Imagery rescripting among young women at risk of developing an eating disorder

When participants arrive at laboratory, they complete some questionnaires and are randomly assigned to one of the four conditions i.e., two imagery rescripting (IR) conditions – body versus general, psychoeducation and control. Both IR conditions consist of three steps: (1) Reliving (i.e., identify problematic memory); Participants complete a battery state measures immediately after this step, (2) Observing (i.e., relive memory from an observer perspective), and (3) Rescripting (i.e., rescript memory in a compassionate manner). The only difference between the general and specific IR conditions is the first step – whether they are prompted to recall a body-specific negative memory or a generic negative memory. Half of the participants in the control group are randomised to undergo step 1 in the body specific IR condition, and half undergo step 1 in the general IR condition. This is designed to standardize the effect of induction (i.e., step 1 in the IR conditions) across conditions. All the interventions are delivered on a computer. Body IR (BIR, n = 35). Reliving (5 minutes). Participants in this condition are asked to close their eyes and visualize a recent event of unpleasant body experience where they might have felt ashamed or embarrassed of their bodies or how their bodies look. An example could be peer teasing or negative comments with respect to appearance, or feeling uncomfortable when looking in the mirror. Then they are asked to hold on to or reflect on the feelings they have during this imagery, and identify the earliest event they could remember associated with those feelings. They then write down as much details as possible about this earlier event, in first person, as if it were happening to them “right now”. Immediately after induction, participants complete a brief questionnaire that contains only the state measures in order to assess the impact of the induction. Observing (5 minutes). Participants are asked to imagine and then write about the same memory (i.e., the earliest event) but in an observer point of view (i.e., in third person), watching what happened to their younger self as it unfolds. Prompts are provided at the end of the writing task for participants to reflect upon what needs to happen in the memory in order for the younger self to feel better or if there’s anything the adult self would like to do to help the younger self in that situation. Rescripting (5 minutes). Participants will then asked to re-imagine the same event in first person, but this time the wiser and more compassionate adult self is with them who can intervene the situation if they want her to. Participants are asked to write about what happened this time with the adult compassionate self presence in as much details as possible. General IR (GIR, n = 31). All steps of IR will be identical to the previous condition except for Step 1 - (1) Reliving (5 minutes): participants are revisited a recent negative event (which is not body related) that has resulted in an intrusive aversive memory. An example could be a social rejection, or emotional neglect, which resulted in them feeling bad about themselves as a person. They will then be asked to trace back their memories to identify any previous events that are associated with that bad feelings about the self, and describe (write about) this early event in as much details as possible. Steps 2 and 3 are identical with respect to this memory as the Body Specific IR condition. Psychoeducation (n=34). After undergoing either step 1 from BIR or GIR, participants in the psychoeducation condition received a handout that contained four sections: “the role of genetics in eating disorders”, “the gene-environment interaction”, “how eating disorders affect the brain” and “what does all this mean for recovery?”. Participants were also then presented with a short quiz which consisted of 7 multiple-choice questions and one open-ended question that were designed to help them engage in the reading. Participants were asked to spend not less than 10 minutes on this task and can only proceed if they have answered the multiple-choice questions correctly based on the handout. This handout is available to download on the Clinical Centre of Intervention website (https://www.cci.health.wa.gov.au/Resources/For-Clinicians/Eating-Disorders).