Reconsolidation of traumatic memories

1. Introduction

Version followed: the Reconsolidation of Traumatic Memories (RTM) Protocol of Richard M. Gray and Frank Bourke (Research and Recognition Project, USA), as described in the developers' published trial reports and presentations (2012–2021), US Department of Defense evidence summaries (2021, 2026), and independent trial and adaptation reports (Sturt et al. 2023; Gorbunova & Hampton 2025; Gorbunova et al. 2026; RTM-C pilot protocol 2025). The full manual, a "manualised 89-step RTM protocol" (Sturt et al. 2023), is restricted to trained practitioners and is not reproduced here; the step order below is reconstructed from published descriptions. Verification: session format, the 89-step manual, the four core steps, the two-second reversed movie, the endpoint, trial inclusion criteria, training and the child version (RTM-C) were checked against the sources listed. The projection-booth position, the number of repetitions per step, whether alternative versions are run associated or dissociated, and the manual's branching rules are not described in the published sources and remain [uncertain]. [source: HDIAC 2020; PHCoE 2021; DoD RTM fact sheet 2026; Sturt et al. 2023; Gorbunova & Hampton 2025; NCT07185126 protocol]

RTM is a brief, manualised, imagery-based treatment for the intrusive symptoms of PTSD (nightmares, flashbacks, physiological reactivity to reminders). It grew out of the visual-kinesthetic dissociation (V/KD) protocol, "also known as the rewind technique", which Gray and Liotta (2012) re-explained in terms of memory reconsolidation; the developers cite an "anecdotal 25-year clinical history" for the procedure. [source: Gray & Liotta 2012 abstract; HDIAC 2020] The developers place RTM within Neuro-Linguistic Programming (NLP): Gray and Bourke co-edited a 2022 Routledge volume on NLP protocols in clinical settings that includes Gray's chapter on RTM. [source: Routledge book page, de Rijk, Gray & Bourke 2022] V/KD is commonly traced to Bandler's NLP phobia procedure, but none of the sources states that lineage, and recent descriptions (Sturt et al. 2023; the RTM-C protocol, which frames RTM in "cognitive and neurobiological models of memory reconsolidation and dissociation") do not mention NLP. [uncertain for the Bandler attribution]

Core idea of change (the developers' hypothesis, not established fact): a brief, non-traumatising recall makes the memory labile for a limited window (the developers cite roughly 1–6 hours, triggered by prediction error). While it is labile, the client re-views the event in altered visual formats (black-and-white, distant, dissociated, fast, reversed) and rehearses non-traumatic alternative versions. The developers hold that the memory is then re-stored without its fear response: the facts are still remembered, but the event is recalled "like JUST another memory". [source: HDIAC 2020; Brookdale 2019; Dr Darienzo practice page]

Pharmacological approaches to memory reconsolidation are also being researched; they are outside the scope of this guide, and no medicine or drug-assisted procedure forms part of the RTM Protocol as described here. Other reconsolidation-informed psychotherapies (e.g., Ecker's coherence therapy) are not covered here.

2. Framework

RTM is a short, fixed sequence repeated across sessions, not a phased therapy. [source: Gorbunova & Hampton 2025; PHCoE 2021]

Format and dose

Typically 3 sessions. Session length differs by source: three 90-minute sessions (developers' 2020 presentation); three 120-minute sessions (the 74-veteran RCT and the 2026 DoD fact sheet); two to four 90-minute sessions (UK feasibility trial); "fewer than five sessions" (2015 pre-pilot). Totals of "less than 6 hours" are reported. [source: HDIAC 2020; Gray et al. 2019 abstract; DoD RTM fact sheet 2026; Sturt et al. 2023; Gray & Bourke 2015; Darienzo]
Sessions can run on consecutive days, with at least one night's sleep between them. [source: Gorbunova & Hampton 2025; Sturt et al. 2023]
No homework. [source: Gorbunova & Hampton 2025; Darienzo]
Delivered individually, in person or by secure video. [source: Sturt et al. 2023; Gorbunova & Hampton 2025]
Minimal verbal disclosure is needed: the client does not have to tell the therapist the details of the event. [source: Gorbunova et al. 2026]

