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Guided Imagery

 Fred Moskovitz, Psy.D.

In 1997 Americans made approximately 600 million visits to practitioners of Alternative Medicine, spending $27 billion dollars of their own money to pay for alternative therapies. In a study conducted by Harvard Medical School it was estimated that one out of every two persons (50%) in the United States between the ages of 35 and 49 years used at least one alternative therapy in 1997; that is a growth of 47% since 1990. Most of the people using alternative medicine, also referred to as complimentary medicine, are primarily well-educated, affluent baby boomers.

Why do people increasingly prefer alternative or complimentary to conventional medicine? For the most part the reasons are pretty simple- it's safe and it works! There is little doubt that traditional medicine works well in the case of trauma and emergencies. It is however much less effective when it comes to prevention, chronic disease, emotional, mental, and spiritual needs of an individual. Alternative medicine encompasses a large variety of different therapies of which Guided Imagery is but one.

Conventional medicine focuses on the relief of symptoms and rarely places emphasis on the cause of a disorder or its prevention. Alternative therapies, on the other hand, focus primarily on the prevention of disease and frown on the  pervasive practice of covering up symptoms through the use of drugs. Traditional medicine practitioners are often guided by treatment rules that are taught in medical schools or endorsed by the FDA, guidelines that are frequently strict and lead to a “one size fits all” approach. Alternative medicine practitioners, on the other hand, treat each patient as an individual and tailor their treatments to that particular person regardless of what the “book” says. Traditional or conventional medicine focuses on specific organ systems such as cardiology, ophthalmology, neurology, or gastroenterology, etc. whereas Alternative medical practitioners consider each individual a unique being and use a holistic approach in their treatment. Conventional medicine uses drugs, surgery, and radiation as part of their treatments, whereas alternative medicine will use natural, age-old remedies that are gentle, and non- toxic. In addition, alternative medicine enables the body to activate its own innate powers of healing. Conventional medical practitioners view the body as a series of pumps or filters, a system of mechanical structures that require drugs to treat the disorders that arise as a result of chemical imbalances. Alternative medicine, however, sees the body as a network of channels or meridians that carry a form of “life energy.” Any imbalance of this life energy leads to disease, whereas clearing the blockages will remedy the disease- causing imbalances. In traditional medicine a patient is expected to take his/her medication, listen to their doctor’s advice, and remain passive. Alternative medicine, however, requires the patient to take an active part in the treatment of disease and its prevention.

Modern Medicine finds itself in a dilemma. It can successfully cure a wide variety of diseases and conditions, with drug therapy and surgical procedures. In certain instances, however, as with pain, chronic diseases, or emotional suffering, conventional medicine often finds itself at a loss of how to treat these elusive conditions. Patients are uncomfortable with the idea of continuously taking large doses of newer- generation drugs, not knowing what the long- term side effects will be. In addition, many people are very resistant to taking psychotropic drugs because it makes them feel sedated, and may cause undesirable behavioral changes. If we took the time to read the pharmaceutical companies warnings to physicians regarding the serious contraindications and side effects of most “safe” drugs, we would have every right to be frightened, and with good reason. Almost all prescription drugs have some side effects, regardless of how little or how mild;  older patients taking as many as 10-15 pills each day are at high risk for toxic drug interactions. Most professionals are well aware of the hazards of polypharmacy among the elderly, and despite this they remain overmedicated, with most admissions to hospitals resulting from non- compliance with drug regimens, improper dosing, or overmedication.

Practitioners of alternative medicine have successfully treated a variety of chronic conditions such as pain for many years. At the same time, the educated consumer is searching for a broad- minded approach in the treatment of physical symptoms, and emotional or behavioral problems. Many of the newly discovered anti-inflammatory drugs have potentially life-threatening side effects such as gastric bleeding or increased rates of heart-attacks. Pain relief medications, while helpful, can often be excessively sedating or habit forming. Even within psychological practices the modern day psychotherapist and psychiatrist are increasingly finding themselves in a position where traditional talk therapy may not be sufficient as the sole form of treatment. Psychotropic drugs, on the other hand, are often prescribed yet not taken by the patient because of the undesirable physical or behavioral effects they are producing. Unfortunately, traditional medicine by itself has neither the answers nor the cures for a host of conditions and complaints leading the consumer to search for complimentary therapies to augment traditional treatments.

