Experiences of imagery‐based treatment for anxiety in bipolar disorder: a qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial
Experiences of imagery‐based treatment for anxiety in bipolar disorder: a qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial
Objectives: intrusive mental imagery is associated with anxiety in bipolar disorder (BD) and presents a novel treatment target. Imagery-based treatments show promise in targeting anxiety and improving mood instability. This qualitative study explored experiences of receiving up to 12 sessions of a brief structured psychological intervention: Image-Based Emotion Regulation (IBER), which targets maladaptive mental imagery in the context of BD with an aim to modify the emotional impact of these images.
Design: a qualitative study embedded within the Image Based Emotion Regulation (IBER) feasibility randomised controlled trial.
Methods: semi-structured interviews were conducted with 12 participants in the treatment arm of the trial who received IBER + treatment as usual. Data were analysed using thematic analysis.
Results: despite some initial scepticism about imagery-focused treatment, all participants expressed broadly positive accounts of treatment experiences. High levels of engagement with imagery modification techniques, beneficial use of techniques post treatment and improvements in anxiety management and agency were described by some. Three sub-groups were identified: those who reported a powerful transformative impact of treatment; those who embedded some new techniques into their daily lives, and those who felt they had techniques to use when needed. No participants reported overall negative experiences of the IBER treatment.
Conclusions: findings from this study highlight the value for treatment recipients of modifying the underlying meanings associated with maladaptive imagery, and the personalised skills development to manage anxiety within bipolar disorders. Findings can inform treatment refinements and further trial-based evaluations.
Elkington, Susan
e38654f9-5360-4593-b4c4-4f9530b02592
Brown, Michael
27736c04-73e9-4b91-9fcb-1f17b1fae421
Wright, Kim
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Regan, Jemma
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Pattarnaraskouwski, Kate
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Steel, Craig
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Hales, Susie
a3031d6a-7848-440b-95b8-700f082c90f7
Holmes, Emily
a6379ab3-b182-45f8-87c9-3e07e90fe469
Morant, Nicola
08bcf5c1-49bc-4827-9b85-a36d73e41893
September 2024
Elkington, Susan
e38654f9-5360-4593-b4c4-4f9530b02592
Brown, Michael
27736c04-73e9-4b91-9fcb-1f17b1fae421
Wright, Kim
d94dfa78-5c60-47e9-8b45-88afc44e1ddf
Regan, Jemma
54bc4bbc-2360-4c04-9995-abb1370bee3e
Pattarnaraskouwski, Kate
18dbba98-0d24-4ece-b789-57059fbaab89
Steel, Craig
170e312a-f535-4a80-8b2c-6e0c62c9e912
Hales, Susie
a3031d6a-7848-440b-95b8-700f082c90f7
Holmes, Emily
a6379ab3-b182-45f8-87c9-3e07e90fe469
Morant, Nicola
08bcf5c1-49bc-4827-9b85-a36d73e41893
Elkington, Susan, Brown, Michael, Wright, Kim, Regan, Jemma, Pattarnaraskouwski, Kate, Steel, Craig, Hales, Susie, Holmes, Emily and Morant, Nicola
(2024)
Experiences of imagery‐based treatment for anxiety in bipolar disorder: a qualitative study embedded within the image based emotion regulation feasibility randomised controlled trial.
Psychology and Psychotherapy: Theory, Research and Practice, 97 (3).
(doi:10.1111/papt.12538).
Abstract
Objectives: intrusive mental imagery is associated with anxiety in bipolar disorder (BD) and presents a novel treatment target. Imagery-based treatments show promise in targeting anxiety and improving mood instability. This qualitative study explored experiences of receiving up to 12 sessions of a brief structured psychological intervention: Image-Based Emotion Regulation (IBER), which targets maladaptive mental imagery in the context of BD with an aim to modify the emotional impact of these images.
Design: a qualitative study embedded within the Image Based Emotion Regulation (IBER) feasibility randomised controlled trial.
Methods: semi-structured interviews were conducted with 12 participants in the treatment arm of the trial who received IBER + treatment as usual. Data were analysed using thematic analysis.
Results: despite some initial scepticism about imagery-focused treatment, all participants expressed broadly positive accounts of treatment experiences. High levels of engagement with imagery modification techniques, beneficial use of techniques post treatment and improvements in anxiety management and agency were described by some. Three sub-groups were identified: those who reported a powerful transformative impact of treatment; those who embedded some new techniques into their daily lives, and those who felt they had techniques to use when needed. No participants reported overall negative experiences of the IBER treatment.
Conclusions: findings from this study highlight the value for treatment recipients of modifying the underlying meanings associated with maladaptive imagery, and the personalised skills development to manage anxiety within bipolar disorders. Findings can inform treatment refinements and further trial-based evaluations.
Text
Psychol Psychother - 2024 - Elkington - Experiences of imagery‐based treatment for anxiety in bipolar disorder A
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Accepted/In Press date: 15 May 2024
e-pub ahead of print date: 28 June 2024
Published date: September 2024
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Local EPrints ID: 507822
URI: http://eprints.soton.ac.uk/id/eprint/507822
ISSN: 1476-0835
PURE UUID: ec47e552-a094-44d5-b819-38fffb6bd441
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Date deposited: 06 Jan 2026 18:00
Last modified: 08 Jan 2026 03:28
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Author:
Susan Elkington
Author:
Kim Wright
Author:
Jemma Regan
Author:
Kate Pattarnaraskouwski
Author:
Craig Steel
Author:
Susie Hales
Author:
Emily Holmes
Author:
Nicola Morant
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