Guided imagery: the claims that can be found in books and the internet are astounding and frequently sound too good to be true. Claims that injured areas can be healed more quickly through healing visualizations, claims that sports performance can be improved simply by visualizing techniques and successes, claims of improved stress management and boosted immune function–fascinating–but what does the evidence say? What research is available concerning guided imagery and visualization?
The power of thought
Guided imagery is enticing I believe specifically because, unlike many things in life, our thoughts are subject to our control and manipulation. Using guided imagery, the mind is prompted to imagine peaceful and healing environments, activities, and at times, healing energies. It can offer a reprieve from an overly stimulating environment, such as a hospital ward.
Indeed the promise of meditation, education, reflection, religion, and numerous self-help movements is that by manipulating or better controlling our thought life, we can drastically alter the course of our current life (and afterlife in the case of religion) for the better. However, putting such notions to the test in rigorous, randomized clinical trials takes these ideas and evaluates the possibilities and limitations of guided imagery in measurable, clinically meaningful ways.
Guided imagery: Findings of a systematic review
A systematic review of randomized controlled clinical trials is considered to be the best method of producing reliable evidence that a treatment works the way it is proposed to work. Randomized trials are those in which groups of similar people are randomly selected to receive an experimental intervention and compared against another group of similar people randomly selected to receive a different (control) intervention. A systematic review evaluated the results of 13 randomized controlled clinical trials concerning guided imagery, and the findings were fascinating (Giacobbi, Stewart, Chaffee, Jaeschke, Stabler, & Kelley, 2017).
Findings noted that guided imagery has positive implications for mitigation of anxiety associated with surgical procedures, dental procedures, pregnancy, asthma, and cancer treatments (Giacobbi et al., 2017). The researchers noted that there were improvements in physical, psychological, and functional measures when guided imagery was measured against control groups as an intervention.
Findings included (Giacobbi et al., 2017):
- Reductions in blood pressure versus a control group when participants used guided imagery paired with biofeedback and were exposed to a stress stimulus
- Reductions in pain versus a control group with interstitial cystitis (a painful condition of the bladder)
- Significant reductions in symptoms related to fibromyalgia versus a control group
- Improved cardio-respiratory function (demonstrated by improvements in VE/VCO2 slope reduction), improved quality of life, and reductions of norepinephrine (noradrenaline) in subjects with optimally managed heart failure who performed two 30-minute guided imagery sessions per day versus a control group of optimally managed heart failure patients
- Reduction in asthma symptoms such as wheezing, improved sense of control, and reduction in anxiety in adults with asthma versus a group who learned about asthma management strategies in a study of 70 adults–both approaches improved status over pre-intervention baselines, but guided imagery proved superior specifically in improving anxiety, wheezing, and sense of control over symptoms versus simply learning asthma management strategies
Ten of the 13 studies analyzed during the systematic review had positive findings for guided imagery (Giacobbi et al., 2017). While the findings are interesting, the studies reviewed were mostly small in size. Many were pilot studies. The results largely seem to be attributable to a general reduction of sympathetic (“fight or flight”) nervous system activity. One study listed was particularly interesting…
Bone fracture healing was enhanced by yogic prana energization technique (YPET)
One of the studies analyzed by Giacobbi et al. (2017) was conducted on 30 patients with acute fractures in short and long bones (Oswal, Nagarathna, Ebnezar, & Nagendra, 2011). Fifteen participants were randomly selected to learn and practice yogic prana energization techniques (YPET) twice a day, for 30 minutes each session. Instruction in the technique initially was follow by use of a recorded audio guide. YPET is described by the study authors as a relaxation technique that pairs chanting, breathing regulation, and visualization of the body’s revitalizing energy. Both the control group and intervention group received plaster casting and immobilization.
Pain, tenderness, swelling, and fracture healing rates were compared between the control group and intervention group at the time of the fracture and three weeks later. Findings at the 3 week post-fracture mark were as follows:
- Pain reduction was significantly superior for the YPET group, with 94.5% of participants reporting improved pain levels versus 58.6% of the control group
- 94.4% of the YPET group participants reported significant reductions in tenderness versus 69.12% of the control group
- Fracture line density improvements were significantly superior for the YPET group with improvements noted in 48% of the YPET group, but only 18.25% of the control group
- Improved bone surface reuniting/ significantly improved fracture repair versus the control group, with 81.4% of the YPET group showing bone tissue reunited versus only 39.7% of the control group
- Swelling improvements were somewhat better in the YPET group than the control group though the differences were considered small/ non-significant (Oswal et al., 2011)
This study was quite fascinating as this particular form of guided imagery seemed speed the healing process. The study was relatively small in size. A repeat study to determine if the results can be replicated would be of interest.
Pre-surgical guided imagery led to reductions in anxiety & post-surgical pain
In a separate, randomized controlled trial in which 44 participants were randomly assigned to receive guided imagery prior to surgery for 30 minutes, or simply given privacy, those assigned to the guided imagery group experienced significant reductions in pre-surgical anxiety. Interestingly, the group who used pre-surgical guided imagery experienced significantly lower pain levels at 2 hours post surgery and shorter stays in the post-anesthesia recovery units by an average of 9 minutes (the post operative team was blinded as to whom received the intervention). While the difference in pain was determined to be significant, the pain medication usage did not differ significantly, and the shortened post-operative recovery time approached but did not achieve statistical significance, however.
