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Therapies

guided imagery

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions
References
Evidence Based Rating Scale


What Is It?

Guided imagery is the conscious use of the imagination to create positive images ("healing visualizations") in order to bring about healthful changes in both the body and the mind. Creating mental images is nothing new for most people. Everyone has daydreams, perhaps of a set of new clothes or of winning the lottery. Guided imagery takes this natural process a step further. By working with a trained practitioner, or using special audiotapes, you can learn to communicate more effectively with your unconscious mind, requesting that your body function in an optimal and healthy way. (1)

The belief that the power of imagination can help people heal has ancient roots. Traditional folk healers known as shamans used guided imagery to treat ailments. (2) In Eastern medicine, envisioning well-being has always been an important part of the therapeutic process. In Tibetan medicine, in particular, creating a mental image of the healing god would improve the patient's chances for recovery. The ancient Greeks, including Aristotle and Hippocrates (the "father of modern medicine") also had their patients use imagery in their healing process. (1,3)

It was not until the 1960s, however, that psychologists exploring the emerging field of Biofeedback first began to appreciate the powers of the mind on the physical body. Through biofeedback, they could teach patients to slow heart rate, lower blood pressure, or open lungs stricken with asthma. In addition, a cardiologist, Dr. Herbert Benson, observes that when people relax their thinking, the body follows with slower breathing and blood pressure. He calls this the "relaxation response." (3) Then, in the 1970s, O. Carl Simonton, M.D., chief of Radiation Therapy at Travis Air Force base in Fairfield, California, and psychotherapist Stephanie Matthews-Simonton, devised a program--today known as the Simonton method--that utilized guided imagery to help cancer patients. (4) The patients pictured their white blood cells attacking their cancer cells (sometimes in scenes that resembled the popular old video game "Pac-Man"). Simonton found that the more vivid the images his patients used (for example, ravenous sharks attacking feeble little fish), the better the process worked.

Since then, a good deal of research into mind-body connections has appeared in mainstream medical literature. And while many conventional physicians remain skeptical that the mind has an actual physical effect on the reversal of an illness, guided imagery (often conducted by psychiatrists or psychologists) is now used in many medical inpatient and outpatient programs throughout the world. Furthermore, many holistically oriented psychologists, trainers, and counselors routinely employ guided imagery for stress reduction, smoking cessation, weight reduction, immune stimulation, improvement in sports performance, as well as for the relief of both physical and emotional illnesses. The pain of childbirth can also be greatly diminished with guided imagery.

How Does It Work?

Practitioners say that guided imagery works because, in terms of brain activity, picturing something and actually experiencing it are equivalent. Brain scans have verified that this is the case. (5) Stimulating the brain with imagery can have a direct effect on the nervous and endocrine systems and can ultimately affect the immune system as well. If you picture yourself luxuriating at the beach on a tropical island, your muscles will actually relax and your skin will "feel" the warmth of the sun's rays. Likewise, if you imagine yourself recuperating quickly and effortlessly from gallbladder surgery, you are more likely to heal faster and with less pain.

The brain's visual cortex, which processes images, has a powerful connection with the autonomic nervous system, which controls involuntary activities such as pulse, breathing, and physical responses to stress. Soothing, uplifting images can actually slow your pulse and breathing and lower your blood pressure, as well as help trigger the release of hormones such as endorphins, which make you feel good and nurture your body's restorative powers. (3)

 What You Can Expect

Although you can learn guided imagery techniques on your own from books, it is often more efficient and effective to work with a practitioner or purchase an audio recording dealing with the issue important to you. If you're a creative individual, you can write your own guided imagery script, read it onto a recording device, and then use it to be your own guide. If you work with a practitioner, it will probably take only a couple of sessions to learn a technique that works well for you. The sessions may be as short as 30 minutes or as long as 90 minutes. It will speed the process considerably if your practitioner allows you to record the session for home use.

During the first session, the practitioner, who may be a physician, behavioral health psychotherapist (psychiatrist, psychologist, licensed social worker, or masters level counselor), nurse practitioner, or a trained educator will ask you your goal for the use of guided imagery and screen for any related physical or emotional health problems. The practitioner will probably also ask you questions about your favorite vacation spots and times of year, and about experiences that have made you feel confident and secure. Your answers will help you and the practitioner develop images that make you feel good. (6)

Next, the practitioner will ask you to lie on a couch or sit in a chair. You will want to wear comfortable clothing and may want to take off your shoes.

Once you're settled in, the practitioner will lead you through a breathing exercise or relaxation technique. Then, the practitioner will guide you through a visualization exercise, using all five senses and perhaps focusing on a special place where you usually feel happy and peaceful. The practitioner may suggest some ideas, but will leave most of the imagining up to you, since not everyone sees things the same way. For example, you might find that imagining the sounds of the surf at the beach is relaxing, but another individual might find that the same sound brings up bad memories of living through a hurricane. The best images are the ones you conjure up yourself because they have personal meaning for you.

