Guided Imagery

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Guided Imagery

Common Names

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

For Patients & Caregivers

What Is It

Imagery is a centuries-old technique that involves deliberate use of the power of imagination to recreate one’s own mental images, sounds, smells and even tastes, to reduce anxiety and to promote mind-body healing. Guided imagery (GI) 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, or progressive muscle relaxation in a quiet environment. Following this, a set of instructions or suggestions is given to enable one’s own imagination to help relieve symptoms. This can also include exploring images that may carry a message about a condition, which can offer understanding or control of the physical issues. Visualization exercises involve holding in mind graphic or vivid images that bring about healing. Repeating these exercises results in a conditioning effect that empowers a patient to use them whenever needed. An important aspect of GI practice is the regularity with which it is practiced and not the amount of time spent at each session.

How It Works

Several studies have shown that GI has positive effects on pain, physical functioning, anxiety, depression and quality of life in patients with fibromyalgia, arthritis and other rheumatic disorders; reduces both musculoskeletal and non-musculoskeletal pain; and helps reduce pain in community-dwelling older adults. When used with standard rehab program, motor imagery training improved gait in stroke patients. As an add-on therapy to dietary modification, GI reduced the severity of symptoms and improved quality of life in patients with irritable bowel syndrome; and when combined with music, it decreased work-related chronic stress, and thereby, the time needed to return to work. 

In children with type-1 diabetes mellitus, GI improved glycemic control, and was also effective in reducing recurrent abdominal pain in both children and adolescents.

Guided imagery was found to be useful in cancer settings as well. In a study of breast cancer survivors, both live-delivered and telemedicine-offered GI reduced fatigue, cognitive dysfunction and sleep disturbance. It also decreased anxiety, depression and body discomfort in gynecologic and breast cancer patients undergoing radiation therapy, and reduced stress and fatigue in patients undergoing radioactive iodine therapy following thyroidectomy. Practicing GI before surgery was shown to improve mood in prostate cancer patients undergoing radical prostatectomy. In addition, small studies have shown GI to be effective in reducing dyspnea in advanced cancer patients, and in decreasing chemo-induced nausea and vomiting. Similar effects were observed in a study that combined GI with music therapy. Also, GI used with progressive muscle relaxation was found to reduce pain, fatigue, retching, nausea, vomiting and to improve mood, anxiety and depression in patients undergoing chemotherapy.

Purported Uses
  • Pain
    Several studies have shown that GI helps reduce both musculoskeletal and non-musculoskeletal pain.
  • Fatigue
    Guided Imagery decreased fatigue in studies of cancer patients.
  • Depression
    Research shows that GI can be useful in reducing depression in patients with fibromyalgia, rheumatic disorders as well as in those with cancer.
  • Stress
    Guided Imagery has benefits in adults with chronic stress, and also helps reduce stress in cancer patients.
  • Anxiety
    Studies indicate that GI is a useful therapy for decreasing anxiety.
  • Chemotherapy-induced nausea and vomiting (CINV)
    Small studies have shown that GI alleviates CINV. Similar benefits were shown when GI was combined with music therapy or with progressive muscle relaxation.
  • Mood disturbance
    A study of prostate cancer patients showed that GI used before radical prostatectomy helped improve mood.
Is It Safe

Guided imagery is generally safe. However, caution is advised in patients with a history of trauma, abuse or mental illnesses such as psychosis or dissociative disorder, which can make it difficult to tell apart reality from one’s own experience or may trigger traumatic imagery that requires further professional support.

Who Can Provide this Service

Psychologists, social workers and complementary health practitioners teach guided imagery. This technique can also be learned by individuals on their own.

The Academy for Guided Imagery offers a professional certification training program involving interactive Guided Imagerysm, or IGIsm.

