“When I picture myself, I just see black and white and dull”: A photo-elicitation study exploring mental images of the self in young people with depression

Background: Negative self-perception plays a crucial role in the development and maintenance of depression in young people. Mental images of the self may be a powerful target for treating depression. However, little qualitative research has explored young people’s mental imagery. The present study aimed to understand experiences of mental images of the self in young people with lived experience of depression or low mood. Methods: Nineteen young people aged 14–21 years old with lived experience of depression or persistent low mood took part in a qualitative photo-elicitation study with semi-structured interviews. Results: Reflexive thematic analysis identified six overarching themes relating to the content of images, sources, triggers, distressing properties, relationship between imagery and mood, and preferences for treatment. Participants described mental images that depicted primarily negative autobiographical memories relating to experiences of low mood, anxiety, and social disconnection, and reflecting hopelessness for the future. When participants did experience positive images, these were often accompanied by dampening appraisals that reduced the positive impact on their mood. Treatment goals included reducing aversive properties of negative mental imagery, such as vividness and uncontrollability, and generating more positive images. Conclusions: This study identified ways in which mental images of the self may contribute towards low mood in young people and highlighted distressing properties of mental imagery and preferences for treatment. Given the novel nature of this research, these findings are a valuable contribution towards informing theoretical frameworks that underpin our understanding of mental images of the self in young people with depression, and could be used to support intervention development in this population.