 Currently, most psychologists and psychotherapists have moved away from the rigid practices and severe time requirements of  traditional psychoanalytic theory, searching for newer therapy modalities. These therapies are more brief and don’t require years of expensive treatment. In addition, insurance companies advocate for newer therapies because they are cost effective in terms of time, and appear to be efficacious as well. In fact, some therapies such as guided imagery, also referred to as visualization can be practiced anytime, anywhere, from 5-20 minutes per session and once mastered can be practiced without subsequent visits to a psychotherapist or social worker. In a manner of speaking, guided imagery is practically “portable”, you can take it with you wherever you go. During the past twenty years or so there has been a great deal of interest directed towards alternative treatments by the consumer, the medical profession, and more recently by The National Institute of Health; many insurance companies are currently reimbursing practitioners for a wide variety of alternative medical treatments. Guided Imagery is but one of the many alternative forms of medicine/therapy, and its applications are very useful in our “stressed out” culture, while current studies have consistently shown that its practice is  both efficacious and provides long- term relief. .

Guided Imagery is a form of directed daydreaming, a way of using the imagination very specifically to help the mind and body heal, stay strong and perform as needed. This might mean conjuring up images of tumors shrinking, or blood pressure slowing down. It might be images of a safe and protected setting, and when elicited is able to lead to emotional calming. These images can also be a “rehearsal” of a successful performance outcome. For example, in the case of a stroke survivor the patient can visualize his right arm and leg functioning more like it used to before his CVA (cerebrovascular accident). The images that are used need not be strictly visual images; they can be any of the sensory impressions that include smell, sound, taste, sight or touch.

Images are often easier to work with than thoughts or ideas. Images are a purer and truer source of information, whereas thoughts or ideas are often edited by the mind and will be reconstructed more selectively and less accurately than images. The long- standing knowledge that imagery is a critical component of healing is evident when we consider the vital role of the placebo effect, faith, and hypnotic suggestion. Images are actually the natural language of the unconscious mind, the only language it understands immediately and without question. Our bodies don’t discriminate between sensory images in the mind and what we call reality. Although an image will not have the exact same impact on the body that real events do, they will nevertheless elicit an almost similar quality of experience in the body. With sensory images we often can see mood and emotional changes that lead to physiological changes that can be documented. An example would be thinking of a recipe and what it would taste like in your mouth and you will immediately feel the saliva beginning to accumulate in your mouth. Or having a sexual fantasy may lead to sexual arousal, the body reacts to sexual fantasy as reality. Sometimes just the thought alone of revisiting a doctor’s office where the last treatment induced pain or nausea is enough to make us start sweating, vomiting and tightening our stomachs.

When we deliberately introduce safe healthful images into the mind we can deceive the body into reacting as if the images were in reality happening; thus engineering a desired response. In one study it has been shown that using imagery can increase the number of white blood cells circulating in the blood cells. In another study 84% of the subjects eliminated the histamine response to poison ivy; itching, swelling, redness and blisters when under hypnosis it was suggested to them that the poison ivy was a harmless plant. Seriously burned patients who used imagery experienced less pain and need for medication.

In yet another study at Stanford University a group of women with metastasized breast cancer were divided into two groups and studied for a year. Both groups received state of the art medical treatment for the cancer. But one group also received training in imagery and self-hypnosis; they were taught to imagine that they were floating gently on water feeling relaxed and peaceful. As expected, after the year was up, the group that was taught imagery was found to have less pain and discomfort, and fewer mood swings. This was no surprise since we have known for many years that group-support and cohesion will foster emotional resiliency. The curious finding was that when these researchers followed-up on the mortality of these women after ten years they found that the second group that was trained to use imagery had lived an average of twice as long as the first group that received medical treatment without the additional imagery and self-hypnosis. The original developers of guided imagery, oncologist, O. Simonton and his wife Stephanie Matthew-Simonton utilized similar techniques to help patients that were undergoing standard treatments for cancer. They emphasized the use of imagery to complement, not to replace, traditional medical therapies. They asked their patients to visualize their immune systems fighting and destroying cancer cells.

These studies show that there is more than psychological implications alone when using imagery; there are also profound an often lasting physiological results. Guided imagery is now finding widespread scientific and public acceptance and it is being used to teach psycho-physiological relaxation, alleviate depression and anxiety, help patients prepare for surgery and relieve physical and psychological symptoms. Mental images are formed long before we learn to understand and use words, these images lie at the core of who we think we are, what we believe the world is like, what we feel we deserve, and what we think will happen to us. All healing treatments revolve around the manipulation of these images either blatantly or covertly. These images often influence our attitudes and beliefs about how we fall ill or what we can do to help us get better. While some may attribute the healing effects of these images to the placebo effect, nevertheless it has been shown repeatedly that they have a positive measurable effect that is therapeutically efficacious. Physically, imagery has been proven to have a direct effect on the autonomic nervous system and the power of imagination can indeed be harnessed to promote both emotional and physiological healing.

