Guided Imagery

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Guided Imagery

Common Names

  • Guided meditation
  • Visualization
  • Guided therapeutic imagery
  • Mental rehearsal
  • Guided self-hypnosis
  • Mental imagery

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


What Is It

Imagery is a centuries-old technique with deep historical roots. It involves deliberate recreation of vivid personal mental images, sounds, smells and even tastes, to ease anxiety and facilitate mind-body healing. Some techniques may overlap with those used in meditation, yoga, or music therapy.

Guided imagery can be learned from books or self-help tapes, or from a licensed practitioner. In a typical session, the practitioner helps foster a state of deep relaxation via breathing techniques, music, and/or progressive muscle relaxation in a quiet environment. Then a series of instructions or suggestions is offered to help relieve symptoms.

How It Works

Studies show that guided imagery has positive effects on pain, fatigue, stress, anxiety, depression, sleep, and recovery in patients with many types of illnesses including cancer.

It can also reduce discomfort during procedures or side effects like nausea and vomiting that may occur with treatment.

An important aspect of guided imagery is the regularity with which it is practiced and not the amount of time spent at each session. Repeating these exercises results in a conditioning effect that empowers a patient to use them whenever needed. This is especially useful for patients with fatigue or many symptoms.

Purported uses and benefits
  • Pain
    Studies show that guided imagery helps reduce many types of pain.
  • Stress, anxiety
    Guided imagery can help reduce chronic stress and anxiety. It can also help with stress and anxiety related to treatment or procedures.
  • Depression
    Guided imagery can be helpful for patients with chronic diseases who also have depression.
  • Fatigue
    Guided imagery may decrease fatigue in cancer patients.
  • Nausea and vomiting
    Small studies suggest guided imagery can help reduce nausea and vomiting related to treatment.
  • Sleeping disturbance
    A study found improvements in sleep disturbance, fatigue, and cognitive dysfunction to be clinically significant.
Is It Safe

Guided imagery is generally safe, but caution is advised for patients with a history of trauma, abuse, or mental illness who should work with a therapist to avoid potential triggers.

Who Can Provide this Service

This technique can be learned by individuals on their own. MSK offers free meditations online that include guided imagery to get started.

Psychologists, social workers, and complementary health practitioners also teach guided imagery at hospitals, clinics and at community centers.

Where Can I Get Treatment

MSK offers free meditations online that include guided imagery to get started. Guided Imagery classes are also offered in hospitals, clinics, and at community centers.

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For Healthcare Professionals

Clinical Summary

Imagery is a centuries-old technique with deep historical roots. It involves deliberate recreation of vivid personal mental images, sounds, smells and even tastes, to ease anxiety and facilitate mind-body healing. Some techniques may overlap with those used in meditation, yoga, or music therapy.

Guided imagery can be learned from books or self-help tapes, or in an interactive manner from a licensed practitioner. In a typical session, the practitioner helps foster a state of deep relaxation via breathing techniques, music, and/or progressive muscle relaxation in a quiet environment. Then a series of instructions or suggestions is offered to help relieve symptoms.

Guided imagery can help reduce

  • Pain
  • Discomfort with procedures
  • Nausea, vomiting
  • Anxiety, stress

It can also help improve

  • Fatigue
  • Sleep
  • Cognition
  • Well-being

Guided imagery in oncology settings
Adjuvant use of guided imagery improves quality of life and reduces anxiety, depression, stress, fatigue, and discomfort in cancer patients undergoing various procedures (12) (15) (16) (17) (18). Improvements in sleep disturbance and cognitive dysfunction were also clinically significant (30). Several other studies suggest it can help with symptom clusters that include nausea and vomiting (20) (21) (22) (23) (24). It may also improve immune function (13) (14) (18), alleviate dyspnea (19), help restore body image (29), and be helpful for pediatric patients with high trait anxiety (31).

In other populations
In patients with arthritis, other rheumatic disorders, or fibromyalgia, guided imagery had positive effects on pain, physical functioning, anxiety, depression, and quality of life (1) (2) (3) (4) (6), and may help reduce analgesic use (5).

It also relieved anxiety and pain in burn patients receiving dressing changes (32), fatigue, stigma, and mood in multiple sclerosis patients (33), and stress and anxiety related to COVID or other isolation (34) (35).

In various pediatric populations, it reduced stress, mood, and related biomarkers in Latino adolescents (36), enhanced glycemic control (10), and reduced recurrent abdominal pain of unknown etiology (11).

