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Complementary & Alternative Medicine
Index Of Alternative Therapies And Modalities
When deciding to begin a complementary therapy or to see a complementary practitioner, first speak with your primary health care provider.
Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.
Historically, imagery has been used by many cultural groups, including the Navajos, ancient Egyptians, Greeks and Chinese. Imagery has also been used in religions such as Hinduism and Judaism. The term "guided imagery" refers to a number of different techniques, including visualization; direct suggestion using imagery, metaphor and storytelling; fantasy and game playing; dream interpretation; drawing; and active imagination.
Therapeutic guided imagery is believed to allow patients to enter a relaxed state and focus attention on images associated with issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style with the aim to encourage patients to tap into latent inner resources and find solutions to problems. Guided imagery is a meditative relaxation technique sometimes used with biofeedback. Books and audiotapes are available as well as interactive guided imagery groups, classes, workshops and seminars.
It is proposed that the mind can affect the body when visualized images evoke sensory memory, strong emotions or fantasy. Imagery has been said to cause many types of changes in the body, including alterations in breathing, heart rate, blood pressure, metabolism, cholesterol levels and functions of the gastrointestinal system, immune system and endocrine system. A goal of guided imagery is to use the senses of touch, smell, sight and sound to achieve a tranquil state that may help reduce or eliminate physical symptoms.
Scientists have studied guided imagery for the following health problems:
Initial research suggests that guided imagery may provide added benefits when used at the same time as standard medical care for migraine or tension headache. Some studies show that relaxation therapies, including use of guided imagery, may be as effective or more effective in reducing the frequency of migraine headaches than are modest doses of a beta-blockade medication. Other study results disagree. Further study is needed to make a strong conclusion.
Some studies suggest that guided imagery techniques (such as relaxation and imagery training tapes) may improve quality of life and sense of comfort (mood, depression) in cancer patients. Further research is needed to confirm these results.
Initial evidence suggests that occasional use of guided imagery techniques may improve quality of life in people with HIV. Additional research would be helpful.
Anxiety and wound healing after surgery
Initial evidence suggests that guided imagery relaxation audiotapes may reduce postoperative anxiety, improve healing and relieve stress. This research is preliminary, and more study is needed before a recommendation can be made.
Anxiety and depression in multiple sclerosis
There is early research that the use of imagery may reduce anxiety but not depression or physical symptoms in patients with multiple sclerosis. Additional research would be helpful in this area.
Preliminary research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.
Congestive heart failure
A small preliminary study reports that guided imagery is of no benefit in congestive heart failure.
Initial research suggests possible reductions in pain and improvements in functioning.
Upper respiratory tract infections
Preliminary research in children suggests that stress management and relaxation with guided imagery may reduce the duration of symptoms due to upper respiratory tract infections. Additional research is needed to confirm these results.
Evidence from preliminary research suggests that guided imagery may be an effective treatment for bulimia nervosa, at least in the short-term. Further study is needed before firm conclusions can be drawn.
Preliminary research supports the value of combined drug therapy and relaxation training in the treatment of insomnia. Further research is necessary to make a firm recommendation.
Juvenile rheumatoid arthritis
Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis. Further research is needed to confirm these results.
Significantly lower postoperative pain ratings and shorter hospital stays in children, less abdominal pain and less pain from laparoscopic surgery have been associated with guided imagery practice. Preliminary research also suggests guided imagery may help in reducing cancer pain, intravenous needle pain or nerve pain from spinal cord damage. Further research is needed to confirm these results.
Preliminary research suggests a reduction in pain and mobility difficulties in patients with osteoarthritis. Further research is needed before a firm conclusion can be drawn.
Relaxation in chronic obstructive pulmonary disease
A small study reports increased relaxation outcomes in people with chronic obstructive pulmonary disease (emphysema or chronic bronchitis) who use guided imagery techniques. Additional research is needed to confirm these results.
Based on early study, guided imagery in addition to education and counseling sessions may be helpful for long-term smoking cessation and abstinence in adult smokers. Further study is needed to confirm these results.
Catheterization/percutaneous coronary intervention
Neither masked prayer nor music, imagery and touch (combined) therapy significantly improved clinical outcome after elective catheterization or percutaneous coronary intervention in a recent study.
Guided imagery has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using guided imagery for any use.
