Proof-of-concept and acceptability of an online imagery rescripting intervention for people experiencing intrusive imagery after suicide bereavement

Background Individuals bereaved by suicide frequently experience upsetting and intrusive imagery relating to the deceased and/or their death, which may play a role in increased psychological morbidity and suicide risk. Imagery rescripting (ImRs) is an intervention frequently used in trauma-reprocessing therapies that may provide clinical and emotional benefits for individuals experiencing such imagery. Aims This study aimed to evaluate proof-of-concept and acceptability of a brief online ImRs intervention for adults experiencing intrusive imagery following suicide bereavement. Method We conducted a proof-of-concept and acceptability study using mixed quantitative and qualitative methods. Six suicide-bereaved adults completed a manualised three-session online ImRs intervention delivered over 3–5 weeks, with two-week follow-up. Participants were predominantly female (5/6) and white (5/6), with a mean age of 56.6 years (SD = 7.23). Outcomes included self-report measures of mood, PTSD symptoms, grief, acquired capability for suicide, and imagery characteristics. Acceptability was explored through thematic analysis of qualitative feedback after Sessions 1 and 3. Results All participants completed treatment and there was no report of significant adverse effects or risk incidents. Descriptive analysis of pre- and post-intervention measures showed reductions in image salience and/or frequency and in mean scores on measures of mood, PTSD and grief but not acquired capability for suicide. Several participants showed reliable improvement on measures of PTSD symptoms and image-related negative affect. Thematic analysis identified that all participants experienced the intervention as emotionally challenging but acceptable, also reporting reduced negative impacts of intrusive images and, in some cases, reduced overall mental distress. Conclusions Our findings present evidence to support proof-of-concept and acceptability of a brief ImRs intervention for intrusive images relating to suicide bereavement. Further feasibility testing with a larger and more diverse sample is warranted.