# Early Evaluation of IMAGINATOR 2.0 Intervention Targeting Self-Harm in Young People: Single-Arm Feasibility Trial

## TL;DR

A new digital app called IMAGINATOR 2.0 was tested to help young people reduce self-harm, showing some promise but needing further study.

## Contribution

IMAGINATOR 2.0 is a novel digital imagery-based intervention co-designed with young people to address self-harm in adolescents and young adults.

## Key findings

- IMAGINATOR 2.0 showed a significant reduction in self-harm episodes over 3 months.
- Therapists found the app acceptable and valuable for supporting mental health services.
- Challenges with participant attrition were identified, requiring improvements for future trials.

## Abstract

Self-harm (SH) affects around 20% of all young people in the United Kingdom. Treatment options for SH 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 SH initially developed for individuals aged 16 to 25 years. It is a blended digital intervention delivering functional imagery training via therapy sessions and a smartphone app.

This study aimed to pilot a new version of the app, IMAGINATOR 2.0, extended to adolescents from the age of 12 years and coproduced with a diverse group of young people with lived experience. Our aim was also to test the feasibility and acceptability of delivering IMAGINATOR 2.0 in secondary mental health services.

A total of 4 co-design workshops were conducted online with UK-based lived-experience co-designers aged 14-25 years to develop the IMAGINATOR 2.0 app. The intervention was then piloted with participants recruited from West London NHS Trust Tier 2 Child and Adolescent Mental Health Services and adult Mental Health Integrated Network Teams. Participants received 3 face-to-face functional imagery training sessions in which the app was introduced and 5 brief phone support sessions. Outcome assessments were conducted after completing therapy, approximately 3 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 analyzed using a coproduced thematic analysis method with young people with lived experiences.

Overall, 83 participants were referred, and 29 (gender: n=28 women, n=1 transgender; mean age 18.9, SD 3.74 years) were eligible and completed screening. Of the 27 participants who started, 59% (n=16) completed therapy per protocol, while only 15 (55.6%) completed the quantitative outcome assessment. There was an overall reduction in the number of SH episodes over 3 months from pre- to postintervention (baseline: median 7, IQR 3.5-21.5 months; postintervention: median 0, IQR 0-7 months; median difference=–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.

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

ClinicalTrials.gov NCT06311084; https://clinicaltrials.gov/study/NCT06311084