Implementing Adjunct Trauma-Focused Imagery Rescripting in Inpatient Treatment for patients who are underweight with comorbid eating disorders and PTSD: Therapist Challenges and the Supporting Role of Peer Group Supervision

Behaviour Research and Therapy, vol. 195, pp. 104912

Abstract

BACKGROUND: Trauma-focused therapies like Imagery Rescripting (ImRs) are seldom offered to patients who are underweight with comorbid eating disorders (uED) and PTSD, due to doubts about their emotional and cognitive capacities. However, high rates of PTSD comorbidity in this group highlight the need for tailored trauma interventions. This study examines therapists' experiences applying ImRs in this population, with a focus on specific challenges and how Peer Group Supervision sessions (PGSs) supported treatment delivery. METHOD: A qualitative thematic analysis was conducted using 11 semi-structured therapist interviews and 32 PGS recordings. Data were analyzed, summarized and classified within a thematic framework. RESULTS: Therapists initially used PGSs to validate their application of ImRs. Over time, PGSs facilitated skills development through role-play, peer exchange, and reflective dialogue. Four main themes emerged: 1) determining the right moment to start rescripting; 2) challenges specific to uED; 3) topics related to ImRs sessions in which patients had to rescript; 4) the therapists' progress. CONCLUSION: With appropriate protocol modifications and PGSs, ImRs appears both feasible and valuable for uED patients with PTSD. This study aims to inform the feasibility of applying ImRs in this population, with a focus on specific challenges and practical suggestions that supported treatment delivery. TRIAL REGISTRATION: International Clinical Trials Registry Platform (ICTRP) (NTR6094), registered 09/23/2016.

Authors 5

1. Marieke C. ten Napel‐Schutz corresponding

   Radboud University Nijmegen

   Affiliation as printed

   Department of Eating Disorders (Amarum), Vordenseweg 12, 7231, PAGGNet Mental Health, Warnsveld, the Netherlands; Radboud Centre Social Sciences, Radboud University, Thomas van Aquinostraat 4, 6525 GD, Nijmegen, the Netherlands; Mental Care Group, Steijnlaan 12, 1217 JS, Hilversum, the Netherlands. Electronic address: m.tennapel@mentaalbeter.nl

2. Simona Karbouniaris Aachen

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Utrecht University of Applied Sciences, Padualaan 101, 3584 CH, Utrecht, the Netherlands; The Netherlands and Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. Electronic address: simona.karbouniaris@hu.nl

3. Suzanne H. W. Mares

   GGNet

   Affiliation as printed

   Department of Eating Disorders (Amarum), Vordenseweg 12, 7231, PAGGNet Mental Health, Warnsveld, the Netherlands. Electronic address: s.mares@ggnet.nl

4. Tineke Abma Aachen Department of Public Health and Primary Care (PHEG)

   Leiden University · Leiden University Medical Center · Leyden Academy on Vitality and Ageing

   Affiliation as printed

   Leiden University Medical Centre, Dept. of Public Health and Primary Care, Leyden Academy on Vitality and Ageing, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. Electronic address: abma@leydenacademy.nl

5. Arnoud R. Arntz

   University of Amsterdam

   Affiliation as printed

   Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands. Electronic address: a.r.arntz@uva.nl