TOPLINE

Adults with persistent adjustment disorder or major depressive disorder (MDD) who received six weekly sessions of videoconference-based imagery rescripting (vImRs) had a greater reduction in intrusive memory-related distress as well as in depressive and anxiety symptoms than those receiving treatment as usual (TAU) alone, a trial showed.

METHODOLOGY

• A randomized controlled trial conducted in Japan (2023-2024) included 30 adults aged 21-62 years who had distressing intrusive memories related to stressful life events. 
• Participants met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria for persistent adjustment disorder (n = 18) or MDD (n = 12) and had Impact of Event Scale-Revised (IES-R) scores ≥ 25 despite previous or ongoing antidepressant treatment.
• Participants received vImRs plus TAU (n = 14; mean age, 38.8 years; 28.6% men) or TAU alone (n = 16; mean age, 38.6 years; 31.3% men).
• The vImRs intervention consisted of 6 weekly 50-minute videoconference sessions. during which participants recounted an intrusive memory as if reliving it, revisited it as an outside observer, then reimagined the scene with their present-day self or a supportive figure stepping in to foster safety, mastery, or compassion.
• Researchers primarily assessed changes in IES-R total scores from baseline to week 6. Secondary outcomes were changes in depressive symptoms, measured using the Beck Depression Inventory-II (BDI-II) and Patient Health Questionnaire-9 (PHQ-9) scores; anxiety symptoms, measured using Generalized Anxiety Disorder-7 (GAD-7) scores; and quality of life, measured using EuroQol-5 Dimension-5 Level scores. Core beliefs about self and others and prosocial behavior were measured using the Brief Core Schema Scale and Strengths and Difficulties Questionnaire, respectively.

TAKEAWAY

• At week 6, a significantly larger decline in IES-R total score was observed in the vImRs group than in the TAU-alone group (between-group adjusted mean difference, -20.59; P < .001). Scores on each IES-R subscale (intrusion, avoidance, and hyperarousal) also fell significantly more with vImRs than with TAU alone (all P < .05).
• At week 6, half of participants in the vImRs group scored ≤ 24 on IES-R, indicating the absence of clinically significant stressor-related symptoms, compared with none in the TAU-alone group; 42.9% of the vImRs group achieved at least a 50% reduction in IES-R score compared with 6.3% in the TAU-alone group.
• The mean BDI-II score in the vImRs group reduced from 27.14 (moderate depression) at baseline to 17.85 (mild depression) at week 6, a significantly greater improvement than with TAU alone (between-group adjusted mean difference, 7.30; P = .013).
• PHQ-9 (between-group adjusted mean difference, -4.29; P = .011) and GAD-7 (between-group adjusted mean difference, -4.98; P = .001) scores reduced significantly at week 6 in the vImRs group compared with the TAU alone group, with both scores in the vImRs group reducing below the clinically meaningful cutoff of 10 points at week 6. No significant between-group differences were observed in quality of life, core schema beliefs, or prosocial behavior.

IN PRACTICE

"These findings suggest that vImRs may be a feasible and accessible option for targeting intrusive memory-related distress in adults with persistent adjustment disorder or major depressive disorder," the investigators wrote.

SOURCE

The study was led by Misa Akutsu, Graduate School of Medicine, Chiba University, Chiba, Japan. It was published online on October 1 in the Journal of Psychiatric Research.

LIMITATIONS

The study was limited by its small sample size, single-site and open-label design, lack of an active psychological control, diagnostic heterogeneity, exclusion of patients with posttraumatic stress disorder, reliance on self-report data, and the absence of follow-up evaluation. 

DISCLOSURES

The study was funded by the Japan Society for the Promotion of Science. The investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.