Imagery-Focused Therapy for Visual Hallucinations: The Clinical Protocol

• Visual hallucinations are common and often distressing in psychotic disorders. • Imagery-Focused Therapy (IFT) targets the imagery linked to visual hallucinations. • A previous case series of IFT showed reduced hallucination severity and distress post-intervention, and was acceptable, safe, and feasible across a transdiagnostic sample. • The paper provides a clinical guide with case examples for applying the therapy. Visual hallucinations (VHs) are more common than previously thought and can cause significant distress and disability in psychotic disorders. Despite this, they have received little clinical research attention. Case series utilising Cognitive Behaviour Therapy (CBT) approaches have shown inconsistent findings. Research in other psychological domains suggests that problematic mental imagery is more strongly linked to negative emotions than verbal thought, with imagery-based CBT techniques often producing better outcomes than standard verbal CBT techniques alone. Since VHs share characteristics with mental imagery and distressing beliefs about VHs are often reinforced by related imagery (e.g., picturing a hallucinated figure attacking), an imagery-focused approach may offer greater therapeutic benefits. Paulik and Taylor (2024) conducted a multiple-baseline case series (N=11) evaluating a 10-session Imagery-Focused Therapy for VHs in a transdiagnostic group of participants. The intervention was found to be acceptable, safe, and appears feasible to test further, with most clients experiencing reductions in VHs severity and distress, with medium to large effect sizes. The current paper aims to provide a clinically rich description of Imagery-Focused Therapy for VHs, providing sufficient detail for clinicians experienced in working with psychosis and clinical researchers to deliver the therapy, with a detailed case illustration provided. Key Practitioner Message • Psychological therapy can help alleviate the distress linked to visual hallucinations and related mental imagery by applying mental imagery strategies to directly modify these cognitive experiences and the meaning made of them.