Healthcare (Commonwealth Union) – A groundbreaking therapy designed to tackle distressing and intrusive mental imagery in people with psychosis could pave the way for a transformative treatment for a condition that costs England nearly £12 billion annually.
Up to 74 per cent of individuals living with psychosis — a disorder that can cause auditory hallucinations and unfounded suspicions that others intend harm — also experience disturbing mental images.
Researchers of the study indicated that the intrusive visuals regularly stem from trauma, anxiety, fear of future activities, or other psychological aspects. In a recent survey of over 10,000 UK adults, mental imagery was shown to be the third most powerful factor linked to mistrust and paranoia. Such vivid, often multi-sensory experiences have the ability to amplify distressing voices as well as reinforcing delusional beliefs.
The present psychological approaches, consisting of Cognitive Behavioural Therapy (CBT), have indicated modest but reliable benefits in improving psychotic symptoms that include hallucinations and delusions. Likewise, while antipsychotic drugs have the ability to lower some symptoms, roughly 74 per cent of patients halt or change medications within 18 months, mainly due to the adverse side effects or limited positive outcomes. This shows the urgent requirement for more effective and tolerable treatments.
Scientists from the University of Sheffield suggest that a new imagery-based therapy may give valuable support alongside existing treatments.
Known as iMAPS therapy, the approach focuses on helping patients recognize, interpret, and reshape their distressing mental images—replacing them with more constructive and positive ones. It also works to transform negative core beliefs about the self and others through guided imagery techniques. The NIHR-funded clinical trial enrolled 45 individuals with psychosis who were seeking help for hallucinations and delusions, all of whom reported experiencing troubling mental imagery linked to their symptoms.
The largest feasibility study to date exploring imagery-focused therapy for individuals with psychosis — involving 45 participants — has shown encouraging outcomes, according to a University of Sheffield study recently published in the Schizophrenia Bulletin. The findings confirm the iMAPS approach is safe and suggest strong potential, paving the way for a larger multi-centre clinical trial to assess its clinical benefits and cost-effectiveness.
Dr Christopher Taylor, Senior Lecturer and NIHR Fellow at the University of Sheffield’s School of Psychology, and Consultant Clinical Psychologist at Pennine Care NHS Foundation Trust, gave an example of considering someone living with psychosis who holds the terrifying belief that their home will be invaded and they’ll be harmed. They may vividly imagine an intruder breaking in, which triggers overwhelming fear and deepens their distress.
He indicated that these intrusive mental images can fuel paranoia and heighten feelings of vulnerability and their aim is to help patients recognise and gradually manage these powerful visual experiences. Dr Taylor indicated that attempting to push away such distressing images often backfires — much like when people resolve to avoid chocolate biscuits, only to crave them even more.
“In therapy, we address this by helping individuals understand these shared experiences. We gently introduce imagery work with ‘safe place’ exercises to foster feelings of safety, then practice altering the image’s size, shape and texture to build a sense of control. We also use imagery rescripting, a technique borrowed from trauma therapy, where we guide individuals to imagine a new, positive ending to a past negative event, engaging all of their senses. While we can’t change the past, we can empower individuals to re-script their experiences and change the meaning.”
During the trial, the talking therapy took place over twelve weekly sessions. Each participant had at least one distressing image associated with a hallucination or delusional belief. These images could stem from past experiences, imagined scenarios, or anxieties about the future.
One participant, 28-year-old Thom Brandwood-Spencer, began experiencing these distressing symptoms at around nine years of age.
He had shown positive results from the iMAPS treatment.
