Guided imagery as an effective therapeutic technique: a brief review of its history and efficacy research

Journal of Instructional Psychology , March, 2006 by Joe Utay, Megan Miller

Guided imagery is a flexible intervention whose efficacy has been indicated through a large body of research over many decades in counseling and allied fields. It has earned the right to be considered a research-based approach to helping. This article provides a brief introduction to the history of guided imagery and examples of selected research indicating its efficacy.

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Prepare to learn in an interesting way ... Some learning will be obvious and some may occur at a different level ... You are about to begin a journey back in time to meet researchers in the helping profession who will help you better understand the scientific validation for the use of guided imagery ... As you read this, you may or may not notice your rate of reading ... or rate of breathing ... As you continue feeling as relaxed and safe as you feel comfortable ... you might be curious about the topic, maybe excited, maybe you have healthy doubts too ... Whatever you are feeling about guided imagery is okay ... You are free at any time to pause to contemplate ... or move on to another article for any reason. Now better prepared, you can begin this brief primer on some history and selected research on therapeutic uses of guided imagery ...

Guided imagery was defined by Bresler and Rossman, co-founders of the Academy for Guided Imagery, as a, "range of techniques from simple visualization and direct imagery-based suggestion through metaphor and storytelling" (2003). It is not a new approach to helping but well established in Native American and other indigenous traditions; Hinduism, Judeo-Christian, and other religious traditions; and traditional Chinese medicine, to name a few historically-based uses. Though guided imagery is currently understood to be mainly an "alternative" or "complementary" therapeutic technique, it has been used in psychotherapy for over a century. So, though guided imagery has long been used in many religious and healing traditions, the focus of this review is limited to the past 100 years.

When writing on the history of guided imagery, Schoettle (1980) described many early 20th century examples of its use, starting with therapeutically working with daydreams. For example, Schoettle pointed out that Freud's psychoanalysis is based on the, "unraveling of the patient's fantasies, daydreams, and dreams" and, "continues to be a cornerstone in current analytical techniques" (p. 220). In the 1920s, Kretschmer and Desoille began using the daydream in therapy. Kretschmer referred to these inner visions as bildstreifendenken, or thinking in the form of a movie. Desoille referred to his therapeutic technique as the guided daydream (Schoettle, 1980).

Jacob Morena developed the therapeutic technique of psychodrama in the 1940s, in which trained participants, referred to as "auxiliary egos," playing key individuals in a person's life, re-enacted the patient's personal problems on stage. This can be now understood as a way of guiding the externalization of the client's internal imagery. In 1954, Hans Carl Leuner developed a technique he called experimentelles katathymes bilderleben, or experimentally introduced cathathymic imagery, and further developed psychodrama, which he called Symboldrama psychotherapy or guided affective imagery. William Swartley introduced Leuner's technique in the United States in 1965 as a diagnostic tool, calling it initiated symbol projection (Schoettle, 1980).

In the late 1960s, Joseph Wolpe introduced several imagery-related techniques in behavior-modification therapy: systematic desensitization, aversive-imagery methods, symbolic-modeling techniques and implosive therapy. Since that time there have been many advocates of guided imagery including the Simontons, Achterberg, Klapish, Lawlis, Oyle, Bresler, and Rossman (Schoettle, 1980).

Efficacy Research.

Not a lot is written on why guided imagery is often helpful. According to Nightningale (1998), guided imagery helps clients connect with their internal cognitive, affective, and somatic resources. The goal is not to provide new-and-improved images for the client, but to facilitate awareness of the imagery that already exists and guide clients to work with this imagery for their own needs (Nightingale, 1998). Regardless of explanation, it certainly has many champions in diverse areas. Guided imagery can be used to learn and rehearse skills, more effectively problem solve through visualizing possible outcomes of different alternatives, and increase creativity and imagination. It has also been shown to affect physiological processes. As described in the remainder of this section, in addition to its use in counseling, guided imagery has also been used with very positive results in sports training, rehabilitative medicine, and healthcare.

Guided imagery has been used increasingly by healthcare providers in the medical field with impressive results. This is particularly true with Cancer patients but also with patients who have other medical concerns such as stroke or recurrent abdominal pain. For example, Walker, Walker, Ogston, Heys, Ah-See, Miller, Hutcheon, Sarkar, and Eremin (1999) compared two groups of Cancer patients. One group received relaxation therapy and the other received relaxation therapy with peaceful imagery. Women in the peaceful imagery group were, "more relaxed and easy going, had fewer psychological symptoms and had a higher self-rated quality of life during chemotherapy" (p. 267). These women also had, "enhanced lymphokine-activated killer cytotoxicity, higher numbers of activated T-cells and reduced blood levels of tumour necrosis factor" (p. 267). In other words, they seemed to be healthier than the group without peaceful imagery.

Always consult your physician before beginning any exercise, health or nutritionally based program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise and /or nutritional prescription. If you experience any pain or difficulty with exercises, nutritional or dietary changes in your daily regimen stop and consult your healthcare provider.