Wild Jennifer, Hackmann Ann, Clark David M
Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
J Behav Ther Exp Psychiatry. 2007 Dec;38(4):386-401. doi: 10.1016/j.jbtep.2007.07.003. Epub 2007 Jul 14.
Research suggests that distorted images of the self are common in social phobia and play a role in maintaining the disorder. The images are often linked in thematic and sensory detail to distressing memories that are clustered around the onset or worsening of the disorder. This has led to speculation about the likely benefit of working directly with these memories to improve symptoms of social phobia. In this exploratory study, we describe a process of cognitive restructuring followed by imagery rescripting to update the meanings of distressing memories and images in social phobia. We first present illustrative clinical examples and then data of 14 patients with social phobia, on whom we developed this approach. Patients attended an imagery rescripting session in which a semi-structured interview was used to identify their recurrent images, the associated memories and their meanings. Next the identified memory was evoked and elaborated. We updated the meaning of the memory by first using cognitive restructuring to arrive at new perspectives and then linking these perspectives with the memory using imagery techniques. The procedure resulted in significant within session change in beliefs, and in image and memory distress and vividness. One week later significant change was seen in social phobia cognitions and a self-report measure of social anxiety. Rescripting distressing memories in social phobia appears to be an effective way of modifying maladaptive beliefs linked to recurrent negative imagery. This paper presents our exploratory investigation of how to work with the memories and encourages more rigorous investigation in this area.
研究表明，自我的扭曲形象在社交恐惧症中很常见，并在维持该障碍方面发挥作用。这些形象在主题和感官细节上往往与围绕该障碍的发作或恶化而聚集的痛苦记忆相关联。这引发了关于直接处理这些记忆以改善社交恐惧症症状可能带来的益处的猜测。在这项探索性研究中，我们描述了一个认知重构过程，随后进行意象改写，以更新社交恐惧症中痛苦记忆和形象的意义。我们首先展示说明性的临床实例，然后呈现14名社交恐惧症患者的数据，我们针对这些患者开发了这种方法。患者参加了一次意象改写疗程，在该疗程中，通过半结构化访谈来识别他们反复出现的形象、相关记忆及其意义。接下来唤起并详细阐述已识别的记忆。我们通过首先使用认知重构来获得新的观点，然后使用意象技术将这些观点与记忆联系起来，从而更新记忆的意义。该程序导致在疗程内信念、形象及记忆的痛苦程度和生动程度发生显著变化。一周后，社交恐惧症认知及一项社交焦虑的自我报告测量中出现了显著变化。改写社交恐惧症中的痛苦记忆似乎是改变与反复出现的负面意象相关的适应不良信念的有效方法。本文介绍了我们对如何处理这些记忆的探索性研究，并鼓励在该领域进行更严格的调查。
