ShameW-ImRsNCT07902869
Online Written Imagery Rescripting for Shame and Negative Self-Cognitions in Malaysian Adults With Childhood Emotional Neglect
A study testing Internet-Based Written Imagery Rescripting (W-ImRs) and Psychoeducation in people with Shame and Childhood Emotional Neglect, run by Taylor's University at 1 site in Malaysia.
Trial summary
The goal of this clinical trial is to learn if an online written imagery rescripting program (W-ImRs) can reduce shame and negative beliefs about oneself in Malaysian adults aged 18 to 58 who experienced childhood emotional neglect. The main questions it aims to answer are: 1. Read more about this study
- Who is it for?
- Ages 18 to 58 years
- Conditions the study is for
- Shame, Childhood Emotional Neglect, Negative Self-Cognitions
- What is being tested?
- Internet-Based Written Imagery Rescripting (W-ImRs) and Psychoeducation
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 34 participants
- Where
- 1 siteMalaysia
- Study dates
- 23 Sep 2026to 11 Nov 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 58 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Malaysian adult aged 18 to 58 years
- History of childhood emotional neglect: defined as a score of 15 or above on the Emotional Neglect subscale of the Childhood Trauma Questionnaire - Short Form (CTQ-SF)
- Access to reliable internet connection
Who cannot join
- Acute suicidality at screening
- Active psychosis
- Currently receiving any other trauma-focused psychological therapy
- Ongoing exposure to active abuse or violence
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Letting Go of the Invisible Wound: Efficacy of Internet-Based Written Imagery Rescripting (W-ImRs) on Shame and Negative Self-Cognitions Among Malaysian Adults With Childhood Emotional Neglect: A Randomized Controlled Trial
The goal of this clinical trial is to learn if an online written imagery rescripting program (W-ImRs) can reduce shame and negative beliefs about oneself in Malaysian adults aged 18 to 58 who experienced childhood emotional neglect.
The main questions it aims to answer are:
Read more
- Does W-ImRs lower shame more than psychoeducation alone?
- Does W-ImRs lower negative beliefs about oneself more than psychoeducation alone?
- Do more people who receive W-ImRs show reliable and meaningful improvement than people who receive psychoeducation alone?
Researcher will compare W-ImRs to a single psychoeducation session to see if W-ImRs reduces shame and negative self-beliefs. Participants in the psychoeducation group will be offered W-ImRs after the study.
Participants will:
- Complete online questionnaires before and after the program
- Attend a live online psychoeducation session (about 60 minutes)
- If in the W-ImRs group, complete two written tasks about a painful childhood memory over about 4 weeks, receive written feedback from the therapist after each task, and attend a live online debriefing session (about 60 minutes)
Read the detailed description
This is a two-arm, parallel, open-label randomized controlled trial with a waitlist design. The intervention protocol is adapted from Wagner et al. (2022, 2024), and the rescripting procedure is aligned with the updated imagery rescripting protocol by Arntz (2025). The protocol is grounded in schema therapy.
The trial is open-label because the therapist, outcome assessor, and data analyst are the same person. Investigator bias is reduced through self-administered online instruments and standardized scoring.
All participants receive a Self-Help Kit with relaxation exercises, a crisis safety plan template, and Malaysian crisis contacts. Item 9 of the PHQ-9 is used as a suicidality checkpoint at pre and post-assessment, and the therapist reviews every written submission for signs of risk. Different safety protocol response is used for mild, moderate, and acute distress. Participants at acute risk are withdrawn on the same day and referred to clinical services. The therapist receives weekly supervision from the research supervisor throughout data collection.
Analyses will be performed in IBM SPSS Version 29 with significance set at α = .05. The main analysis is a 2 (Group) × 2 (Time) mixed-design repeated-measures ANOVA on the EISS and PTCI-9 separately. Effect sizes will be reported as partial η² and Cohen's d. The Reliable Change Index (Jacobson \& Truax, 1991) will be used to identify participants whose change exceeds measurement error.
- Conditions
- Shame, Childhood Emotional Neglect, Negative Self-Cognitions
- Being tested
- Internet-Based Written Imagery Rescripting (W-ImRs), Psychoeducation
- Keywords
- Imagery Rescripting, Written Imagery Rescripting, Internet-Based Intervention, Negative Self-Cognitions, Childhood Maltreatment, Malaysia, Schema Therapy
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Internet-Based Written Imagery Rescripting (W-ImRs)Behavioural
A four-session protocol delivered over approximately 4 weeks.
