Arnoud Arntz
Arnoud Arntz is an Professor Emeritus of Clinical Psychology at the University of Amsterdam. He contributed to the development and empirical validation of Schema Therapy and Imagery Rescripting. He is a Honorary Scientific Advisor of the ISST.
Change mechanisms of Imagery Rescripting compared with EMDR
Co-presented with Sophie Rameckers
Abstract
Imagery Rescripting (ImRs) and EMDR are two effective treatments for Posttraumatic Stress Disorder (PTSD). It is assumed that with EMDR, taxing the working memory by the double task of imagining the trauma and following the moving fingers decreases the vividness and distress of traumatic memories. In ImRs, rescripting is hypothesised to decrease the core beliefs and memories-related distress. The current study investigated whether the changes in both treatments work through these mechanisms. For distress, it was explored whether this was stronger for EMDR or ImRs. The current study is part of a multicentre trial in which 155 patients with childhood-related PTSD were offered up to 12 sessions of EMDR or ImRs. During the Imagination Interview, patients imagined the most severe event of the index trauma, and rated the associated vividness, distress and credibility of the core belief. The severity of PTSD was measured using the IES-R (self-report) and CAPS-5 (clinical interview). To test the hypotheses about change mechanisms mixed regression and Granger causality were used. The results showed that the relationship between changes in distress and core beliefs, and severity of PTSD symptoms at the next (vs previous) measurement time point were stronger for ImRs than for EMDR. No evidence of changes in vividness as an underlying change mechanism was found for EMDR. The findings suggest that during ImRs, changes in distress and core beliefs are underlying mechanisms of action. Despite the fact that these changes did not appear to be mechanisms of action in EMDR, both treatments were about equally effective. This study is the first to directly compare the underlying mechanisms of EMDR and ImRs. Understanding more about these mechanisms is important to improve treatments and may allow us to combine effective components of treatments or offer treatments according to specific symptom profiles.
Target Audience
Beginners, intermediate, and advanced-level participants
The Healthy Adult Mode: Current state of affairs in research and clinical practice
In Jeffrey Young’s initial thinking the Healthy Adult mode was primarily an internalization of the therapist’s reparenting behaviors, notably the ability to sooth the vulnerable child mode, set limits to the externalizing child modes, and combat punitive/demanding parent modes. Hence, its function seemed primarily regulation of dysfunctional schema modes. Interestingly, while working with patients with severe personality problems, therapists discovered two things. First, the reduction of strength and frequency of vulnerable child externalizing child, and combat punitive/demanding parent modes seemed to involve not only internalized reparenting actions towards these modes – rather the modes themselves changed. Second, the Healthy Adult mode seemed important not only to cope in a functional way with activation of dysfunctional modes, but also in developing functional ways to get “normal” human needs met. Similarly, empirical research indicated that the Healthy Adult mode is generally not very central in the network of dysfunctional modes, indicating that the Healthy Adult mode is not a simple opposite of dysfunctional modes. Moreover, research into mechanisms of change during treatment indicated that the increases in the Healthy Adult mode, next to decreases in the Vulnerable Child mode, are pivotal in change in personality pathology. Hence, research also indicates that the function of the Healthy Adult mode is wider than self-regulation of dysfunctional modes. These observations remind of the fundamental findings that positive emotions are not the opposite of negative emotions, and that happiness is not the opposite of sadness. In this presentation I will share research, both clinical and qualitative, as well as clinical observations that help to understand how the Healthy Adult mode is of importance in the recovery process during therapy; especially if we aim not only a reduction of psychopathology, but also a development of a fulfilling life. I will argue that development of an Healthy Adult mode is essential for issues such as making healthy choices, especially in the later phases of therapy, particularly when this mode is weakly developed. Despite its importance, I will also argue against a treatment mainly focusing on the Healthy Adult mode.