Visualisation gets sold as a one-size-fits-all wellness tool. For many anxiety disorders, it is genuinely useful. For schizophrenia, the relationship is more nuanced. Some forms of imagery — short, externally anchored, simple — can help. Others — long, immersive, deeply internal — can amplify the very experiences a person is trying to manage. This article walks through the difference.
Visualisation in schizophrenia is best used in short, focused doses with external anchors, and skipped when imagery tends to fuel hallucinations or delusional content.
What the science says
Mental imagery research, including work led by groups such as the Oxford Cognitive Approaches to Psychosis lab and summarised in studies indexed on PubMed, has shown two consistent findings. First, people with psychosis tend to have more vivid, intrusive imagery than people without. Second, imagery-based techniques used carefully (such as imagery rescripting in trauma-informed CBTp) can help when they are bounded and clinician-guided. The blanket "imagine your safe place for 20 minutes" approach common in wellness culture is less well-studied in this group and can be unhelpful.
Visualisations that often help
1. Short anchor images
A single, clear, simple image held briefly. Examples:
- The face of someone you love, held in mind for 30 seconds while you breathe.
- A favourite room, brought to mind in three details: the colour of the wall, the texture of the chair, the light through the window.
- A small object you remember well, like a piece of jewellery from a parent.
Why this works: short and detail-bounded, with no narrative arc. You return to the room you are in within a minute.
2. Movement-paired imagery
Imagine yourself completing a small task you find hard — getting out of bed, walking to the kitchen, calling a friend — in concrete physical detail. Then do the action. This is a behavioural activation tool with a small imagery component.
3. Compassionate-self imagery (with care)
From compassion-focused therapy: briefly imagine someone (real or imagined) who is calm and kind, looking at you with warmth. Used in moments of self-criticism. Best learnt with a clinician — see compassion-focused therapy for psychosis.
Visualisations to be careful with
Long "safe place" guided meditations
The classic 15-minute "imagine yourself on a beach" script can pull people into immersive imagery that interferes with reality monitoring. If you try one, keep it under five minutes and end with eyes-open grounding.
Imagery of figures or characters
Imagery work that involves visualising figures (a wise elder, a guide, a guardian) can become entangled with hallucinated voices for some people. If you have voices, this kind of imagery is best done with a CBTp clinician, not from an app.
Body-scan visualisations
Long internally focused body scans can be destabilising for people prone to dissociation or somatic delusions. A short, external-focus scan ("notice the floor under your feet, the chair under your back") is usually safer.
Visualisations to usually skip
- Heavy past-life or "journey" visualisations common in some new-age practices.
- Light-flooding visualisations in which one imagines coloured energy moving through the body.
- Detailed visualisations of feared scenarios — these are sometimes used in exposure therapy, but should only be done with a clinician trained in working with psychosis.
How to use imagery safely
- Keep it short. Under three minutes is a sensible default.
- Use external anchors. Eyes open or softly focused. Notice your hands, feet, the floor.
- Choose simple, familiar content. A real room you have been in. A real face you know.
- End deliberately. Open eyes, name three things in the room, take one slow exhale. Re-enter the present.
- Track effects. If imagery work consistently leaves you more distressed or more lost in internal experience, skip it.
What to do instead, if visualisation isn't your tool
You don't need imagery to cope well. Many people with schizophrenia rely on body-based and external-sensory tools instead — see grounding, sensory toolbox, breathing, and PMR.
Imagery rescripting for trauma
Many people with schizophrenia have a history of trauma, sometimes including traumatic memories of past episodes or hospitalisations. There is a structured imagery-rescripting technique used in trauma-focused CBT and in some trauma-informed CBTp protocols, in which a memory is gently re-entered with a clinician and rewritten with a different ending. This is genuinely useful — but it is a clinician-led intervention, not a self-help technique.
Imagery work is intensifying voices, paranoia, or distress; you are having thoughts of self-harm; or you can no longer easily return to the present. Stop the technique and contact your treatment team or call 988 (US).
Working with a therapist
If you want to use imagery beyond the simple anchor versions above, do it with a clinician trained in CBTp. The NAMI psychotherapy guide and SAMHSA helpline can help you find one.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.