East of EnglandMental Health
Start Date: 1 Apr 2016 End Date: 30 Sep 2017

Imaginator: A pilot study for a brief technology-based intervention to reduce self-harm in young people, harnessing mental imagery


Self-harm (up to 10% of 15-16 year old in UK) has substantial personal impacts and costs on the NHS. In Cambridgeshire self-harm is a significant issue with number of hospital admissions for self-harm higher than UK average. Treating underlying mental illness leads to small reductions in self-harm but these are long treatments for complex disorders. There is a need for effective short-term therapy for self-harm , with a specific focus on young people. Mental imagery is the process of ‘seeing through the mind’s eye’. Intrusive mental images carrying intense negative emotions are central to several mental disorders (Holmes & Matthews, 2010). Addressing distressing mental images and promoting positive imagery has been used for trauma, depression and self-harm in personality disorders ). We have successfully treated cases with self-harm behaviour using a short course of imagery-focused therapy for Bipolar Disorder. We propose that an imagery-focused intervention is a potentially effective treatment for people who self-harm. Imagining something makes it more likely to act). Our intervention will train individuals to imagine more adaptive behaviours rather than self-harm when distressed (functional imagery) and reduce likelihood of self-harm .Imagery focus on visual techniques makes it easily amenable for a smartphone app. Smartphone usage by young people is high. Our tailored app-based intervention can aid overcome barriers to access treatment.

Research questions

  • Can a new technology-based intervention (smartphone app ‘Imaginator’) reduce self-harm behaviour and associated distress in young people over 3 and 6 months after intervention?

Proposed methods

A feasibility study comparing individuals randomly assigned to one of two groups: Standard Care (SC)+Immediate Functional Imagery Training (FIT) vs SC plus 3-month Delayed FIT; assessments at Baseline, 3 and 6 months.

Expected Output of Research and Impact

  • Output. Feasibility data (recruitment rate, acceptability, indication of efficacy) for further application to test intervention in a full RCT, 1 publication; qualitative data from user-led feedback interviews, 1 publication.
  • Impact and added value. Intervention within 3 months of assessment for self-harm; captures young people’s preferences (app-based); reduces stigma (treatment done remotely); promotes coping and self-management immediately available in most vulnerable young individuals including those not meeting criteria for ongoing care or on waiting lists; no diagnostic boundaries; community recruitment to address access barriers to standard mental health services.
  • Potential output and added value (future RCT). Reducing A&E access and psychiatric assessments; wide implementation across trusts at low cost (e.g. via brief training); adaptation to other clinical groups who may benefit, e.g. intellectual (learning) disabilities.
Dr Martina Di Simplicio