Research to Support Guided Imagery:
Guided imagery research indicates that guided imagery can:
Reduce fear and decrease feelings of helplessness when first learning of diagnosis
Reduce depression and instill confidence when one is feeling lost
Reduce tension & stress, at a time when the body needs it most
Reduce side effects to current conventional medical treatments for cancer
Enhance the immune response and assist the body's natural healing abilities
Help manage pain and reduce unwanted suffering
Deepen intuitive skills to enable better choices
Deepen one's will to live, an important factor in any prognosis
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Guided Imagery Can Reduce Fear
Cancer is a diagnosis being received by as many as one in three
Americans in their lifetime, yet its commonness does not make it easier to
hear. Cancer tends to be a diagnosis that invokes fear to even the most
emotionally strong individuals. These clients can benefit from tools that
enable them to cope with these feelings of chaos and stress…feelings that are
known to inhibit the body’s natural ability to heal. Guided imagery helps to reduce
fear by offering a sense of control to the person who incorporates it
regularly into their 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 Can Reduce Depression
The emotional response to receiving a diagnosis such as cancer
can be depression. Statistically, the likelihood is high that a person
diagnosed with cancer has also faced other substantial loss(es) within the four years preceding this diagnosis, which
potentially put that person in a state of depression even before diagnosis.
Depression is known to suppress the immune system. Biochemists have been
uncovering various biochemical methods of the intricate process of how the
mind affects the immune system by finding receptor sites for each neuropeptide
(proteins of the mind) on virtually every leukocyte (cells of the immune
system) identified thus far. Guided imagery is documented as a means to
relieve depression, thereby creating a better quality of life through the
enhancement of one’s mood, as well as enhancing the body’s innate ability to
heal.
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 Can Reduce Tension and Stress
Preoperative and postoperative
stresses are hurdles that add to a cancer patient’s initial anxiety levels,
which only inhibit the body’s natural abilities to heal. Guided imagery can reduce these
stresses, 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 those 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 Can Reduce Side Effects for Current Cancer Treatments
Current conventional medical treatments for cancer — radiation and chemotherapy
— have side effects that make the long weeks of treatment seem even longer, yet
relaxation
and 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.
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 Can Enhance the Immune Response
Conventional medical treatments such as radiation therapy and
chemotherapy currently possess their effectiveness in the fact that they
challenge rapidly growing cells. Since the immune system is also comprised of
rapidly growing cells, 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. A healthy immune response is what
enables our bodies to completely heal itself of any remaining cancer cells and
continue in its vigilance of protection for total health.
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 Can Help to Manage Pain
Cancer often arrives with symptoms of pain. Conventional medical
treatments can introduce additional bodily discomforts that appear as unwanted
side effects. And finally, there are times that even once a person’s body is
cancer-free and finding its way back to complete and total health, there
lingers some new side effects that can be considered painful. 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.
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 Can Deepen One's Intuitive Skills
There is a sense of helplessness that helps to be addressed 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 by a physician. A person can change his or her lifestyle to
include more healthy lifestyle, 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, which is why recorded imagery that can be taken home works
best. 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 the
early 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 its 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 medicineMind/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.
Guided Imagery Can Deepen One's Will to Live
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].
to continue . . .
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