Session 1 is a live video session on Microsoft Teams (about 60 minutes) in which the psychoeducation session is extended to identify a target memory, explain the rationale for W-ImRs, and schedule the written sessions.
Session 2 is an asynchronous writing task in a private Google Document: participants write a detailed first-person, present-tense account of the target memory and a letter to the person responsible for the memory.
Session 3 is a second writing task: participants rescript the memory so that their adult self meets the child's unmet needs, and write a comforting letter to their younger self. The therapist gives written feedback after Sessions 2 and 3.
Session 4 is a live debriefing session on Microsoft Teams (about 60 minutes).
PsychoeducationBehavioural
A single live video session on Microsoft Teams (about 60 minutes) covering childhood emotional neglect, shame, and negative self-cognitions, with a verbal risk assessment. The shared psychoeducation content is identical across both arms.
| Study group | Role | What they receive |
|---|---|---|
| W-ImRs | Experimental | Participants receive psychoeducation followed by Internet-Based Written Imagery Rescripting (W-ImRs) over approximately 4 weeks. Receives: Behavioral: Internet-Based Written Imagery Rescripting (W-ImRs); Behavioral: Psychoeducation |
| Psychoeducation and Waitlist | Active comparator | Participants receive a single psychoeducation session. They are offered the full W-ImRs intervention after completing the post-assessment. Receives: Behavioral: Psychoeducation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change From Baseline in Shame on the External and Internal Shame Scale (EISS) at Post-Intervention
The EISS is an 8-item self-report questionnaire measuring external and internal shame. Items are rated from 0 to 4, giving a total score from 0 to 32. Higher scores indicate greater shame.
Measured: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Secondary outcomes (3)
Change From Baseline in Negative Self-Cognitions on the Posttraumatic Cognitions Inventory-9 (PTCI-9) at Post-Intervention
The PTCI-9 is a 9-item self-report questionnaire measuring negative cognitions about the self, negative cognitions about the world, and self-blame. Items are rated from 1 to 7, giving a total score from 9 to 63. Higher scores indicate more negative cognitions.
Measured: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Number of Participants Showing Reliable Improvement in Shame on the EISS
Reliable improvement is defined as a decrease in EISS total score from baseline to post-intervention with a Reliable Change Index (RCI) greater than 1.96 (Jacobson \& Truax, 1991). An RCI above 1.96 means there is 95% confidence that the decrease is a real change, and not due to chance or small day-to-day differences in how a person answers the questionnaire.
Measured: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Number of Participants Showing Reliable Improvement in Negative Self-Cognitions on the PTCI-9
Reliable improvement is defined as a decrease in PTCI-9 total score from baseline to post-intervention with a Reliable Change Index (RCI) greater than 1.96 (Jacobson \& Truax, 1991). An RCI above 1.96 means there is 95% confidence that the decrease is a real change, and not due to chance or small day-to-day differences in how a person answers the questionnaire.
Measured: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Oct 2026
- Study start23 Sep 2026
- Primary completion11 Nov 2026 (estimated)
- Study completion11 Nov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for ShameStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Two-arm parallel design with a waitlist control. Participants were assigned by block randomization using a computer-generated sequence in Microsoft Excel. Control participants are offered the full W-ImRs intervention after completing the post-assessment.
- Masking
- None (open label)
- Enrolment
- 34 participants (actual)
Sponsor and investigators
- Lead sponsor
- Taylor's University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Lee Thean Elaine, Taylor's University
- Investigators
- Lee Thean Elaine, Principal investigator, Taylor's UniversityFaeza Hasnan, Study director, Taylor's UniversityAkif Basri, Study director, Taylor's University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07902869
- Sponsor's protocol ID
- HEC 2026/361
- Acronym
- W-ImRs
- Status last verified
- Oct 2026
- First submitted
- 21 Oct 2026
- Last updated
- 29 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data will not be shared. Participants disclosed sensitive information about childhood emotional neglect, and the informed consent form states that their data will not be shared with anyone other than the researcher and the research supervisor. Because of the small sample size, sharing individual data could also risk identifying participants. All data will be stored securely for at least three years after the study is completed and then permanently deleted.
Publications
Wagner B, Grafiadeli R, Martin T, Bohm M. Internet-based imagery rescripting intervention for adult survivors of institutional childhood abuse in the former German Democratic Republic - a pilot study. Eur J Psychotraumatol. 2022 Sep 21;13(2):2117222. doi: 10.1080/20008066.2022.2117222. eCollection 2022.
