the benefits of guided imagery in healthcare

Guided Imagery Reduces Fear and other Feelings of Powerlessness that can Occur when one Learns of a Life-Threatening Medical Diagnosis

Many medical diagnoses tend to invoke fear to even the most emotionally strong individuals. Patients can benefit from tools that help them cope with feelings that are known to inhibit the body’s natural ability to heal. Guided imagery helps to reduce fear and offer a sense of control to the person who incorporates it regularly into treatment.

Jeanne Achterberg, well known for her medical use of imagery, states in ‘Imagery In Healing’ (1985), that imagery can provide an element of strong internal control, leading to a reduction in stress and therefore relieving the body’s various biophysical responses to stress.

L. Baider, et al. examined the long-term effects of relaxation and guided imagery on patients recently diagnosed with cancer at Hadassah University Hospital, and results showed a decrease in psychological distress and an increase in the patient’s sense of internal control [Gen Hosp Psychiatry 2001 Sep-Oct;23(5):272-7].

A study by J. A. Royle, et al. of Ontario, found that guided imagery was the intervention best used by nurses to decrease patient anxiety [Can Oncol Nurs J 1996 Feb;6(1):20-5].

C. H. McKinney et al. from the University of Miami found that 13 weeks of guided imagery and music showed significant decreases in cortisol level (the “stress hormone” strongly correlated with mood disturbances, as well as demonstrating a significant reduction in depression, fatigue, and total mood disturbance. The study also [Health Psychol 1997 Jul;16(4):390-400].

Guided Imagery Reduces Depression and helps a Person Gain Confidence and Optimism During this Time when one tends to Feel Lost

The emotional response to diagnosis alone can be depression, but statistically, the likelihood is also high that a person diagnosed with cancer or heart disease has faced other substantial loss (or losses) within four years preceding the diagnosis. Depression is known to suppress the immune system and biochemists have found receptor sites for each neuropeptide on virtually every leukocyte identified thus far. Guided imagery is documented to relieve depression and enhancement mood.

Fawzy et al. in the late 1980’s found significant evidence that freeing cancer patients from depression increased the wide array of cancer cells [Fawzy F I, Cousins N, Fawzy N W et al 1990 A structured psychiatric intervention for cancer patients: I. Changes over time in methods of copying and effective disturbance. Archives of General Psychiatry 47:720-5].

Fawzy et al. found that information on the cancer and training in stress management and coping skills, showed participants exhibiting less fatigue, depression, mood disturbances, as well as increased vigor[Fawzy F I, Kemeny M E, Fawzy N W et al. 1990 A structured psychiatric intervention for cancer patients: II. Changes over time in immunological measures. Archive of General Psychiatry 47:729-35].

D. S. Burns at the Group/Walther Cancer Institute found that individuals who participated in guided imagery sessions scored better on both mood scores and quality of life scores than those who did not. Interestingly, these scores continued to improve in the experimental group, even after sessions were complete, indicating that guided imagery is effective in improving mood and quality of life in cancer patients [J. Music Ther. 2001 Spring; 38(1):51-65].

B. L. Rees reported that patients receiving 4 weeks of relaxation and guided imagery scored significantly lower on trait anxiety, state anxiety, and depression, while scoring significantly higher on measurements of self-esteem [J. of Holistic Nursing. 13(3): 255-267. Sept. 1995].

Guided Imagery Reduces Tension and Stress so that the Body can put its Focus on Healing

Pre-operative and post-operative stress only add to a patient’s initial anxiety levels, which then only inhibits the body’s natural abilities to heal. Guided imagery has been found to reduce stress, reduce blood loss during surgery, reduce postoperative pain, and shorten recovery times after surgery.

C.L. Norred at the University of Colorado Health Sciences Center Department of Anesthesiology in Denver found that guided imagery may be an integrative therapy that can minimize preoperative anxiety[AORN J 2000 Nov; 72(5):838-40, 842-3].

K. L. Kwekkeboom studied the increase in the patients’ use of relaxation strategies (breathing, imagery, music, meditation) vs. pharmacologic strategies for the management of pain after discharge from surgical hospitalization in Iowa [Cancer Nurs 2001 Oct;24(5):378-86].

