Have you forgotten how to tap into your imagination? As we mature and become adults, society may make us feel that we no longer need our imaginations. Some may believe that we only need to focus on behaving realistically and not bother wasting our time dreaming about things that seem unlikely or far-fetched. For those of us who haven’t allowed our imaginations to dwindle, we may have the power to use our imaginations to explore our body in ways that can be extremely beneficial to our overall health. Through the fascinating process of guided imagery, we can utilize our imaginations to gain control of our body on a cellular level and to promote healing and the creation of new thought patterns (1). By incorporating this powerful technique into therapy sessions, clinicians may also have the ability to assist their patients in coping with their pain and eliminate fear. For these reasons, it is vital that clinicians are educated on what guided imagery is, why guided imagery is useful, and how do utilize guided imagery properly in their treatments.

What is Guided Imagery?

Guided imagery is a process by which the imagination is used to stimulate all of the senses of the body creating an imaginary experience for reconstruction of fearful or painful thoughts. For example, if someone is afraid of walking up stairs due to an injury or a negative previous experience with stairs, guided imagery can be used to help them imagine themselves successfully walking up and down stairs eliminating this fear. Guided imagery is also commonly used to aid the healing process. If a patient is experiencing pain in their knee, a clinician may use guided imagery to help them imagine their cells working to replenish their bones, ligaments, tendons, and muscles associated with their knee for optimal functioning. (2) Some other common uses for guided imagery may include:

• To reduce side effects of treatments
• To prepare for fearful situations
• Lower stress levels
• Obtain an understanding symptom causation
• Cope with illnesses
• Form new habits

Components of Guided Imagery

One of the significant facets of guided imagery is that it requires the use of little equipment or resources. If someone has a thorough understanding of how guided imagery works, it can be done on their own, anywhere at any time. It is best to be in a quiet, relaxing environment with some soothing music or sounds playing softly in the background to get the most out of your guided imagery experience (3). Qualified clinicians can be an advantageous resource for directing the guided imagery process, if someone may not be sure how to access their imagination on their own.

Guided Imagery Misconceptions

Many people may create the wrong first impression when hearing about guided imagery, so it is essential to make sure you thoroughly explain the concept of guided imagery before you implement it into your treatment. Just like with any other treatment, your patient may already have their own beliefs as to what the effects of guided imagery may be. They may be hesitant to participate in guided imagery due to negative feelings associated with hypnosis. You must reassure them that this is different from hypnosis because you will have no control over their minds. Inform them that your role in the process is to directly guide them through an imaginary experience that they have full control over. There are also people who believe that they no longer have an imagination. To overcome this misconception, you may have to start with a basic visualization of experiences they are most familiar with such as the feeling of the heat of the sun on their skin and gradually work towards more elaborate displays.  

Is Guided Imagery Effective?

Is it worth taking time away from your day or setting aside time in your sessions to engage in guided imagery? If you are interested in possibly altering your paradigm of thinking to fill your life with positive thoughts and feelings, guided imagery is something you should be interested in giving a try.

Who Needs Guided Imagery?

There is no specific population of people who can benefit the most from the effects of guided imagery. You also do not have to have a disorder or illness for guided imagery to have a positive impact on your life. Although guided imagery is popularly used for the management or reversal of pain or disease, it can also be used as a means of establishing goals and creating an attitude that is driven to achieve these goals. Because of the versatility of guided imagery, health-related goals, financial goals, career goals, and relationship goals can all become more feasible to the one who incorporates it as a habit in their life. People who are experiencing high amounts of stress, excessive pain, depression, or fear can implement guided imagery to lessen the severity of their symptoms and possibly reverse them. Guided imagery can be done by anyone, but not everyone may be as confident in their decision to participate in guided imagery. As a clinician, it is essential to recognize and discuss what your patient’s opinions may be in regards to guided imagery, and encourage them that with your assistance, they can have a pleasant experience with guided imagery no matter what their situation may be.

How Does Guided Imagery Work?

One of the primary goals of guided imagery is to gain access to your unconscious mind and think about controlling processes in your body that you usually may not have conscious control over (4). For example, imagine that you are holding a lemon. You can feel its tough skin, see its bright yellow color, and possibly get a small hint of its citrusy scent. Now you are going to grab a knife and cut the lemon hearing the sound of the knife slice through the skin and pulp of the lemon and then hit the cutting board beneath it. The citrusy scent of the fruit is now becoming stronger as you pick up half of the lemon and squeeze the juice into a small glass. After squeezing all of the juice you can out of the lemon, you pick up the glass and take a sip. You taste its sourness and can feel the texture that the pulp and possible few seeds bring as you swish it around in your mouth. If you followed along with this example of guided imagery, you might have noticed that your mouth began to water. You have very little conscious control over your ability to salivate, but by creating a situation that may cause you to salivate, you were able to provoke your unconscious response to salivation.
This same concept applies when it comes to managing a disease or stress-related symptoms. By creating a relaxing situation, a patient may be able to slow their breathing, decrease their heart rate, and lower their blood pressure without consciously thinking about these processes. Solely focusing on the relaxing situation causes their respiration, heart rate, and blood pressure to decrease as a beneficial side effect. The opposite of this is also true. Thinking about stressful situations will likely make these processes increase causing a patient to feel the stress associated with the situation. This is why guided imagery is effective in altering bodily functions and should be utilized by clinicians to aid in adjusting the functioning of the body for better recovery. Using your imagination to think abstractly requires you to use the right side of your brain. The function of the right side of your brain is associated with positive emotions and thoughts such as laughter, spirituality, and empathy. By exercising the right side of your brain through guided imagery, you can strengthen the pathways in your brain that cause these thoughts and emotions to express themselves.