When we refer to imagery we are talking about imagery in the altered state, a form of self-hypnosis that uses for its content the deliberate production of healing sensory images. Some claim that hypnosis is effective while imagery is not, they are usually thinking of imagery as a two-dimensional visualization in the normal waking state. When we refer to imagery we are referring to the altered state, a state of very relaxed focus. In the altered state we are capable of more rapid growth, learning, intense healing and change. The altered state is a state of relaxation, calm, a focused reverie while being mentally energized and alert. Our attention is focused on the work at hand and we decrease the awareness and exclude extraneous things happening around us. We may not hear people talking to us and we will lose track of time. This allows us to reach peak performance, and can often be seen being used by athletes before executing a complex dive, or an excruciating marathon run. Imagery has been shown to affect most of the body's physiologic systems including; respiration, heart rate, blood pressure, sexual functions, blood lipids, and even immune responsiveness.

Therapeutic guided imagery allows a client to enter a relaxed state of mind and then to focus their attention on images associated with the issues they are confronting. For example, one can invite an image that represents a particular medical symptom and then initiate an imaginary dialogue with the image to learn what it wants, where its going and why its there. It is in effect having a conversation with your deepest self at the core, except that the conversation is conducted in the form of images and not words. Patients coping with chronic pain can be invited to visit a deeply rooted “inner sanctuary” where there is no pain and can attain some level of respite and solace. This pain free zone can be expanded to include greater intervals of everyday life and can provide both psychological and physiological reprieve from pain. The experienced imagery practitioner can encourage his clients to tap their deepest inner resources in order to find new and creative solutions for various problems. These resources are not readily accessed in the everyday waking state and require a more narrowly focused and relaxed altered state. This technique is non-judgmental, with minimal transference between therapist and client, allowing the client increased autonomy and self-efficacy. The client can access his/her own wise “inner advisor” who can encourage and support them in exploring feelings and options. Many of the images that are conjured up are from the most inaccessible recesses of the unconscious and are hence, therapeutically beneficial for treatment.

Guided imagery can be utilized in a variety of health care settings. It can be used to teach stress reduction and relaxation. A patient can also be encouraged to imagine a desired therapeutic outcome while in a focused, and relaxed state of mind. The patient feels in control of both their own healing and body, and that affords value in and of itself. Visualization can alleviate symptoms; modify health -endangering behavior such as smoking or substance abuse. It can be effective in providing motivation for making positive life changes. The applications for guided imagery are very broad and have been used for, but not limited to:

· Acute and chronic pain relief

· Addictions

· Anxiety disorders

· Cancer treatment and life-threatening illness

· Couples and relationships

· Depression

· Family and parenting

· Fertility, birth and delivery

· Fitness training

· Grief Therapy

· Immune augmentation

· Issues of aging

· Meaning and purpose

· High blood pressure

· Headaches

Guided imagery is usually taught in small classes or one-on-one. It is not a passive experience and clients are expected to participate in every session. You will be asked to sit comfortably in a chair or lie on a floor mat. Comfortable, loose fitting, clothing is recommended. Often, there is background music to enhance relaxation. No one will touch you and no instrumentation is used. A session will usually begin with relaxation exercises and then the practitioner will move to a specific visualization. You will be asked to construct this image in your mind using all your five senses. You may then be asked to substitute your own image from your own personal experience. Depending on whether you have a specific medical complaint, a localized disorder, or a generalized problem you will be asked to visualize different images. For example, if you have a localized disorder you’ll be encouraged to picture the affected organ working properly, visualizing, for instance, your lungs breathing freely, a tumor shrinking, your heart beating regularly. An athlete may visualize him/her self as performing perfectly. The treatment session may last anywhere from 15- 30 minutes. You can use a generalized audiotape or one that has been recorded specifically for you. If time is an issue or you cannot concentrate for lengthy periods of time you can practice the imagery exercise for 5 minutes or even as you are waiting for a traffic light to change. Sessions are held once or twice a week or more frequently if needed. The practice sessions can be performed in the privacy of your own home once you learn the correct method of sliding into an altered state. However, it has been shown that being in a group setting is often more effective in attaining the altered state of concentration, as if it were contagious. The more one practices imagery the better the concentration and the easier it is to conjure up images and maintain them without extraneous distractions.

Often, the image that is initially visualized will spontaneously change and a new image will pop up in the mind, as in a slide-projector. The beauty of imagery is that the mind offers up past images from deep in the unconscious mind, images that will not be selectively or inaccurately projected. The image is as real as when it happened. There is no ego to mediate and paint a picture that is untrue as we often find with our thoughts and ideas. The image that arises is often the visualization that the client no longer recalls, denies, or is too painful to dredge up. By practicing imagery techniques frequently a person can have an experience that avoids resistance that so often complicates the psychotherapeutic process. The image is true and raw material; it has not been doctored by the conscious mind.

