The imagery rescripting protocol for obsessive-compulsive disorder (ImRs-OCD) A decade of iterative refinement in treatment sequencing following ERP

Obsessive-Compulsive Disorder (OCD) is a debilitating psychological condition that remains resistant to treatment in a significant proportion of clients, even following completion of first-line psychological and pharmacological treatments. This paper describes a sequenced treatment protocol combining Exposure and Response Prevention (ERP) with Imagery Rescripting for OCD (ImRs-OCD) as an adjunctive intervention for individuals with treatment-resistant OCD. The ImRs-OCD protocol has undergone multiple rounds of refinement over the past 10 years through iterative protocol development, based on clinician and client feedback. We describe the evolution of the protocol, key adaptations for OCD, illustrative case examples, and preliminary evidence supporting its efficacy. A standardised 10-step ImRs-OCD protocol is presented, along with guidelines for implementation and a set of standard rescripting questions and handouts. This work aims to provide guidance to clinicians and to encourage further research into imagery rescripting as a comprehensive treatment approach for treatment-resistant OCD.