Martin Mitrevski

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 limited. 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. Fifteen 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 62.5% reduction in suicidal ideation severity. Our pilot study provides preliminary indications 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.