PubMed 36186156Wagner B, Schulz W, Knaevelsrud C. Efficacy of an Internet-based intervention for posttraumatic stress disorder in Iraq: a pilot study. Psychiatry Res. 2012 Jan 30;195(1-2):85-8. doi: 10.1016/j.psychres.2011.07.026. Epub 2011 Aug 2.
PubMed 21813187Arntz A. Imagery Rescripting: an update of the treatment protocol. Behav Res Ther. 2025 Dec;195:104913. doi: 10.1016/j.brat.2025.104913. Epub 2025 Nov 10.
PubMed 41270523Wagner B, Bohm M, Grafiadeli R. Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse - A randomized controlled trial. Child Abuse Negl. 2024 Jan;147:106557. doi: 10.1016/j.chiabu.2023.106557. Epub 2023 Nov 28.
PubMed 38029559
Study at a glance
From the registry record, last updated by the sponsor on 29 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Letting Go of the Invisible Wound: Efficacy of Internet-Based Written Imagery Rescripting (W-ImRs) on Shame and Negative Self-Cognitions Among Malaysian Adults With Childhood Emotional Neglect: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07902869
- Acronym / sponsor ID
- W-ImRs / HEC 2026/361
- Conditions
- Shame, Childhood Emotional Neglect, Negative Self-Cognitions
- Keywords
- Imagery Rescripting, Written Imagery Rescripting, Internet-Based Intervention, Negative Self-Cognitions, Childhood Maltreatment, Malaysia, Schema Therapy
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 34 participants (actual)
- Lead sponsor
- Taylor's UniversityUniversity, hospital or other
- Study start
- 23 Sep 2026 (actual)
- Primary completion
- 11 Nov 2026 (estimated)
- Study completion
- 11 Nov 2026 (estimated)
- First posted
- 29 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to learn if an online written imagery rescripting program (W-ImRs) can reduce shame and negative beliefs about oneself in Malaysian adults aged 18 to 58 who experienced childhood emotional neglect.
The main questions it aims to answer are:
- Does W-ImRs lower shame more than psychoeducation alone?
- Does W-ImRs lower negative beliefs about oneself more than psychoeducation alone?
- Do more people who receive W-ImRs show reliable and meaningful improvement than people who receive psychoeducation alone?
Researcher will compare W-ImRs to a single psychoeducation session to see if W-ImRs reduces shame and negative self-beliefs. Participants in the psychoeducation group will be offered W-ImRs after the study.
Participants will:
- Complete online questionnaires before and after the program
- Attend a live online psychoeducation session (about 60 minutes)
- If in the W-ImRs group, complete two written tasks about a painful childhood memory over about 4 weeks, receive written feedback from the therapist after each task, and attend a live online debriefing session (about 60 minutes)
Detailed description
This is a two-arm, parallel, open-label randomized controlled trial with a waitlist design. The intervention protocol is adapted from Wagner et al. (2022, 2024), and the rescripting procedure is aligned with the updated imagery rescripting protocol by Arntz (2025). The protocol is grounded in schema therapy.
The trial is open-label because the therapist, outcome assessor, and data analyst are the same person. Investigator bias is reduced through self-administered online instruments and standardized scoring.
All participants receive a Self-Help Kit with relaxation exercises, a crisis safety plan template, and Malaysian crisis contacts. Item 9 of the PHQ-9 is used as a suicidality checkpoint at pre and post-assessment, and the therapist reviews every written submission for signs of risk. Different safety protocol response is used for mild, moderate, and acute distress. Participants at acute risk are withdrawn on the same day and referred to clinical services. The therapist receives weekly supervision from the research supervisor throughout data collection.
Analyses will be performed in IBM SPSS Version 29 with significance set at α = .05. The main analysis is a 2 (Group) × 2 (Time) mixed-design repeated-measures ANOVA on the EISS and PTCI-9 separately. Effect sizes will be reported as partial η² and Cohen's d. The Reliable Change Index (Jacobson \& Truax, 1991) will be used to identify participants whose change exceeds measurement error.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Two-arm parallel design with a waitlist control. Participants were assigned by block randomization using a computer-generated sequence in Microsoft Excel. Control participants are offered the full W-ImRs intervention after completing the post-assessment.