Stages (reconstructed)

Stage	Goal	Move on when
A. Assessment and pre-treatment	Confirm PTSD with intrusive symptoms; screen out exclusions; build rapport; frame the procedure; list the traumatic events	Client is eligible, stable enough to consent, and the target events are named
B. Visual-formats practice	Rehearse the imagery formats on a neutral memory (black-and-white recall, fast backwards recall, seeing oneself on a screen)	Client can produce each format; trouble visualising is identified early
C. Treatment cycle for one event	Brief activation with a 0–10 SUD rating, reorientation, bookends, theatre, black-and-white movie, reversed associated rewind, alternative versions, check	Event recalled without significant autonomic arousal; SUD low
D. Further events and sessions	Repeat the cycle for the next intrusive event (nightmare or flashback content)	Each target meets the criterion; intrusive symptoms resolved or plateaued
E. Post-treatment check	Re-measure (e.g., PCL-5) and arrange follow-up	Gains held at follow-up (published trials checked within days, at about 1 month, and up to 1 year)

[source: PHCoE 2021 (stage C order and endpoint); Gorbunova & Hampton 2025 (pre-treatment, neutral practice, SUD); Darienzo (formats); HDIAC 2020 (follow-up)] The order of stages A–B and the criteria in the right-hand column are partly [synthesis].

Eligibility and readiness (published trial criteria)

Included: adults with DSM PTSD and at least one flashback or nightmare in the past month (US pilot). The two US veteran RCTs (74 and 30 male veterans) required current-month flashbacks and nightmares. [source: HDIAC 2020; Gray et al. 2019 abstract; Tylee et al. 2017 abstract]
Excluded in the UK trial: current PTSD treatment elsewhere; substance dependence; suicidality in the past month; comorbid disorder severe enough to impair cooperation; inability to consent; psychoactive medication change in the past 4 weeks; clinician judgement of not being ready. [source: Sturt et al. 2023]
Added cautions [synthesis]: active psychosis, severe dissociative disorder (frequent unbidden switching or amnesia), current danger or ongoing abuse, and medical instability. Stabilise first, then reassess.

Monitoring

0–10 SUD within the cycle. [source: HDIAC 2020; Gorbunova & Hampton 2025]
PCL-5 before and after treatment (one trial used ≥31–33 for probable PTSD). [source: Gorbunova & Hampton 2025]
A safety rule used in the UK trial: treat a PCL-5 rise of 10 or more points between sessions, or 15 or more from baseline, as an adverse event and review. [source: Sturt et al. 2023]

Training RTM is taught by the Research and Recognition Project and affiliated trainers (in the UK and Europe, Awaken Consultancy, the UK trial's training provider). In the UK trial, training was pre-course reading plus about 40 hours over 4 days, then observed fidelity assessment on 2 patients by the RTM trainer and an external assessor from the US team; 4 of 10 RTM-arm therapists reached competence, and therapists had 2–4 weekly supervision sessions. Bourke describes a 3-day programme with follow-up. Certified practitioners are listed on a register. RTM-C adds one training day for certified RTM practitioners. [source: Sturt et al. 2023; Bourke testimony 2024; Gorbunova & Hampton 2025; NCT07185126 protocol]

