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According to attachment theory, psychotherapy is a process of reappraising and reworking inadequate, dysfunctional, outdated schematic models of the self and attachment figures (Bowlby 1988). It is the task of the therapist to create a reliable and secure base from which patients may begin to explore their internal schematic attachments. Similarly, in IRRT [Imagery Rescripting and Reprocessing Therapy] a primary task of the therapist is to provide a secure base or safety zone that serves as a therapeutic anchor, within which the individual’s unresolved traumatic material can be re-experienced, re-scripted, and reprocessed.  The therapist facilitates cognitive and affective shifts back and forth in the therapy session from the secure therapeutic base to the anxiety-provoking imagery of the individual’s traumatic material.

Adapted from Cognitive-Behavioral Treatment for Adult Survivors of Childhood Trauma: Imagery Rescripting and Reprocessing by Mervin Smucker and Constance Dancu.

Mervin Smucker

Some traumatized individuals present with a more generalized psychogenic amnesia accompanied by the presence of frequent dissociative episodes, an autohypnotic skill that functions as an“affective anesthetic.”  While dissociation may serve to shield individuals from painful trauma-related stimuli, as well as afford them an escape from unpleasant affect associated with tensions and stress of daily living, it can also interfere significantly with their productive functioning and lead to aversive consequences (e.g., putting individuals at risk for losing their job or marriage because the boss or spouse will no longer tolerate their dissociate episodes or their“high maintenance”unproductivity).

Mervin Smucker

Diagnostic Criteria and Symptom Picture
Posttraumatic stress disorder refers to specific psychological reactions which may occur as a result of disaster, combat, interpersonal violence, or other forms of extreme psychological stress. As defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM IV, 1994), a combination of features from four core criteria comprise the PTSD syndrome: (a) exposure to a traumatic event; (b) subsequent reexperiencing of the trauma in the form of recurrent and intrusive recollections, dreams, flashbacks, or heightened physiological reactivity; (c) emotional numbing or persistent avoidance of stimuli reminiscent of the event; and (d) symptoms of increased arousal such as hypervigilance, irritability, exaggerated startle response, and sleep disturbance. Without exception, each of the above symptoms has been reported in the literature as a long-term effect of childhood sexual abuse (Briere, 1989). This evidence strongly suggests that PTSD is part of the clinical picture presented by adult survivors of childhood sexual abuse.

Mervin Smucker

In Beck’s model of Cognitive Therapy, the automatic thoughts that we have at any point in time are linked to the emotions we experience. Beck asserts that we change how we feel and replace our negative emotions with neutral or positive emotions by changing the way we think, especially by changing our automatic thoughts.

Below is a list of characteristics that are thought to describe the nature of automatic thoughts.

• they are specific rather than vague
• occur in shorthand form – only the essential words
• may be words or pictures
• do not arise from reasoning about, or reflecting on, the situation
• follow no logical sequence of steps, as occurs in problem solving
• “just happen”spontaneously, as though by reflex
• Are difficult to “turn off”
• require no effort
• appear plausible or reasonable, although they may be far-fetched
• can occur in spite of objective evidence to the contrary

Mervin Smucker

Symposium presentated at the 37^th Annual Congress of the European Association for Behavioural & Cognitive Therapies, Helsinki, Finland.

Since the early 1990s, the use of imagery as a primary therapeutic agent in fostering cognitive and emotional processing of traumatic material is being employed by a rapidly growing number of CBT clinicians and theorists. Traumatic memories and associated meanings are often encoded as vivid images and sensations embedded in the traumatic imagery itself and is not accessible through linguistic retrieval alone.  As such, imagery-based interventions are increasingly used as primary therapeutic agents to facilitate alleviation of PTSD symptomatology and modify traumagenic beliefs and schemas.

In this talk, Dr. Smucker describes how he “stumbled” across a powerful imagery rescripting intervention which induced a dramatic change within one session with a rape victim twenty years ago, and how he went on to build on this case to develop an imagery rescripting treatment for individuals who have been traumatized and are struggling with PTSD.

Empirical data from 3 recent studies are presented on the outcomes of two imagery-based treatments for victims of Type I work-related accidents suffering from PTSD:  (1) prolonged exposure, (2) imagery-rescripting and reprocessing therapy. The results of these studies are discussed along with their implications for treatment.  The underlying mechanisms involved in both the maintenance and alleviation of PTSD symptoms are also addressed.  Evidence-based hypotheses are advanced pertaining to how the clinician may ascertain the best treatment fit between specific imagery interventions and the trauma characteristics of a given PTSD patient.

Mervin Smucker

Workshop presented at the 38^th European Association of Behavioural and Cognitive Therapies, Helsinki, Finland.

The use of imagery as a primary therapeutic agent in fostering cognitive and emotional processing of traumatic material is being employed by a growing number of CBT clinicians.  Since much of the cognitive-affective disturbance associated with intrusive memories is embedded in the traumatic images themselves, directly challenging and modifying the traumatic imagery becomes a powerful, if not preferred, means of processing trauma-related material.