| Arm | Type | Receives |
|---|---|---|
| W-ImRs | Experimental | Behavioral: Internet-Based Written Imagery Rescripting (W-ImRs), Behavioral: PsychoeducationParticipants receive psychoeducation followed by Internet-Based Written Imagery Rescripting (W-ImRs) over approximately 4 weeks. |
| Psychoeducation and Waitlist | Active comparator | Behavioral: PsychoeducationParticipants receive a single psychoeducation session. They are offered the full W-ImRs intervention after completing the post-assessment. |
Who may qualify
- Ages
- 18 to 58 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Malaysian adult aged 18 to 58 years
- History of childhood emotional neglect: defined as a score of 15 or above on the Emotional Neglect subscale of the Childhood Trauma Questionnaire - Short Form (CTQ-SF)
- Access to reliable internet connection
Key exclusion criteria (4 listed)
- Acute suicidality at screening
- Active psychosis
- Currently receiving any other trauma-focused psychological therapy
- Ongoing exposure to active abuse or violence
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Internet-Based Written Imagery Rescripting (W-ImRs)A four-session protocol delivered over approximately 4 weeks. Session 1 is a live video session on Microsoft Teams (about 60 minutes) in which the psychoeducation session is extended to identify a target memory, explain the rationale for W-ImRs, and schedule the written sessions. Session 2 is an asynchronous writing task in a private Google Document: participants write a detailed first-person, present-tense account of the target memory and a letter to the person responsible for the memory. Session 3 is a second writing task: participants rescript the memory so that their adult self meets the child's unmet needs, and write a comforting letter to their younger self. The therapist gives written feedback after Sessions 2 and 3. Session 4 is a live debriefing session on Microsoft Teams (about 60 minutes). | Behavioural | W-ImRs |
| PsychoeducationA single live video session on Microsoft Teams (about 60 minutes) covering childhood emotional neglect, shame, and negative self-cognitions, with a verbal risk assessment. The shared psychoeducation content is identical across both arms. | Behavioural | Psychoeducation and Waitlist, W-ImRs |
Primary outcome
Change From Baseline in Shame on the External and Internal Shame Scale (EISS) at Post-Intervention
Time frame: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
The EISS is an 8-item self-report questionnaire measuring external and internal shame. Items are rated from 0 to 4, giving a total score from 0 to 32. Higher scores indicate greater shame.
3 secondary outcomes
Change From Baseline in Negative Self-Cognitions on the Posttraumatic Cognitions Inventory-9 (PTCI-9) at Post-Intervention
Time frame: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Number of Participants Showing Reliable Improvement in Shame on the EISS
Time frame: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Number of Participants Showing Reliable Improvement in Negative Self-Cognitions on the PTCI-9
Time frame: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Oct 2026.
- Results publication: PubMed 36186156Wagner B, Grafiadeli R, Martin T, Bohm M. Internet-based imagery rescripting intervention for adult survivors of institutional childhood abuse in the former German Democratic Republic - a pilot study. Eur J Psychotraumatol. 2022 Sep 21;13(2):2117222. doi: 10.1080/20008066.2022.2117222. eCollection 2022.
- Results publication: PubMed 21813187Wagner B, Schulz W, Knaevelsrud C. Efficacy of an Internet-based intervention for posttraumatic stress disorder in Iraq: a pilot study. Psychiatry Res. 2012 Jan 30;195(1-2):85-8. doi: 10.1016/j.psychres.2011.07.026. Epub 2011 Aug 2.
- Results publication: PubMed 41270523Arntz A. Imagery Rescripting: an update of the treatment protocol. Behav Res Ther. 2025 Dec;195:104913. doi: 10.1016/j.brat.2025.104913. Epub 2025 Nov 10.
- Results publication: PubMed 38029559Wagner B, Bohm M, Grafiadeli R. Efficacy of an internet-based written imagery rescripting intervention for survivors of institutional childhood abuse - A randomized controlled trial. Child Abuse Negl. 2024 Jan;147:106557. doi: 10.1016/j.chiabu.2023.106557. Epub 2023 Nov 28.
- Individual participant dataSharing planned: No. Individual participant data will not be shared. Participants disclosed sensitive information about childhood emotional neglect, and the informed consent form states that their data will not be shared with anyone other than the researcher and the research supervisor. Because of the small sample size, sharing individual data could also risk identifying participants. All data will be stored securely for at least three years after the study is completed and then permanently deleted.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Lee Thean Elaine principal investigator
Taylor's University
Faeza Hasnan study director
Taylor's University
Akif Basri study director
Taylor's University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Internet-Based Written Imagery Rescripting (W-ImRs) and Psychoeducation in people with Shame and Childhood Emotional Neglect, run by Taylor's University at 1 site in Malaysia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 29 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Malaysia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change From Baseline in Shame on the External and Internal Shame Scale (EISS) at Post-Intervention (time frame: Baseline (Day 0) and Post-Intervention (Collected 3 days after each participant's final session)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07902869, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Oct 2026.