Martijn van Teffelen

Imagery-enhanced cognitive restructuring: Protocol 105 5 JOHN: “So I have this small table in the middle of the room, and I can see my cat chasing a fly. He gets excited. He’s jumping across a chair but then he crashes into the table and a vase falls off and breaks.” THERAPIST: “Very good. Now I want to ask you to rewind ‘the tape’ and go back to the moment you are sleeping in bed. When you wake up, I want you to clearly imagine seeing the image of your cat crashing into the table whilst chasing a fly. Okay? Now, you are in your bed at night. Feel the bed you are lying on. Feel your head on the pillow. Feel the blanket around you. Feel the matrass. Hear the nightly sounds in your room. Suddenly, a loud noise wakes you up in the middle of the night. Can you see the image of your cat? What do you feel now? How do you respond in the image? JOHN: “Yea I can see it clearly. I do feel calmer because it happened more often. I turn around and fall asleep again.” THERAPIST: “Alright you can open your eyes again. I would like to discuss the two images you have just generated. What strikes you? What is the difference? JOHN: “Well, the second time with the cat was a lot less disturbing.” THERAPIST: Indeed, John, the difference shows that it is not the situation itself (the loud noise), but our interpretation of the situation generated in an image (the burglar or the cat) that influences how we feel and behave. In the technique we’re using we will question the thoughts from which these images originate.” Recall phase Identifying hostile belief After explaining the rationale of the intervention, we asked our participants to recall an anger-provoking autobiographical event 1 that still makes them angry at present. Typically, the entire recall phase took about 20 minutes. To determine the hostile belief, we asked participants: “What is the worst thing about the event? What does this say about the intention of the other person involved?” We then encouraged participants to summarize the meaning of the event into one sentence. Based on our clinical experience and experiences in the pilot phase of the study we decided that the following elements had to be included into this hostile belief: an aggressor, a victim, a harmful behavior, and an intention. For example: “My mother (i.e., the aggressor) said something nasty to my friend 1 We asked for events that provoked anger (as opposed to hostile beliefs), as we thought that the concept of ‘anger’ was easier to grasp for our participants.