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.