IMAGINATOR 2.0 - co-design and early evaluation
Research type
Research Study
Full title
IMAGINATOR 2.0: Co-design and early evaluation of a novel blended digital intervention targeting self-harm in young people
IRAS ID
310211
Contact name
Martina Di Simplicio
Contact email
Duration of Study in the UK
1 years, 0 months, 30 days
Research summary
Summary of Research
Self-harm, defined as any act of self-injury regardless of intent (NICE, CG133), affects around 20% of young people under 25, and is associated with poor educational and social outcomes. It is also the strongest predictor of suicide, and is therefore a significant social and healthcare issue for young people that demands efforts to create effective treatments.However, evidence-based treatment options for self-harm are few, resource intensive, and not widely available. Digital treatment approaches could be especially feasible, as they enable early intervention and wider accessibility for young people.
Many young people experience mental imagery related to their self-harm, for example they imagine the injury itself or enacting out the self-harm. These mental images can trigger intense emotional reactions and increase the likelihood of self-harming. Imagery based therapies that promote alternative positive imagery may, therefore, provide young people with effective tools for reducing self-harm and promoting adaptive coping in its place.
This study will pilot the IMAGINATOR intervention, which employs Functional Imagery Training (FIT) as a digitally supported ‘guided self-help’, delivered to young people aged 12-25 who currently engage in repeated self-harm and have been referred to the adult community mental health services (Mental Health Integrated Network Teams; MINT) and Community Child and Adolescent Mental Health Services (CCAMHS). FIT will use mental imagery techniques to motivate young people to engage in more helpful behaviours to cope with the distress that may trigger self-harm.
The young people will also get access to the IMAGINATOR app, which supports them to practice what they have learned and developed during the therapy.
The IMAGINATOR app has been co-designed and co-produced with young people with lived experience of self-harm, and we would now like to evaluate it as part of the IMAGINATOR intervention in this case series.
Summary of Results
Main Results Eighty-three patients were referred to the study, of whom 32 (30 female, 1 transgender, mean age = 18.4) were both eligible and interested in participating, and completed the screening pro-cess. out of 32, 3 participants became ineligible and were withdrawn from the study before starting therapy. Of the 27 individuals who began therapy, 59.3% followed the protocol, which included attending all face-to-face sessions (3 sessions) and at least two phone calls. While 70% completed all face-to-face sessions, only 33.3% attended all follow-up sessions (5 follow up phone call sessions). On average, participants waited 4.1 (range: 0.7-9) weeks to start therapy, and the intervention lasted about 21.3 (range: 9.7-36) weeks. However, only 15 (51.7%) partici-pants completed the first outcome assessment, and 11 completed the feedback interviews.Participants reported high satisfaction with the intervention, scoring an average of 24.92 (SD=2.9) out of 28 on the satisfaction scale (Client Satisfaction Scale; CSQ). Ratings for the app (through User Experience Questionnaire; UEQ) showed it was clear and easy to use but less effi-cient, stimulating, or novel. Importantly, no adverse events occurred during the study.
The intervention showed promising results in reducing self-harm. The number of self-harm epi-sodes dropped significantly (p = 0.006), from a median of 7 (IQR = 32) before therapy to 0 (IQR = 10) afterward. Participants reported reduced cravings to self-harm and greater motivation to stop self-harm following the intervention. Adult participants experienced improvements in de-pression, anxiety, and stress levels after Imaginator (as measured by the DASS-21), while young-er participants did not show significant changes (as measured by the RCADS). Overall wellbeing improved significantly (p = 0.012), from a median score of 32.5 (IQR=12.75) before therapy to 41 (IQR=11.5) after. This indicates a positive influence of Imaginator on their mental health. No significant changes were seen in other measures, including alcohol use, drug use, and emotion-al regulation.
Feedback interviews from 11 participants (3 from CCAMHS and 7 from adult services) revealed that Imaginator had a positive impact on mental health and self-harm reduction. Participants appreciated the support from therapists, who created a safe space and provided practical ad-vice on using the app. They valued the flexible structure of the intervention, though some found phone calls or certain sessions challenging. Despite these difficulties, participants found the intervention helpful for reducing self-harm, regulation emotions, improving routines, set-ting goals, and enhancing overall wellbeing.
REC name
West of Scotland REC 5
REC reference
22/WS/0087
Date of REC Opinion
23 Jun 2022
REC opinion
Favourable Opinion