The physiological signature of imagery rescripting: Associations between heart rate and session-level outcomes

Objective: Imagery rescripting (IR) as an emotion-focused technique involves an evoking as well as a rescripting phase, which incorporates cognitive restructuring. The different components of IR might be characterized by different physiological patterns. The main aim of this study is to test whether clients' physiological arousal during the evoking phase and clients’ physiological arousal during the rescripting phase follows specific patterns and predicts improvement on next-session outcomes. Methods: The results are based on 108 therapy sessions from an imagery-based treatment with 64 clients with test anxiety. The treatment protocol involves two consecutive IR sessions of past events related to test anxiety. Clients’ heart rate (HR) was continuously monitored, next-session outcome was assessed with the State Test Anxiety Measure and Outcome Rating Scale. Results: Clients showed on average an increase in HR during the evoking phase and a decrease during the rescripting phase in the first IR session. These effects reduced in the second IR session. In addition, no latent subgroups were identified. Furthermore, an increase in HR during the evoking phase was significantly associated with lower next-session test anxiety and marginally associated with higher next-session well-being. Conclusion: The results provide initial evidence that clients’ physiological arousal during the evoking phase of IR might play a role in the effectiveness of IR.