Rewriting trauma: A systematic review of treatment effects of imagery rescripting for PTSD and complex PTSD

Objective Imagery Rescripting (ImRs) has emerged as a promising, evidence-based intervention to process traumatic experiences. No prior review has systematically examined its application for Post Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD). Furthermore, there still is not a clear understanding of mechanisms of change involved in ImRs, which are crucial for trauma-focused treatments. This review addresses this gap by summarizing the effectiveness and change processes of ImRs in PTSD and C-PTSD. Method A systematic search was conducted across PubMed, Scopus, Web of Science, and PsycINFO. Eligible studies were published in English or Italian, included clinical populations aged 18 or older, and used experimental or quasi-experimental designs. Results Twenty-four studies met inclusion criteria. Across randomized, clinical, and multiple-baseline studies, ImRs was associated with consistent reductions in trauma-related symptoms, showing treatment effects consistent with its targeting of core transdiagnostic processes—modifying aversive memory representations in PTSD and fostering integration and emotional safety in C-PTSD. Conclusions This review offers a focused synthesis of the evidence of ImRs for trauma-related disorders, highlighting its potential as a brief, powerful clinical intervention operating through distinct mechanisms of change across varying symptom profiles.