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Feasibility of Imagery in Psychopathology

by Olga Luppino, Remco Van Der Wijngaart, Barbara Basile, Katia Tenore, and Robert Brockman

General Abstract:

Imagery is a powerful experiential technique that allows to access early memories through an emotional pathway, bypassing rational control mechanisms. Due to its powerful characteristic imagery plays a fundamental role in psychopathology as it allows accessing, healing, and changing the content of early childhood memories related to actual symptomatology.
In this symposium we will first present an overview of the development and working mechanisms of this technique, adding some practical tips and tricks. Further, specific applications of imagery will be provided within different psychopathological conditions (e.g., Eating Disorders and Obsessive-Compulsive Disorder), where imagery was used with different purposes, and in different settings (individual vs group context).

Presentation 1


Imagery: an overview of its development and working mechanisms

Presenter's Name:

Remco van der Wijngaart

General Abstract for Presentation 1:

Background and Objectives: Imagery rescripting has been described as a method of change in psychotherapy for more than a century. Over the last two decades, however, there has been a significant growth in the clinical and scientific interest in the applications and working mechanisms of this technique. This presentation gives an overview of this recent development and how imagery rescripting can be applied as a treatment method for various complaints, such as personality disorders or as a stand-alone treatment of anxiety and mood disorders.

Methods and conclusions: The presentation will have a clinical orientation, showing the different phases of the technique. It explains how imagery exercises can be used in the diagnostic phase, how the therapist will rescript images during the initial phase of treatment and how clients will learn to rewrite meaningful images from the past. Finally, it argues how imagery rescripting can be a method to prepare clients for future trigger situations. Based on the latest scientific research, practical tips and tricks to enhance the effectiveness of this powerful therapeutic tool.

Presentation 2


Childhood memories in Eating Disorders: an explorative study using Diagnostic Imagery

Presenter's Name:

Barbara Basile

General Abstract for Presentation2:

Background: Childhood trauma, particularly involving caregivers, has been related to Eating Disorders (ED). Nevertheless the content of such traumatic experiences remains largely unknown. Imagery is a powerful experiential technique that allows exploring early memories, bypassing cognitive control, which is particularly relevant in patients with ED. The first aim of this study was to investigate the content of negative early memories (e.g., emotions, unmet core needs and caregiver engagement) in adult anorectic and bulimic patients, applying diagnostic imagery technique. The second goal was to explore whether childhood episodes were associated to specific individual and parental maladaptive schemas, as assessed through self-report measures.

Method: So far, 29 female in-patients with a diagnosis of Anorexia (AN) or Bulimia Nervosa (BN) were recruited. All patients underwent diagnostic imagery exercises and completed measures in order to assess for ED severity, general levels of psychopathology, and individual and parental schemas. Descriptive and group analyses were performed.
Results: The content of each early memory was analyzed revealing that patients with ED reported unmet needs specifically related to the disconnection/rejection (e.g., mistrust/abuse, emotional deprivation) and hypervigilance/ inhibition (e.g., emotional inhibition) domains. Patients’ childhood episodes were characterized by sadness and fear emotions, being associated with the need for safety/protection and emotional expression. Differences between anorectic and bulimic patients’ memories, and their association with self-report measures were also examined.

Conclusion: This study aimed at investigating the content of childhood memories in patients suffering from ED, undergoing diagnostic imagery technique. Patients’ early episodes were characterized by traumatic experiences involving mistrust/abuse, emotional deprivation and emotional inhibition. Future studies should assess for the role of such contents in ED treatment, validating imagery with rescripting as a therapeutic tool to fulfill unmet core needs.

Presentation 3


Imagery rescripting on guilt-inducing memories in OCD: A single case series study

Presenter's Name:

Katia Tenore

General Abstract for Presentation 3:

Background and Objectives: Imagery with Rescripting (ImRS) is an experiential technique that has been investigated across a wide range of psychopathological conditions and has been found to be effective also as a stand-alone treatment in some disorders. ImRS addresses aversive memories, which are related to current problems. Memories of patients with OCD are characterised by guilt-inducing reproaches and criticism plays an important role in obsessive-compulsive disorder (OCD), and obsessive behaviours have been considered as childhood strategies to avoid criticism. Starting from these assumptions, the aim of this study was to check whether intervening on childhood memories of guilt-inducing reproaches could reduce current OCD symptoms.

Methods: After baseline monitoring, 18 OCD patients underwent three sessions of ImRS, followed by three months follow-up. Indexes of OCD, depression, anxiety, and fear of guilt were collected across the different time points.
Results: Patients showed a significant decrease in OCD symptoms, at 3 months follow-up. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) mean score changed from 25.94 to 14.11, with 13 out of 18 patients reporting a reliable improvement (RCI = 9.94), and with 10 reporting a clinically significant change. Reliable changes were not observed for depression and anxiety rates. Moreover, patients with the highest change in fear of guilt across treatment showed a higher improvement in the obsessive symptoms, compared to those with a low change in guilt.

