The Effect of Imagery Rescripting on Aggression and Distress Tolerance in Individuals With <scp>BPD</scp> : A Clinical Trial Compared With Medication‐As‐Usual

ABSTRACT Background Borderline personality disorder (BPD) is linked to challenges such as low career success, relationship difficulties, increased conflicts, and lower life satisfaction, often due to poor distress tolerance and high aggression. Psychotherapy is the main treatment, with medication as a supplementary option. This study investigated the effectiveness of imagery rescripting in reducing aggression and improving distress tolerance compared to medication‐as‐usual. Method The study used an experimental design with pre‐tests and post‐tests and included a control group. Thirty‐two individuals with BPD were matched and assigned to experimental and control groups. Over 5 weeks, the experimental group received one weekly session of mental imagery reconstruction along with medication‐as‐usual, while the control group only received medication‐as‐usual. Findings The results indicated that imagery rescripting, along with medication, facilitated a reduction in aggression scores from 103.53 to 86.93 (mean = 16.60, SD = 6.23, p = 0.000) and increased distress tolerance scores from 26.86 to 38.59 (mean = 11.73, SD = 5.37, p = 0.000) in individuals with BPD. Medication alone facilitated a reduction in aggression scores from 104.64 to 85.78 (mean = 18.85, SD = 9.13, p = 0.000). However, unlike the distress tolerance scale, there was no significant difference in the aggression scale between the two groups (mean = 1.14, SD = 3.13, p = 0.717). Conclusion The imagery rescripting technique may help individuals with BPD reduce aggression and distress intolerance by addressing the roots of unpleasant emotions. This technique shows promise in enhancing distress tolerance and potentially decreasing self‐harming behaviours.