Urgent call for research into imagery rescripting to reduce suicidal mental imagery: clinical research considerations

ABSTRACT

Dysfunctional mental imagery is integral to the maintenance of many psychological disorders and is typically associated with stronger affective and behavioural responses than verbal cognitions. This finding extends itself to the high prevalence of suicidal mental imagery in disorders such as depression and bipolar disorder. Imagery Rescripting is a therapy approach which has been found to effectively reduce dysfunctional mental images across various mental health conditions. Thus, Imagery Rescripting of suicidal mental imagery may be effective at reducing such cognitions and ultimately associated risk. However, this remains an unexplored area within the treatment literature. This paper puts out an urgent call for clinical research to evaluate the effectiveness of such a treatment intervention, and to assist, we propose and describe a clinical approach to this to stimulate further thought and research. There are also many research questions of clinical relevance that must be explored in this field of work, which we put forward and consider in this commentary piece.

Key PointS

What is already known about this topic:

1. Mental imagery is a form of cognition that generates stronger emotional responses compared to verbal-linguistic thinking and is integral to the maintenance of most psychological disorders.

2. Cognitive Behavioural Therapy (CBT) approaches are typically more effective when mental imagery techniques – such as Imagery Rescripting (ImRs) – are incorporated to target intrusive, distressing mental imagery.

3. Mental images of suicide (comprised of both flash-back and/or flash-forward mental images) are more distressing, realistic and promote suicidal behaviours more than verbal thoughts, and are common in disorders such as depression and bipolar disorder.

What this topic adds:

1. Urgent clinical research is needed to evaluate the effectiveness of ImRs at reducing intrusive suicidal mental images, and thus related risk, and this paper proposes and describes an approach for researchers to use as a framework.

2. There are several clinical research considerations to be made when examining ImRs of suicidal mental images, including around the delivery and safety of the intervention.

3. More research is needed to clarify the above clinical considerations, and to further understand change mechanisms, to learn the most safe and effective ImRs approach.

4. If ImRs is found to be effective at reducing suicidal images in upcoming clinical trials, it is strongly recommended clinicians receive adequate training and ongoing clinical supervision from an experienced practitioner given the complexities around this approach.

KEYWORDS:

• Flashback
• flashforward
• imagery rescripting
• mental images
• psychological therapy
• suicide

Acknowledgements

We would like to acknowledge the Perth Imagery Rescripting Salon, who contributed through rich and lively discussions to the development of clinical ideas shared in this paper. We would also like to acknowledge our institutional affiliations, which include Orygen, the University of Melbourne, Perth Voices Clinic, Murdoch University, and University of Western Australia.

Disclosure statement

No potential conflict of interest was reported by the author(s).