S. A. Lambert found that guided imagery and relaxation therapy significantly lowered postoperative pain ratings and shortened the hospital stays, as well as decreased the postoperative anxiety [J Dev Behav Pediatr 1996 Oct;17(5):307-10].

D. L. Tusek and R. E. Cwynar of Ohio acknowledge that patients often describe the experience in a hospital as overwhelming, evoking fear, anger, helplessness, and isolation. Tusek and Cwynar view guided imagery as one of the most well-studied complementary therapies being used that can improve the patient experience and outcome by providing a significant source of strength, support, and courage as they prepare for a procedure or manage the stresses of a hospital stay [AACN Clin Issues 2000 Feb;11(1):68-76].

D.L. Tusek, R. Cwynar, and D.M. Cosgrove studied the effect of listening to taped guided imagery for patients undergoing cardiovascular surgeries and concluded that guided imagery can decrease length of stay, pain, and anxiety [J of Cardiovascular Management. 22-28. March-April 1999].

C. Holden-Lund found that the use of an audiotape series employing relaxation with guided imagery demonstrated significantly less state anxiety, lower cortisol levels one day following surgery, and less surgical wound erythema than the control group. Thus, the guided imagery tapes demonstrated stress-relieving outcomes closely associated with healing [Res Nurs Health 1988 Aug; 11(4):235-44].

C Renzi et al. found that listening to guided imagery tapes before, during, and after surgery showed results in which there was a trend for reduction in pain following surgery and a significant improvement in the quality of sleep [Int J Colorectal Dis 2000 Nov;15(5-6):313-6].

Gaston-Johansson et al. of Johns Hopkins University School of Nursing in Baltimore, Maryland showed significant benefits from the use of information, cognitive restructuring, and relaxation with guided imagery in patients with breast cancer who underwent autologous bone marrow/peripheral blood stem cell transplantation. This strategy was found to be effective in significantly reducing anxiety, nausea, and nausea combined with fatigue 7 days after surgery when the side effects of treatment are usually the most severe [Cancer Nurs 2000 Aug; 23(4):277-85].

D.A. Rapkin, M. Straubing, and J.C. Holroyd from the University of California, Los Angeles explored the value of imagery-hypnosis on recovery from head and neck cancer surgery and found there were fewer surgical complications and less blood loss during surgery [Int J Clin Exp Hypn 1991 Oct; 39(4): 215-26].

Omlor et al. found that preoperative relaxation techniques significantly reduced the number of postoperative hematomas as well as the amount of pain medication being required after surgery [Zentralbl Chir 2000; 125(4):380-5; discussion 385-6].

Guided Imagery helps Manage Pain to Reduce Unwanted Suffering

Many conventional medical treatments have side effects that make long weeks of treatment seem even longer. Yet guided imagery can help to alleviate these symptoms, and according to some studies, have the potential to improve even the effectiveness of these treatments’ performance. Guided imagery helps a person to manage pain by first relaxing any muscular tension that coincides with one’s normal physical reaction to it; and secondly, by altering the mind’s perception of the pain itself.

Lawrence LeShan found that psychological conditions had an enormous influence not only on the production of cancer, but also on the disease’s evolution and even on the person’s response to a particular treatment (LeShan L, Worthington R 1956 Personality as a factor in the pathogenesis of cancer: a review of the literature. British Journal of Medical Psychology 29:49-56).

Journal of Consulting and Clinical Psychology: 1991 Aug; 59(4): 518-25 concluded that relaxation therapy is effective in reducing adverse consequences of chemotherapy, for a study involving 81 cancer patients showed relaxation therapy to decrease nausea and anxiety during chemotherapy.

L. G. Walker et al. of the University of Aberdeen Medical School found that cancer patients receiving standard care plus relaxation training and imagery were more relaxed and easy going during the study, experiencing a higher quality of life overall during primary chemotherapy [Br J Cancer 1999 Apr; 80(1-2): 262-8].

K. Kolcaba and C. Fox measured the effectiveness of customized guided imagery for increasing comfort in early stage cancer. They found that listening to a guided imagery audiotape once a day for the duration of the study indicated a significant overall increase in comfort over time, and was especially salient in the first three weeks of therapy. [Oncol Nurs Forum 1999 Jan-Feb; 26(1): 67-72].

