Imagery Rescripting of Hypothetical Worst-Case Scenarios: Impact on Worry and Associated Difficulties

Research suggests that when individuals with chronic worry engage in written exposure (i.e., "confront" their worries by writing them out in vivid, concrete detail), their worrying improves. The literature on imagery rescripting (IR), an intervention aimed at changing negative meanings linked to distressing memories, suggests that IR may augment the efficacy of written exposure for worry. The objective of the present study was to investigate the efficacy of a future-oriented written IR intervention for improving worry, generalized anxiety disorder (GAD) symptoms, and cognitive processes, relative to standard written exposure or neutral writing. Adults high in worry and GAD symptoms (N = 101) were randomly assigned to one of three conditions: (1) standard written exposure (WE), (2) written exposure with rescripting (RWE), or (3) neutral writing (NC) and engaged in four 30-minute writing sessions over the course of 2 weeks. During the 2-week intervention and 3 days postintervention, participants also tracked their day-to-day experiences of affect, worry duration, controllability, and intensity using an online diary. Outcomes were assessed at baseline, postintervention, 1-week and 1-month follow-ups. Participants in all three conditions displayed significant improvements in worry at midtreatment, but not posttreatment or follow-up. Participants in the RWE condition displayed significant improvements in general self-mastery, and perceptions of probability, cost, and coping.