3. Guiding principles

Minimal, non-traumatising exposure. Activation is brief and stopped as soon as distress appears. Practical meaning: never let the client relive the event at length; a short spike in SUD is enough. [source: Sturt et al. 2023; PHCoE 2021; Gorbunova & Hampton 2025]
Comfort and safety come first. In the developers' words, "Client comfort and safety are crucial." Practical meaning: if distress rises, go back to the dissociated position before going on. [source: Brookdale 2019]
Dissociated before associated. The client watches themselves from outside, in black and white, before stepping into any colour, first-person version. Practical meaning: move to the associated rewind only once the black-and-white viewing is comfortable. [source: HDIAC 2020; PHCoE 2021]
Work within the reconsolidation window. The developers hold that changes made shortly after activation update the stored memory. Practical meaning: do the imagery steps straight after the brief activation, in the same session. [source: HDIAC 2020 (labelled a hypothesis)]
Manual fidelity. Every step is compulsory and done in order. Practical meaning: don't skip or reorder steps; adapt the wording, not the structure. [source: Gorbunova et al. 2026]
Content can stay private. Practical meaning: the client can work with the memory without describing it; ask only for ratings and for confirmation that each step is done. [source: Gorbunova et al. 2026; Gray & Liotta 2012 ("content-free")]
Client-designed alternatives. The new versions belong to the client. Practical meaning: invite and shape them; don't write them. [source: PHCoE 2021]
Physiology is the endpoint. Practical meaning: a target is finished when it can be recalled without significant autonomic arousal, not when the client says it is fine. [source: PHCoE 2021]
Treat the memory as the client's experience. RTM changes how a memory feels; it does not uncover or verify facts. Practical meaning: work only with memories the client already has; never use the imagery to search for "hidden" events. [synthesis]
Fit the language to the client. Practical meaning: in the Ukrainian military adaptation, therapists used command-style cues instead of a softer invitation. [source: Gorbunova & Hampton 2025]

4. Intervention inventory

The published sources name the components below but not the 89 manual steps or the manual's wording. Steps are written at the level of detail the sources support; additions are tagged [synthesis]. All example language is illustrative and is not the manual's wording. RTM uses guided imagery, not hypnosis: there is no trance induction, and nothing in it is used to search for unremembered events.

4.1 Pre-treatment assessment, framing and rapport

Purpose / when: Before any memory work, establish eligibility, safety and a working alliance, and explain the procedure. [source: Gorbunova & Hampton 2025 (pre-treatment = rapport-building and framing); Sturt et al. 2023 (exclusions)]
Steps:
1. Confirm PTSD with a structured measure (CAPS-5 or PCL-5) and check for current intrusive symptoms. [source: Sturt et al. 2023; HDIAC 2020]
2. Screen for the trial exclusions: suicidality, substance dependence, recent medication change, severe comorbidity, other current PTSD treatment. Add screening for psychosis, severe dissociation and current danger. [source: Sturt et al. 2023] [synthesis for the additions]
3. Explain the rationale in plain terms: a short recall, then imagery exercises that change how the memory feels; the facts stay. [source: HDIAC 2020; Darienzo]
4. Agree a stop signal and get informed consent, including that brief distress is expected and that the client controls the pace. [synthesis]
5. Take a PCL-5 baseline. [source: Gorbunova & Hampton 2025]
Example language (illustrative): "We won't go through what happened in detail. You'll touch the memory for a moment, then we'll do some picture exercises with it. You'll still remember what happened, but the aim is that it stops grabbing your body the way it does now."
Watch for: Expectations of erasing the memory (correct this). Unrealistic hopes raised by "cure" marketing. Disclosure of current risk, which pauses treatment. [synthesis]

4.2 Identifying the target events

Purpose / when: In pre-treatment, list the events that drive the intrusions, so each session has a defined target. [source: Darienzo ("clients identify their traumatic events")]
Steps:
1. Ask which memories return as nightmares, flashbacks or strong body reactions. [source: HDIAC 2020 (target symptoms)]
2. Give each event a short private label, without details. [synthesis, consistent with minimal disclosure: Gorbunova et al. 2026]
3. Get a 0–10 SUD estimate for each event, and agree an order to work in. Taking the most intrusive event first is [synthesis]; the manual's rule is not published. [uncertain]
Example language (illustrative): "Just give it a name, a few words that tell us both which one you mean. You don't need to tell me what happened."
Watch for: Many separate events (complex or childhood trauma) may need more sessions; the developers report using RTM with complex and childhood trauma. [source: HDIAC 2020] Events the client is unsure ever happened are not targets. [synthesis]