K. L. Syrjala et al. of the Fred Hutchinson Cancer Research Center in Seattle, WA concluded in their study that stand-alone relaxation and imagery training reduces cancer treatment-related pain [Pain 1995 Nov; 63(2): 189-98].

L. M. Troesch et al. of the Arthur G. James Cancer Hospital and Research Institute at Ohio State University in Columbus found that those patients using a chemotherapy-specific guided-imagery audiotape expressed a significantly more positive experience with chemotherapy, finding guided imagery to be an effective intervention to promote patient involvement in self-care practices and to increase patient coping abilities during symptom occurrence [Oncol Nurs Forum 1993 Sep; 20(8): 1179-85].

K. L. Kaufman et al. at Ohio State University tried a self-hypnotic, cue-controlled relaxation, and guided imagery intervention that showed a marked and clinically significant reduction in nausea and vomiting as well as a concurrent increase in sleep duration [J Adolesc Health Care 1989 Jul; 10(4): 323-7].

Guided Imagery Enhances the Immune Response and Hormonal Balance, to assist in the Body’s Innate but Complex Healing Response

Radiation therapy and chemotherapy possess their effectiveness by challenging rapidly growing cells. Since the immune system’s rapidly growing cells are also affected, we ideally want the body to protect these particular cells during treatment and produce dramatic numbers of additional new cells after treatments. Guided imagery is beginning to receive recognition for its ability to enhance the number of immune cells as well as the activity of those cells already matured and in existence.

Kiecold-Glaser and Ronald Glaser, studying a group of elderly people, found that over a month of relaxation training three times per week significantly increased their natural killer lymphocytes and T cell activity [Cousins N 1989 Head first. Dutton, NY].

Howard Hall, measuring the effects of healthy people imagining their white blood cells as strong as powerful sharks, found a number of subjects could demonstrate an increase in the number of lymphocytes as well as an increased responsiveness of the immune system after the session as compared to before [Hall H R 1983 Hypnosis and the immune system. American Journal of Clinical Hypnosis, 25:92-103].

James Pennebaker found that “confessional writing,” of the type that occurs when journaling, led to salubrious changes in the immune system and better health in general. He felt that there is structuring and resolving of the harmful effects of those “hidden” feelings and images going on through the process of writing. [Pennebaker J W 1990 Opening up: the healing power of confidence in others. Avon, NY].

Dr. Alan Watkins states that every idea, thought and belief has a neurochemical consequence, which is what makes imagery such a significant mind-body bridge. He writes that the flow of neuropeptides from the CNS, which enhances or inhibits one’s immunology through two major neuroimmunomodulatory pathways; neuroendocrine and autonomic, are critically important in maintaining health and fighting disease [Watkins A 1997 Mind-body medicine. Churchill Livingstone, NY].

V. W. Donaldson in NC at the Center for Stress Management examined the effects of mental imagery on the immune system response, and specifically, on depressed white blood cell (WBC) counts. Results indicated significant increases in WBC count for all patients over a 90-day period, even when possessing disease and illnesses that would have predicted a decrease in WBC count [Appl Psychophysiol Biofeedback 2000 Jun; 25(2):117-28].

Guided Imagery Deepens Intuitive Skills, Enabling a Person to Make Better Choices

Patient progress is always easier when the person is empowered by treatment rather than feeling victimized or helpless until the next form of treatment comes along to “fix” the problem.

R. Sloman from the University of Sydney in Australia observed that progressive muscle relaxation combined with guided imagery has the potential to promote relief of cancer pain. The techniques appear to produce a relaxation response that may break the pain-muscle-tension-anxiety cycle and facilitate pain relief through a calming effect. This technique seems to provide a self-care strategy that, to a limited extent, shifts the locus of control from clinician to patient [Nurs Clin North Am 1995 Dec; 30(4): 697-709].

R. J. Moore and D. Spiegel from the Anderson Cancer Center in Houston, TX observed a desire for and a benefit from patients being able to attach meaning to the disease and its treatment. They felt that this is why many are drawn to guided imagery as a tool in the management of cancer-related anxiety and pain by using it to reconnect to the self, to make sense of their experiences with breast cancer, and for managing cancer pain in a manner that increases one’s sense of control, thereby alleviating the suffering of the survivor [1096-2190 2000 Mar 21; 2(2): 115-126].

