Imagery Interventions and Cognitive-Behavioural Therapy for Psychological Complaints related to Bullying: A Systematic Review and Meta-analysis

Background: Bullying is associated with internalising symptoms and impaired everyday functioning. Cognitive-behavioural therapy (CBT) and imagery interventions have been studied as treatments to improve mental health after such experiences. Objectives: This meta-analysis aimed to evaluate the effects of individual CBT and imagery interventions in targeting internalising symptoms (negative affect, depression, anxiety and post traumatic symptom ) and improving self-perception and coping in bullying victims. Methods: 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. Results: Significant reductions in internalising symptoms were observed from pre- to post-intervention (g = 0.72), with imagery interventions (g = 0.89) and CBT interventions (g = 0.62) demonstrating medium to high effect sizes. Follow-up assessments (k = 9) suggested that symptom reduction was maintained (g = 0.53). Significant improvements in self-perception and coping outcomes were also observed (g = 0.82). Sensitivity analyses identified specific studies contributing to large heterogeneity (I2: 94–98%). Number-Needed-to-Treat (NNT) values increased sharply after bias correction, ranging from 3.11 to 12.67, indicating more modest clinical benefits than initially estimated. Conclusions: When considering the available literature, the findings suggest that both CBT and imagery interventions demonstrate potential efficacy in reducing internalising symptoms and are associated with more positive self-perception and coping in bullying victims. These findings provide preliminary support for the potential benefits of structured psychological interventions to improve mental health following bullying experiences. However, large heterogeneity and publication bias warrant cautious interpretation and indicate a need for high-quality, manualized controlled trials to confirm clinical efficacy.