4.3 Visual-formats practice with a neutral memory

Purpose / when: In pre-treatment, before any trauma work, teach the imagery skills on safe material and find out early if the client struggles to visualise. In the UK trial, trouble visualising was the main reason for withdrawing from RTM. [source: Gorbunova & Hampton 2025; Darienzo; Sturt et al. 2023]
Steps:
1. Ask the client to choose an ordinary recent memory with no emotional charge (e.g., a routine errand). [source: Gorbunova & Hampton 2025; Darienzo]
2. Have them recall it as a still picture, then drain the colour so it is black and white. [source: Darienzo]
3. Have them see themselves in the scene from outside, as if on a screen across the room. [source: Darienzo]
4. Have them run it as a short film, then run it quickly backwards from the end to the start. Variations of speed (very fast) are reported. [source: Darienzo; Gorbunova et al. 2026 ("different speeds and perspectives")]
5. Have them confirm each format with a nod or a word. [synthesis]
Example language (illustrative): "Think of making breakfast this morning. Now let the picture go black and white, like an old film. Can you see yourself in it, over there, as if someone filmed you? … Now run it backwards, fast, from the last moment to the first."
Watch for: A client who cannot see images can sometimes use "knowing" or a sense of the scene instead; whether the manual allows this is not documented. [uncertain] If the client cannot manage any formats after practice, consider a different trauma-focused therapy. [synthesis]

4.4 Brief activation ("opening the window") with SUD rating

Purpose / when: At the start of each treatment cycle, briefly activate the target memory so that it becomes open to updating, as the developers hypothesise. [source: HDIAC 2020; PHCoE 2021; Gorbunova & Hampton 2025]
Steps:
1. Ask the client to begin recalling or telling the event briefly. [source: PHCoE 2021]
2. Stop as soon as distress shows (visible arousal or a reported rise). The developers say these brief recalls are "quickly terminated". [source: Gorbunova & Hampton 2025; PHCoE 2021]
3. Take a 0–10 SUD rating. [source: Gorbunova & Hampton 2025]
4. Reorient to the present, e.g., ask a neutral question, have the client look around the room or shift posture. [source: PHCoE 2021 ("reoriented to the present")] The specific grounding moves are [synthesis].
Dosing: Seconds of recall, not a full narrative and not prolonged exposure. [source: HDIAC 2020 ("brief, non-traumatizing exposure")]
Example language (illustrative): "Start to tell me about it, just the beginning … OK, stop there. Zero to ten, how strong is it right now? … Good. Look over at the window for me; what colour is the car outside?"
Watch for: Talking too long in a strong rush of feeling (stop sooner). A SUD that stays high after reorienting means more grounding is needed before going on. Note the activation SUD as the baseline for the cycle. [synthesis]

4.5 Choosing the bookends

Purpose / when: Right after activation, set a safe start and end point that frame the trauma film, so it has a defined beginning and an end at which the client was safe again. [source: PHCoE 2021]
Steps:
1. Help the client find a moment before the event, when they were still safe and nothing had happened yet. [source: PHCoE 2021]
2. Help them find a moment after the event, when the danger was over and they knew they had survived. [source: PHCoE 2021]
3. Check that both moments are low in distress; adjust them until they are. [synthesis]
Example language (illustrative): "Find a moment just before it all started, when you were still OK. … Now a moment afterwards, when it was over and you were safe, even if things were still hard."
Watch for: An "after" moment that is itself traumatic (e.g., a hospital scene). Move it further on, to when safety was clear. [synthesis]

