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Guided Imagery
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Guided imagery involves the use of the imagination to create mental images to help bring about desired changes in one’s physical or emotional state. It is often combined with behavioral approaches, such as smoking cessation. When used by people with physical illness, guided imagery relies upon the neuro-anatomy of the mind/body connection to induce changes in the physical body. The term "guided" imagery is used because images are suggested and sometimes even described by a therapist or group leader. Guided imagery may also be practiced on one’s own, often with the use of audiotapes. History From prehistoric cave paintings to modern art, and from poetry to television, humans have communicated and made sense of their world through the use of images. Religious ceremonies, poetry, and song are filled with images. Prayer, meditation, and other healing traditions often invoke the use of images. It is widely understood that the use of imagery can cause changes in states of consciousness, emotions, and the body itself. In the late 18th and early 19th centuries the Austrian physician Franz Friedrich Anton Mesmer, the father of modern hypnosis, used the suggestion of certain images to help lead his subjects into hypnotic states. In the 20th century, stress research pioneer Hans Selye, MD explained how an image of a negative or disturbing event could trigger the stress response (the "fight or flight" response) in the body, even though the imagined event was not really happening(1). Herbert Benson, MD later found that meditation and prayer involving positive and peaceful images could induce what he termed the relaxation response in the body, which Benson concluded was a profoundly healing state(2). In the 1970s, radiation oncologist Carl Simonton, MD popularized the use of imagery with cancer patients to try to stimulate their immune systems(3). While guided imagery was, at that time, a controversial practice, it is now widely used in cancer treatment centers and support groups. Researchers in the field of mind/body medicine have since been studying ways in which imagery can be used to reduce symptoms and promote healing in a wide variety of illnesses. Theory Mind/Body Communication. There are two anatomical pathways through which the mind can influence the body: the nervous system and the circulatory system. The nervous system reaches from the brain into all the body's tissues and organs, and influences their functioning all the way down to the cellular level. Thus, the entire body is "wired" to the brain. In addition, the brain is a gland that releases thousands of different chemicals into the bloodstream, which circulate throughout the body. These chemicals, which are received by receptors on the surface of each cell, influence the function and activity of all the body’s tissues. The mind/body connection is a two-way street: just as the brain’s chemicals are sent out to all the cells of the body, the body provides feedback to the brain. This is accomplished both in the form of nerve impulses, and in chemical "messages" picked up by the brain’s own receptor cells. Technique. Guided imagery involves intentionally focusing the mind on images that represent changes you want to take place in your body. Guided imagery is also used to bring about psychological and behavioral changes. The term "guided" is used in that this process is guided by another person, such as a therapist or group leader, who suggests certain images for you to imagine, or directs you to invent your own images. Guided imagery may also be practiced on one’s own, with prerecorded audiotapes, music, meditation, drawing, painting, or just sitting quietly. The images used may be symbolic, and need not be detailed or anatomically accurate. For example, you might imagine that arthritis pain in your fingers’ joints is melting, dripping like a warm liquid out of your fingertips. You might imagine that your immune cells are preying on cancer cells as a pack of wolves might devour field mice. Guided imagery is a highly personal technique, and the images chosen must be inspiring and meaningful to the person using them. It is thought that the image is a vehicle through which the individual’s intention for healing is expressed. In this sense, it is believed that a powerful image mobilizes unconscious forces to influence the body’s responses, though the exact mechanisms by which this happens are yet unknown. Research Studies have found that imagery can help people influence a variety of bodily functions and illnesses. For example, a controlled study of 55 nursing mothers found they could double their milk production by using images of pleasant surroundings, milk flowing in their breasts, and the baby's warm skin against their own(4). Cancer patients using imagery daily for one year achieved significant improvements in natural killer cell activity and several other measures of immune functioning(5). Patients who used an imagery audiotape before, during, and after colorectal surgery had significantly less anxiety, pain, and need for narcotic medications, and had greater patient satisfaction than those using routine care alone(6). Patients with bulimia who used guided imagery had significantly reduced bingeing and purging episodes, and showed improvements in psychological well-being(7). And, women with breast cancer who used guided imagery audiotapes had significantly less anxiety, and higher comfort