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Using prompted re\u2010experiences and simulations with contrasting valence, we assessed the acute impact of a deliberate mental imagery task on cocaine craving.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A quantitative\u2013qualitative \u2018mixed\u2010methods\u2019 analysis of data collected for a randomized controlled trial that was stopped prematurely.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>UK National Health Service addictions treatment clinic and outpatient clinical research facility (laboratory).<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Adults with CUD. The original target sample was 120. All participants enrolled at the point the original trial was stopped were included (38 enrolled, 31 completed study).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Personalized (3\u2010minute) cue\u2013exposure (handling cocaine paraphernalia and watching video of drug preparation), immediately followed by a single 5\u2010minute, audio\u2010recorded, self\u2010guided and verbally described imagery task with random assignment to one of four conditions: two mental imagery memory re\u2010experiences (positive image before initiation to cocaine use or a negative image of a \u2018worst time\u2019 adverse cocaine use episode) or two future simulations (positive theme of recovery from CUD or negative theme of worsened CUD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Task transcripts were rated for imagery detail using five dimensions using a six\u2010point scale of imagery detail (ID) (total score\u00a0=\u00a00\u201325) and thematically coded. The outcome measure was cocaine craving using the Craving Experiences Questionnaire\u2014strengths version (CEQ\u2013S11; score\u00a0=\u00a00\u2013110) reported at baseline, arrival at the laboratory, and immediately after the cue\u2013exposure and mental imagery tasks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>A mixed\u2010effects, longitudinal, restricted linear regression, with the past\u2010positive imagery condition as referent, showed main effects of reduced craving after the imagery task (<jats:italic>b<\/jats:italic>\u00a0=\u00a0\u201329.2, 95% confidence interval (CI)\u00a0=\u00a0\u201345.3 to \u221213.1, <jats:italic>P\u2010<\/jats:italic>value &lt;\u00a00.001) and increased craving for the future\u2010negative task (<jats:italic>b<\/jats:italic>\u00a0=\u00a014.2, 95% CI\u00a0=\u00a00.1\u201328.4, <jats:italic>P<\/jats:italic>\u2010value 0.049). There was a future\u2010negative task by post\u2010imagery craving interaction (<jats:italic>b<\/jats:italic>\u00a0=\u00a028.1, 95% CI\u00a0=\u00a00.1\u201356.1, <jats:italic>P<\/jats:italic>\u2010value 0.049). A theory\u2010driven, deductive\/inductive qualitative analysis of the transcripts revealed six major themes: sensory characteristics, CUD vicious cycle, self\u2010care, emotions and appraisals, social role and CUD recovery. Positively themed simulations included interpersonal connections and rewarding activity; negative images included personal adversity, with appraisals of self\u2010criticism and hopelessness. Transcripts with more imagery detail were not associated with significantly greater reductions in craving in the positive or negative imagery task (<jats:italic>r<\/jats:italic> =\u00a0\u20130.32, 95% CI\u00a0=\u00a0\u20130.69 to 0.13 and <jats:italic>r<\/jats:italic>\u00a0=\u00a00.06, 95% CI\u00a0=\u00a0\u20130.58 to 0.53, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In people with cocaine use disorder, after cue\u2013exposure, a self\u2010guided imagery task with positive themes reduced craving, whereas mental imagery simulating worsened cocaine use disorder did not appear to.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15405","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T03:51:32Z","timestamp":1610077892000},"page":"2418-2430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Acute impact of self\u2010guided mental imagery on craving in cocaine use disorder: a mixed\u2010methods analysis of a randomized controlled trial"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9137-5005","authenticated-orcid":false,"given":"Natalie","family":"Lowry","sequence":"first","affiliation":[{"name":"Addictions Department Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"},{"name":"South London and Maudsley NHS Mental Health Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1307-2498","authenticated-orcid":false,"given":"John","family":"Marsden","sequence":"additional","affiliation":[{"name":"Addictions Department Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"},{"name":"South London and Maudsley NHS Mental Health Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Clydesdale","sequence":"additional","affiliation":[{"name":"Addictions Department Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1485-5571","authenticated-orcid":false,"given":"Brian","family":"Eastwood","sequence":"additional","affiliation":[{"name":"Addictions Department Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Maria","family":"Havelka","sequence":"additional","affiliation":[{"name":"South London and Maudsley NHS Mental Health Foundation Trust  London UK"},{"name":"Guy's and St Thomas\u2019 NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Goetz","sequence":"additional","affiliation":[{"name":"Addictions Department Institute of Psychiatry, Psychology and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/35090055"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2015.08.003"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.concog.2008.03.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00426-018-1127-z"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0012590"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1037\/1528-3542.5.4.489"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0018113"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2010.01.001"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(99)00161-8"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2011.06.012"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7967(99)00123-0"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2006.02.002"},{"key":"e_1_2_9_14_1","unstructured":"HackmannA. 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