Bone and wound healing
Chronic fatigue syndrome
Control of blood pressure
Creative thinking stimulation
Enhanced athletic performance
Gastrointestinal motility and secretion
| Herpes simplex virus|
Immune system enhancement
Increased breast milk
Irritable bowel syndrome
Nausea and vomiting
Post-traumatic stress disorder
Reduced healing time
Sexual function and impotence
Guided imagery has not been associated with severe adverse effects in the available scientific literature. In theory, excessive inward focusing may cause pre-existing psychological problems or personality disorders to surface. Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if your mental or physical health is unstable or fragile.
Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Be careful if you have any physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. If you feel unusually anxious while practicing guided imagery, or if you have a history of trauma or abuse, speak with a qualified health care provider before practicing guided imagery.
Guided imagery has been suggested for many different health conditions. Although guided imagery has not been proven effective for any specific condition, research is early and is not definitive. Do not rely on guided imagery alone to treat potentially dangerous medical conditions. Speak with your health care provider if you are considering guided imagery therapy.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Guided Imagery
Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Ackerman CJ, Turkoski B. Using guided imagery to reduce pain and anxiety. Home Healthc Nurse 2000;Sep, 18(8):524-530;quiz, 531.
- Afari N, Eisenberg DM, Herrell R, et al. Use of alternative treatments by chronic fatigue syndrome discordant twins. 1096-2190 2000;Mar 21, 2(2):97-103.
- Antall GF, Kresevic D. The use of guided imagery to manage pain in an elderly orthopaedic population. Orthop Nurs 2004;23(5):335-340.
- Baider L, Peretz T, Hadani PE, et al. Psychological intervention in cancer patients: a randomized study. Gen Hosp Psychiatry 2001;Sep-Oct, 23(5):272-277.
- Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs 2004;5(3):97-104.
- Ball TM, Shapiro DE, Monheim CJ, et al. A pilot study of the use of guided imagery for the treatment of recurrent abdominal pain in children. Clin Pediatr (Phila) 2003;Jul-Aug, 42(6):527-532.
- Barak N, Ishai R, Lev-Ran E. [Biofeedback treatment of irritable bowel syndrome]. Harefuah 1999;Aug, 137(3-4):105-107, 175.
- Baumann RJ. Behavioral treatment of migraine in children and adolescents. Paediatr Drugs 2002;4(9):555-561.
- Brown-Saltzman K. Replenishing the spirit by meditative prayer and guided imagery. Semin Oncol Nurs 1997;Nov, 13(4):255-259.
- Burke BK. Wellness in the healing ministry. Health Prog 1993;Sep, 74(7):34-37.
- Burns DS. The effect of the bonny method of guided imagery and music on the mood and life quality of cancer patients. J Music Ther 2001;Spring, 38(1):51-65.
- Castes M, Hagel I, Palenque M, et al. Immunological changes associated with clnical improvement of asthmatic children subjected to psychosocial intervention. Brain Behav Immun 1999;Mar, 13(1):1-13.
- Crow S, Banks D. Guided imagery: a tool to guide the way for the nursing home patient. Adv Mind Body Med 2004;20(4):4-7.
- Danhauer SC, Marler B, Rutherford CA, et al. Music or guided imagery for women undergoing colposcopy: a randomized controlled study of effects on anxiety, perceived pain, and patient satisfaction. J Low Genit Tract Dis 2007;Jan, 11(1):39-45.
- Dennis CL. Preventing postpartum depression: part II. A critical review of nonbiological interventions. Can J Psychiatry 2004;49(8):526-538.
- Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. J Psychiatr Res 2002;May-Jun, 36(3):179-187.
- Gaston-Johansson F, Fall-Dickson JM, Nanda J, et al. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nurs 2000;Aug, 23(4):227-285.
- Gruzelier JH. A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. Stress 2002;Jun, 5(2):147-163.
- Halpin LS, Speir AM, CapoBianco P, et al. Guided imagery in cardiac surgery. Outcomes Manag 2002;Jul-Sep, 6(3):132-137.
- Hewson-Bower B, Drummond PD. Psychological treatment for recurrent symptoms of colds and flu in children. J Psychosom Res 2001;Jul, 51(1):369-377.
- Hosaka T, Sugiyama Y, Tokuda Y, et al. Persistent effects of a structured psychiatric intervention on breast cancer patients' emotions. Psychiatric Clin Neurosci 2000;Oct, 54(5):559-563.