4.6 The imagined movie theatre and dissociated watcher

Purpose / when: Before viewing the trauma film, set up a dissociated vantage point: the client sees themselves sitting in a theatre, watching a screen. The client is outside the scene and outside the seat. [source: HDIAC 2020 ("dissociated watcher who sees themselves sitting in a movie theater"); PHCoE 2021]
Steps:
1. Have the client imagine a cinema and place themselves in a seat. [source: HDIAC 2020; PHCoE 2021]
2. Have them take a further step back, so they are watching themselves in that seat watching the screen. [source: HDIAC 2020 (dissociated watcher seeing themselves in a movie theatre)] A projection-booth position, often described for V/KD, is not mentioned in the published RTM sources (HDIAC 2020, PHCoE 2021, DoD fact sheet 2026, Sturt et al. 2023, RTM-C protocol); use it only as an optional extra distancing aid. [uncertain for the booth]
3. Put the "before" bookend on the screen as a black-and-white still, and keep the client dissociated from it. [source: PHCoE 2021]
4. Check SUD; it should stay low. [source: HDIAC 2020 (SUD checks)]
Example language (illustrative): "Picture a cinema. See yourself in a seat in the middle. Now step back further, so you can see the back of your own head watching the screen. On the screen there's a black-and-white still of that safe moment before."
Watch for: The client "falls into" the scene (signs: SUD rise, first-person description, physical reaction). Add distance (back row, smaller and fainter screen) and confirm they are watching from outside before going on. [synthesis]

4.7 Dissociated black-and-white movie, repeated

Purpose / when: The main viewing step. The client watches the event as a black-and-white film from the dissociated position, as many times as needed until it is comfortable. [source: HDIAC 2020; PHCoE 2021]
Steps:
1. From the "before" still, have the client let the film run in black and white to the "after" still, then freeze it. [source: PHCoE 2021 (from bookend to bookend)]
2. Take a SUD rating after each run. [source: HDIAC 2020]
3. Repeat the run, altering how the film looks as needed (e.g., more distance, smaller screen, different speed); the sources say only that alterations are repeated "as needed" and that the client is guided through "repeated versions". [source: DoD RTM fact sheet 2026; HDIAC 2020; Gorbunova et al. 2026] No published source gives a number of repetitions. [uncertain]
4. Go on when the client reports being comfortable watching. [source: HDIAC 2020 ("when comfortable")]
Example language (illustrative): "From over here, watch yourself in the seat, watching the film. Let it run in black and white from that first moment to the safe moment after, and freeze it there. … What number now?"
Watch for: Movies that "jump" into colour or close-up mean the client has partly associated. Restore black and white and distance. Falling SUD across runs shows it is working. [synthesis]

4.8 Associated, reversed rewind (about two seconds)

Purpose / when: Once black-and-white viewing is comfortable, the client steps into the end of the event and experiences it in reverse, fully associated and with all the senses. The developers describe this as taking "about two seconds". [source: HDIAC 2020; Brookdale 2019; PHCoE 2021]
Steps:
1. Confirm comfort (low SUD) with the black-and-white film. [source: HDIAC 2020]
2. Have the client step into the "after" bookend and be inside it, seeing through their own eyes, safe. [source: PHCoE 2021 (from post-trauma bookend)]
3. Have them run the whole event backwards, very fast, in full colour and sensation, so they arrive at the "before" bookend in about two seconds. [source: HDIAC 2020; PHCoE 2021]
4. Take a SUD rating. Repeat if needed. [source: HDIAC 2020 (SUD checks track progress "through the cycles of treatment")] No published source states how many repeats the manual allows. [uncertain]
Dosing: The associated contact is a two-second reversed run, not a forward reliving. [source: HDIAC 2020]
Example language (illustrative): "Step into that safe moment at the end; you're in it now. When I say go, everything rewinds, really fast, all the way back to the safe moment before, in a couple of seconds. Go … And you're at the start. Number?"
Watch for: A forward replay, or slowing down in the middle, means the client is reliving rather than rewinding. Stop, return to the theatre, and practise the rewind again on the neutral memory. [synthesis] A brief flicker of feeling that fades straight away is expected. [synthesis]