Where Can I Get Treatment

Guided Imagery classes are 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 use of the power of imagination to recreate vivid personal mental images, sounds, smells and even tastes, to ease anxiety and to facilitate mind-body healing. Guided imagery (GI) 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, or progressive muscle relaxation in a quiet environment. Following this, a set of instructions or suggestions is given to enable one’s own imagination to help relieve symptoms. This can also include exploring images that may carry a message about a condition, which can offer understanding or control of the physical issues. Visualization exercises involve holding in mind graphic or vivid images that bring about healing. Furthermore, repeating these exercises results in a conditioning effect that empowers a patient to use them whenever needed. An important aspect of GI practice is the regularity with which it is practiced and not the amount of time spent at each session. This modality is particularly accessible and easy to adapt, even with minimal instruction and no prior experience. There is the possibility of passively following a narration offered by a licensed practitioner or via media, making it ideal for patients with fatigue or high symptom-burden. Yet, there is also the option of actively shaping the narration and imagery, therefore personalizing the practice.

Over the last few years, GI has been investigated for its role as a psycho-supportive modality, and findings thus far are promising. Systematic reviews indicate that GI has positive effects on pain, physical functioning, anxiety, depression and quality of life in patients with arthritis and other rheumatic disorders (7 studies, 287 participants) (1); affects significant reductions in both musculoskeletal (9 studies, 201 subjects) (2) and non-musculoskeletal pain (15 studies, 1172 subjects) (3) when compared to control groups; and helps reduce pain levels in community-dwelling older adults (10 studies, 221 participants) (4).

Randomized trials of GI reported reduced use of analgesics in adults with osteoarthritis (5); and greater improvements in pain and depressive symptoms in subjects with fibromyalgia compared to a control group (6). In conjunction with standard rehabilitation program, motor imagery training was shown to improve gait in the sub-acute phase following stroke (7). As an adjunct to dietary modification, GI reduced symptom severity and improved quality of life in patients with irritable bowel syndrome (8); and when combined with music, it alleviated work-related chronic stress, thereby facilitating faster job return (9).

Benefits have been reported in pediatric population as well. In a study of children with type-1 diabetes mellitus, GI was shown to enhance glycemic control (10); and a meta-analysis (18 studies, 928 participants) showed its utility in reducing recurrent abdominal pain in children and adolescents (11). More studies are needed to assess the long-term effects.

The potential benefits of GI in oncology settings have also been explored, with data showing improved quality of life when used as an adjuvant to cancer treatment (12); and enhanced immune function in patients undergoing surgery (13) (14). In a trial of breast cancer survivors, both live-delivered and telemedicine-offered GI had favorable outcomes on fatigue, cognitive dysfunction and sleep disturbance scores (15). Guided imagery practice was also shown to alleviate anxiety, depression and body discomfort in gynecologic and breast cancer patients undergoing brachytherapy (16); and to reduce stress and fatigue in patients undergoing radioactive iodine therapy following thyroidectomy  (17). In another study of prostate cancer patients undergoing radical prostatectomy, presurgical use of GI decreased mood disturbance along with improving immune parameters, post-surgery (18).

Preliminary findings suggest benefits of GI in alleviating dyspnea in patients with advanced cancer (19); and in reducing chemo-induced (20) nausea and vomiting. Similar effects were observed in a study that combined GI and music therapy (21). Further, a mixed intervention of GI and progressive muscle relaxation was reported to ameliorate pain, fatigue, retching, nausea, vomiting and to improve mood, anxiety and depression (22) (23) (24) in patients undergoing chemotherapy.

Emerging evidence supports the benefits of GI, but much of it is based on poorly designed studies. Methodologically robust, larger trials are warranted to establish it as a supportive therapy.

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. Also, akin to perception, imagery elicits physiological responses. For example, images that conjure fear produce stress response whereas those that evoke calm and joy, a relaxation response (26).

Furthermore, data from a randomized trial suggest that positive picture-word cues used to evoke mental imagery resulted in improving 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. However, caution is advised in patients with a history of trauma, abuse or mental illnesses such as psychosis or dissociative disorder, which can make it difficult to distinguish objective reality from subjective experience or may trigger traumatic imagery that requires further professional support (26).

Practitioners and Treatments

Psychologists, social workers and complementary health practitioners teach guided imagery at hospitals, clinics and at community centers. This technique can also be learned by individuals on their own.

The Academy for Guided Imagery (28) offers a professional certification training program involving interactive Guided Imagerysm, or IGIsm.

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. Accessed September 17, 2020.
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