Benefits of Guided Imagery

Guided imagery is a potent method available for reducing the effects of pain without the use of medication (5). If you take a closer look at how most pain medications work, they block the messages being sent to your brain from nerves that are at the site of injury or pain. Through the relaxation that is achieved through guided imagery, chemicals such as serotonin, norepinephrine, and dopamine are released to work similarly to the pain medications. There are no side effects to guided imagery, so nobody has to worry about using guided imagery too much or becoming addicted to guided imagery. Some of the most well-known benefits of guided imagery include but are not limited to:

• Decreased Stress
• Decreased Pain Levels
• Chronic Pain Relief
• Elimination of Fear
• Reduced Anxiety
• Reversal of Depression
• Replacing Bad Habits With Good Habits
• Increasing Self-Esteem
• Boosting Confidence
• Improving Healing
• Improving Sleep
• Decreasing Blood Pressure
• Reestablishing Heart Rhythm

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Performance of Guided Imagery

Guided imagery is not a complicated process. It can be performed alone or with the help of a clinician. As long as you have a place that is quiet and relaxing, you are ready to begin. There are 5 simple steps to conducting guided imagery properly including:

1. Assessing the Problem
2. Positioning
3. Breathing
4. Developing the Scene
5. Creating the Journey

By following these five steps, you will be able to unleash the power of your imagination and reap the many benefits that can come from guided imagery.

Step #1 Pinpoint the Problem

The first step to correctly performing guided imagery would be to establish the reason you want to conduct guided imagery. The route you take on the imaginative journey that you are about to begin can vary depending on what your overall goal is. For example, for someone who is looking to overcome fear, you may take them on an imaginary journey involving them being comfortable in a situation they may usually be fearful in. If you are looking to help someone enhance the healing process, you may have them imagine parts of their body regenerating back to their optimal form. If you are just looking to lower stress and anxiety levels, you will benefit most from imagining that you are in a relaxing environment while focusing on your breathing. You may want to discuss with your patient what they think of when asked what a relaxing environment is to them. It could be the beach, a forest, on their back porch, or on a cloud in the sky. Whatever they think of as their “happy place” this will be the scene that you are working to help them create in their minds.

Step #2 Assume a Relaxed Position

The generic form of a relaxed position would require someone to lie on their back with their hands by their sides. They would close their eyes and keep their ankles uncrossed. For patients that may find this position painful due to injury or pain, you may have to work to help them find a position in which they can relax. An excellent method for assisting them to find this position would be to ask in what position they usually fall asleep and give that one a try. Having a patient take off their shoes may aid them in relaxing, and some may like a pillow under their head with a soft, warm blanket. Do your best to help your patient utilize and obtain all of the techniques and resources necessary to help them get into a relaxed position.

Step #3 Controlled Breathing Pattern

Once you have found a comfortable position, it is time to get in tune with your breath. Deep breathing alone has been shown to have numerous mental and physical health benefits such as stress relief, toxin removal, and raising the pH of the body to a level that promotes healing (6). Breathing deeply with your diaphragm in through your nose and out through your mouth is the proper technique for relaxation. Counting up to three seconds while inhaling and five seconds while exhaling is an easy tempo to maintain with your breathing, and is a good way to help you stay focused on your breathing while preparing yourself for the imaginary journey.

Step #4 Create the Imaginary Environment

Now you are ready to create the environment you decided on earlier to deepen your state of relaxation further. In order for this to be effective, you must stimulate all of your senses. For example, if you are trying to get your patient to imagine themselves by the ocean you would probably create the scene in this manner:
“Imagine that you are lying on the beach with your feet in the sand right where the waves come out far enough to meet your feet. You can feel the warmth and graininess of the sand between your toes and periodically feel the rush of cool, foamy ocean water cover your feet and ankles. You can hear the whooshing of the waves and smell the faint salty scent of the ocean water. You’re sipping an ice-cold glass of freshly squeezed lemonade from a straw and can taste the perfect harmony of sweetness and tartness. You can see the white fluffy clouds in the sky through your sunglasses and can feel the warmth of the bright sun against your face.”
You can feel the sand, see the clouds, smell the ocean, taste the lemonade, and hear the waves. To create a scene that will have the greatest impact on your patient, you will have to be certain to cause the patient to use all of their senses.