4.9 Alternative versions (client-designed rescripts)

Purpose / when: After the rewind, when the client is free of emotion or comfortable enough, they create non-traumatising alternative versions of the event and run them until comfortable. Sources differ on the number: the DoD summaries say "several" client-designed versions; the developers' 2020 presentation describes one alternative version practised until comfortable. The developers hold that this updates the memory's meaning during the open window. [source: PHCoE 2021; DoD RTM fact sheet 2026; HDIAC 2020]
Steps:
1. Invite the client to design a different version of the event. It can be realistic, absurd or comic; the content is theirs. [source: PHCoE 2021 (client designs)] The examples of style are [synthesis].
2. Have them run it from the "before" bookend to the "after" bookend. Whether alternatives are run associated or dissociated is not stated in the published sources (HDIAC 2020, PHCoE 2021, DoD fact sheet 2026, Sturt et al. 2023); letting the client choose is [synthesis]. [uncertain]
3. Create and run further versions ("several"). [source: PHCoE 2021]
4. Check SUD after each. [source: HDIAC 2020]
Example language (illustrative): "Now you get to be the director. Make a version of that scene that goes some other way: anything you like, sensible or silly. Run it from the safe start to the safe end and let me know when you're done. … Now make another one."
Watch for: Rescripts are imaginative alternatives, not a claim about what happened; say so if the client confuses them. Avoid versions in which the client "should have" prevented the event, as these can feed self-blame. [synthesis]

4.10 Checking the result (re-activation probe)

Purpose / when: At the end of each cycle, and at the start of the next session, test whether the memory still triggers arousal. A target is finished when the trauma "can be recalled without significant autonomic arousal". [source: PHCoE 2021; HDIAC 2020 (SUD checks)]
Steps:
1. Ask the client to recall the event again, as in 4.4, and watch for physiological signs (breathing, colour, posture, tearfulness). [source: PHCoE 2021 (autonomic arousal endpoint)] The specific signs listed are [synthesis].
2. Take a SUD rating. [source: Gorbunova & Hampton 2025]
3. If arousal remains, repeat the cycle (4.5–4.9) or look for a separate fragment or associated event to target. [synthesis] The published endpoint is recall and narration without significant autonomic arousal [source: DoD RTM fact sheet 2026; PHCoE 2021], but the manual's branching rules are not published. [uncertain]
4. Ask how the memory feels now. The developers' success criterion is that it feels like "just another memory": unpleasant perhaps, but not frightening. [source: Brookdale 2019; Darienzo]
Example language (illustrative): "Think about it now, the way you did at the beginning. What happens? … What number is it now?"
Watch for: A verbal "it's fine" while the body still reacts. Trust the physiology. [synthesis, consistent with PHCoE 2021]

4.11 Sequencing across events and sessions

Purpose / when: Plan how to cover all target events within the brief format. [source: Gorbunova & Hampton 2025; Sturt et al. 2023]
Steps:
1. One cycle (4.4–4.10) per event; open each session by checking previously treated events (4.10). [source: PHCoE 2021 (activation at the start of each session)] The re-checking is [synthesis].
2. Allow at least one sleep between sessions; consecutive days are acceptable. [source: Gorbunova & Hampton 2025; Sturt et al. 2023]
3. Re-measure the PCL-5 shortly after the last session and again at about 1 month. [source: Gorbunova & Hampton 2025]
Watch for: Generalisation: once several events are done, related memories often lose charge too. This is [synthesis] and is not documented in the published RTM sources.

