JMIR Publications

ABSTRACT

Background:

Self-harm (SH) affects around 20% of all young people in the UK. Treatment options for self-harm remain limited and those available are long and costly and may not suit all young people. There is an urgent need to develop new scalable interventions to address this gap. IMAGINATOR is a novel imagery-based intervention targeting self-harm initially developed for 16- to 25-year-olds. It is a blended digital intervention delivering Functional Imagery Training (FIT) via therapy sessions and a smartphone app.

Objective:

In this study, we piloted a new version of the app, IMAGINATOR 2.0, extended to adolescents from age 12 and co-produced with a diverse group of young people with lived experience. Our aim was to test the feasibility and acceptability of delivering IMAGINATOR 2.0 in secondary mental health services. This study was registered with ClinicalTrials.gov (NCT06311084) prior to participant enrolment.

Methods:

Four co-design workshops were conducted online with UK-based lived-experience co-designers aged 14-25 to develop the IMAGINATOR 2.0 app. The intervention was then piloted with participants recruited from West London NHS Trust Tier 2 CAMHS and adult Mental health Integrated Network Teams (MINT) teams. Participants received three face-to-face FIT sessions in which the app was introduced, and five brief phone support sessions. Outcome assessments were conducted after completing therapy, approximately three months post-baseline. Two focus groups gathered the therapists' perspectives on IMAGINATOR 2.0’s acceptability and means of improvement. For quantitative data, descriptives are reported. Qualitative data were analysed using a co-produced thematic analysis method with young people with lived experiences.

Results:

Eighty-three participants were referred and 29 (Gender: n = 28 women, n = 1 transgender, mean age = 18.9) were eligible and completed screening. Of the 27 participants who started, 59% completed therapy per protocol, while only 15 completed the quantitative outcome assessment. There was an overall reduction in number of SH episodes over 3-months from pre- to post-intervention (baseline: median = 6.5, IQR = 35; post-intervention: median = 0, IQR = 7; median diff = -6.5, r = 0.69). Six themes were identified through thematic analysis of therapists’ feedback, including mental imagery’s potential and boundaries, therapy expectations, experience and effectiveness, accessibility of digital support, and adaptation of the IMAGINATOR 2.0 app to complement care pathways. The app was valued by therapists who highlighted the need for an intervention like IMAGINATOR 2.0 in their services.

Conclusions:

IMAGINATOR 2.0 shows initial promise as an acceptable brief intervention targeting self-harm in young people under adolescent and adult mental health services. Challenges with attrition need to be addressed for a definitive randomised controlled trial to test the intervention efficacy.