When prolonged exposure fails: Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD

Authors: Hagner, D., Cloutier, H., Arakelian, C., & Brucker, D.
Year Published 2003
Publication Cognitive and Behavioral Practice
Volume 41
Number 7
Pages 333-346
Publisher Association for Advancement of Behavior

Accidents within the workplace affect a large number of individuals each year. The most frequently studied traumas have involved victims of combat,physical and sexual assault, natural disaster, and motor vehicle accidents. (p.333)


The purpose of this study is to examine the efficacy of adding an imagery-based, cognitive restructuring component to the treatment of two victims of work-related injuries suffering from PTSD who failed to improve from prolonged exposure alone.


The study took place in individual treatment sessions provided by the senior author.


This article reviews 2 case studies of individuals receiving Imagery Rescripting and Reprocessing Therapy (IRRT) in addition to Prolonged Exposure (PE).

Data Collection

The BDI, IES, State-Trait Anxiety Scale, and the WMS-R Digit Span Subtest were administered at pre and post-treatment, and again at 1-month, 3-month, and 6 month follow-ups. SUDS ratings were recorded throughout each treatment session as well as at intake, post treatment, and each of the follow-ups.


There was no control or comparison condition.


Imagery Rescripting and Reprocessing Therapy appeared to facilitate and foster a significant cognitive shift, which resulted in successful emotional processing and an immediate alleviation of PTSD symptoms. (p.343)


Prolonged exposure is more likely to be an effective PTSD treatment when fear is the primary emotion and avoidance is the primary coping strategy. An imagery based cognitive-restructuring treatment (IRRT) is likely to be an effective PTSD treatment when non-fear emotions are primary.

URL http://www.sciencedirect.com/science/article/pii/S1077722903800512
Disabilities Emotional disturbance
Populations Male
Outcomes Return to work
NIDILRR Funded Not Reported
Research Design Case reports
Peer Reviewed Yes