4.12 Remote, hospital and field adaptations

Purpose / when: To deliver RTM by video or in a medical or field setting. [source: Gorbunova & Hampton 2025; Gorbunova et al. 2026]
Steps (as reported for injured Ukrainian service members):
1. Book a private space without interruptions. For bed-bound patients, position the bed for comfort and arrange nurse access by call button. [source: Gorbunova & Hampton 2025]
2. Use a secure video platform (Signal was used) and have a backup connection (power bank, hospital Wi-Fi). [source: Gorbunova & Hampton 2025]
3. Shorten sessions (to about 45 minutes) by moving pre-treatment to its own session; one patient had four sessions on consecutive days. [source: Gorbunova & Hampton 2025]
4. Once a patient can visualise without distress, let them lead some steps themselves. [source: Gorbunova & Hampton 2025]
5. Use culturally fitting cues (e.g., military-style commands such as "Execute"). [source: Gorbunova & Hampton 2025]
6. In unstable settings, make sure the client can settle themselves if a session is cut short. [source: Gorbunova et al. 2026]
Example language (illustrative): "When you're ready, run the black-and-white film. Tell me when it's done."
Watch for: Connection drops mid-cycle. Agree in advance how the client will ground themselves and how you will reconnect. [synthesis]

4.13 Child version (RTM-C, in development)

Purpose / when: RTM-C, a child adaptation, is being piloted in Ukraine (NCT07185126; GlobalInMind with Voices of Children; lead trainer Viktoriia Gorbunova). Per the pilot protocol: children aged 6–14 (Gorbunova et al. 2026 give 6–12); a parent session first, then six sessions of about 60 minutes, with diagnostic follow-up at 1 and 6 months. It "retains the essential procedural components of the adult method" but adds child-friendly language, play-based imaginative exercises, animated instruction videos, cardboard cinema and screen models as visual aids when words are not enough, structured parental involvement (parents may be present) and small end-of-session rewards. Before trauma work the child must show a reliable "break state" (disengages from imagery, reorients to the room, makes eye contact, looks relaxed). Therapists interrupt distress at once and redirect the child to a safe, neutral task; recall is kept "stress-free", with no detailed verbal account. Providers are certified RTM practitioners with one extra day of RTM-C training; fidelity is checked with session checklists and coaching. Session-by-session step content is not published. [source: NCT07185126 protocol 2025; Gorbunova et al. 2026] [uncertain for step content]
Watch for: Use with children only with specific RTM-C training, and within child-safeguarding procedures. [synthesis]

5. Handling problems

The published sources say little about troubleshooting. Most of what follows is [synthesis] unless a source is cited.