Step #5 Begin the Journey

The patient is relaxed, and the setting of this imaginary experience has been created. It is time to begin the journey. Where you want to guide the experience from this point varies depending on what outcome you are trying to achieve. If you are merely looking to increase relaxation and lower stress levels, you may continue to have the patient imagine engaging in activities they may enjoy on the beach such as going for a walk, floating on the waves, or even taking a trip on a boat.

Guided Imagery and Spirituality

If your main goal of the guided imagery experience is to eliminate fear or promote healing within the body, you may incorporate a person’s connection with a higher power with the guided imagery experience. The higher power can be seen as what is eliminating the thoughts of pain, fears, or depression by filling the patient’s mind with the higher power’s light and positive thoughts. You can also guide your patient to imagine that their higher power is working within their body to expedite the healing process.
Guiding your patient through an imaginary experience with their higher power may follow a similar pattern like this:
“Imagine that you can see a beam of light in the sky. This beam of light is God, Mother Nature, or however you want to perceive it. The light is gradually working its way to your forehead right in between your eyes. All of your fears, doubts, worries, and pains are being vaporized by the intense power of the light. The light is filling all of the space in your mind not leaving any room for negative thoughts or emotions to come in and stay. Now the light is working its way down to your abdomen and is rebuilding the lining of your gut and upregulating the process of digestion. The bacteria that promote digestion are repopulating, and the pathogenic bacteria are being swept away.”
This is a brief example of how you can utilize your patient’s spirituality to help them cope with their pain and promote regeneration within their body.

Restructuring Fearful Situations With Guided Imagery

Another method for eliminating fear through guided imagery would be taking the patient through an experience that they may fear, but help them to replace these fearful emotions with positive and comforting thoughts. In physical therapy, this can be useful for patients who have experienced injury from falling. You can restructure this painful memory of falling by having them visualize successfully standing and walking with confidence.
Here is an example of how you may want to walk them through imagining this situation:
“You are sitting in your cozy chair at home and decide that you want to get up to get a glass of water. Your legs are strong, and your core is stable giving you the full confidence that you are capable of completing this task. With the help of the strength that you have in your arms, you push down on the sides of the chair to give yourself a small boost while initiating the motion of standing. You suck your belly button in to stabilize your core while simultaneously pushing through your knees to bring yourself to an upright position. Your shoulders are retracted, and your chin is up as you look ahead to begin walking. You take a full stride with your right leg allowing your heel to strike the ground first. You complete your stride by distributing your weight evenly on your right foot while simultaneously bringing your left leg forward for your next step. You feel balanced and safe as you continue to walk to your cupboard for a glass.”
The patient can imagine going through this process multiple times to help them mentally practice the task. Because their mind will already be prepared for how it is going to behave in the situation through guided imagery, the patient will be less and fearful of walking (7).

Increasing Body Awareness With Guided Imagery

You may also enable your patient to take control of the healing process within their body by having them imagine what their body is doing on a cellular level. For example, if a patient is diagnosed with degeneration of the knee, you can turn this nocebo concept around by helping them imagine their knee in the process of regenerating. An example of applying this concept to guided imagery would look similar to this:
“Imagine the bones, ligaments, muscles, and tendons of your knee. The cells that make up these tissues are continually working to maintain the functional integrity of your knee. There is synovial fluid flowing in your knee joint bringing nutrients and lubricating the articulations of the bones in your knee. Bone cells called osteoblasts are releasing materials to be used for the repairing of your bones that form your knee. Blood is rushing into your muscles and tendons to provide nutrients for the strengthening of these tissues. Little by little, all of the tissue that forms your knee is being regenerated through the innate intelligence of your body.”

Imagining Success Through Guided Imagery

Your mind has a fantastic power to alter the experiences you have in your body. With the use of guided imagery, you can use your mind’s ability to think abstractly for managing symptoms of pain, eliminating fear, and controlling your future responses to certain stimuli. Guided imagery can be altered for the accommodation of anyone who wishes to utilize it making it a versatile tool for both healthcare and personal use. Many clinicians may be unaware of what guided imagery is, or may not have been trained on how to perform guided imagery with a patient. To combat this issue, we should work to popularize the use of guided imagery in more fields than psychology and provide more options for training in guided imagery. If people can learn how to implement guided imagery into their lives by their clinicians, they will be able to amplify the positive effects of their sessions with their clinicians and maintain a positive mindset outside of the clinic. The most effective way to change the health of our patients is by helping our patients change their lifestyles to promote positive thinking and healthy habits. Guided imagery can create these changes in our patients and should be considered as an option for helping our patients recover as efficiently as possible.

Remember, reversing pain requires an integrated approach.
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