Guided Imagery for Treating Psychological Conditions

Learn about guided imagery, an alternative treatment for depression, anxiety, insomnia, bulimia and other mental health - health conditions.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

1. Background
2. Theory
3. Evidence
4. Unproven Uses
5. Potential Dangers
6. Summary
7. Resources

Background

Historically, imagery has been used by many cultural groups, including the Navajos, ancient Egyptians, Greeks and Chinese. Imagery has also been used in religions such as Hinduism and Judaism. The term "guided imagery" refers to a number of different techniques, including visualization; direct suggestion using imagery, metaphor and storytelling; fantasy and game playing; dream interpretation; drawing; and active imagination.

Therapeutic guided imagery is believed to allow patients to enter a relaxed state and focus attention on images associated with issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style with the aim to encourage patients to tap into latent inner resources and find solutions to problems. Guided imagery is a meditative relaxation technique sometimes used with biofeedback. Books and audiotapes are available as well as interactive guided imagery groups, classes, workshops and seminars.

Theory

It is proposed that the mind can affect the body when visualized images evoke sensory memory, strong emotions or fantasy. Imagery has been said to cause many types of changes in the body, including alterations in breathing, heart rate, blood pressure, metabolism, cholesterol levels and functions of the gastrointestinal system, immune system and endocrine system. A goal of guided imagery is to use the senses of touch, smell, sight and sound to achieve a tranquil state that may help reduce or eliminate physical symptoms.

Evidence

Scientists have studied guided imagery for the following health problems:

Headache
Initial research suggests that guided imagery may provide added benefits when used at the same time as standard medical care for migraine or tension headache. Some studies show that relaxation therapies, including use of guided imagery, may be as effective or more effective in reducing the frequency of migraine headaches than are modest doses of a beta-blockade medication. Other study results disagree. Further study is needed to make a strong conclusion.

Cancer
Some studies suggest that guided imagery techniques (such as relaxation and imagery training tapes) may improve quality of life and sense of comfort (mood, depression) in cancer patients. Further research is needed to confirm these results.

HIV
Initial evidence suggests that occasional use of guided imagery techniques may improve quality of life in people with HIV. Additional research would be helpful.

Anxiety and wound healing after surgery
Initial evidence suggests that guided imagery relaxation audiotapes may reduce postoperative anxiety, improve healing and relieve stress. This research is preliminary, and more study is needed before a recommendation can be made.

Anxiety and depression in multiple sclerosis
There is early research that the use of imagery may reduce anxiety but not depression or physical symptoms in patients with multiple sclerosis. Additional research would be helpful in this area.

Memory
Preliminary research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.

Congestive heart failure
A small preliminary study reports that guided imagery is of no benefit in congestive heart failure.

Fibromyalgia
Initial research suggests possible reductions in pain and improvements in functioning.

Upper respiratory tract infections
Preliminary research in children suggests that stress management and relaxation with guided imagery may reduce the duration of symptoms due to upper respiratory tract infections. Additional research is needed to confirm these results.

Bulimia nervosa
Evidence from preliminary research suggests that guided imagery may be an effective treatment for bulimia nervosa, at least in the short-term. Further study is needed before firm conclusions can be drawn.

Insomnia
Preliminary research supports the value of combined drug therapy and relaxation training in the treatment of insomnia. Further research is necessary to make a firm recommendation.

Juvenile rheumatoid arthritis
Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis. Further research is needed to confirm these results.

Pain
Significantly lower postoperative pain ratings and shorter hospital stays in children, less abdominal pain and less pain from laparoscopic surgery have been associated with guided imagery practice. Preliminary research also suggests guided imagery may help in reducing cancer pain. Further research is needed to confirm these results.

Osteoarthritis
Preliminary research suggests a reduction in pain and mobility difficulties in patients with osteoarthritis. Further research is needed before a firm conclusion can be drawn.

Relaxation in chronic obstructive pulmonary disease
A small study reports increased relaxation outcomes in people with chronic obstructive pulmonary disease (emphysema or chronic bronchitis) who use guided imagery techniques. Additional research is needed to confirm these results.

Unproven Uses

Guided imagery has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using guided imagery for any use.

Potential Dangers

Guided imagery has not been associated with severe adverse effects in the available scientific literature. In theory, excessive inward focusing may cause pre-existing psychological problems or personality disorders to surface. Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if your mental or physical health is unstable or fragile.

Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Be careful if you have any physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. If you feel unusually anxious while practicing guided imagery, or if you have a history of trauma or abuse, speak with a qualified health care provider before practicing guided imagery.

