Videoconference-based imagery rescripting for persistent stressor-related intrusive memories in adults with adjustment disorder or major depressive disorder: A randomized controlled trial

Background: Intrusive memories are increasingly recognized as a transdiagnostic mechanism underlying persistent distress across stress-related disorders. Although persistent adjustment disorder (AD) and major depressive disorder (MDD) are classified as distinct diagnoses, both are frequently associated with distressing intrusive memories. Imagery rescripting (ImRs) is an effective cognitive-behavioral technique targeting intrusive memories, but its efficacy via videoconference delivery remains unclear. Aims: This randomized controlled trial evaluated the efficacy and feasibility of videoconference-based ImRs (vImRs) in adults experiencing distressing intrusive memories related to stressful life events, including those meeting criteria for persistent AD or MDD. Methods: Thirty participants were randomized to vImRs (six weekly 50-min sessions plus treatment-as-usual [TAU]) or TAU alone. The primary outcome was change in Impact of Event Scale–Revised (IES-R) scores at week 6. Secondary outcomes included measures of depression, anxiety, and quality of life. Analyses were conducted according to the intention-to-treat principle. Results: No adverse events were observed. The vImRs group showed significantly greater reductions in IES-R scores compared with the TAU group (between-group difference=−20.59, p<0.001; Cohen's d=−1.58). Significant improvements were also observed in depressive and anxiety symptoms. Conclusions: vImRs significantly reduced distress related to intrusive memories, as well as depressive and anxiety symptoms. These findings support vImRs as a feasible and accessible transdiagnostic intervention targeting intrusive memory-related processes. However, results should be interpreted with caution due to the small sample size, absence of an active control condition, and lack of follow-up assessment. Trial registration: jRCT1032220619.