Efficacy of imagery rescripting in non-fear emotions: A meta-analytic and systematic review

Imagery rescripting (ImR) is a therapeutic intervention aimed at modifying the emotional impact of distressing memories by altering the associated negative mental imagery. This systematic review and meta-analysis investigates the efficacy of ImR in reducing non-fear emotions such as anger, guilt, disgust, sadness, and shame across healthy populations and those diagnosed with various mental disorders. It was preregistered via PROSPERO and was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across multiple databases (PsycInfo; PSYNDEX; PubMed; and Web of Science), followed by rigorous screening procedures. Meta-analytic findings (k = 26, N = 1103) showed significant reductions across all five emotions, with moderate to large pooled effect sizes. Effects were significantly stronger for sadness, anger, and shame compared to disgust. No significant differences were found between ImR and other imagery-based interventions, such as imagery modification or positive imagery. While follow-up effects tended to be even larger than immediate post-intervention effects, this trend did not reach statistical significance. Moderator analyses indicated that ImR was particularly effective in populations with social anxiety disorder, health anxiety, or chronic pain. These findings support the transdiagnostic potential of ImR for reducing a range of non-fear negative emotions and highlight the need for more targeted research into mechanisms of change and emotion-specific applications.