With practice, you will be able to relax and bring up healing images quickly--anytime, anywhere. You'll be able to use guided imagery to relax during stressful moments, as well as to treat a particular health problem. (7)

Health Benefits

While there is no scientific evidence indicating that guided imagery by itself helps to heal disease, this technique has been shown to promote relaxation and to improve quality of life. It is especially useful for conditions that are made worse by stress, such as high blood pressure, pain, and headache, as well as stress and anxiety themselves. It may also help certain eating disorders.

Guided imagery is a prime example of what is meant by a "complementary" health practice; one that's not necessarily curative when used on its own, but that assists in achieving your therapy plan or wellness goals more easily.

In a 1997 study at the University of Miami, researchers found that guided imagery helped elevate mood and decrease stress. The participants rated their moods before and after practicing guided imagery and had their blood levels of the stress Hormone cortisol measured. The subjects who used guided imagery reported a significant decrease in depression, fatigue, and total mood disturbance, and measured significant decreases in cortisol, as compared to the control group. (8) Stress reduction from guided imagery has also been shown to improve lung function in children with asthma. (18)

Imagery has been successfully tested as a strategy for relieving nausea and vomiting associated with chemotherapy in cancer patients, and it has also been found to relieve stress and promote weight gain in those with cancer. (9) Patients using the Simonton method (see "What Is It," above) have successfully used guided imagery as an adjunct therapy to conventional cancer treatments to mobilize their immune systems.

Other studies have shown that guided imagery is particularly helpful for patients preparing for and recovering from surgery. A 1996 study at the Cleveland Clinic showed that patients who used guided imagery prior to colorectal surgery had less anxiety before and less pain after the surgery than did the control group. The members of the guided imagery group used 37% less pain medication, regained their bowel function sooner, and were released from the hospital an average of a day and a half earlier.(10) Blue Shield of California has even begun to distribute guided imagery recordings to its members scheduled for major surgery in the hope that the practice will decrease surgical complications and the pain and anxiety associated with surgery.

In a case report of bulimia (an eating disorder where individuals binge and purge), imagery was used as an adjunct to cognitive behavior therapy (a form of psychotherapy based on the belief that our thoughts cause our feelings and behaviors). One session of guided imagery almost completely ended the binge-purge behavior in this case study. (13)

Imagery showed effectiveness in a case study of a stroke patient undergoing physical therapy for rehabilitation. Four times a week, the patient listened to an audiotape instructing him to imagine his affected arm being functional. At the end of six weeks, the patient had reduced impairment and improved function in his arm. (14)

Healthcare practitioners have used guided imagery to help their clients with diabetes become consistent in following strategies aimed at controlling their blood sugar levels. In a study where practitioners gave an imagery motivation script to diabetic patients, the patients showed improvement in blood testing, regular exercise, weight management, and consumption of a restricted lifetime diet. (15)

Guided imagery has shown effectiveness in treating illnesses and disorders requiring pain management. Studies indicate guided imagery helped to reduce pain in interstitial cystitis (a syndrome involving urinary urgency, frequency and pelvic pain) and children with recurrent abdominal pain. (16,17) There is also strong evidence that guided imagery is effective in managing the symptoms of fibromyalgia, a chronic pain disorder. (19,20). Other conditions such as chronic lower back pain and stress during pregnancy have improved using guided imagery. (21,22)

Actors, athletes, and public speakers also use guided imagery to prepare for important events. They say that picturing themselves performing at top form helps them do their best in reality.

How To Choose a Practitioner

There is no national or state certification or licensing for practitioners of guided imagery, although many professionals who practice it--psychiatrists, nurse practitioners, clinical psychologists, licensed social workers, and masters level counselors, for example--are licensed in behavioral health care and skilled in handling mental and physical illness-related problems. Guided imagery is frequently a component of hypnosis. See the WholeHealthMD article on hypnotherapy for guidance in choosing a practitioner. Additionally, many schools in the United States have training programs that lead to a certificate in guided imagery. (6) Guided imagery training is also available as a self-help method for "healthy" people from some coaches, trainers, childbirth educators, physical therapists, and hypnotists.

Make sure that the practitioner you select is recognized by the relevant state licensing agency, has had some verified professional training in guided imagery, and has experience helping others with similar problems.

The best way to find a reputable practitioner is to seek referrals from a trusted health-care professional or from friends. Ask for references and check them. Be sure you feel comfortable with a practitioner's style before you begin to work together.

If you'd rather learn guided imagery on your own, look for a class at a local hospital, wellness center, or community center. Guided imagery recordings that help visualization are also widely available. (7)

See also the WholeHealthMD Reference Library entries on Behavioral Health Practitioner and Mind-Body Skills Instructor

Cautions

  • Guided imagery generally is a safe and enjoyable experience for everyone, from children to the elderly. However, people who suffer from some form of mental illness, particularly people who are prone to severe anxieties, hallucinations, or post traumatic stress disorder, should discuss the process in advance with a trained therapist. If you ever experience disturbing images or memories during or after a session, you may also wish to discuss the experience with a trained therapist.

