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Focusing on the present is often effective but not always sufficient for trauma-based fears.

Traumatic memories can keep the brain locked in a state of helplessness.

A technique called "memory rescripting" can help dissolve fear by replacing helplessness with empowerment.

Content warning: The story you’re about to hear is quite graphic, with references to childhood sexual abuse and sexual assault.

While I've built my whole career on helping people challenge and crush their negative thoughts in the here-and-now, let me tell you the story of a woman whose recovery required us to revisit a traumatic event from her childhood. I used a powerful technique called memory rescripting, developed in the 1990s by Drs. Merv Smucker, Edna Foa, and colleagues.1

Since then, a number of newer studies have supported memory rescripting as a promising treatment for some trauma survivors. Like every technique in therapy, it won’t be for everyone—for certain patients, however, it can be helpful2, 3, 4 as you'll see in this article.

The story features a young woman who came for the treatment of agoraphobia. Her fear was specific and intense: public transportation. Buses, trains, taxis, airplanes—any form of public transportation where she couldn’t immediately escape filled her with terror.

Aside from that, she was doing well. She was a bright student at a top university, highly motivated, and genuinely pleasant to work with. She completed her written homework faithfully, identifying and challenging distorted negative thoughts associated with her anxiety. On paper, she was an ideal CBT patient.

But there was one problem. With anxiety patients, I always include exposure techniques, where you safely and gradually confront feared situations, so you can learn that the feared consequences do not occur. Sadly, I could not persuade her to do exposure.

I tried everything. I even offered an extremely gentle form of exposure—one I thought was almost foolproof. She would get on a Philadelphia bus, and I would be waiting for her at the next stop, just a couple of blocks away. That way, she wouldn’t be moving toward danger, but toward safety.

Even that was too much. She refused.

I was puzzled. She was cooperative, motivated, and clearly wanted help. But fear can be overpowering, much like severe physical pain, and logic alone rarely overcomes it.

One day, she told me something she had never shared with anyone.

She lived with her mother, a single parent and businesswoman. When she was a young girl, her mother often went out for the evening, and an older boy who lived next door would come over to babysit. Once he thought she was asleep, he would creep into her bedroom, and molest her under the covers.

She was terrified and humiliated. Frozen with fear, she pretended to be asleep, not knowing what else to do. She was so ashamed that she never told her mother—or anyone—until that day in my office.

To make matters worse, the boy still lived next door. Whenever she went home for holidays and saw him, she was flooded with feelings of fear and rage, emotions that had never found resolution.

Around that time, I had just learned about memory rescripting. The idea is simple but powerful. When children are abused, they experience themselves as helpless victims—because they are. Later, when the trauma is replayed in memory, the same scene unfolds again and again, reinforcing a single devastating belief: I am powerless. Every time they replay the same scenario, it strengthens those circuits in their brain.

Take our Post-Traumatic Stress Disorder Test

Find a therapist to heal from trauma.

With memory rescripting, I ask the patient to relax and vividly re-imagine the traumatic event until the emotional intensity returns. Then, instead of passively reliving the memory yet again, the patient is invited to rewrite it—to change the outcome, much like a movie director revising a scene. What matters is that the rescripted memory must contain the theme of power instead of helplessness.

My patient found the idea immediately appealing, so we gave it a try.

I asked her to close her eyes and imagine herself as a little girl climbing into bed. Then I asked her to picture the babysitter entering the room. Could she see him?

She could—vividly. His plaid shirt. His Levi’s. His sneakers. As he crept toward the bed and reached under the covers, her anxiety shot up to 100 percent.

I asked how she would like to change the scene. She could imagine me or her mother entering the room—or imagine herself as a powerful adult intervening. I emphasized that she was limited only by her imagination.

Dr. Smucker and others who created this technique warned that sometimes the patients’ fantasies might become violent. They strongly advised allowing these fantasies, rather than giving in to the urge to censor them.

At any rate, my patient knew exactly what she wanted. She imagined herself entering the room as a large, powerful woman holding a white-hot branding iron. She pulled him away from the child and branded a large P—for Pervert—into his forehead.

I was getting pretty freaked out, but remembered Dr. Smucker’s advice—to stick with it. I hoped we were done, but that wasn’t the end.

In the next scene, she dragged him next door, where his parents were hosting a neighborhood Christmas party, and forced him to confess loudly to what he had done. In the final scene, she imagined building an open-air prison cell in front of his house, clearly labeled Sexual Pervert, where he would have to sit for all to see.

