Brief imagery rescripting is equivalent to imaginal exposure in improving response to worry images among high worry...

Generalized anxiety disorder is characterised by aversive mental images of feared outcomes. This study investigated whether a single session of imagery rescripting would produce greater reductions in anxious response, threat appraisals, and intrusive images regarding a feared event than imaginal exposure among individuals high in trait worry.

Undergraduate participants (N = 89) high in trait worry attended a 45-min video-call session with a psychologist in which they identified a worry image, rated their anxiety, worry, threat appraisals, and imagery-related distress, and were randomised to 15-min therapist-guided imagery rescripting or imaginal exposure. Imagery rescripting involved rewriting the worry image to achieve a positive outcome. Participants were asked to listen to a recording of the exercise on three days and provided outcome ratings after 1 week.

Linear mixed effect modelling revealed both conditions produced medium-to-large decreases in worry, anxiety, threat appraisals, and frequency and distress associated with worry images between baseline and 1-week post-intervention (ds = 0.54-0.2.33). Results were comparable between conditions, and the study hypotheses predicting that imagery rescripting would produce greater reductions in outcome variables than imaginal exposure were not supported.

A novel, future-oriented imagery rescripting intervention produced comparable effects to imaginal exposure in improving participants' anxious response, threat appraisals, and intrusive imagery regarding their worries 1 week later. However, the intervention was not superior to imaginal exposure as predicted. Future studies may further investigate longer term outcomes and mechanisms of change of imagery rescripting for worry, and apply imagery rescripting with clinical samples and comparison to additional comparator conditions.