Using Imagery Rescripting to Treat Posttraumatic Stress Disorder in Refugees: A Case Study

Abstract

Posttraumatic stress disorder (PTSD) is among the most prevalent mental disorders in refugees. Imagery Rescripting (ImRs) has gained growing interest as an innovative and effective treatment for several disorders, including PTSD. The technique aims to change the meaning of traumatic memories by asking the patient to imagine a different outcome of a particular memory. As ImRs focuses on meeting individual needs, it can be tailored to patients with different cultural and religious backgrounds and may be a promising intervention for refugees. This case study therefore illustrates the application and challenges of ImRs as a stand-alone treatment for a refugee patient. The patient had experienced multiple traumatic events during flight and met full criteria for PTSD according to the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; total score of 32). The treatment was conducted with the assistance of an interpreter and consisted of 12 100-min sessions, during which the most distressing traumatic events were rescripted. Cognitive restructuring and imagery modification—another imagery-based intervention showing some similarities with ImRs—was applied as an additional intervention to address feelings of contamination. At the end of treatment, symptoms were reduced and the patient no longer met diagnostic criteria for PTSD (CAPS-5 total score of 25); however, only change in self-reported symptoms reached clinical significance. Challenges during treatment included frequent dissociative symptoms that were managed by instructing the patient to use antidissociative skills during ImRs. Findings corroborate ImRs as a feasible approach for the treatment of PTSD in patients with complex trauma histories.