Guided imagery has also been used as an adjunct in rehabilitation following stroke (7), along with dietary modifications to improve irritable bowel syndrome symptoms (8), and to improve physical activity behavior (37).

Overall, this modality is particularly accessible and easy to adapt for patients with fatigue or high symptom-burden, but is not suggested for patients who are emotionally unstable without directly working with a therapist.

Mechanism of Action

Neuropsychological studies revealed that many of the mechanisms underlying mental imagery and perception are similar (25). This suggests that imagery plays an important role in learning, memory, action, and information processing. Physiological responses with imagery are also similar to those with perception. For example, images that conjure fear produce a stress response whereas those that evoke calm and joy produce a relaxation response (26).

Further, data from a randomized trial suggest that positive picture-word cues can improve positive mood in those with dysphoria (27). Additional research is needed to elucidate the cognitive and neural mechanisms underlying mental imagery.

Adverse Reactions

Guided imagery is generally safe, but caution is advised for patients with a history of trauma, abuse, or mental illness who should work with a therapist to avoid potential triggers (26).

Practitioners and Treatments

This technique can be learned by individuals on their own. MSK offers free meditations online that include guided imagery to get started.

Psychologists, social workers, and complementary health practitioners also teach guided imagery at hospitals, clinics and at community centers.

The Academy for Guided Imagery (28) offers a professional certification training program.