- Hudetz JA, Hudetz AG, Klayman J. Relationship between relaxation by guided imagery and performance of working memory. Psychol Rep 2000;Feb, 86(1):15-20.
- Hudetz JA, Hudetz AG, Reddy DM. Effect of relaxation on working memory and the Bispectral Index of the EEG. Psychol Rep 2004;95(1):53-70.
- Johnstone S. Guided imagery: a strategy for improving relationships and human interactions. Aust J Holist Nurs 2000;Apr, 7(1):36-40.
- Klaus L, Beniaminovitz A, Choi L, et al. Pilot study of guided imagery use in patients with severe heart failure. Am J Cardiol 2000;86(1):101-104.
- Kvale JK, Romick P. Using imagery for role transition of midwifery students. J Midwifery Womens Health 2000;Jul-Aug, 45(4):337-342.
- Kwekkeboom KL, Kneip J, Pearson L. A pilot study to predict success with guided imagery for cancer pain. Pain Manag Nurs 2003;4(3):112-123.
- Laurion S, Fetzer SJ. The effect of two nursing interventions on the postoperative outcomes of gynecologic laparascopic patients. J Perianesth Nurs 2003;Aug, 18(4):254-261.
- Lewandowski WA. Patterning of pain and power with guided imagery. Nurs Sci Q 2004;17(3):233-241.
- Louie SW. The effects of guided imagery relaxation in people with COPD. Occup Ther Int 2004;11(3):145-159.
- Marks IM, O'Dwyer AM, Meehan O, et al. Subjective imagery in obsessive-compulsive disorder before and after exposure therapy: pilot randomised controlled trial. Br J Psychiatry 2000;176:387-391.
- Marr J. The use of the Bonny Method of Guided Imagery and Music in spiritual growth. J Pastoral Care 2001;Winter, 55(4):397-406.
- Mehl-Madrona L. Complementary medicine treatment of uterine fibroids: a pilot study. Altern Ther Health Med 2002;Mar-Apr, 8(2):34-6, 38-40, 42, 44-46.
- Moody LE, Webb M, Cheung R, et al. A focus group for caregivers of hospice patients with severe dyspnea. Am J Palliat Care 2004;21(2):121-130.
- Moore RJ, Spiegel D. Uses of guided imagery for pain control by african-american and white women with metastatic breast cancer. 1096-2190 2000;Mar 21, 2(2):115-126.
- Moseley GL. Using visual illusion to reduce at-level neuropathic pain in paraplegia. Pain 2007;Aug, 130(3):294-298.
- Murray LL, Heather Ray A. A comparison of relaxation training an syntax stimulation for chronic nonfluent aphasia. J Commun Disord 2001;Jan-Apr, 34(1-2):87-113.
- Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference: Evidence-Based Clinical Reviews, USA. Elsevier/Mosby, 2005.
- Norred CL. Minimizing preoperative anxiety with alternative caring-healing therapies. AORN J 2000;Nov, 72(5):838-840, 842-843.
- Peeke PM, Frishett S. The role of complementary and alternative therapies in women's mental health. Prim Care 2002;Mar, 29(1):183-197, viii.
- Rosen RC, Lewin DS, Goldberg L, et al. Psychophysiological insomnia: combined effects of pharmacotherapy and relaxation-based treatments. 1389-9457 2000;Oct 1, 1(4):279-288.
- Rossman ML. Interactive Guided Imagery as a way to access patient strengths during cancer treatment. Integr Cancer Ther 2002;Jun, 1(2):162-165.
- Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am 2000;Jun, 47(3):589-599.
- Sloman R. Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nurs 2002;Dec, 25(6):432-435.
- Toth M, Wolsko PM, Foreman J, et al. A pilot study for a randomized, controlled trial on the effect of guided imagery in hospitalized medical patients. J Altern Complement Med 2007;Mar, 13(2):194-197.
- Tusek DL, Cwynar RE. Strategies for implementing a guided imagery program to enhance patient experience. AACN Clin Issues 2000;Feb, 11(1):68-76.
- Walker JA. Emotional and psychological preoperative preparation in adults. Br J Nurs 2002;Apr 25-May 8, 11(8):567-575.
- Weydert JA, Shapiro DE, Acra SA, et al. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr 2006;Nov 8, 6:29.
- Yip KS. The relief of a caregiver's burden through guided imagery, role-playing, humor, and paradoxical intervention. Am J Psychother 2003;57(1):109-121.
Last updated April 30, 2008
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