Imagery Rescripting of Painful Memories in Social Anxiety Disorder: A Qualitative Analysis of Needs Fulfillment and Memory Updating

Background: Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets autobiographical memories of painful past events. IR is thought to promote needs fulfillment and memory updating by guiding patients to change unhelpful schema through addressing the needs of the younger self within the memory. Methods: Qualitative coding was used to examine the features of clinically relevant strategies enacted during IR to fulfill needs and update memories in 14 individuals with SAD. Results: Participants typically enacted multiple strategies to address the needs of the younger self during rescripting, with compassionate and assertive strategies used more frequently than avoidance. Most strategies were practically feasible and enacted by the imagined self rather than imagined others, with the majority of patients achieving a strong degree of needs fulfillment, especially when strategies were consistent with identified needs. Participants’ reflections on how their memories have changed are provided from follow-up data collected 6 months post-intervention. Themes of self-reappraisal, self-compassion, and self-distancing are highlighted as potentially important for facilitating needs fulfilment and memory updating. Conclusions: Findings illuminate the clinical processes through which socially traumatic memories in SAD may be updated in IR by guiding patients to fulfill their needs and promote improved emotional health.