In this workshop, Dr. Smucker demonstrates how trauma victims suffering from PTSD can be effectively treated with Imagery Rescripting and Reprocessing Therapy (IRRT) – an imagery-based, trauma-processing CBT treatment (with stabilization components) that blends visual and verbal interventions to access, modify, and process traumatic memories.  Specifically, each IRRT session comprises three phases that involve: (1) visually activating and reliving the traumatic imagery, (2) transforming the trauma-related imagery into mastery/coping imagery, and (3) facilitating emotional self-regulation through self-calming, self-soothing, and self-nurturing imagery.

IRRT applications are brought to life via instructional videos, experiential exercises, and case examples.  Participants experience first-hand how this combination of intense trauma-processing followed by a stabilization-focused 3^rd phase, can lead to dramatic cognitive shifts (sometimes within a single session) that (a) reduce or eliminate PTSD symptoms, (b) modify maladaptive trauma-related beliefs, (c) enhance one’s capacity to self-nurture and self-calm, and (d) promote the development of adaptive schemas.  IRRT is a manualized CBT treatment for PTSD with solid empirical support.

In this workshop, Dr. Smucker also addresses how to use critical information about the patient’s specific trauma characteristics for effective treatment planning – such as, when to focus on trauma-processing vs. stabilization interventions, the importance of assessing the patient’s predominant PTSD emotion (e.g., guilt, shame, anger, or fear), and the effect that such information may have on treatment.

Mervin Smucker Ph.D.

 

Workshop presented at the 33rd AACBT National Conference, Melbourne, Australia.

Since Dr. Smucker first developed Imagery Rescripting as a CBT intervention in the early 1990s, the use of imagery as a primary therapeutic agent in fostering cognitive and emotional processing of traumatic material has been being employed by a growing number of CBT clinicians.  Since much of the cognitive-affective disturbance associated with intrusive memories is embedded in the traumatic images themselves, directly challenging and modifying the traumatic imagery becomes a powerful, if not preferred, means of processing trauma-related material.

In this workshop, Dr. Smucker demonstrates how trauma victims suffering from PTSD can be effectively treated with Imagery Rescripting and Reprocessing Therapy (IRRT) – an imagery-based, trauma-processing CBT treatment (with stabilization components) that blends visual and verbal interventions to access, modify, and process traumatic memories.  Specifically, each IRRT session comprises three phases that involve: (1) visually activating and reliving the traumatic imagery, (2) transforming the trauma-related imagery into mastery/coping imagery, and (3) facilitating emotional self-regulation through self-calming, self-soothing, and self-nurturing imagery.

IRRT applications are brought to life via instructional videos, experiential exercises, and case examples.  Participants experience first-hand how this combination of intense trauma-processing followed by a stabilization-focused 3^rd phase, can lead to dramatic cognitive shifts (sometimes within a single session) that (a) reduce or eliminate PTSD symptoms, (b) modify maladaptive trauma-related beliefs relating to guilt, shame, anger, and fear, (c) enhance one’s capacity to self-nurture and self-calm, and (d) promote the development of adaptive schemas.  IRRT is a manualized CBT treatment for PTSD with solid empirical support.

Dr. Mervin Smucker

 

The hero’s journey begins with the call to adventure. The call to adventure appears to be an accident— a stumble or a mistake—but according to Campbell, this is the mythic world bubbling up underneath the surface. This stumble connects the hero with the opportunity for adventure. Campbell uses the example of the Grimm’s fairy tale of the Frog Prince. A princess is playing with a golden ball, and accidentally throws it into a pond. A frog emerges from the pond and offers to retrieve the ball if she promises to invite him to dinner in the palace and let him eat from her plate. She reluctantly fulfills this promise and her adventure begins.

Mervin Smucker

The primary trigger of a borderline’s acting-out behaviors is abandonment panic; a pervasive fear of abandonment which threatens to overwhelm the individual and recreate the traumatic affect associated with memories and fears of early abandonment experienced (abandonment depression).  Thus, when borderlines perceive the signal or threat of abandonment, an abandonment schema is activated.  The ensuing abandonment panic response of borderlines propels them to activate behaviors and responses designed to ward off, and defend against, the overwhelming threat of abandonment depression.  Borderlines do this by engaging in acting-out behaviors (e.g. suicide gestures, or other acts of self-abuse), which precipitate a crisis.  An outcome, or secondary gain, of the crisis of often a feeling of re-connectedness with significant others (e.g., through hospitalization, emergency phone calls or therapy sessions, evoking of “caring” responses from people close to them).  Thus, what may appear to be dysfunctional or maladaptive behaviors, often has the effect of actually protecting borderlines from abandonment and keeping them connected with significant others.

Mervin Smucker

In his classic work Man’s Search for Meaning, Viktor Frankl examines the experience of a concentration camp inmate through the lens of his own experiences in Auschwitz and other concentration camps during World War II. Frankl, who was already an expert on depression and suicide before the war, lost both of his parents and his wife to the hardships of concentration camps. After this immense suffering, Frankl resumed his work in psychiatry and earned a Ph.D. in Philosophy. He went on to develop Logotherapy, known as the third Viennese school of psychiatry, an existentialist version of psychotherapy based on the theory that the human drive to make sense of the world can create meaning from suffering. Frankl became a professor of Neurology and Psychiatry at the University of Vienna in 1955 and published 39 books before his death in 1997.

Mervin Smucker