I’ll admit, I was shaken. I had never done this before and wasn’t entirely sure whether I was practicing good therapy or malpractice. But she appeared calm, focused, and deeply relieved when the imagery ended.

Then she asked if we could do another rescripting. She explained that her college roommate had been gang raped by a group of boys in an abandoned car in the woods. Although she hadn’t been there, the graphic details haunted her. She was plagued by intrusive images that filled her with anxiety and rage.

We did another rescripting. Once again, she entered the scene as a powerful adult. I’ll spare you the details; the imagery was intense.

When the session ended, I wasn’t sure what to think. Had I helped her, or made things worse?

My doubts eased when I read her written feedback later that day. She gave me perfect scores on the empathy and helpfulness scales and wrote that the session had been “incredibly helpful.”

The following week, she arrived with what looked like airline tickets.

Her mother was planning a weeklong business trip to Nepal. Instead of staying home, she proposed that they fly together. Then, she would fly home the next day by herself, traveling alone on public transportation for 23 hours.

She asked, “Would that be enough, doctor?”

I smiled. “More than enough!”

When she returned, she told me something that surprised even her. Not only did she experience no anxiety during the trip, she couldn’t even make herself anxious when she tried. Her fear of all public transportation had vanished.

That was our final session. I never saw her again.

And that was the point. Her fear had never been about buses or airplanes. It was about fear, helplessness and powerlessness. Although the trauma happened in the past, sometimes genuine healing can happen in the present.

And sometimes, the memory itself must be rewritten—so the brain can finally learn what it never knew before: This time, I am not helpless. I am a powerful woman!

A Few Important Questions About Memory Rescripting

Will this technique work for everyone?

No. I always individualize treatment for each patient, and over the years I’ve developed more than 140 different therapeutic techniques. In my book, Feeling Great, I reviewed 40 consecutive trauma patients I treated live during my 2-day trauma workshops for mental health professionals.5 Interestingly, I did not use memory rescripting, yet all of them had dramatic improvements during a single two-hour session using the standard TEAM CBT6 approach, which focuses on identifying and modifying distorted negative thoughts and feelings in the here-and-now.

Memory rescripting is simply one technique among many. It won’t be appropriate for everyone, but as you’ve seen, it can sometimes be remarkably powerful.

Does recovery last forever?

At the end of therapy, I tell all my patients that relapses are normal from time to time, and we practice powerful techniques they can use to overcome them quickly. I also offer all my patients free lifetime tune-ups if they ever need additional help. In this case, however, I never saw this young woman again.

Does imagery rescripting typically involve revenge fantasies?

No, you and your patient are limited only by your creativity and imagination. The important key is whether or not you’re getting powerful healing effects for your patient.

Are revenge fantasies safe?

Powerful techniques like memory rescripting should always be used with care, compassion, and sound clinical judgment. Before using this method, I make sure the patient can clearly distinguish fantasy from reality and has no intention of harming anyone. The goal is empowerment, not real-world retaliation.

1. Smucker, M. R., Dancu, C. V., Foa, E. B., & Niederee, J. L. (1995). Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. Journal of Cognitive Psychotherapy, 9(1), 3–17.

2. Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., van Es, S. M., Menninga, S., Meewisse, M.-L., Rijkeboer, M., Kousemaker, M., & Arntz, A. (2020). Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: Randomised clinical trial. The British Journal of Psychiatry, 217(5), 609–615. https://doi.org/10.1192/bjp.2020.158

3. Wagner, B., Böhm, M., & Grafiadeli, R. (2024). Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse: A randomized controlled trial. Child Abuse & Neglect, 147, 106557. https://doi.org/10.1016/j.chiabu.2023.106557

4. Visco-Comandini, F., Papa, C., Uvelli, A., Mancini, F., & Pugliese, E. (2025). Rewriting trauma: A systematic review of treatment effects of imagery rescripting for PTSD and complex PTSD. European Journal of Trauma & Dissociation, 9(4), 100609. https://doi.org/10.1016/j.ejtd.2025.100609

5. Burns, D. D. (2024). Feeling Great: The Revolutionary New Treatment for Depression and Anxiety (Chap. 6, “High-Speed Treatment—Is It Possible? Desirable? Or Just Fool's Gold?”). Bridge City Books.

6. TEAM CBT: T = Testing, E = Empathy, A = Paradoxical Agenda Setting, M = Methods.

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