Better sleep, lower anxiety, lower pain levels in a hospital step-down unit
A step down unit is typically a stressful place for patients (Elliott Patricolo, LaVoie, & Slavin, 2017) . These patients are deemed stable enough to be discharged from an intensive care unit, yet too high risk to be transferred to a general medical-surgical unit. In such a setting, anxiety, pain, and insomnia are prevalent. The alarms, monitors, surgical or disease related pain, uncertainty, and noise can be distressing for patients.
In this setting, guided imagery recordings with a focus on pain, anxiety, and sleep improvements were made available to patients at a hospital. Forty-five patients listened to the recording during their stay for various reasons. Eleven out of 12 patients who listened due to suffering pain reported that the guided imagery helped reduce their pain–91.7% experienced pain relief.
Another 26 listened to the guided imagery to assist with their anxiety, with 23 of the 26 (88.5%) finding guided imagery helpful in reducing anxiety. Finally, 11 patients listened to the guided imagery to help with insomnia. Nine of the 11 patients (81.8%) using guided imagery for insomnia concerns reported improved sleep and reductions in insomnia symptoms. Separate research on 55 mental health workers likewise found significantly improved self-reports of sleep and reduced anxiety when guided imagery was listened too during workday break periods versus a control group who just took their regular work breaks over a four-week period (Kiley, Sehgal, Neth, Dolata, Pike, Spilsbury, & Albert, 2018).
My experience with guided imagery: Better sleep
In a series of posts, I described my own battles with insomnia. I attribute my overcoming of insomnia to a number of lifestyle changes as well as potentially the adoption of “grounding” or “earthing” (a fascinating topic of its own). There was no single silver-bullet in my case for insomnia, but a combination of interventions.
One thing that I did notice, however, was that a particular guided imagery meditation titled “Guided Evening Meditation – Gratitude, Forgiveness and Letting Go” by Suzanne Robichaud seemed to consistently help me sleep better. I found it interesting as I continued to try different interventions such as mindfulness meditations before bed, prayer meditations before bed, healing meditations, etc. Consistently I found that, for me, they were not as effective for sleep as this particular guided imagery meditation (no, I’m not affiliated in any way to Suzanne Robichaud). Either way, guided imagery has become a daily part of my nighttime routine and does seem to help me feel more peaceful and sleep better.
The research on guided imagery using high-level research techniques such as randomized controlled trials tends to be limited. Nonetheless, there seems to be evidence supporting guided imagery’s ability to reduce symptoms that cause distress, such as anxiety, pain, and insomnia. Guided imagery appears to reduce activation of the “fight or flight” arm of the nervous system and induce a more relaxed state–even in high stress environments such as surgical centers and hospital wards.
In terms of more rapid healing from injury or illness, there was very little research of high quality that I could find to support such notions. However, the research on the improved fracture healing as confirmed through objective measures such as x-ray is very interesting. Is it possible guided imagery really enhances the body’s own healing capabilities?
Such may be possible by allowing the body to relax and balance its immediate stress response. This allows a person to sleep more soundly and better activate internal healing responses. For example, research analyzing the effects of pessimism, persistent anxiety, and depression have found such states blunt the immune response, decreasing antibodies and function of natural killer immune cells (Caine, 2003).
Clearly, in terms of more rapid healing responses, more research is needed. Nevertheless, guided imagery is a readily available, low cost intervention that shows promise for helping people suffering from work stress, pain, insomnia, anxiety, and/ or suffering from diseases that cause or are worsened by such symptoms!
Thanks for reading!! I hope you enjoyed! Sign up on my email list to receive notifications when I post new articles!! Sincerely, Donovan
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Caine, R. M. (2003). Psychological Influences in Critical Care: Perspectives From Psychoneuroimmunology. Critical Care Nurse, 23(2), 60. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12725196/
Elliott Patricolo, G., LaVoie, A., & Slavin, B. (2017). Beneficial effects of guided imagery or clinical massage on the status of patients in a progressive care unit. Critical Care Nurse, 37(1), 62–69. https://doi-org.lopesalum.idm.oclc.org/10.4037/ccn2017282
Giacobbi, P. R., Jr, Stewart, J., Chaffee, K., Jaeschke, A. M., Stabler, M., & Kelley, G. A. (2017). A Scoping Review of Health Outcomes Examined in Randomized Controlled Trials Using Guided Imagery. Progress in preventive medicine (New York, N.Y.), 2(7), e0010. https://doi.org/10.1097/pp9.0000000000000010
Gonzales EA, Ledesma RJA, McAllister DJ, Perry SM, Dyer CA, & Maye JP. (2010). Effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures: a randomized, single-blind study. AANA Journal, 78(3), 181–188.
Kiley, K. A., Sehgal, A. R., Neth, S., Dolata, J., Pike, E., Spilsbury, J. C., & Albert, J. M. (2018). The Effectiveness of Guided Imagery in Treating Compassion Fatigue and Anxiety of Mental Health Workers. Social Work Research, 42(1), 33–43. https://doi-org.lopesalum.idm.oclc.org/10.1093/swr/svx026
Oswal, P., Nagarathna, R., Ebnezar, J., & Nagendra, H. R. (2011). The effect of add-on yogic prana energization technique (YPET) on healing of fresh fractures: A randomized control study. Journal of Alternative & Complementary Medicine, 17(3), 253–258. doi: 10.1089/acm.2010.0001