Guided imagery theory proposes that picturing something and actually experiencing it are equivalent as far as the brain is concerned. Brain scans (PET) have verified this effect, and it is thought that through imagery there can be a direct effect upon the nervous and endocrine systems. Imagery should be used as a supplement to traditional treatments when life- threatening illnesses are targeted. Guided Imagery is safe for everyone, and no side effects have been found. In fact, guided imagery has been successfully used with children to alleviate pain. A study in the Journal of Developmental and Behavioral Pediatrics (October 1996) found that guided imagery lowered postoperative pain in children. Children are often better at imagery than adults because they have a better sense of imagination than adults do. Adults are more grounded in reality and may have difficulty in conjuring up an image. The National Institute of Health has recently given a grant to the University of Arizona to study alternative therapies for children. Many practitioners of traditional medicine are currently more likely to acknowledge the mind-body connection than ever before. Guided Imagery does not work for everyone. Many people have difficulty in relaxing for periods long enough to enter an altered state and conjure an image.

Guided imagery is available through many practitioners with a variety of backgrounds. Most often, psychologists, nurses, and social workers will run imagery groups, however there is no licensing or certification process that is required. Investigate the educational background and qualifications of the practitioner whose group you are interested in, and caveat emptor, or buyer beware.


Favorite Place Imagery

(Approximately 8 minutes)

To begin with, see if you can position yourself as comfortably as you can, shifting your weight so that you’re allowing your body to be fully supported by your chair or couch or whatever is supporting you. Try to arrange it so that your head, neck, and spine are straight

And taking a deep, full, cleansing breath…… inhaling as fully as you can…….

Breathing deep into the belly if you can……. And breathing all the way out……

And again …. breathing in…. and this time, seeing if you can send the warm energy of the breath to any part of the body that’s tense or sore or tight… and releasing the tension with the exhale…. And breathing it out….

So you can feel your breath going to all the tight, tense places, loosening and warming and softening them…… and then gathering up all the tension and breathing it out….. so that more and more, you can feel safe and comfortable, relaxed and easy, watching the cleansing action of the breath…. With friendly but detached awareness…..

And any unwelcome thoughts that come to mind, those too can be sent out with the breath…. Released with the exhale…. So that for just a moment, the mind is empty…. For just a split second, it is free and clear space, and you are blessed with stillness.

And any emotions that are rocking around in there…. Those, too, can be noted, and acknowledged, and sent out with the breath…. So your emotional self can be still and quiet… like a lake with no ripples.

And now, imagining a place where you feel safe and peaceful and easy…. A place either make believe or real….. a place from your past….or somewhere you’ve always wanted to go…. It doesn’t matter…. Just so it’s a place that feels good and safe and peaceful to you.

And allowing the place to become real to you…. looking around you…. taking the place in with your eyes….enjoying the colors…. The scenery…. Looking over to your right…. And over to your left…..

And listening to the sounds of the place…..whatever they might be……wind or water…. Birds or crickets…. Or a whole multi-layered texture of sounds…. Just so your ears can become familiar with all the beautiful music that your special, safe place offers up to you….

And feeling whatever you’re sitting against or lying upon… or perhaps feeling the texture of the ground beneath your feet…. Whether it’s sand or pine needles or grass…. or you might be in a cozy armchair….or sitting on a nice, warm rock in the sun….

And feeling the air on your skin… crisp and dry…. or balmy and wet…. perhaps you are inside, feeling the warmth of a cozy fire on your face and hands…. Or maybe you are outdoors, and there’s just the subtlest caress of a fragrant, gentle breeze…. So just enjoying the feel of the place on your skin…

And smelling its rich fragrance…. Whether it’s the soft, full scent of flowers…. Or sharp, salt sea air…. Sweet meadow grass….or maybe the pungent smell of peat moss in the forest….

So just taking it all in, all the richness of it…. With all of your senses…. Becoming more and more attuned to your safe and beautiful special place…. Just feeling thankful and happy to be there….

And letting your body soak in the vibrancy of the place…. letting its richness penetrate all the way into you….

So just letting the beauty of the place nourish you…. taking it with every full, deep breath…. all the way down into your belly… all the way down to the tip of your toes…. feeling the penetrating warmth and power of the place…. soaking into your skin…. Down through muscle and bone…. All the way to each and every cell… reaching down to the peaceful stillness at your very center….

(longer pause)

And so…. Knowing that you can call forth this place…. whenever you wish….once again, feeling yourself sitting in your chair or lying down…. Just breathing in and out, very rhythmically and easily…. And very gently and with soft eyes, letting yourself come back into the room whenever you are ready…. Knowing in a deep place that you are better for this….

And so you are…….


Quoted from; “Staying Well with Guided Imagery”: How to Harness The Power of You Imagination For Health and Healing Belleruth Naparstek (Warner Books 1994).