Rescripting suicidal mental imagery in young people: A pilot study of feasibility, acceptability and safety
Abstract
Suicidal mental imagery – vivid, intrusive mental images of suicide or death - is common among young people experiencing suicidal ideation and may increase risk of suicidal behaviour, yet interventions directly targeting these images are lacking. We conducted a single-arm pilot study evaluating the feasibility, acceptability and safety of a brief, therapist delivered imagery rescripting intervention targeting action-facilitating suicidal mental imagery in help-seeking young people aged 16–25 years with mood disorders and current or recent suicidal ideation. Fourteen participants were recruited; 12 were eligible for the intervention and 11 (92%) completed treatment and follow-up. The recruitment target (N=25) was not met, largely due to service disruptions and clinician capacity constraints. Acceptability and safety criteria were met: 73% reported that sessions were not distressing, none felt less safe following treatment, and no participant showed increased suicidal ideation from baseline to follow-up. Two serious adverse events occurred but were judged unrelated to the intervention. Exploratory analyses showed reductions in suicidal-image frequency, realness, compellingness, intrusiveness and distress, alongside a 52% reduction in suicidal ideation severity. Our pilot study indicates that directly rescripting action-facilitating suicidal mental imagery showed encouraging short-term safety and acceptability signals in young people, supporting evaluation in a larger randomised controlled trial.
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BibTeX
@misc{schmaal2026rescripting,
title = {{Rescripting suicidal mental imagery in young people: A pilot study of feasibility, acceptability and safety}},
author = {Lianne Schmaal and Georgie Paulik and Zamantha Munoz and Laura van Velzen and Pemma Davies and Martin Mitrevski and Eleanor Bailey and Phoebe Gleeson and Lisa Incerti and Samantha Galea},
howpublished = {PsyArXiv},
year = {2026},
month = sep,
doi = {10.31234/osf.io/4ybzh_v3},
url = {https://osf.io/preprints/psyarxiv/4ybzh_v3/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Rescripting suicidal mental imagery in young people: A pilot study of feasibility, acceptability and safety
AU - Lianne Schmaal
AU - Georgie Paulik
AU - Zamantha Munoz
AU - Laura van Velzen
AU - Pemma Davies
AU - Martin Mitrevski
AU - Eleanor Bailey
AU - Phoebe Gleeson
AU - Lisa Incerti
AU - Samantha Galea
PY - 2026
DA - 2026/09/11
PB - PsyArXiv
DO - 10.31234/osf.io/4ybzh_v3
UR - https://osf.io/preprints/psyarxiv/4ybzh_v3/
AB - Suicidal mental imagery – vivid, intrusive mental images of suicide or death - is common among young people experiencing suicidal ideation and may increase risk of suicidal behaviour, yet interventions directly targeting these images are lacking. We conducted a single-arm pilot study evaluating the feasibility, acceptability and safety of a brief, therapist delivered imagery rescripting intervention targeting action-facilitating suicidal mental imagery in help-seeking young people aged 16–25 years with mood disorders and current or recent suicidal ideation. Fourteen participants were recruited; 12 were eligible for the intervention and 11 (92%) completed treatment and follow-up. The recruitment target (N=25) was not met, largely due to service disruptions and clinician capacity constraints. Acceptability and safety criteria were met: 73% reported that sessions were not distressing, none felt less safe following treatment, and no participant showed increased suicidal ideation from baseline to follow-up. Two serious adverse events occurred but were judged unrelated to the intervention. Exploratory analyses showed reductions in suicidal-image frequency, realness, compellingness, intrusiveness and distress, alongside a 52% reduction in suicidal ideation severity. Our pilot study indicates that directly rescripting action-facilitating suicidal mental imagery showed encouraging short-term safety and acceptability signals in young people, supporting evaluation in a larger randomised controlled trial.
ER -