Guided Imagery Deepens one’s “Will to Live,” which is an Important Factor in any Prognosis

Discovering that one’s body has been paused by an illness as emotionally charged as cancer is often an event that encourages deep reflection of what’s important in one’s life. Sometimes this then becomes transformative and turns out to be the unexpected opening for choosing to live a more satisfactory life. Although we all know we cannot live forever, we can choose to live whatever life we do have with the intention of ‘singing our own song’ and ‘dancing at our own pace,’ thereby experiencing our own healing in a way that is uniquely ours. Guided imagery is one key that can help a person uncover any core beliefs that may be inhibiting his or her ability to live life to the fullest.

Howard Hall found that using symbolic work like drawings and dreams generally encouraged clients with critical illnesses to find ways of living that brought zest and enthusiasm to their daily lives, showing far superior results in survival time to those receiving only classic strategies [Hall H R 1983 Hypnosis and the immune system [American Journal of Clinical Hypnosis, 25:92-103].

C. Maack & P. Nolan in Hamburg, Germany report that the main gains conveyed by former clients of GIM therapy are (a) getting more in touch with one’s emotions, (b) gaining insights into some problems, (c) spiritual growth, (d) increased relaxation, and (e) discovering new parts of oneself. These changes appeared to stabilize over a period of time but even continued to improve after termination of therapy, especially in the mental and transpersonal areas [J Music Ther 1999; 36(1):39-55].

Guided Imagery helps a Person Evaluate and change Unhealthy Beliefs in Order to Involve the Body more Completely in its Journey back to Health and Attain Overall, a Higher Quality of Life

There is a sense of helplessness occurs when one’s body is not well. There are many things one can do to put a sense of control back into one’s hands. A person can question diagnosis and treatments being offered. A person can change his or her lifestyle to include more healthy choices, behaviors, diet, or exercise. A person can learn everything possible about an illness and the body’s ability to heal. A person can choose to not take others at their word but discover the answers that are out there for themselves. Guided imagery acts as the bridge to the bodymind, offering a pathway for each person to effectively communicate with his or her body, to access deeper parts of the mind, and involve him or herself more completely in the process of developing a more satisfying relationship with the self.

In the words of Deepak Chopra (1987) in ‘Creating Health: Beyond Prevention, Toward Perfection’, he claims that “Various mental techniques, including visualization therapies, are showing promise as useful additions to the treatment of cancer … These mental techniques restore intelligence (to the mindless cancer cells) by operating from the mind’s awareness. It is one intelligence in our bodies speaking to another and bringing it back to normal. What seems so promising is that the cure grows from within the patient, taking advantage of the mind-body connection.”

Imagery is most effective when a patient can internalize new images. This involves repeat practice sessions of a light-hearted, yet consistent approach. The client who can place their intention on a positive future that helps them find reason for being, appears to be one of the most important motives for restoration of health according to Simonton (1978) in ‘Getting Well Again Larry Dossey (2001) in ‘Healing Beyond the Body’ believes that it also helps to ease the burden of disease. These understandings are not new and have been known as having great value in determining the duration of life since observations of Carl Jung and Viktor Frankl in the 1950’s.

Human behavior draws upon past experience, so that any previous result becomes the expectation for any similar future event. All past experiences or future expectations are communicated by the mind as internal images, which are then relayed to the body through complex biological systems. The body’s subsequent interpretation of these messages involves the parasympathetic as well as the sympathetic response(s) to the associated emotions, actions, and reactions to that particular image. While many people are interpreting their everyday activities and obligations with internal images that are negative or stressful, the redesigning of those same images into positive or at least neutral experiences can bring corresponding positive or neutral interpretations to the body. Individuals can be taught to reframe these images through the use of guided imagery.

N. W. D’Epiro explores the premises and practices of the mind/body movement and how these attitudes and techniques could be integrated into primary care medicine Mind/body medicine. He defines it as using the power of the mind to effect changes in a patient’s attitude and immune, endocrine, and nervous systems in order to heal the body. A principle of mind/body medicine is that the patient and physician must work together, with the physician guiding the patient, to achieve better control over health and disease.