Imagery Rescripting in Primary Care (IMPACT MADE)

Imagery Rescripting Within Primary Care to Manage Depression: A Single-Case Experimental Design

In the current study we aim to investigate the feasibility, acceptability, and effectiveness of ImRs offered by mental health assistants within primary care to reduce depressive symptoms. In a single-case experimental design (SCED) study, the following hypotheses will be tested:

1. ImRs results in a reduction of depressive symptoms compared to baseline, and this reduction lasts up to six months.
2. Patients with complaints of depressive symptoms find ImRs an acceptable form of intervention when offered by mental health assistants within a general practice setting.

Participants will wait for 2-4 weeks and then receive 5 sessions of ImRs over a period of 10 weeks. During these sessions, negative memories related to their depressed feelings are rescripted.

Study Overview

• Status: Recruiting
• Conditions: Mood Disorders; Major Depressive Diorder; Low Self-Esteem
• Intervention / Treatment: Behavioral: Imagery Rescripting

Detailed Description

The study consists of a multiple-baseline case series in which the effectiveness and feasibility of Imagery Rescripting as a therapeutic technique will be investigated within primary care, with the aim of reducing depressive symptoms. The intervention will be provided by the mental health assistants (POH-GGZ) at the GP practice that is linked to the University of Amsterdam (Huisartsenpraktijk UvA). These mental health assistant have been trained in Imagery Rescripting. In the study, participants are randomly assigned to a baseline condition of 2-4 weeks, and a subsequent intervention condition of 10 weeks. During the intervention, all patients receive five sessions of Imagery Rescripting (45 minutes per session). Throughout these 12-14 weeks, and for 4 weeks after, participants complete bi-weekly (i.e., twice per week) measurements. The total number of bi-weekly measurements is thus 32-36, depending on the baseline condition that participants are randomized to. In addition, there will be 5 longer questionnaires, including a 3 and 6-month follow-up. Participants that are invited to the study but that do not want to participate will receive care as usual by the mental health assistant.

• Study Type: Interventional
• Enrollment (Estimated): 12
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lotte Stemerding; Phone Number: 0031614401653; Email: l.e.stemerding@uva.nl

Study Locations

• Netherlands
  • North Holland
    • Amsterdam, North Holland, Netherlands, 1018VZ
      • Recruiting
      • UvA Huisartsen
      • Contact: Anna Kastelein; Phone Number: 0031205252878; Email: a.m.kastelein@uva.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Main complaint of depressive feelings, as indicated by both the mental health assistant and the patient.
• HADS score for the depression subscale ≥ 11.
• Ability to understand, read, write and speak Dutch or English.
• Age between 18 and 70.
• Willingness to participate in the study and treatment.

Exclusion Criteria:

• Acute suicide risk (BDI-II-item9 score of 3).
• If the mental health assistant suspects that the patient may have a primary diagnosis of bipolar disorder, psychosis, substance use disorder, low IQ, or if the patient suffers from serious neurological problems such as dementia, then the patient is not included. There will not be a formal assessment of a primary diagnosis.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Imagery Rescripting; The ImRs will follow the protocol as developed by Arntz and Weertman (1999), that was tailored for the primary care setting. The total of sessions will be set at 6. In session 1, the patient and therapist will create a list of core beliefs and memories to be rescripted. Session 1 will take place before the baseline phase, allowing us to assess core beliefs prior to the intervention. In session 2-6, one negative emotional memory is selected and rescripted (45 minutes per session). If necessary, a memory can be rescripted twice. In session 2-3 the therapist enters the image and rescripts the memory, whereas in session 4-6 the patient adult-self enters the image and rescripts the memory. If patients are uncomfortable doing so, session 4 can still be guided by the therapist.

Behavioral: Imagery Rescripting; During ImRs, the patient brings a negative memory to mind and changes, together with the therapist, the outcome of the memory into a more positive; Other Names: ImRs

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depressive symptom severity	Depressive symptom severity is assessed with the PHQ-2 (Kroenke et al., 2003). The PHQ-2 consists of the first two items of the PHQ-9 and measures the frequency of depressed mood and anhedonia in the past week. Scores range from 0-6 and higher scores mean more depressive symptoms.	16-18 weeks, twice a week
Self-esteem	Self-esteem will be measured with a single question "How have you felt about yourself in the past week?" Participants rate this question on a scale from -100 (very negative) to +100 (very positive).	16-18 weeks, twice a week
Dysfunctional core beliefs	Participants will formulate these negative beliefs about themselves or the world/other people together with the mental health assistant during the first session and then rate how convincing these beliefs are on a scale from 0 (not at all convincing) -100 (very convincing).	16-18 weeks, twice a week + 3 month and 6 month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital Anxiety and Depression Scale	Measures depressive and anxious symptoms on a 14 item scale (Zigmond & Snaith, 1983). Scores range from 0-21 per scale (Anxiety and Depression) and higher scores reflect higher symptom severity.	Baseline, pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up
Rosenberg Self-Esteem Scale	Measures self-esteem with 10 items scored on a 4-point scale, scores range from 0 to 30, and higher scores reflect higher self-esteem (Rosenberg, 1965).	Baseline, pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up
Suicidal thoughts	Suicidal thoughts are measured using item 9 of Beck's depression inventory (BDI-II)	Baseline, pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up
Emotional memory	We will measure the following characteristics of the reported memories that will be rescripted: Vividness, Emotional Intensity, Emotional Impact, Intrusivity. These characteristics will be assessed with subscales of the Memory Experiences Questionnaire (MEQ; Vividness and Emotional Intensity) and two added subscales (Emotional Impact, Intrusivity). These measures are based on a previous study that these indices of a negative emotional memory related to depression scores (Stemerding et al., 2025). Each aspects is scored from 1-5 and higher scores mean stronger vividness, emotional intensity, emotional impact and intrusiveness.	Pre-treatment, 4-weeks post-treatment, 3 month follow-up, 6 month follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acceptability	We assess the acceptibility of the intervention using six questions that are formulated to measure how the participants feel about the intervention. An example is "To what extent would you recommend this intervention to a friend or family member that experiences symptoms similar to yours?". These items are assessed on a 9 point likert scale ranging from "not at all" to "very much".	4- weeks post-treatment

Collaborators and Investigators

• Sponsor: University of Amsterdam
• Collaborators: UvA Huisartsen

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): January 31, 2027

Study Registration Dates

• First Submitted: December 16, 2025
• First Submitted That Met QC Criteria: January 14, 2026
• First Posted (Actual): January 23, 2026

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 14, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Depression; Primary care; Imagery Rescripting
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Behavior; Depression; Mood Disorders
• Other Study ID Numbers: FMG-11030

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Due to privacy regulations we are not allowed to share individual patient data.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No