Is it magic? An exploratory randomized controlled trial comparing imagery rescripting and cognitive restructuring in the treatment of depression

Olivia Y. T. MA, Barbara C. Y. LO

Research output: Journal PublicationsJournal Article (refereed)peer-review

3 Citations (Scopus)


Background and objectives
To investigate whether working with intrusive images and the use of imagery processes would be beneficial to treating depression, an imagery-based intervention (imagery rescripting, IR) was compared with a more commonly used verbal-based technique (cognitive restructuring, CR). The study aimed not only to test the efficacy of IR as a brief modular treatment for depression, but to explore whether such experiential use of imagery would alleviate the abstract-evaluative, verbal processes of rumination and worry.

Forty-one participants diagnosed with clinical depression and who also reported intrusive images underwent one assessment session of imagery properties before they were randomly assigned to an IR group or to an active control group of CR. They then received three weekly sessions of treatment, and outcomes were measured before and after treatment, as well as at two-month follow-up.

The results showed that IR was equally if not more effective than CR in alleviating depression. Significant differential reductions in rumination, worry and experiential avoidance between treatments added support to the technique's experiential nature, and possibly, a defusing out of an abstract-evaluative mode of processing.

Only self-report measures were used, with a small number of treatment sessions by one clinician.

The findings support the therapeutic potential of imagery modalities in the treatment of depression, which compared to cognitive restructuring, appear to bring about more significant emotional change with time (clinical trial registered at the Joint CUHK-NTEC CREC Ref. No. 2015.458).
Original languageEnglish
Article number101721
JournalJournal of Behavior Therapy and Experimental Psychiatry
Early online date20 Dec 2021
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
Special gratitude is expressed to all participants in this study, who courageously shared their haunting imagery, as well as Dr. Michelle Deng for providing statistical consultation. This study did not receive any external funding.

Publisher Copyright:
© 2021

Copyright © 2021. Published by Elsevier Ltd.


  • Cognitive restructuring
  • Depression
  • Experiential avoidance
  • Imagery rescripting
  • Intrusive imagery
  • Repetitive negative thinking


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