Adults carrying persistent fear of failure from childhood criticism may find lasting relief through specific memory-based interventions that literally rewrite their autobiographical narratives. This finding challenges the assumption that traumatic memories are immutable and suggests the brain's capacity for therapeutic memory modification extends well into adulthood. A controlled trial involving 180 young adults with elevated fear of failure tested three imagery-based approaches over four sessions: standard memory rescripting, delayed rescripting designed to disrupt memory reconsolidation, and exposure therapy. Standard rescripting emerged as the most consistently effective approach, with participants experiencing significant reductions in negative emotions and physiological stress responses that persisted for six months. The mechanism appears linked to prediction error—moments when the brain's expectations are violated during the rescripting process, creating windows for memory modification. Physiological monitoring revealed that transient spikes in arousal during rescripting sessions predicted stronger therapeutic outcomes, but this pattern did not apply to exposure therapy. The research provides compelling evidence that imagery rescripting works through distinct neurobiological pathways compared to traditional exposure methods. For adults struggling with self-criticism rooted in childhood experiences, these findings suggest that therapeutic interventions targeting specific autobiographical memories can produce enduring changes in both emotional responses and physiological reactivity. The study's six-month follow-up data particularly strengthens confidence in the durability of these memory-based therapeutic approaches, offering hope for long-term resolution rather than temporary symptom management.