  • Choose images that are pleasant to you. If you know in advance that an image may be disturbing, let your practitioner know. If you're participating in a group session, feel free to sit out the exercise.
 

References

1. Mind-Body Medicine: An Overview. Web page. Available at: http://nccam.nih.gov/health/whatiscam/mind-body/mindbody.htm. Accessed: January 11, 2009.
2. Money M. Shamanism and complementary therapy. Complement Ther Nurs Midwifery. 2000 Nov;6(4):207-12.
3. Finger W, Arnold EM. Mind-body interventions: applications for social work practice. Soc Work Health Care. 2002;35(4):57-78.[Full text saved as PDF file]
4. Simonton Cancer Center. Web page. Available at: http://www.simontoncenter.com/index.html. Accessed: January 11, 2009
5. Fletcher PC, Shallice T, Frith CD, Frackowiak RS, Dolan RJ. Brain activity during memory retrieval. The influence of imagery and semantic cueing. Brain. 1996 Oct;119 ( Pt 5):1587-96.
6. Breast Cancer: Guided Imagery. Web page. Available at http://www.breastcancer.org/treatment/comp_med/types/imagery.jsp Accessed: January 12, 2009
7. Alternative Medicine Therapies Guide. Web page. Available at http://stason.org/TULARC/health/alternative-medicine/What-to-Expect-from-Guided-Imagery.html. Accessed: January 12, 2009
8. McKinney CH, Antoni MH, Kumar M, Tims FC, McCabe PM. Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychol. 1997 Jul;16(4):390-400.
9. Mansky PJ, Wallerstedt DB. Complementary medicine in palliative care and cancer symptom management. Cancer J. 2006 Sep-Oct;12(5):425-31.
10. Tusek DL, Church JM, Strong SA, Grass JA, Fazio VW. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum. 1997 Feb;40(2):172-8.
11. Eremin O, Walker MB, Simpson E, Heys SD, Ah-See AK, Hutcheon AW, Ogston KN, Sarkar TK, Segar A, Walker LG. Immuno-modulatory effects of relaxation training and guided imagery in women with locally advanced breast cancer undergoing multimodality therapy: A randomised controlled trial. Breast. 2008 Nov 11.
12. Freeman L, Cohen L, Stewart M, White R, Link J, Palmer JL, Welton D. Imagery intervention for recovering breast cancer patients: clinical trial of safety and efficacy. J Soc Integr Oncol. 2008 Spring;6(2):67-75
13. Ohanian V. Imagery rescripting within cognitive behavior therapy for bulimia nervosa: an illustrative case report. Int J Eat Disord. 2002 Apr;31(3):352-7.
14. Page SJ, Levine P, Sisto SA, Johnston MV. Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke. Phys Ther. 2001 Aug;81(8):1455-62.
15. Wichowski HC, Kubsch SM. Increasing diabetic self-care through guided imagery. Complement Ther Nurs Midwifery. 1999 Dec;5(6):159-63.
16. Carrico DJ, Peters KM, Diokno AC. Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study. J Altern Complement Med. 2008 Jan-Feb;14(1):53-60.
17. Weydert JA, Shapiro DE, Acra SA, Monheim CJ, Chambers AS, Ball TM. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr. 2006 Nov 8;6:29.
18. Kemper KJ, Lester MR: Alternative asthma therapies: An evidence-based review. Cont Pediatrics 1999; 16: 162-195.
19. Thieme K, Häuser W, Batra A, Bernardy K, Felde E, Gesmann M, Illhardt A, Settan M, Wörz R, Köllner V. Psychotherapy in patients with fibromyalgia syndrome. Schmerz. 2008 Jun;22(3):295-302.
20. Menzies V, Kim S. Relaxation and guided imagery in Hispanic persons diagnosed with fibromyalgia: a pilot study. Fam Community Health. 2008 Jul-Sep;31(3):204-12.
21. Morone NE, Lynch CS, Greco CM, Tindle HA, Weiner DK. "I felt like a new person." the effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries. J Pain. 2008 Sep;9(9):841-8.
22. Jallo N, Bourguignon C, Taylor AG, Utz SW. Stress management during pregnancy: designing and evaluating a mind-body intervention. Fam Community Health. 2008 Jul-Sep;31(3):190-203.

23. Ohanian V. Imagery rescripting within cognitive behavior therapy for bulimia nervosa: an illustrative case report. Int J Eat Disord. 2002 Apr;31(3):352-7.

Evidence Based Rating Scale 

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

 

  

 

 

Asthma

 

 

 

 

 

 

 

Studies have shown improved lung function in children (18)

 


Date Published: 04/19/2005
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