Abstract
Traumatic visual images are a central feature of post-traumatic stress disorder and are commonly experienced as distressing. The distress associated with these images typically leads to their avoidance, which appears to play a critical role in the maintenance of PTSD. Therefore, it has been proposed that strategies that reduce this distress might be of therapeutic benefit. Anecdotal evidence suggests that transforming visual images, for example, by decreasing their size might be an effective strategy for reducing their distress. However, this has yet to be established empirically. Consequently, this study aimed to evaluate the comparative effects of this strategy, exposure (known to be effective in treating PTSD symptomatolgy) and distraction, which formed the control, on the distress associated with traumatic images. The effects of transforming traumatic images, exposure and distraction on both mood (e.g. anxiety) and image characteristic's (e.g. vividness) were examined immediately following intervention and at three-day follow up. The comparative frequency of intrusive images experienced during the three-day follow period was also evaluated. An analogue design was used in which traumatic images were induced in a normal population by means of distressing videotape. The transforming strategy was found to be effective in reducing the overall distress associated with traumatic visual images. It was superior to exposure on most measures and superior to distraction on several measures immediately following intervention. Interestingly, the distraction group was also superior to exposure immediately following intervention and the possible reasons for this are discussed. However, by follow up the differences between the three groups had disappeared. In addition, no difference in frequency on intrusive images between the three groups was found. Findings are discussed in terms of their potential clinical implications for the treatment of PTSD. For example, although both exposure and transforming an image were effective in the long term, only the transforming strategy resulted in an immediate reduction in distress. It is suggested that this strategy might therefore prove more acceptable to clients than exposure, which is commonly experienced as distressing. However, the results of this study need to be replicated within a clinical sample. Methodological issues relating to the findings are discussed and potential directions for further research highlighted.