Original title: Rescripting suicidal mental imagery in young people: A pilot study of feasibility, acceptability and safety
Lianne Schmaal, Georgie Paulik, Zamantha Munoz, Laura van Velzen +6 · September 2026
Many young people who think about suicide experience vivid, intrusive mental pictures of suicide or death. These mental images can raise the risk of suicidal behaviour, but few treatments target them directly. Researchers tested a brief therapy called imagery rescriptingA therapy technique where a person changes the content of a distressing mental image—like editing a movie scene—to make it less upsetting or dangerous., where a therapist helps patients actively reshape these mental pictures. They tested it with young people aged 16–25 years who have mood disorders and suicidal thoughts. The team found that the treatment was safe and well received. Most participants did not find the sessions distressing, and none felt less safe afterwards. Nobody had an increase in suicidal thoughts from baseline to follow-up. The therapy also reduced how often the images appeared, how real and compelling they felt, how much they intruded, and how distressing they were.
Imagine you keep replaying a scary movie scene in your head where a character walks toward a cliff. The image feels so real you start to believe you are that character. Now a friend sits with you and helps you rewrite the scene—maybe the character stops, turns around, and walks back to safety. After a few tries, the scary image loses its power and pops up less often. In this paper, therapists help young people rewrite their own mental images of suicide in a similar way, changing the ending so the image no longer pushes them toward action.
Suicidal mental images—vivid, intrusive pictures of death—are common in young people with suicidal thoughts and may push them toward action, yet no existing therapy directly targets these images. This pilot study suggests a brief intervention that 'rescripts' those images is safe and acceptable, and early data hint it might reduce both the images and suicidal thinking. If confirmed in larger trials, it could fill a critical gap in suicide prevention for young people.
This was a small single-arm pilot study with only 11 completers, so there was no control group to compare against. The recruitment target of 25 was not met, partly due to service disruptions and clinician capacity constraints, which limits generalizability. Two serious adverse events occurred, though judged unrelated to the intervention. All outcome analyses were exploratory and not confirmatory, so the observed reductions in suicidal imagery and ideation may not be reproducible in a larger trial.
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Rescripting suicidal mental imagery in young people: A pilot study of feasibility, acceptability and safety — Lianne Schmaal, Georgie Paulik, Zamantha Munoz et al. — PsyArXiv — doi:10.31234/osf.io/4ybzh_v3
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper. This is a preprint, so it hasn't necessarily been peer reviewed.