The role of imagery rescripting as an adjunct treatment for disordered eating

Author: Yuan Zhou

Zhou, Yuan, 2021 The role of imagery rescripting as an adjunct treatment for disordered eating, Flinders University, College of Education, Psychology and Social Work

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Imagery rescripting is a treatment adjunct that seeks to rescript a negative memory or image in order to reduce the current impact of the negative emotional valence of that memory. Research suggests that imagery rescripting can be helpful in reducing symptoms in a variety of mental disorders such as posttraumatic stress disorder and social anxiety disorder. To date, research of the use of imagery rescripting in treating disordered eating has been scarce. Hence, this research aims to fill the gap in the literature by examining the efficacy of using imagery rescripting in treating disordered eating.

Study 1 (N = 130) and 2 (N = 100) were conducted among young females at risk of disordered eating. Study 1 aimed to understand whether there are differential benefits to using general (i.e., rescripting a general negative event that is not specific to disordered eating) versus body (i.e., rescripting a negative event specific to one’s perception of weight/shape) imagery rescripting. A comparison of general versus body imagery rescripting with psychoeducation and control suggested that both imagery rescripting approaches helped reduced disordered eating and increase body image flexibility. However, their respective effect size changes were smaller than psychoeducation. Additionally, the general imagery rescripting helped reduce dysfunctional attitudes, whereas body imagery rescripting helped increase self-compassion and decrease fear of self-compassion.

Study 2 then investigated whether combining both psychoeducation and body imagery rescripting can lead to a larger effect than when approaches were used alone (COVID-19 and associated lockdowns occurred during the conduct of this study). Findings from Study 2 suggest that combination of the approaches did not necessarily reduce both disordered eating and self-compassion. However, the combination approach did help improve body image flexibility during COVID.

Study 3 (N = 12) was a pilot study conducted among day patients with an eating disorder to investigate the feasibility of using imagery rescripting as an adjunct to treatment as usual. Participants either received treatment as usual or treatment as usual plus imagery rescripting provided during first week of treatment. Results suggest that imagery rescripting seemed to have slowed recovery for patients in terms of their readiness, depression, stress, psychological distress, disordered eating and body image flexibility. However, those who received imagery rescripting demonstrated significant reduction in dysfunctional attitudes compared to those in treatment as usual.

Finally, Study 4 (N = 121) aims to understand whom psychoeducation or imagery rescripting benefits (i.e., moderator analyses). Results suggest that if the treatment goal is to reduce disordered eating, psychoeducation is more likely to benefit those who had higher body image flexibility at baseline, whereas imagery rescripting is more likely to benefit those who reported higher self-compassion or lower body image flexibility at baseline. If the treatment goal is to enhance self-compassion, body image rescripting is the preferred approach compared to psychoeducation regardless of moderator levels.

In summary, findings from this thesis suggest imagery rescripting has promise in reducing disordered eating and enhancing self-compassion among those at risk of disordered eating. More randomized controlled trials are needed to examine the efficacy of imagery rescripting as a treatment adjunct in a clinical setting, developing a better understanding of how this can best work for people being treated for an eating disorder.

Keywords: Imagery rescripting, Disordered eating, Eating Disorders, Self-compassion, Psychoeducation

Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Education, Psychology and Social Work
Supervisor: Tracey Wade