Summary

Guided imagery has been suggested for many different health conditions. Although guided imagery has not been proven effective for any specific condition, research is early and is not definitive. Do not rely on guided imagery alone to treat potentially dangerous medical conditions. Speak with your health care provider if you are considering guided imagery therapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Guided Imagery

Natural Standard reviewed more than 270 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

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3. Ahsen A. Imagery treatment of alcoholism and drug abuse: a new methodology for treatment and research. J Mental Imagery 1993;17(3-4):1-60.
4. Antall GF, Kresevic D. The use of guided imagery to manage pain in an elderly orthopaedic population. Orthop Nurs 2004;23(5):335-340.
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6. Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs 2004;5(3):97-104.
7. Ball TM, Shapiro DE, Monheim CJ, et al. A pilot study of the use of guided imagery for the treatment of recurrent abdominal pain in children. Clin Pediatr (Phila) 2003;Jul-Aug, 42(6):527-532.
8. Barak N, Ishai R, Lev-Ran E. [Biofeedback treatment of irritable bowel syndrome]. Harefuah 1999;Aug, 137(3-4):105-107, 175.
9. Baumann RJ. Behavioral treatment of migraine in children and adolescents. Paediatr Drugs 2002;4(9):555-561.
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12. Burns DS. The effect of the bonny method of guided imagery and music on the mood and life quality of cancer patients. J Music Ther 2001;Spring, 38(1):51-65.
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15. Crow S, Banks D. Guided imagery: a tool to guide the way for the nursing home patient. Adv Mind Body Med 2004;20(4):4-7.
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36. Kvale JK, Romick P. Using imagery for role transition of midwifery students. J Midwifery Womens Health 2000;Jul-Aug, 45(4):337-342.
37. Kwekkeboom KL, Kneip J, Pearson L. A pilot study to predict success with guided imagery for cancer pain. Pain Manag Nurs 2003;4(3):112-123.
38. Lambert SA. The effects of hypnosis/guided imagery on the postoperative course of children. J Dev Behav Pediatr 1996;Oct, 17(5):307-310.
39. Laurion S, Fetzer SJ. The effect of two nursing interventions on the postoperative outcomes of gynecologic laparascopic patients. J Perianesth Nurs 2003;Aug, 18(4):254-261.
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42. Louie SW. The effects of guided imagery relaxation in people with COPD. Occup Ther Int 2004;11(3):145-159.
43. Maguire BL. The effects of imagery on attitudes and moods in multiple sclerosis patients. Altern Ther Health Med 1996;2(5):75-79.
44. Mannix LK, Chandurkar RS, Rybicki LA, et al. Effect of guided imagery on quality of life for patients with chronic tension-type headache. Headache 1999;39(5):326-334.
45. Manyande A, Berg S, Gettins D, et al. Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. Psychosom Med 1995;Mar-Apr, 57(2):177-182.
46. Marks IM, O'Dwyer AM, Meehan O, et al. Subjective imagery in obsessive-compulsive disorder before and after exposure therapy: pilot randomised controlled trial. Br J Psychiatry 2000;176:387-391.
47. Marr J. The use of the Bonny Method of Guided Imagery and Music in spiritual growth. J Pastoral Care 2001;Winter, 55(4):397-406.
48. McKinney CH, Antoni MH, Kumar M, et al. Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychol 1997;Jul, 16(4):390-400.
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50. Moody LE, Fraser M, Yarandi H. Effects of guided imagery in patients with chronic bronchitis and emphysema. Clin Nurs Res 1993;2(4):478-486.
51. Moody LE, Webb M, Cheung R, et al. A focus group for caregivers of hospice patients with severe dyspnea. Am J Palliat Care 2004;21(2):121-130.
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53. Murray LL, Heather Ray A. A comparison of relaxation training an syntax stimulation for chronic nonfluent aphasia. J Commun Disord 2001;Jan-Apr, 34(1-2):87-113.
54. Norred CL. Minimizing preoperative anxiety with alternative caring-healing therapies. AORN J 2000;Nov, 72(5):838-840, 842-843.
55. Ott MJ. Imagine the possibilities: guided imagery with toddlers and pre-schoolers. Pediatr Nurs 1996;Jan-Feb, 22(1):34-38.
56. Peeke PM, Frishett S. The role of complementary and alternative therapies in women's mental health. Prim Care 2002;Mar, 29(1):183-197, viii.
57. Rees BL. An exploratory study of the effectiveness of a relaxation with guided imagery protocol. J Holist Nurs 1993;Sep, 11(3):271-276.
58. Rees BL. Effect of relaxation with guided imagery on anxiety, depression, and self-esteem in primiparas. J Holist Nurs 1995;Sep, 13(3):255-267.
59. Rosen RC, Lewin DS, Goldberg L, et al. Psychophysiological insomnia: combined effects of pharmacotherapy and relaxation-based treatments. 1389-9457 2000;Oct 1, 1(4):279-288.
60. Rossman ML. Interactive Guided Imagery as a way to access patient strengths during cancer treatment. Integr Cancer Ther 2002;Jun, 1(2):162-165.
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64. Speck BJ. The effect of guided imagery upon first semester nursing students performing their first injections. J Nurs Educ 1990;Oct, 29(8):346-350.
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67. Thompson MB, Coppens NM. The effects of guided imagery on anxiety levels and movement of clients undergoing magnetic resonance imaging. Holist Nurs Pract 1994;Jan, 8(2):59-69.
68. Troesch LM, Rodehaver CB, Delaney EA, et al. The influence of guided imagery on chemotherapy-related nausea and vomiting. Oncol Nurs Forum 1993;20(8):1179-1185.
69. Turkoski B, Lance B. The use of guided imagery with anticipatory grief. Home Healthc Nurse 1996;Nov, 14(11):878-888.
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