levels, while undergoing radiation therapy(8). What Are the Potential Uses of Guided Imagery? The most effective uses of guided imagery are in stress-related conditions, chronic illnesses, and pain control. It has also been found useful in relieving the side effects of medical treatments such as surgery, radiation, or chemotherapy in cancer. Specific conditions in which imagery is commonly used include: Addictions Allergies Anxiety Arthritis Asthma Cancer Chronic pain Depression Gastrointestinal disorders Heart disease Hypertension Auto-immune and immune system dysfunction Infectious diseases Neck and back pain Organ transplantation Surgery (preparation and recovery) Tension and migraine headaches Who Practices Guided Imagery and What is Their Training? Guided imagery is one technique within the broader field of mind/body medicine, also known as behavioral medicine. This field is cross-disciplinary in that health and mental health professionals from a wide range of backgrounds may practice it. Many training programs among the different health disciplines offer courses in the field of mind/body medicine. Although there are no standardized credentials or requirements for the practice of guided imagery, some states provide licensing for those practicing mind/body medicine. Before choosing a mind/body practitioner, check with your state’s medical licensing board for any qualification requirements. Beyond licensing, there are numerous organizations and advanced training programs in mind/body medicine that offer certification, some of which specialize in guided imagery itself. It is most important that a practitioner be a competent professional who has a healthy regard for the limitations and appropriate uses of mind/body medicine. Is Guided Imagery Safe? Adverse Effects There are no adverse effects from guided imagery per se. It is a subtle, gentle, noninvasive process that is completely within the control of the individual. If a group leader or therapist suggests an image that an individual finds disturbing or upsetting in any way, the process should be stopped immediately. The degree of benefit varies widely from one person to the next depending on many factors, including the severity of illness. Also, the importance of the individual’s openness to the technique, trust in the process, and expectation that at least some benefit may be achieved should not be underestimated. Still, people expecting dramatic or instantaneous results from the use of guided imagery may be setting themselves up for feelings of failure, self-blame, or disappointment when such results are not forthcoming. Realistic and modest expectations are important for patients and practitioners alike. Contraindications The use of guided imagery is complementary to other forms of treatment, and is not a substitute for proven therapies, especially in serious illness. While it may be a safe and beneficial therapy in many instances, it may be contraindicated in cases involving serious mental illnesses. What to Expect in a Practitioner’s Office Guided imagery is used in psychotherapy, counseling, hypnosis, support groups, and cognitive behavior therapy programs for specific illnesses. It is also used in hospitals in preparation for surgery, recovery from surgery, and pain control. A guided imagery session will generally last from ten to thirty minutes. The introductory instructions, usually given by a therapist or group leader, are quite basic, and might go something like this: "Place yourself in a comfortable position, and adjust your body in order to be as comfortable as possible. Allow your eyes to close whenever you wish. Bring your attention to your breathing, and take a series of long, slow, relaxing breaths. Allow your body to relax as completely as possible, while at the same time, let your mind remain wide awake and alert..." Then, you might be asked to use your imagination in a variety of ways, such as imagining yourself in a safe and peaceful place, or imagining a certain healing process happening in your body. You may imagine that your body – even a specific organ – has a voice of its own, and can speak to you about its needs. Most practitioners encourage patients to practice at home between sessions, often with the help of audiotapes. There is evidence that with regular, frequent practice, the benefits of guided imagery can build over time. William Collinge, Ph.D., M.P.H. Notes 1. Selye H. The Stress of Life. New York: McGraw-Hill, 1956 2. Benson H. The Relaxation Response, New York: Avon Books, 1975, and Beyond the Relaxation Response, New York: Berkley Books, 1985 3. Simonton OC, Matthews Simonton S, Creighton J. Getting Well Again. Los Angeles: Tarcher, 1978 4. Feher SK, Berger LW, Johnson JD, Wilde JB. Increasing breast milk production for premature infants with relaxation and imagery. Advances: The Journal of Mind-Body Health, summer 1989, 6(2):14-16 5. Gruber B, Hall N. Immune system and psychological changes in metastatic cancer patients using relaxation and guided imagery: A pilot study. Scandinavian Journal of Behavior Therapy, 1988; 17:25-45 6. Tusek DL; Church JM; Strong SA et al. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum, 40(2):172-8 1997 Feb 7. Olmsted M; Gallop RM; Kennedy S. A randomized controlled trial of guided imagery in bulimia nervosa. Esplen MJ; Garfinkel PE; Psychol Med, 28(6):1347-57 1998 Nov 8. Kolcaba K; Fox C. The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncol Nurs Forum, 26(1):67-72 1999 Jan-Feb

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