Martijn van Teffelen

Chapter 5 102 techniques in CBT are more challenging for hostility than, for example, for anxiety disorders (DiGiuseppe et al., 1994). Hostile thoughts are shown to focus more on fairness, blaming, justification and cathartic expression rather than the interpretation of facts (DiGiuseppe et al., 1994), making the identification of hostile interpretation biases that underlie these thoughts more difficult. The challenging nature of hostility treatment moved us to explore how to amplify the effectiveness of cognitive interventions for hostility. In our exploration, it seemed that enrichment with imagery could be a valuable addition in hostility treatment. The theoretical basis for enriching cognitive treatment with imagery is rooted in mounting evidence that images generate a stronger emotional response than only verbal-linguistic representations of emotions (Holmes & Mathews, 2010; Pearson et al., 2015).This seems to hold for anger too. That is, a qualitative analysis of emotions and thoughts reported during the recall of intrusive mental images demonstrates that recalling intrusive mental images positively relates to experiencing a variety of affect, including anger (Holmes et al., 2005). In other words, evidence suggests that the underlying mechanism for mental imagery is that of promoting emotional processing. That being said, the idea of integrating imagery in CBT treatment is not new. Edwards (1990) already provided a description of an empirically untested intervention that integrated imagery techniques with cognitive therapy. A decade later, mental imagery was integrated in existing CBT-focused interventions, such as imagery exposure for PTSD (Ehlers et al., 2005), imagery rescripting for negative childhood memories (Arntz & Weertman, 1999; Smucker et al., 1995), and CBT for social anxiety disorder (e.g., McEvoy et al., 2015; McEvoy & Saulsman, 2014). Pioneering work by McEvoy and Saulsman (2014) on imagery enriched CBT included a cognitive restructuring (CR) procedure and seemed a suitable candidate for challenging hostile beliefs. We decided to tailor this procedure to a CR procedure for hostile beliefs and most importantly, to test whether this added effectiveness compared to active control and traditional CR. Indeed, I-CR was more efficacious and sustainable over time in reducing hostile beliefs and aggressive inclinations (Van Teffelen et al., under revision). In the current paper we will share the details of this CR procedure for hostility illustrated with examples of participants of this study and discuss difficulties and further challenges for hostility treatment. In sum, I-CR seems a promising novel technique for reducing hostile beliefs in transdiagnostic hostility. In the present article, we describe in detail an I-CR procedure for transdiagnostic hostility that aims at adapting hostile beliefs that occur in patients’ everyday situations. I-CR is therefore intended for patients who experience hostility on a regular basis. The target population includes patients who hold a general tendency to interpret situations in a hostile way, but also patients who specifically struggle with hostility in specific situations.