| Summary: | <p><strong>Background:</strong> Even in cases with complexity, simple techniques can be useful to target a specific symptom. Intrusive mental images are highly disruptive, drive emotion, and contribute to maintaining psychopathology. Cognitive science suggests we might target intrusive images using competing tasks.</p>
<p><strong>Aims:</strong> We describe an imagery competing task technique within cognitive behavioural therapy with a patient with bipolar disorder and post-traumatic stress disorder symptoms. The intervention – including Tetris computer game-play – was used 1) to target a specific image within one therapy session, and 2) to manage multiple images in daily life.</p>
<p><strong>Method:</strong> A single case (AB) design was used. 1) To target a specific image, the patient brought the image to mind and, after mental rotation instructions and gameplay practice, played Tetris for 10 minutes. Outcomes, pre- and post-technique, were: vividness/distress ratings when the image was brought to mind; reported intrusion frequency over a week. 2) To manage multiple images, the patient used the intervention after an intrusive image occurred. Outcomes were weekly measures of: a) imagery characteristics; b) symptoms of PTSD, anxiety, depression and mania.</p>
<p><strong>Results:</strong> 1) For the target image, there were reductions in vividness (80% to 40%), distress (70% to 0%), and intrusion frequency (daily to twice/week). 2) For multiple images, there were reductions from baseline to follow-up in a) imagery vividness (38%), realness (66%) and compellingness (23%), and b) PTSD symptoms (IES-R score 26.33 to 4.83).</p>
<p><strong>Conclusion:</strong> This low-intensity intervention aiming to directly target intrusive mental imagery may offer an additional, complementary tool in CBT.</p>
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