Neural Mechanisms and Efficacy of Imagery Rescripting for Fear of Failure

NCT ID: NCT07196085

Last Updated: 2025-10-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 81 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-06-01
• Study Completion Date: 2023-05-30

Brief Summary

This randomized controlled trial investigates the neural and psychophysiological mechanisms of Imagery Rescripting (ImRs) in individuals with high fear of failure. Participants (N=81, aged 21-34) were randomized to ImRs or an active control condition. The intervention targeted autobiographical memories of parental criticism across four sessions delivered within two weeks. Neuroimaging (fMRI), skin conductance, and self-report measures were assessed pre- and post-intervention (accordindly, TP1, TP5), with follow-ups at 3 and 6 months (accordingly, TP6, TP7). The primary aim was to examine whether ImRs reduces neural and subjective reactivity to autobiographical criticism memories and whether prediction error or memory reconsolidation disruption underlie therapeutic effects.

Detailed Description

Fear of failure is a common psychological problem often associated with parental criticism and maladaptive perfectionism. Imagery Rescripting (ImRs) is a therapeutic technique derived from schema therapy that aims to modify distressing autobiographical memories by introducing corrective experiences in imagination. While ImRs has shown efficacy in anxiety and personality disorders, its underlying neural mechanisms remain insufficiently understood.

This randomized controlled neuroimaging trial investigated the effects of ImRs on autobiographical memories of criticism in young adults with high levels of fear of failure. The study specifically examined whether therapeutic change is driven by disruption of memory reconsolidation or by prediction error mechanisms, both of which have been proposed as key pathways for updating maladaptive memories.

Participants (N=81, aged 21-34) meeting inclusion criteria for high fear of failure (Performance Failure Appraisal Inventory ≥ 108) were randomized in a 2:1 ratio to either an ImRs intervention group or an active control group. Exclusion criteria included psychiatric disorders (e.g., PTSD, major depression), active pharmacotherapy, history of childhood abuse, and contraindications to MRI.

All participants underwent two fMRI sessions (pre- and post-intervention), four intervention sessions within a two-week period, and follow-up assessments at 3 and 6 months. During fMRI, participants listened to personalized autobiographical scenarios: five involving parental criticism and five neutral ones. In the ImRs group, the criticism scenario was modified by introducing an imagined therapist figure who interrupted the critical interaction, addressed the child's needs, and suggested alternative positive outcomes. In the control group, participants engaged in a structurally similar neutral imagery task without therapeutic modification.

Primary outcomes included changes in neural activation (BOLD fMRI) in fear-related brain regions (amygdala, thalamus, insula, ventromedial prefrontal cortex) when processing criticism versus neutral memories. Secondary outcomes included functional connectivity between prefrontal and subcortical regions, subjective ratings of arousal and emotions during scenarios, and questionnaire-based measures of fear of failure, perfectionism, and failure-related schemas. An exploratory outcome examined activation of the caudate nucleus during rescripting as a neural correlate of prediction error.

The trial aimed to clarify whether ImRs reduces emotional reactivity at neural and subjective levels, and whether therapeutic effects are mediated reconsolidation-related neural changes or by prediction error. By combining personalized autobiographical stimuli, fMRI, psychophysiological measures, and longitudinal follow-up, the study provides novel insights into the mechanisms of memory-focused psychotherapy in individuals at risk of maladaptive perfectionism and fear of failure.

Conditions

Fear of Failure

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: SINGLE

Study Groups

Imagery Rescripting

Four ImRs sessions over 2 weeks, targeting autobiographical criticism memory. Therapist-guided rescripting involved modifying the "hotspot" scene (critical interaction) with protective interventions addressing unmet needs.

Group Type: EXPERIMENTAL

Imagery Rescripting

Intervention Type: BEHAVIORAL

Four ImRs sessions over 2 weeks, targeting autobiographical criticism memory. Therapist-guided rescripting involved modifying the "hotspot" scene (critical interaction) with protective interventions addressing unmet needs.

Sham Neutral Imagery

Four neutral imagery sessions over 2 weeks. Participants imagined neutral interpersonal interactions matched in structure and duration to ImRs but with rescription of neutral instead of criticism memories.

Group Type: ACTIVE_COMPARATOR

Sham Neutral Imagery

Intervention Type: BEHAVIORAL

Four neutral imagery sessions over 2 weeks. Participants imagined neutral interpersonal interactions matched in structure and duration to ImRs but with rescription of neutral instead of criticism memories.

Interventions

Imagery Rescripting

Four ImRs sessions over 2 weeks, targeting autobiographical criticism memory. Therapist-guided rescripting involved modifying the "hotspot" scene (critical interaction) with protective interventions addressing unmet needs.

Intervention Type: BEHAVIORAL

Sham Neutral Imagery

Four neutral imagery sessions over 2 weeks. Participants imagined neutral interpersonal interactions matched in structure and duration to ImRs but with rescription of neutral instead of criticism memories.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• adults aged 18-35
• high fear of failure
• not currently undergoing psychotherapy or psychopharmacotherapy
• no severe punitive experiences in the past

Exclusion Criteria

• current severe affective disorders
• current severe anxiety
• current severe personality disorders
• active suicidality
• psychosis
• substance abuse

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Social Sciences and Humanities, Warsaw

OTHER

Sponsor Role: lead

Responsible Party

Jaroslaw Michalowski

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Jarosław M. Michałowski, PHD

Role: PRINCIPAL_INVESTIGATOR

Poznań Laboratory of Affective Neuroscience, Institute of Psychology, SWPS

Locations

Poznań Laboratory of Affective Neuroscience, Institute of Psychology, SWPS University, Warsaw, Poland

Poznan, Wielkopolska, Poland

Countries

Poland

References

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Other Identifiers

SONATA_BIS_JM2019b

Identifier Type: -

Identifier Source: org_study_id