Conclusions: Our findings suggest that an ImRS intervention focusing on patients’ blame and reproach early experiences considerably reduced OCD symptomatology. Data supports the role of ImRS in reducing clinical symptoms without the need for a direct intervention on active clinical symptoms. Our findings also support previous cognitive models on OCD, highlighting the role of guilt-related early life experiences on vulnerability to OCD.

Presentation 4


Group Schema Therapy for Eating Disorders: Experiential Methods & Clinical Outcomes

Presenter's Name:

Robert Brockman

General Abstract for Presentation 4:

Eating disorder (ED) treatment is complicated by high rates of chronicity, comorbidity, complex personality traits and client dropout. Given these complexities Schema Therapy (ST) has been identified as a suitable treatment option. The focus of this paper will be to present preliminary outcome findings from a pilot study on group ST for the treatment EDs, with an emphasis on describing the experiential techniques utilised, and in particular the use of imagery rescripting in the context of group-work.

Method. Participants attended 90-minute weekly group sessions over 25 weeks. Groups consisted of six to eight participants and were facilitated by two psychologists, at least one of who was trained in ST. Measures assessed ED symptoms, schemas, schema modes, quality of life, self-compassion and psychological distress.
Discussion. Overall, the findings from the current study support the use of group ST for the treatment of EDs. It is expected that lengthier treatment is needed for reduction in schema severity. Given the low participant dropout rate compared with other treatments, this study has important treatment implications for the suitability of ST for the treatment of ED.

We know that using experiential work in Schema therapy is vital to helping the client have a corrective emotional experience and therefore, critical to the success of Schema therapy. Moreover,  perhaps you are one of the many therapists who find it difficult actually to DO it! So if you have wished you were more confident and had some idea of the words and actions you could use to DO experiential work with clients rather than just talk about it, this workshop is for you. You will watch two therapists do several role-plays of specific ‘BRIDGES": taking a client from dialogue to imagery or chair work. You will then have opportunities to practice those skills. Improvisation exercises will also be presented, which are used to encourage creativity and being present with the client. 

The workshop will also address the need of therapists who work with different models but are interested in ST and have limited exposure to learning this aspect of the therapy. 

Level of Experience Required for Participants: 


About the Presenters:

Olga Luppino: 

Psychologist, CBT psychotherapist, forensic psychologist, trainer and supervisor in Schema Therapy. Since 2012 working in Private Practice and teaching at School of Cognitive Psychotherapy (SPC) and Cognitive Psychological Association (APC) in Rome-Italy.Author of book chapters and scientific publications on Schema Therapy, OCD and other psychopathological conditions

Remco Van Der Wijngaart: 

Remco van der Wijngaart is a psychotherapist and healthcare psychologist. For over 20 years he worked in the academic department of an outpatient mental health institution. As a therapist he participated in numerous treatment studies into anxiety, somatic symptom and eating disorders, as well as personality disorders. In a first treatment study into the effectiveness of schema therapy for borderline personality disorder, he was trained and supervised in imagery rescripting by Jeffrey Young, the founder of schema therapy. Remco has his own independent practice for psychotherapy in Maastricht. Together with others, he developed various audio-visual productions including Fine Tuning Imagery Rescripting; 35 scenes showing imagery rescripting in all its facets

Barbara Basile: 

Barbara Basile, PhD in Neuropsychology, Psychologist/ CBT Psychotherapist, Trainer and Supervisor in Schema Therapy at the Institute “Dialogo in Schema Therapy”, Frankfurt (Germany).Teaching at the School of Cognitive Psychotherapy (SPC) and Cognitive Psychology Association (APC) in Italy. Wrote book chapters on OCD, ED, depression and trauma. Author of many scientific publications on Schema Therapy, Emotional Processing, and Neuroimaging in OCD and other psychopathological conditions

Katia Tenore:

Katia Tenore, clinical psychologist, teacher at School of Cognitive Psychotherapy (SPC) and Cognitive Psychology Association (APC),Trainer and Supervisor in Schema Therapy at the Institute “Dialogo in Schema Therapy”, Frankfurt (Germany),teacher member of the Italian Society of behavioral and cognitive therapy (SITCC). Author of many academic publications on OCD and Schema Therpy

Robert Brockman: 

Robert Brockman is a Clinical Psychologist and senior research fellow at the Institute for Positive Psychology and Education,Australian Catholic University. He is alsoprinciple Clinical Psychologist atSchema Therapy Sydney,a Sydneybased psychology clinicfocused on the practice and dissemination of schema therapy.His clinical practice and research has largely focused on the applicability of schema therapy to novel treatment populations (e.g. Eating Disorders, GAD, Psychotic Symptoms), and the integration of 3rd Wave Therapy techniques into Schema Therapy practice

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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