References
  1. Giacobbi PR, Jr., Stabler ME, Stewart J, Jaeschke AM, Siebert JL, Kelley GA. Guided Imagery for Arthritis and Other Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials. Pain Manag Nurs. Oct 2015;16(5):792-803.
  2. Posadzki P, Ernst E. Guided imagery for musculoskeletal pain: a systematic review. Clin J Pain. Sep 2011;27(7):648-653.
  3. Posadzki P, Lewandowski W, Terry R, Ernst E, Stearns A. Guided imagery for non-musculoskeletal pain: a systematic review of randomized clinical trials. J Pain Symptom Manage. Jul 2012;44(1):95-104.
  4. Tang SK, Tse MMY, Leung SF, Fotis T. The effectiveness, suitability, and sustainability of non-pharmacological methods of managing pain in community-dwelling older adults: a systematic review. BMC Public Health. Nov 8 2019;19(1):1488.
  5. Baird CL, Murawski MM, Wu J. Efficacy of guided imagery with relaxation for osteoarthritis symptoms and medication intake. Pain Manag Nurs. Mar 2010;11(1):56-65.
  6. Onieva-Zafra MD, Garcia LH, Del Valle MG. Effectiveness of guided imagery relaxation on levels of pain and depression in patients diagnosed with fibromyalgia. Holist Nurs Pract. Jan-Feb 2015;29(1):13-21.
  7. Oostra KM, Oomen A, Vanderstraeten G, Vingerhoets G. Influence of motor imagery training on gait rehabilitation in sub-acute stroke: A randomized controlled trial. J Rehabil Med. Mar 2015;47(3):204-209.
  8. Boltin D, Sahar N, Gil E, et al. Gut-directed guided affective imagery as an adjunct to dietary modification in irritable bowel syndrome. J Health Psychol. Jun 2015;20(6):712-720.
  9. Beck BD, Hansen AM, Gold C. Coping with Work-Related Stress through Guided Imagery and Music (GIM): Randomized Controlled Trial. J Music Ther. Fall 2015;52(3):323-352.
  10. Gelernter R, Lavi G, Yanai L, et al. Effect of auditory guided imagery on glucose levels and on glycemic control in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. Feb 2016;29(2):139-144.
  11. Abbott RA, Martin AE, Newlove-Delgado TV, et al. Psychosocial interventions for recurrent abdominal pain in childhood. Cochrane Database Syst Rev. Jan 10 2017;1(1):CD010971.
  12. Roffe L, Schmidt K, Ernst E. A systematic review of guided imagery as an adjuvant cancer therapy. Psychooncology. Aug 2005;14(8):607-617.
  13. Lengacher CA, Bennett MP, Gonzalez L, et al. Immune responses to guided imagery during breast cancer treatment. Biol Res Nurs. Jan 2008;9(3):205-214.
  14. Eremin O, Walker MB, Simpson E, et al. Immuno-modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: a randomised controlled trial. Breast. Feb 2009;18(1):17-25.
  15. Freeman LW, White R, Ratcliff CG, et al. A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care. Psychooncology. Aug 2015;24(8):910-918.
  16. Leon-Pizarro C, Gich I, Barthe E, et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Psychooncology. Nov 2007;16(11):971-979.
  17. Lee MH, Kim DH, Yu HS. The effect of guided imagery on stress and fatigue in patients with thyroid cancer undergoing radioactive iodine therapy. Evid Based Complement Alternat Med. 2013;2013:130324.
  18. Cohen L, Parker PA, Vence L, et al. Presurgical stress management improves postoperative immune function in men with prostate cancer undergoing radical prostatectomy. Psychosom Med. Apr 2011;73(3):218-225.
  19. Lai WS, Chao CS, Yang WP, Chen CH. Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: a pilot study. Biol Res Nurs. Oct 2010;12(2):188-197.
  20. Hosseini M, Tirgari B, Forouzi MA, Jahani Y. Guided imagery effects on chemotherapy induced nausea and vomiting in Iranian breast cancer patients. Complement Ther Clin Pract. Nov 2016;25:8-12.
  21. Karagozoglu S, Tekyasar F, Yilmaz FA. Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting. J Clin Nurs. Jan 2013;22(1-2):39-50.
  22. Charalambous A, Giannakopoulou M, Bozas E, Marcou Y, Kitsios P, Paikousis L. Guided Imagery And Progressive Muscle Relaxation as a Cluster of Symptoms Management Intervention in Patients Receiving Chemotherapy: A Randomized Control Trial. PLoS One. 2016;11(6):e0156911.
  23. Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. A Randomized Controlled Trial for the Effectiveness of Progressive Muscle Relaxation and Guided Imagery as Anxiety Reducing Interventions in Breast and Prostate Cancer Patients Undergoing Chemotherapy. Evid Based Complement Alternat Med. 2015;2015:270876.
  24. Yoo HJ, Ahn SH, Kim SB, Kim WK, Han OS. Efficacy of progressive muscle relaxation training and guided imagery in reducing chemotherapy side effects in patients with breast cancer and in improving their quality of life. Support Care Cancer. Oct 2005;13(10):826-833.
  25. Kosslyn SM, Behrmann M, Jeannerod M. The cognitive neuroscience of mental imagery. Neuropsychologia. Nov 1995;33(11):1335-1344.
  26. Kubes LF. Imagery for Self-Healing and Integrative Nursing Practice. Am J Nurs. Nov 2015;115(11):36-43; quiz 44.
  27. Pictet A, Coughtrey AE, Mathews A, Holmes EA. Fishing for happiness: the effects of generating positive imagery on mood and behaviour. Behav Res Ther. Dec 2011;49(12):885-891.
  28. Academy of Guided Imagery. http://acadgi.com
  29. Esplen MJ, Wong J, Warner E, et al. Restoring Body Image After Cancer (ReBIC): Results of a Randomized Controlled Trial. J Clin Oncol. Mar 10 2018;36(8):749-756.
  30. Freeman LW, White R, Ratcliff CG, et al. A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care. Psychooncology. Aug 2015;24(8):910-918.
  31. Hoag JA, Karst J, Bingen K, et al. Distracting Through Procedural Pain and Distress Using Virtual Reality and Guided Imagery in Pediatric, Adolescent, and Young Adult Patients: Randomized Controlled Trial. J Med Internet Res. Apr 18 2022;24(4):e30260.
  32. Aghakhani N, Faraji N, Alinejad V, et al. The effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing changes in burn patients: A randomized controlled trial. Burns. Nov 26 2021.
  33. Beitollahi M, Forouzi MA, Tirgari B, et al. Fatigue, stigma, and mood in patients with multiple sclerosis: effectiveness of guided imagery. BMC Neurol. Apr 22 2022;22(1):152.
  34. Gordon JS, Sbarra D, Armin J, et al. Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19-Related Stress: Pilot Feasibility Study. JMIR Form Res. Oct 4 2021;5(10):e32353.
  35. Pellas J, Renner F, Ji JL, et al. Telephone-based behavioral activation with mental imagery for depression: A pilot randomized clinical trial in isolated older adults during the Covid-19 pandemic. Int J Geriatr Psychiatry. Jan 2022;37(1).
  36. Weigensberg MJ, Wen CKF, Spruijt-Metz D, et al. Effects of Group-delivered Stress-reduction Guided Imagery on Salivary Cortisol, Salivary Amylase, and Stress Mood in Urban, Predominantly Latino Adolescents. Glob Adv Health Med. 2022;11:21649561211067443.
  37. Ackermann N, Cameron LD, Maki J, et al. Mental imagery-based self-regulation: Effects on physical activity behaviour and its cognitive and affective precursors over time. Br J Health Psychol. May 2022;27(2):484-500.
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