Harnessing mental imagery to improve mental health in the perinatal period: a systematic review and meta-analysis.

BACKGROUND: Mental imagery is an important maintenance factor in many mental health difficulties, and imagery-based treatments are effective, yet often underutilised. The perinatal period is a critical time for mental health outcomes. This review synthesised data on the relationship between imagery and mental health and the effectiveness of imagery-based interventions in the perinatal period. METHODS: Eligibility criteria were quantitative design, perinatal sample, a mental health outcome and either a measure of imagery or an intervention with an imagery component. Six databases were searched in May 2024 with the search updated in May 2026. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Data were synthesised narratively and in meta-analyses. RESULTS: Of 1592 de-duplicated identified reports, 38 studies were included (34 intervention studies, 2 retrospective cohort studies, 2 cross-sectional studies). Meta-analyses found no clear effect on anxiety (SMD -0.17, 95% CI -0.36 to 0.03) or depression (SMD -0.17, 95% CI -1.15 to 0.80), with overall low certainty of evidence. CONCLUSION: This review found that mental imagery has been harnessed in a limited fashion in the perinatal period. The majority of identified interventions aimed to enhance positive imagery with very few aiming to address negative imagery. Only one of the cross-sectional studies included examined the relationship between measures of perinatal mental imagery and mental health. In order to develop effective interventions that can both use and target dysfunctional mental imagery, it is critical that a strong theoretical basis is developed for use of imagery in the perinatal period.