Imagery rescripting: Is incorporation of the most aversive scenes necessary?

During imagery rescripting (ImRs) an aversive memory is relived and transformed to have a more positive outcome. ImRs is frequently applied in psychological treatment and is known to reduce intrusions and distress of the memory. However, little is known about the necessity to incorporate the central aversive parts of the memory in ImRs. To examine this necessity one hundred participants watched an aversive film and were subsequently randomly assigned to one of four experimental conditions: ImRs including the aversive scenes (Late ImRs), ImRs without the aversive scenes (Early ImRs), imaginal exposure (IE) or a control condition (Cont). Participants in the IE intervention reported the highest distress levels during the intervention; Cont resulted in the lowest levels of self-reported distress. For the intrusion frequency, only the late ImRs resulted in fewer intrusions compared to the Cont condition; Early ImRs produced significantly more intrusions than the Late ImRs or IE condition. Finally, the intrusions of the Late ImRs condition were reported as less vivid compared to the other conditions. To conclude, it seems beneficial including aversive scenes in ImRs after an analogue trauma induction.