Exploring the acceptability and feasibility of a blended imagery‐based digital intervention for self‐harm in young people (Imaginator 2.0): a co‐produced qualitative study

Abstract

BACKGROUND: Around 20% of 12- to 25-year-olds experience self-harm, but interventions deemed both acceptable and effective in reducing self-harm behaviour are rare. Digital interventions can be effective; however, they often lack sustained engagement and co-design. Imaginator 2.0 is a brief, blended intervention with a co-designed app using mental imagery to help young people manage self-harm. This study explores the acceptability and perceived feasibility of Imaginator 2.0 with young people. METHODS: Semi-structured interviews were conducted via Microsoft Teams with a purposive sample of young people who had used Imaginator 2.0 in the United Kingdom between April 2022 and December 2023. Open questions covered therapy and app experience, mental imagery and intervention experience overall. Three young people with lived experience of self-harm (co-researchers) informed all research stages from design to dissemination. Thematic analysis was conducted. RESULTS: Ten participants were interviewed (all female). Four themes were generated: Imaginator 2.0 therapy impact, mental imagery efficacy and limitations, app experience and engagement, and Imaginator 2.0 expectations and need for improvement. The app was deemed acceptable as a support tool for self-harm and a useful adjunct to therapy. Most participants described imagery plans, audios, mood tracker and crisis support features as helpful, whereas journal and goal tracker features were less favoured. Mental imagery was considered beneficial in reducing self-harm, though not always sufficient during crises. Overall, participants indicated Imaginator 2.0 helped them manage their emotions and behaviour, and they valued the therapist-patient relationship. However, most felt the app required better therapy integration and greater personalisation. CONCLUSION: These findings support Imaginator 2.0 as a brief early intervention for young people accessing mental health services to help manage and contain self-harm. The next step is to further improve Imaginator 2.0 based on participant feedback and feasibility testing, followed by a randomised controlled trial comparing Imaginator 2.0 with usual care.

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