoming trained to logically  examine and modify their dysfunctional cognitions themselves.

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Mervin Smucker (2016). The Nature of Traumatic vs. Non-Traumatic Memory.

The nature of traumatic memories has implications for how trauma-related material is accessed, confronted, and processed in psychotherapy.  Traumatic memories are generally encoded and accessed differently from non-traumatic or narrative memories.  In contrast to narrative memories, traumatic memories are more likely to:

• lack in verbal narrative and context;
• involve primary sensory stimuli (visual, kinesthetic, auditory)
• be encoded in the form of vivid sensations and images that are not accessible by linguistic means alone;
• be state dependent;
• be difficult to integrate via assimilation or accommodation because they are stored differently
• dissociated from conscious control
• “fixed” in their original form and remain unaltered by the passage of time.

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Mervin Smucker. A Stress Inoculation Training (SIT) Approach to Trauma and PTSD

Stress inoculation training focuses on teaching a traumatized individual to develop more effective coping skills with a particular focus on learning better problem-solving and anger control strategies, as well as self-calming, self-soothing, and relaxation techniques. Examples of techniques used in stress inoculation training include: early identification of anxiety-provoking cues and use of appropriate coping skills, thought-stopping, Beck/Ellis cognitive restructuring, guided self-dialogue, deep muscle relaxation plus breathing retraining, listening to relaxation and/or guided imagery tapes, biofeedback, social skills training, and distraction.

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Mervin Smucker Slides

Interested in Mervin Smucker Slides? Here on slideshare.net you find slides about IRRT and PTSD:
Mervin Smucker Slides

Mervin Smucker: Overcoming Spider Phobia

Mervin Smucker published a new Video on “Overcoming Spider Phobia”:
Watch now: Mervin Smucker: Overcoming Spider Phobia

Mervin Smucker (2016). Post-Imagery Rescripting SUDS Homework Form.

The Post-Imagery Rescripting SUDS Homework Form is designed to assist the client while listening to the audiotaped recording of an imagery rescripting session.

Post-Imagery Homework: Listen daily to audiotape of entire Imagery Rescripting session for one week. Record date and time of each audiotape listening session.

Record Subjective Units of Distress (SUDS: 0 – 100) at the beginning and end of listening to the audiotape. Also record the peak (highest) SUDS experienced while listening to the audiotape.

Self-administer the Post-Imagery Questionnaire (PIQ-A or PIQ-B) immediately after listening to the audiotape and record the total PIQ score.

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Mervin Smucker (2016). Meaning, Story and Psychotherapy-1.

Our minds crave stories to make meaning of events around us. If we cannot find available stories that produce a satisfactory explanation for a troubling event, our minds will create them—much as spiders spin webs—in an attempt to capture meaning. Many times these “self-created” stories draw on deeper narratives stemming from our perceptions of past life experiences, which we have internalized and of which we are often not fully aware. These deeper narratives have a profound effect on the cognitive and emotional templates we develop, which in turn can have a profound influence on our overall wellbeing, as well as on our worldview and how we interpret our lives.  Psychotherapy is, in part, about uncovering, confronting, and modifying the underlying stories we tell ourselves.

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Mervin Smucker (2015). Developing Positive Introjects

Because childhood trauma victims often have developed hostile introjects resulting from their traumatic experiences, having imaginary “therapeutic” conversations with important support people (e.g., a therapist, counselor, coach, teacher, mentor) can be useful in helping individuals to develop positive introjects that compete with and eventually replace the old negative, hostile introjects. The new positive introject is essentially a positive internal representation of the support person that, when visually activated or “summoned up”, can have a calming/soothing effect on the individual’s mood – especially during times of emotional distress – and which eventually becomes a permanent part of the individual’s schematic internal representation of self. The goal for trauma victims is not only to develop an enhanced ability to self-calm and self-soothe when feeling upset, but also to develop stronger “shock absorbers” so that they can better absorb the daily “knocks” of life without being thrown into a major crisis whenever they “go over a bump on the road

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Mervin Smucker (2015). Haiku Learning’s creative integration of Harmony, Simplicity, and Community to extend classroom learning.

Haiku Learning is about making teaching and learning online as easy as possible, whether it’s in a blended or virtual classroom.  Through the use of technology Haiku Learning provides a Learning Platform that is easy to use, easy on the eyes, and easy on the budget. Haiku’s modus operandi is to listen to the needs of teachers, students, and parents and to have an open exchange and sharing of ideas about how to best accomplish their goals, the result of which is a digital learning platform that evolves to do support teachers and students in an elegant, user-friendly format.  Haiku Learning partners with other service providers to ensure the best value to those who use Haiku.

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Mervin Smucker (2015). Frankl’s Views on the Human Quest for Meaning.

