Grief-related mental images and their association with prolonged grief symptoms and grief cognitions: a mixed-methods study

Aversive mental images occur across psychological disorders. Images related to the deceased and the loss can also develop after the death of a close person and seem related to prolonged grief. The present study investigated the content and characteristics of grief-related mental images and tested hypotheses regarding their associations with prolonged grief symptoms (PGS) and negative grief cognitions. Bereaved participants (<i>N</i> = 261) completed an online mental images questionnaire and measures of PGS and negative grief cognitions. Data were analyzed using hierarchical regression analyses and group comparisons, alongside a thematic analysis of image descriptions. More frequent and more uncontrollable mental images were associated with higher levels of PGS and higher endorsement of different domains of negative grief cognitions. Image specificity was unrelated to PGS levels. The qualitative analysis resulted in 12 distinct image themes that differed in frequency, uncontrollability, fantasy content, and emotional responses. Associations with PGS and endorsement of negative grief cognitions related to life and the future also differed for the distinct themes. Because the design precludes conclusions about causality, longitudinal studies need to clarify how such images relate to PGS development and maintenance. Imagery-focused interventions may be a promising treatment approach for PGS.