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DEFINITION

According to the National Center for Complementary and Integrative Health, guided imagery is a practice used for healing or health maintenance that involves a series of relaxation techniques followed by the visualization of detailed images, usually calm and peaceful in nature. As is the case with psychotherapeutic techniques, guided imagery can be applied in a variety of ways. It may be directive, with the therapist providing specific images, or it may be more receptive, inviting patients to find their own images. It may be supportive, with the intention to create a relaxed, pleasant, or specifically positive feeling (eg, trust or patience), or it may intend to directly work with an area of active challenge (eg, anxiety or pain). If used for treatment, persons may visualize their bodies free of the specific problem or condition. Guided imagery can be conducted live with a therapist one-on-one, in a group setting (less common), or via audio recording.

HISTORY

Imagery has been used throughout history and can be found in the origins of all ancient healing systems still extant today. In contemporary Western medicine, the psychiatrist Dr. Carl Jung recognized the importance of imagery as an expression of the subconscious and in 1915 developed a psychotherapeutic technique called “active imagination.” With the similar intention to aid psychoanalytic exploration, the French psychotherapist Dr. Robert Desoille in the late 1930s created a method he called “directed daydreaming,” and in the 1950s, Dr. Hanscarl Leuner introduced “guided affective imagery.” Medical research on guided imagery began in the 1970s and increased greatly in the 1980s. In 1989, the physician Dr. Martin Rossman and the psychologist Dr. David Bresler founded the Academy for Guided Imagery, which began certifying health professionals. One modern application of guided imagery has been through technology and virtual reality. A recent pilot study of 34 patients with Parkinson disease found that treadmill training augmented by virtual reality (in which participants were presented obstacles and real-life challenges in a virtual environment) resulted in possibly improved function, perhaps reflecting increased brain efficiency. Another small pilot study of children with cerebral palsy in which they visualized themselves as an avatar, representing movement in real time, found clinically important improvements in measures of gait.

MECHANISM OF ACTION

The mechanism of action of guided imagery is not well known, but some physiologic effects have been demonstrated. Three of five studies examining cortisol levels in relation to guided imagery have found that serum levels decreased after the intervention. Studies of the effect of guided imagery on immune function have shown mixed results. However, a 2009 randomized controlled trial of women with breast cancer showed improved NK cell cytotoxicity and increased IL-2-activated NK cell activity. One study documented reduced physiologic arousal around chemotherapy sessions, as measured by heart rate and systolic blood pressure. Some proposed psychological mechanisms postulated to explain the effects of guided imagery include cognitive ...

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