Viktor Frankl’s years of personal experience spent as a prisoner in the Nazi concentration camps, and later as a psychiatrist, led him to develop logotherapy – a meaning-oriented psychotherapy that helps individuals to create meaning and purpose out of suffering. From a logotherapy perspective, the quest for meaning to one’s own existence is viewed as the primary motivational force in humans, which may be discovered in three different ways: (1) through achievement, accomplishment or deeds (e.g., through one’s work or occupation), (2) by experiencing something that deeply touches us – e.g., beauty, goodness – or encountering another human being via love, (3) transforming a personal tragedy or crisis into a triumph (e.g., rising above oneself and changing oneself when faced with a hopeless situation that one cannot change).

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One picture is worth 10,000 words (Mervin Smucker 2015)

„One picture is worth 10,000 words“ (Ancient Chinese Proverb)

In traditional cognitive-behavioural therapy, a range of verbal techniques are used to identify, challenge, and modify critical thoughts and beliefs associated with negative affect. However, sometimes an individual’s memory of an upsetting event, as well as the beliefs and affect asossciated with the event, are encoded in imagery rather than in words. When this is the case, the skillful application of imagery techniques can provide unique access to an individual’s underlying cognitive structures in ways that verbal techniques cannot.

When individuals experience a trauma, not only are their emotions associated with the trauma at a more primitive level (primary process), but the meaning of the traumatic event remains at a primitive level as well. Thus, while the individual might attempt to gain a more rational perspective on the traumatic event, simply talking about the event or trying to evaluate it rationally (secondary process) is often not enough. In order for individuals to be liberated from their recurring, upsetting images, the images associated with the traumatic event often need to be „relived“ and re-experienced, then challenged and modified in several stages within a therapeutic setting.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Identifying and confronting maladaptive avoidance behaviors following stressful events (Mervin Smucker 2014)

It is sometimes difficult to identify all the various maladaptive avoidance behaviors that individuals may have developed in response to a stressful, upsetting, or traumatic event. Some persons may have been avoiding places, thoughts, situations and people for so long that they have adapted their lives so as not to cope with what makes them feel upset. While some avoidance behaviors may be relatively easy to identify, others will be more difficult. A person who has been raped in a park may develop avoidance to going to any park. Someone who has been in an airplane crash (or a near plane crash) may avoid flying. However, it is not uncommon to generalize fears and avoidance to cues that remind them of the trauma. For example after a plane accident, not only flying may be avoided but also traveling by bus, train, car or/and boat.

The following is an example of how a therapist or coach may briefly explain the rationale for identifying and confronting maladaptive avoidance behaviors to a potential client:

You have experienced a very stressful event, and it is normal to avoid certain situations, people, places or even thoughts that make you feel more distressed because they remind you of this upsetting event. However, one of the reasons why many of your fears are maintained is because of your maladaptive (irrational) avoidance behaviors, which do not allow you to test your unrealistic/catastrophic assumptions or interpretations that you may hold about yourself, others, or the world. It is important that you begin by identifying your maladaptive avoidance behaviors so that you can in turn challenge and modify them, as a means of overcoming and mastering your irrational fears that are interfering with your life. One way to begin this process of challenging your avoidance behaviors is to first write down your thoughts and feelings in situations which frighten you and which you want to avoid. It can be especially helpful to record your level of distress (discomfort) using a 0 to 10 scale, where 0 indicates no fear at all, and 10 indicates maximal fear. The next step then is to challenge yourself to stay in the situation that frightens you (assuming that objectively the situation itself is relatively safe) for extended periods of time, until your distress level begins to come down while you are still in the feared situation. Using this approach consistently and repeatedly may eventually lead to a significant reduction in your fear and avoidance and thereby improve significantly the quality of your life.

Copyright: Mervin Smucker (2014)

Smucker, Mervin (2013). The use of imagery as a healing agent in the processing of traumatic memories.

The characteristics of trauma and memory have implications for therapy with individuals who continue to be plagued by memories of distressing/traumatic events. Because trauma memories are encoded primarily in images, and the affective disturbance is embedded in the traumatic imagery, it follows that the utilization of imagery is essential as a healing agent in the processing of traumatic memories. Numerous studies have indeed found that while simply talking about traumatic events on a rational level may give some insight into why individuals continue to relive and re-experience negative images, it does not change the images per se. In order for the alleviation of these recurring, upsetting images to occur, it is necessary to visually re-activate and re-process them together with all of the associated thoughts and feelings. As such there are three critical elements that characterize the use of imagery as a healing agent with traumatic memories:

1. imagery is actively employed during cognitive recall, reprocessing, and restructuring;
2. the recurring traumatic imagery is a primary target for intervention;
3. the level of affective arousal during visual reliving is similar to what was experienced at the time of the traumatic event.

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Smucker, Mervin (2013). Different theories on what constitutes emotional processing of trauma.

