Imagery-based RIM psychotherapy might trigger psychedelic-like brain activity

A brief, imagery-based psychotherapy known as Regenerating Images in Memory (RIM) appears to reduce anxiety, depression, and stress symptoms after a single session, while triggering altered states of consciousness and distinct shifts in brain activity. These findings come from a new exploratory study published in Frontiers in Psychology, which tested RIM in a group of nursing students during the COVID-19 pandemic.

RIM is a verbal psychotherapy designed to help individuals reprocess distressing memories by engaging bodily sensations and spontaneous mental imagery. The goal is to transform painful experiences into more empowered and integrated memories, which can then guide healthier emotional and behavioral responses. RIM sessions are typically divided into three stages: the “dip” phase focuses attention inward through bodily awareness; the “see” phase involves visualizing and altering difficult memories; and the “do” phase supports integration and action planning.

To explore how RIM might bring about such rapid psychological change, researchers turned to Two Minds Theory, which posits that behavior is primarily guided by fast, unconscious processes rather than conscious thought. RIM is thought to work by activating the Intuitive Mind—an automatic, emotion-driven mental system—and then reintegrating experiences into the Narrative Mind, which handles verbal thought and self-reflection.

The current study aimed to detect whether RIM facilitates a shift in brain activity from the frontal lobes (associated with conscious control) to the temporal lobes (associated with emotion and intuitive awareness), and back again—reflecting the proposed back-and-forth between the Narrative and Intuitive Minds.

“I am a psychotherapy researcher by training, and have always been interested in what treatments are most helpful to people in distress. Knowing how to help someone depends on understanding not just what options are available, but also why or how those options work. That’s what we were trying to understand about the Regenerating Images in Memory (RIM) approach in the current study,” said study author Paul F. Cook, a professor at the University of Colorado College of Nursing

The research took place at the University of Colorado College of Nursing between 2022 and 2024. A total of 30 undergraduate nursing students were recruited from a mental health course and volunteered to participate in a single RIM session lasting between one and two hours. These students were not required to have a diagnosed mental health condition, although many had prior experiences with trauma and were actively engaged in mental health treatment.

Each session was conducted by Dr. Deborah Sandella, the originator of the RIM method. Participants wore a five-lead EEG headband to monitor brain activity in real time. The researchers focused on activity in the frontal and temporal lobes during each of the three RIM stages. Participants also completed several validated questionnaires before and after the session, assessing depression, anxiety, stress, self-esteem, and motivation. After the session, participants rated their satisfaction and completed a scale measuring altered states of consciousness, commonly used in psychedelic research.

This was not a randomized trial, and there was no control group. Instead, the study was designed to explore potential mechanisms behind RIM’s effects.

The researchers found that students reported improvements in four of five mental health outcomes after just one RIM session. On average, they experienced large reductions in depression, anxiety, and perceived stress, along with increased motivation for managing stress. The only measure that did not improve was self-esteem.

These symptom changes were unusually large for a single-session intervention. Compared to traditional psychotherapy, which often requires multiple weeks to show similar improvements, RIM’s effects appeared both rapid and pronounced.

Participants also described strong subjective effects that mirrored reports from people undergoing psychedelic therapy. On a standardized mystical experiences scale, at least a quarter of the participants endorsed the highest possible ratings across multiple domains, including a sense of timelessness, unity, deep meaning, and ineffability—the feeling that an experience cannot be captured in words. The ineffability subscale, in particular, has previously been linked to therapeutic outcomes in psychedelic studies.

One student, who had prior experience with psychedelics, reported that her RIM session was even more impactful than previous drug-induced experiences. Many participants described their sessions as emotionally intense, personally transformative, and difficult to articulate.

“I was very surprised by the strength of people’s subjective experiences,” Cook told PsyPost. “As described in the article, we added a survey partway through the study that was taken from psychedelic research. The research setting wasn’t all that conducive to mystical experiences: Participants were sitting at my desk in a university building, wearing a 5-lead EEG device around their head, while I sat in the corner taking notes. Yet participants in our study reported experiences that were similar in intensity to psychedelic studies! It’s important to note that our participants didn’t take any drug. Instead, it was their own mind producing the experience.”

