Abstract
Innovation is urgently needed for school-based early interventions for depression. Imagery rescripting for aversive memories has been shown to be a valuable therapeutic approach in adults. Yet it is rarely applied to young people or to depression. This is surprising given that intrusive images of aversive memories are implicated in the development and maintenance of depression. We review the literature and describe the co-development of an imagery rescripting protocol for young people (age 16–18) with high symptoms of depression. To contextualize and illustrate this approach, we identify three themes of negative images emerging from the 37 participants who completed imagery rescripting and provide a detailed case example for each theme. The identified themes are failure, interpersonal adversity, and family conflict or disruption. Given that there is some therapist concern about using imagery rescripting, we highlight any reported negative consequences of engaging in imagery rescripting. We propose that imagery rescripting is an acceptable and potentially effective tool for early intervention in depression, which is significantly underutilized in current practice.
Highlights
Impairing symptoms of depression are present in 5% of young people (YP) aged 17–19 [1]
We have aimed to provide a comprehensive account of imagery rescripting (IR) for adolescent depression
We have described the dearth of literature in young people, the developmental adaptations and stages in co-designing our protocol, three key themes of negative images with case examples, and that there were no reported negative consequences of IR
Summary
Impairing symptoms of depression are present in 5% of young people (YP) aged 17–19 [1]. We review the types of images reported by 37 participants, identifying key themes, each with a case example. Exclusion criteria were: diagnosis of intellectual disability or significant head injury, neurological disorder or epilepsy; unable to fluently communicate in spoken English; unable to give informed consent; factors contra-indicating imagery rescripting (e.g., high levels of current risk); currently receiving another psychological intervention (including school counseling); experiencing distressing psychotic symptoms or depressed in the postnatal period (participants with comorbid physical illness or non-psychotic disorders, such as anxiety, were not excluded). One young person (age 16, female, White British) spoke about being bullied and spoke about one powerful intrusive image This was of the group laughing at her in the classroom, and she left and closed the door (which shut loudly). It is important to have supervision structures in place, including time to debrief on difficult sessions
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