There is considerable agreement among researchers and clinicians that post-traumatic stress symptoms develop as a result of inadequate emotional processing of a traumatic event and that these PTSD symptoms are alleviated once a degree of adequate cognitive and emotional processing has occurred. However, consensus has not yet been reached on exactly what constitutes adequate emotional processing of traumatic material or on what specific interventions can best facilitate such processing. Several different views on this topic are summarized here:

1. Rachman (1980), in his theory of emotional processing of fear, proposed that successful emotional processing can „be gauged from the person’s ability to talk about, see, listen to or be reminded of the emotional events without experiencing distress or disruptions“ (pp. 51-52).

2. Horowitz (1986) contends that the processing of traumatic material is complete once the cognitive schemata have been altered to successfully incorporate and integrate the new information. Until such processing occur, a „completion tendency“ causes unintegrated material (e.g. flashbacks and nightmares) to emerge repetitively. Successful processing of traumatic material is thus frequently delayed or prevented by means of denial or numbing which, according to Horowitz, are defense maneuvers designed to protect the victim from „information overload“.

3. Lang (1986) developed a theory of emotional processing in which traumatic, fear-inducing memories are thought to be encoded in a neural „network“ consisting of stimuli, responses, and the subjective meaning assigned to the stimulus and response data. Lang contended that vivid response imagery and affective involvement must be present both in accessing and altering a fear memory.

4. Foa & Kozak (1986) expanded Lang’s theory by placing greater emphasis on the cognitive meaning of the trauma and define emotional processing as „the modification of memory structure that underlie emotions.“ They concluded that recovery from PTSD requires activation of the entire „fear network“ – along with the associated affect – and incorporation of corrective information that is incompatible with traumatic elements of the fear structure.

Mervin Smucker

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Imagery Rescripting: A New Treatment for Survivors of Childhood Sexual Abuse Suffering From Posttraumatic Stress

Some theoretical foundations for you: Here is an article published in the Journal of Cognitive Psychotherapy: An International Quarterly, Volume 9, Number 1,1995 by Constance Dancu, Edna B. Foa, Jan L. Niederee and yours truly, Mervin Smucker PhD.

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Mervin Smucker on the IRRT method

Link to Mervin Smucker’s german homepage.

Smucker, Mervin (2013). Childhood Depression: Five major depressive factors in pre-adolescent children.

A factor analysis conducted with a large nonclinical sample of pre-adolescent children yielded the following five depressive constructs (factors) related to the syndrome of children depression, as measured by the Children’s Depression Inventory and reported in Psychological Assessment (1998, 10, 156-165):

Externalizing – is characterized by high loadings on items typically associated with externalizing, acting-out behaviors, such as misbehavior, disobedience, and aggression (boys scored significantly higher on this factor than girls).

Dysphoria – items that loaded highly on this factor were associated with sadness, crying spells, irritability, and loneliness (girls scored significantly higher on this factor than boys).

Self-Deprecation – is characterized by high loadings for items relating to self-hate, negative body image, and feeling unloved (girls scored significantly higher on this factor than boys).

School Problems – items that loaded highly on this factor related to difficulties in school work and performance in addition to low self-esteem and sleep disturbance (boys scored significantly higher on this factor than girls).

Social Problems – is characterized by high loadings on items that include social withdrawal, lack of friendships, and aggression as well as school dislike and anhedonia (boys scored significantly higher on this factor than girls).

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Smucker, Mervin (2013). Overcoming Depressive Moods, Lethargy and Inactivity by Significantly Increasing One’s Level of Activity.

Pessimistic thoughts and negative predictions about upcoming activities or events (e.g., „I would not enjoy myself“, „No one would talk to me“, „I would look like a social misfit“, „I’m too tired to do anything“) can result in a loss of interest in activities, low energy, chronic fatigue, and social isolation. The deeper one sinks into a state of lethargy and inactivity, the more depressed one feels, the less one feels like doing anything from which one could derive pleasure or a sense of accomplishment. This vicious cycle is propelled by negative thoughts that arise whenever one thinks about engaging in an activity.

One method for reversing this cycle of inactivity is to plan activities for each day and then to push onself to engage in these activities, regardless of how difficult this may be. The goal is not necessarily to accomplish everything on one’s activity schedule, but to become more externally-focused (and less internally-focused!) by increasing one’s level of physical activity. Clinical research on depression and activity clearly indicates that increasing one’s level of physical activity by itself is a significant mood elevator, a kind of behavioural anti-depressant. In short, the more active one is, the better one feels, and the better one feels, the more active one is likely to be.

Mervin Smucker on strategies to deal with depressions (German)

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Mervin Smucker on Twitter

Follow Mervin Smucker on Twitter.

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Mervin Smucker on YouTube

My YouTube channel, containing several educational videos on trauma therapy and the IRRT method (in German).

Free presentations on Slideshare

You can watch or download my free presentations here: Mervin Smucker on Slideshare

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Mervin Smucker on Pierre Janets clinical application of Imagery – a historical overview

A presentation about the early usage of imagery in trauma therapy.