Martijn van Teffelen

Imagery-enhanced cognitive restructuring: Protocol 103 5 IMAGERY-ENHANCED COGNITIVE RESTRUCTURING A brief overview of the I-CR intervention is presented in Figure 1. In short, the procedure includes three phases (i.e., rationale, recall and intervention). The procedure begins with a detailed explanation of the technique using a neutral example during the rationale phase. Then, in the recall phase, participants are asked to describe a recent event that triggered hostility (recall). While recalling the event, the strongest accompanying hostile belief is identified. Following this, participants are guided to relive this event based on the reliving part of the imagery interview described by Hackmann et al. (2000). After that, participants are asked to transform their hostile belief into a mental image. Subsequently, in the intervention phase, participants engage in a regular cognitive restructuring (CR) exercise, which is concluded by formulating a more helpful belief. Although many techniques can be used during cognitive restructuring (e.g., multidimensional evaluation or the pie-chart technique) we followed McEvoy and Saulsman (2014) by using ‘evidence gathering’ (Beck, 2011). Evidence gathering encourages participants to look for evidence in support of, or against a belief. Last, participants are asked to transform their helpful belief into a helpful (i.e., less hostile) mental image. The full version of the I-CR protocol is provided in Appendix A. Rationale Recall phase 1. Identifying hostile belief 2. Imagery phase 3. Hostile image transformation Intervention phase 1. Cognitive restructuring 2. Identifying helpful belief 3. Helpful image transformation time Figure 1 Intervention overview Rationale phase At the beginning of the session, we start with providing an explanation of the intervention. The rationale phase takes approximately 10 minutes. Participants were provided with an interactive example (see below) that is often used in CBT to explain the relationship between thoughts, feelings, and behavior. The I-CR procedure follows this example with the notable difference that it integrates parts of the imagery procedure, allowing participants to practice generating hostile and helpful mental images. Instructions were provided with a calm voice leaving sufficient time after each sentence, allowing participants to generate a clear image of the example. First, participants were asked to image they are lying in bed, waking up to a