1 Imagery-Based Cognitive Therapy for Trauma and PTSD

2 Cognitive Therapy Model (Beck) Mental Activity consists of • Words or Phrases Thoughts  verbal cognitions (e.g. depression) • Mental Pictures Images  visual cognitions (e.g. anxiety)

3 Earliest CBT Applications of Imagery Beck et. al. (1985) Imagery Modification techniques used to activate, challenge, and modify distressing images - Repetition, De-catastrophization, Exaggeration of negative images - Time Projection - Imaginal Cognitive Flooding - Substituting Positive Imagery - Coping Imagery - Goal Rehearsal Imagery

4 Cognitive Therapy (Beck) • If affective disturbance is encoded verbally, use verbal techniques for cognitive restructuring • If affective disturbance is embedded in imagery, use imagery techniques for cognitive restructuring

5 IMAGERY (when skillfully applied) • Can access a client’s affective distress and related underlying cognitive structures not previously available for scrutiny • Can enable these structures to be identified, challenged, and modified in new ways

6 Verbal Processing of Distressing Imagery (outside reliving) • Often less effective • Too intellectual, superficial • Doesn’t really get at the deep stuff “I understand it my head, but I don’t feel it in my gut”

Imagery-Based Cognitive Therapy with Trauma • involves varying amounts of – visual imagery – exposure – cognitive restructuring • focus on emotional and cognitive processing of trauma-related material

Targeted Trauma-Related Cognitions in Imagery-based Cognitive Therapy • Intrusive memories, recurring flashbacks, repetitive nightmares • Maladaptive trauma-related beliefs • Avoidance behaviors • Maladaptive self-calming / affective self-regulation strategies

Empirically-Supported Imagery-based Cognitive Treatments for PTSD • Prolonged Exposure (PE) • Imagery Rescripting and Reprocessing Therapy (IRRT) • Cognitive Restructuring within Reliving