Imagery Interventions and Cognitive-Behavioural Therapy for Psychological Complaints Related to Bullying: A Systematic Review and Meta-Analysis.

Bullying is associated with internalizing symptoms and impaired everyday functioning. Cognitive-behavioural therapy (CBT) and imagery interventions have been studied as treatments to improve mental health after such experiences. This meta-analysis aimed to evaluate the effects of individual CBT and imagery interventions in targeting internalizing symptoms (negative affect, depression, anxiety and post-traumatic stress symptoms) and improving self-perception and coping in bullying victims. Systematic searches of PubMed, PsycInfo, Embase and Web of Science identified 23 studies applying CBT (n = 15) and imagery interventions (n = 8) in bullying victims. Risk of bias and random-effects meta-analyses were conducted for pre - post and pre - follow-up comparisons. Sensitivity analyses and meta-regressions explored potential moderators. Unadjusted analyses showed reductions in internalizing symptoms pre- to post - intervention (k = 21, g = 0.72). These symptoms were maintained at follow-up assessments (k = 9, g = 0.54). Similar initial improvements emerged for self-perception and coping outcomes (k = 15, g = 0.75). However, substantial heterogeneity existed (I2 = 68%-98%). Crucially, after adjusting for publication bias, the pre-post internalizing effect dropped to g = 0.26 and was no longer statistically significant. Conversely, the adjusted effect for self-perception and coping increased to g = 0.98, whereas the follow-up internalizing effect decreased (g = 0.37) but remained significant. Both CBT and imagery interventions may offer potential benefits for bullying victims in reducing internalizing symptoms and in improving self-perception and coping abilities. However, large heterogeneity, methodological limitations and publication bias warrant cautious interpretation. Further high-quality controlled trials are needed to establish the robustness and clinical efficacy of these interventions.