These reported experiences aligned with the EEG findings. As sessions progressed, participants showed a marked shift in brain activity away from the frontal lobes and toward the temporal lobes. This shift was particularly strong during the middle “see” phase of RIM, when participants engaged in vivid mental imagery and emotional processing. In that phase, faster-frequency brain waves (linked to alertness and insight) decreased in the frontal lobes and increased in the temporal lobes, consistent with a shift from analytical to intuitive processing.

During the final “do” phase, frontal activity partially returned, suggesting re-engagement of the Narrative Mind to integrate the newly processed memories. The co-activation of frontal and temporal lobes during this phase echoes patterns seen in psychedelic research, where synchronized brain activity across different regions has been tied to therapeutic breakthroughs.

“Changing your behavior or feelings is not something that you can do just by exerting your reason or willpower,” Cook said. “Our study showed that the RIM approach helped people to overcome difficult past experiences in a way that relies on imagination, creativity, and inherent strengths or resources. We collected EEG brainwave data during RIM, and found that the prefrontal cortex areas that are usually assumed to provide ‘executive functioning’ were in a state of sleepiness or meditation, while other parts of the brain were actively engaged. It was during that exact part of the procedure that the most creative imagery and intuitive problem-solving occurred.”

Although the results are promising, the study has important limitations. Most notably, it did not include a control group, so it cannot establish whether RIM itself caused the improvements. Pre-post comparisons can be influenced by a range of factors, such as placebo effects, participant expectations, or natural mood fluctuations.

Additionally, all RIM sessions were conducted by the method’s originator, which may have amplified the effects due to facilitator expertise. Participants were also predominantly young adults from a single academic setting, limiting the generalizability of the findings.

“This study wasn’t designed to prove that RIM is an effective form of mental health treatment,” Cook noted. “People in our study frequently reported traumatic experiences, but they weren’t required to have any specific mental health condition in order to participate. We compared pre- versus post-treatment scores on several measures and found that people reported less anxiety and depression after RIM, but there could be other explanations for that change. Our goal with those surveys was just to confirm that people found RIM to be helpful, as they have in other studies. If our participants didn’t find RIM to be beneficial, then it wouldn’t have made sense to interpret the EEG readings at all.”

Despite these limitations, the study provides initial evidence that RIM may work through mechanisms different from those in conventional talk therapy. The observed brain activity patterns and subjective reports suggest that RIM engages emotional and intuitive systems more directly, perhaps resembling the effects of psychedelic therapy—without the use of drugs.

“Now that we do have some understanding of how RIM works, we want to conduct a larger-scale randomized controlled trial in order to conclusively demonstrate that it is a beneficial treatment,” Cook explained. “In that study we plan to recruit firefighters who have had traumatic experiences in the line of duty, use a structured interview to confirm that they meet criteria for post-traumatic stress disorder (PTSD), and then randomly assign them to receive either RIM or usual care for trauma. Our hypothesis is that RIM will have stronger effects than the best-available current treatment options, which have limited benefits for many people with PTSD.”

“I’m also currently working with some students to analyze transcripts collected during the RIM procedure, to see if we can identify significant events that occurred during the RIM session and then match those up with the EEG readings made at that specific time. The hypothesis is that there might be some marker for creativity or insight that we could observe via brain activity.”

“I have learned a lot in working with my co-author Dr. Deb Sandella, who is the original developer of RIM and provided all of the RIM sessions for this study,” Cook added. “Her clinical expertise is a big part of what made our participants’ experiences so positive.”

The study, “How is a psychotherapeutic process like a psychedelic drug? Neurocognitive evidence for a novel mechanism of action with Regenerating Images in Memory,” was authored by Paul F. Cook, Laurra M. Aagaard, Lisa Krug Avery, Nichole Long, Allen Alford, and Deborah Sandella.