There are many studies examining the use of guided imagery on outcomes related to surgeries and procedures, including heart surgery, colorectal surgery, abdominal surgery, laparoscopic gynecologic surgery in adults, bone marrow aspiration, lumbar puncture, burn wound debridement, and administration of immunizations in children. Although many of the studies have methodologic limitations, reviews and meta-analyses have found overall benefit of small to moderate effect sizes for reducing psychological distress and reducing postoperative pain. A 2013 systematic review of the effect of mind-body therapies on postoperative outcomes concluded there was strong evidence that guided imagery improved psychological well-being measures and moderate evidence that it reduced analgesic intake. Two of the three randomized controlled trials assessing effect on average length of hospital stay found a significant decrease with guided imagery intervention. Other studies have shown significant decreases in total opioid use and average pharmacy costs. An interesting 2012 randomized controlled trial on guided imagery's effect on wound healing found that the intervention reduced perceived stress and increased hydroxyproline deposition in the surgical wound, a measure of the healing response. The most significant negative trial of the perioperative use of guided imagery was a randomized controlled trial of guided imagery for periprocedural pain and anxiety conducted with 170 women undergoing colposcopy, which did not show significant effect in the experimental group. In addition, a small 2016 three-arm randomized controlled trial of patients undergoing colorectal surgery did not find benefit from guided imagery or progressive muscle relaxation on quality of life after surgery.
B. Cancer-Related Symptoms
Most of the studies in patients with cancer that use guided imagery do so in combination with another modality, such as progressive muscle relaxation, meditation, hypnosis, biofeedback, or music therapy. These studies vary in methodologic quality. There are at least 20 randomized controlled trials in this category, and all show benefit for psychological outcomes, such as quality of life, anxiety, and depression. Studies that assessed the effect of guided imagery in combination with other modalities on nausea and vomiting also showed uniform benefit. For example, in a 2016 randomized controlled trial of 208 patients receiving a combination of guided imagery and progressive muscle relaxation once a week for 4 weeks while undergoing chemotherapy, the experimental group experienced significant improvements in fatigue, pain, and health-related quality of life when compared with usual-care control group. With respect to nonprocedural, cancer-related pain, there are at least six randomized controlled trials using guided imagery as part of a combination intervention. Three studies showed significant pain reduction with guided imagery intervention, two showed no pain reduction, and one showed significant benefit in patients' self-reported ability to decrease pain but not in measured pain intensity.
There are also several randomized controlled trials of guided imagery used alone, as a sole adjunctive treatment for patients with cancer. All of these studies again showed that guided imagery led to improvement in psychological outcomes, and in approximately half of the studies, the improvement was superior to other comparison interventions, such as progressive muscle relaxation or hypnosis. The evidence for guided imagery alone in preventing chemotherapy-related nausea and vomiting is mixed.
A single study examined the effect of guided imagery directly on cancer disease regression using clinical (Union for International Cancer Control criteria) and pathologic (biopsy) measures and found no effect.
There are several studies of guided imagery for various chronic pain conditions, such as phantom limb pain, osteoarthritis, headache, low back pain, fibromyalgia, and interstitial cystitis. Some of the studies are controlled, and all but one show benefit in either pain or psychological distress, or both. A rigorous systematic review found that eight of nine randomized controlled trials showed benefit of guided imagery for musculoskeletal pain, but due to variable quality of these studies, the review concludes that the evidence is encouraging but inconclusive. Similarly, a 2012 review of 15 randomized controlled trials on guided imagery for nonmusculoskeletal pain concluded that the evidence of benefit is encouraging but inconclusive. A 2017 systematic review and meta-analysis of studies on fibromyalgia concluded that guided imagery and hypnosis hold promise for this painful condition.
D. Stroke Rehabilitation
In at least two dozen trials, a variety of imagery techniques have been shown to be effective for stroke rehabilitation. These usually involve having patients practice imagining the movement or function they wish to execute, in a sense cognitively rehearsing. There are positive studies on hand function, upper extremity function, gait and lower extremity function, and balance.
et al. Immediate effects of immersive biofeedback on gait in children with cerebral palsy. Arch Phys Med Rehabil. 2019 Apr;100(4):598–605.
et al. Disparate effects of training on brain activation in Parkinson disease. Neurology. 2017 Oct 24;89(17):1804–10.
et al. Efficacy, acceptability and safety of guided imagery/hypnosis in fibromyalgia—a systematic review and meta-analysis of randomized controlled trials. Eur J Pain. 2017 Feb;21(2):217–27.