Imagery rescripting as an adjunct clinical intervention for obsessive compulsive disorder

Abstract

Novel adjunct psychological techniques are needed for the large number of patients with OCD who remain symptomatic despite the effective implementation of standard evidence-based treatments. The aim of this study was to examine the efficacy of imagery rescripting (ImRs), an established technique for the treatment of traumatic stress, as a treatment for OCD symptoms that were not responsive to standard exposure and response prevention (ERP). Thirteen patients completed a baseline assessment followed by a control intervention that involved discussion of an aversive memory linked with the onset of OCD symptoms. Treatment then involved provision of 1-6 ImRs sessions; ImRs continued until patients achieved a 35% reduction in symptoms, as measured using the Y-BOCS one week after each treatment. Patients were followed up one and three months after the treatment completion. Twelve out of thirteen patients achieved ≥35% improvement in Y-BOCS. Of these patients, six required only a single ImRs session, while the remaining six patients required 2-5 ImRs sessions to achieve a clinically significant change. Lower baseline Y-BOCS predicted improvement after a single treatment session. ImRs may be a useful adjunct for treatment-resistant OCD associated with past aversive experiences, especially when symptomatology remains within the mild-moderate range after standard ERP.

Keywords: Cognitive behavior therapy; Exposure response prevention therapy (ERP); Imagery rescripting; Obsessive compulsive disorder (OCD).