Intrusive mental imagery and negative beliefs about self and others are frequently reported problems for individuals who experience psychosis, but there are few treatment approaches that have specifically targeted these. Intrusive mental images and negative schema have been identified as potential maintaining factors for persecutory delusions. These can range from paranoia-related recurrent intrusive images (e.g., being attacked by others, being followed by unknown figures who mean you harm) from the past or “flash-forward” future paranoia related intrusive mental images. In this article we outline clinical issues and adaptations of an imagery-focused approach for persecutory delusions. Drawing on a number of sources including a systematic literature review, a qualitative study exploring core beliefs, an experience sampling study and techniques from existing manuals and approaches, we adapted these imagery approaches to work with images and schema. The close links between imagery and core beliefs highlighted an opportunity to also use imagery rescripting approaches to transform negative schema and reduce persecutory delusions. Individuals with psychosis often want help with intrusive mental images and negative beliefs; adapted evidence-based imagery focused interventions can be used and the interventions may also help to reduce persecutory delusions.