Underlying mechanisms of emotional and posttraumatic symptom changes following imagery rescripting and imaginal exposure: Results of an experimental analogue study

Background: Imagery rescripting (ImRs) and imaginal exposure (IE) are both effective for treating distressing memories. ImRs is thought to promote mastery and positive memory revaluation, while emotion tolerance is seen as a key factor in exposure models. This study investigated emotional responses and PTSD analogue symptoms in an analogue design and explored mastery and emotion tolerance as potential mediators. Methods: 154 participants (46.8% male) selected a distressing autobiographical event and received a brief analogue of ImRs or IE, delivered via pre-recorded audio instructions, or a control condition. Emotional responses, distress, PTSD analogue symptoms, sense of mastery and emotion tolerance were assessed before and after memory reactivation and post-intervention. Results: Mixed-effects analysis indicated unique positive changes in self-conscious and positive emotions as well as sense of mastery following ImRs – but only in males, whereas females improved across all conditions. In contrast, IE led to significantly different increases in anger and memory distress. Changes in fear, distress, PTSD analogue symptoms and emotion tolerance did not differ across conditions. Multiple parallel mediation analyses yielded that mastery, but not tolerance, mediated positive emotional shifts in ImRs. There was no evidence to support emotion tolerance as a mechanism of change in IE. Conclusion: Our results cautiously support the hypothesis that ImRs leads to positive memory revaluation but not that emotion tolerance mediates changes in IE. We discuss possible explanations for the gender differences and point out shortcomings in procedure and measurement that may explain the unexpected findings in IE.