Can't visualise. This was the main reason for withdrawing from RTM in the UK trial. [source: Sturt et al. 2023] Response [synthesis]: spend longer on neutral practice (4.3); allow a "sense" or "knowing" of the scene, or a felt sense of distance; use props (a real screen, drawing the theatre layout). If the formats still fail after a full practice session, switch to a trauma-focused therapy that relies less on imagery (TF-CBT or CPT) rather than pushing on.
Overwhelm during activation or viewing. Response: stop the recall at once and reorient to the present ("reoriented to the present": PHCoE 2021). Then [synthesis]: ground the client (feet on floor, name objects in the room, slow breathing); wait until SUD is back near the pre-session level. Restart from the theatre with more distance (back row, a smaller, fainter and further screen, the booth), and shorten each run. Never push through high distress to "finish" a cycle.
Dissociation (glazing over, losing time, depersonalisation). RTM uses deliberate, controlled dissociation (the watcher position); unbidden dissociation is different. Response [synthesis]: pause the imagery; reorient with sensory grounding and orientation questions (date, place, your name). Resume only if the client can stay present; if dissociation recurs, stop RTM and assess for a dissociative disorder before going on.
Falling into the scene (unwanted association). Signs: first-person description, colour, rising SUD. Response [synthesis]: freeze the frame, drain the colour, and float back to the seat, then the booth; check that they are watching themselves before running again.
SUD won't drop after repeated cycles. Response [synthesis]: check whether there is a separate "hotspot" moment (a sound, a smell, a later moment) or an earlier linked event, and make it its own target with its own bookends. Check that the bookends are truly safe (4.5). Check for unresolved guilt or moral injury, which imagery may not resolve; address it with cognitive work or refer.
Generalised or complex trauma with many events. The developers report using RTM with complex and childhood trauma. [source: HDIAC 2020] Response [synthesis]: prioritise the events behind current intrusions; expect more than three sessions; make sure stabilisation and safety are in place first; combine with phase-based care where needed.
Non-attendance or drop-out between sessions. UK trial completion in the RTM arm was 60%, against a 70% target. [source: Sturt et al. 2023] Response [synthesis]: schedule sessions close together (consecutive days are allowed); make sure each session ends on a closed cycle, with no event left half-done; follow up quickly after a missed session.
Sceptical or resistant clients ("it's too simple", "a trick"). Response [synthesis]: explain the reconsolidation rationale as the developers' hypothesis, not a promise; offer the neutral-memory practice as a no-risk trial; respect a decision to choose a different evidence-based therapy.
Rupture or alliance strain (e.g., feeling rushed through a script, or the therapist seeming detached because of the minimal disclosure). Response [synthesis]: name it; slow down; check consent before each step; explain that the client may tell more of the story if they want to, but don't need to.
Symptom worsening. Use the UK trial's adverse-event rule (a PCL-5 rise of ≥10 between sessions, ≥15 from baseline, or the maximum score) as a trigger for clinical review. [source: Sturt et al. 2023] Response [synthesis]: pause RTM, reassess risk, and consider stabilisation work or a different approach.
Suicidality or self-harm emerging. Suicidality in the past month excluded people from the UK trial. [source: Sturt et al. 2023] Response [synthesis]: stop memory work, do a standard risk assessment and safety plan (including lethal-means counselling: safe storage or removal), and involve crisis services as indicated.
"New" memories or uncertainty about what happened. Response [synthesis]: don't treat images that appear during the movie or rescript steps as evidence; say plainly that the rescripts are imagined alternatives. Never use RTM to find or confirm events the client doesn't already remember; keep forensic questions separate from therapy.
Expectation of total erasure. Response: explain that the memory stays but should feel like "just another memory". [source: Brookdale 2019; Darienzo]
Practising without certification. The manual is detailed and fidelity-assessed. [source: Sturt et al. 2023; Gorbunova et al. 2026] Response [synthesis]: this guide doesn't replace RTM training; use the full protocol only after certified training and supervision.

Sources

Web pages:

Further works cited:

Gray, R. M., & Liotta, R. F. (2012). PTSD: Extinction, reconsolidation, and the visual-kinesthetic dissociation protocol. Traumatology, 18(2). doi:10.1177/1534765611431835
Gray, R. M., & Bourke, F. (2015). Remediation of intrusive symptoms of PTSD in fewer than five sessions. Journal of Military, Veteran and Family Health, 1(2).
Tylee, D. S., Gray, R., Glatt, S. J., & Bourke, F. (2017). Evaluation of the reconsolidation of traumatic memories protocol for the treatment of PTSD: a randomized, wait-list-controlled trial. Journal of Military, Veteran and Family Health.
Gray, R. M., Budden-Potts, D., & Bourke, F. (2019). Reconsolidation of traumatic memories for PTSD: a randomized controlled trial of 74 male veterans. Psychotherapy Research (online December 2017). doi:10.1080/10503307.2017.1408973.
Gray, R. M., Budden-Potts, D., Schwall, R. J., & Bourke, F. (2021). An open-label, randomized controlled trial of the RTM Protocol in military women. Psychological Trauma, 13(6), 641–651.
de Rijk, L., Gray, R., & Bourke, F. (Eds.) (2022). Neurolinguistic Programming in Clinical Settings: Theory and evidence-based practice. Routledge (Ch. 3, Gray, on RTM).
RTM Protocol treatment manual (Research and Recognition Project): restricted to trainees. [uncertain]

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