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

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.