Summary: iMAPS is a new imagery-focused therapy designed to help people with psychosis gain control over intrusive mental images that intensify paranoia, fear, and hallucinations. In a feasibility trial of 45 participants, the approach achieved high engagement and meaningful reductions in distress by teaching people to understand, transform, and re-script disturbing images.
Unlike some standard treatments that deliver modest benefits or cause troublesome side effects, iMAPS directly addresses the mental imagery that often fuels mistrust and threatening beliefs. Early findings indicate this therapy could complement existing psychosis treatments, and researchers are preparing a larger multi-site clinical trial to test clinical and cost-effectiveness.
Key Facts
- Imagery as a driver: Many people with psychosis experience vivid intrusive images—reported in up to around three quarters of patients—that can amplify paranoia, voices, and other psychotic symptoms.
- Targeted intervention: iMAPS teaches practical techniques to reshape frightening images, reduce perceived threat and powerlessness, and shift negative beliefs about the self and others.
- Promising feasibility trial: The largest feasibility study of imagery-focused therapy for psychosis to date showed safety, strong adherence, and promising reductions in distress related to hallucinations and delusions.
Source: University of Sheffield
A pioneering, imagery-focused therapy for people with psychosis offers a new route to reduce distress from intrusive mental images.
Psychosis can cause hearing voices, unfounded fears that others intend harm, and vividly intrusive mental images. These images may arise from past trauma, anxiety about the future, or other sources, and they often combine sensory qualities and meaning that increase distress and mistrust.
Existing treatments—such as Cognitive Behavioural Therapy (CBT) and antipsychotic medication—can help some people but have limitations. CBT shows small but reliable effects for psychotic experiences, and many patients stop or change antipsychotic medication within months because of side effects or lack of perceived benefit. This leaves a gap for therapies that directly target the mechanisms that sustain paranoia and hallucinations.
The University of Sheffield team developed iMAPS (iMAgery Focused Therapy for PSychosis) to work explicitly with distressing mental images and the negative beliefs they maintain. The therapy helps people make sense of their images, physically alter image qualities (for example size, clarity, texture) to regain control, and use imagery rescripting to create less threatening or more empowering endings to past or imagined scenes. Alongside imagery techniques, iMAPS addresses negative schemas about the self and others that commonly underpin psychotic beliefs.
An NIHR-funded, assessor-blind feasibility randomized controlled trial recruited 45 people seeking help for hallucinations and delusions who reported distressing intrusive imagery. Participants were randomly assigned (2:1) to receive 12 weekly sessions of iMAPS plus usual care or treatment as usual (TAU), with assessments at baseline, 16 and 28 weeks. The trial aimed to test recruitment, retention, therapy attendance, safety, and acceptability.
Results met feasibility targets: recruitment reached 100% of the target, retention at 16 weeks was 80%, and 77% of those allocated to therapy adhered to the treatment. Participants reported positive experiences with the approach and meaningful reductions in distress from psychotic symptoms. Two serious adverse events occurred in the therapy arm but were judged unrelated to the treatment; there were none in the TAU group. Taken together, these findings support the safety and acceptability of iMAPS and justify a fully powered clinical and economic trial.
Dr Christopher Taylor, Senior Lecturer and NIHR Fellow at the University of Sheffield and Consultant Clinical Psychologist, explains that intrusive images can act like a “multisensory amplifier” for paranoia. He describes practical therapy steps used in iMAPS: establishing a sense of safety with guided safe-place imagery, practicing control by changing image attributes, and applying imagery rescripting to alter the emotional meaning attached to memories or feared future events. The goal is not to erase memories but to reduce the images’ power to trigger distressing beliefs and reactions.
Participants reported real-world benefits. One early participant described how imagery work and rescripting helped reduce feelings of powerlessness and separate the threatening images from the reality of risk. After therapy he was able to continue his studies and later support others with mental health challenges, citing the experience as a turning point.
Researchers emphasise that iMAPS is not intended to replace existing evidence-based treatments but to complement them: a larger multi-centre randomized trial will determine whether iMAPS provides additional clinical and cost-effective benefits when offered alongside standard care recommended for psychosis.
Key Questions Answered:
A: iMAPS is an imagery-focused psychological therapy that helps people reshape distressing mental images linked to psychosis. It addresses a common but under-targeted maintenance factor—intrusive imagery—offering an additional route to reduce paranoia and distress when other treatments have limited effect.
A: Therapists guide people through safe-place visualisations, exercises to change image size, shape and sensory qualities, and imagery rescripting to imagine new, less threatening outcomes. These techniques help change the emotional meaning attached to memories or feared scenarios and reduce distress.
A: The feasibility trial with 45 participants demonstrated that iMAPS is safe, acceptable, and engaging, with encouraging reductions in distress related to hallucinations and delusions. The study supports progressing to a larger clinical and cost-effectiveness trial.
About this psychosis research news
Author: Amy Pullan
Source: University of Sheffield
Contact: Amy Pullan – University of Sheffield
Image: The image is credited to Neuroscience News
Original Research: Open access.
“iMAgery Focused Therapy for PSychosis (iMAPS-2): An Assessor-blind Feasibility Randomized Controlled Clinical Trial” by Christopher Taylor et al. Schizophrenia Bulletin
Abstract
iMAgery Focused Therapy for PSychosis (iMAPS-2): An Assessor-blind Feasibility Randomized Controlled Clinical Trial
Background and Hypothesis
Intrusive mental images and negative schematic beliefs are implicated in maintaining—and possibly causing—some psychotic experiences, but current psychosis therapies rarely focus on imagery. The primary aim was to test the feasibility and acceptability of a randomized controlled trial of a novel imagery-focused psychological therapy for psychosis (iMAPS).
Study Design
An assessor-blind RCT enrolled help-seeking participants with hallucinations or delusions who reported distressing intrusive imagery. Participants were randomised (2:1) to 12 sessions of iMAPS plus standard care or to treatment as usual (TAU). Assessments occurred at baseline, 16 and 28 weeks. Primary feasibility outcomes included recruitment, retention at 16 weeks, and therapy session attendance.
Study Results
Recruitment reached the target of 45 participants. Retention at the 16-week primary endpoint was 80% (36 participants). Adherence to the imagery-focused therapy was high (77%), and qualitative feedback was positive. Two serious adverse events occurred in the iMAPS arm but were judged unrelated to the therapy; no serious adverse events were reported in the TAU group.
Conclusions
This largest-to-date feasibility trial of imagery-focused therapy for psychosis demonstrates safety, acceptability, and promising signals of clinical benefit. A fully powered clinical and cost-effectiveness trial is warranted to estimate iMAPS’s effects when delivered alongside standard care.