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Guided Imagery
What is it? Overview Usage Side Effects and Warnings

Guided Imagery Overview

Written by Jennifer Yee, sshowalter.

Guided imagery is a learned technique that teaches patients to guide their minds to more relaxed and focused states. This can directly affect brain and physical functioning as imagining relaxed states (such as sitting calmly on a beach) can have the same physiological effects -including lowered blood pressure and heart rate- as actual relaxation (i.e. actually sitting calmly on a beach.)

Guided imagery is defined by the Academy for Guided Imagery as A wide variety of techniques, including simple visualization and direct suggestion using imagery, metaphor and story-telling, fantasy exploration and game playing, dream interpretation, drawing, and active imagination where elements of the unconscious are invited to appear as images that can communicate with the conscious mind. (“What is Guided Imagery,” 2009)

Guided Imagery therapists bring a client to a relaxed state of mind and body, and then focus their client’s attention on the images associated with the issue they are dealing with.

Licensed health care practitioners, educators, and wellness and life coaches are excellent candidates to learn guided imagery techniques. Typically a health practitioner, such as a therapist, would use guided imagery techniques as part of therapy. GI Therapist Terry Reid suggested that clients have at least three guided imagery sessions to be effective (T, Reid, personal communication, August 31, 2009). She also emphasized that guided imagery is not a therapy model; instead it is an educational model. The therapist does not tell the client what to do – the therapist guides the client to discover the answers within oneself. The therapist also does not use “I” statements during an imagery session – she is trying to avoid having the client go into the “cognitive realm” (ibid.).

How It Works

Guided Imagery has been used to improve the immune response for cancer patients, to help alleviate depression, for surgery patients before and after surgery, to decrease pain, to reduce blood loss during surgery, to reduce menopausal symptoms, among other applications (Micozzi, 2006 p. 302-3). The Academy for Guided Imagery has a long list of conditions helped by GI, including addictions, anxiety, chronic pain, fertility and birthing, headache management, managing chronic illnesses, post-traumatic stress issues, sleep disorders, smoking cessation, and weight control.

Imagery affects all the major systems of the body, including “respiration, heart rate, blood pressure, metabolic rates in cells, gastrointestinal mobility and secretion, sexual function, cortisol levels, blood lipids, and even immune responsiveness” (Academy for Guided Imagery, 2009). There are only a few contraindications: organic brain syndrome, psychosis, and pre-psychosis (University of Michigan, n.d.).

Evidence on How It Works

There was a wide variety of research into guided imagery for health problems in 2009. Apóstolo, and Kolcaba had 60 short-term psychiatric patients listen to GI compact disks once a day for 10 days. They found that the guided imagery group “had significantly improved comfort and decreased depression, anxiety, and stress over time” (2009, p. 403). Eremin et al. conducted a study of 80 women with large or advanced breast cancer who were undergoing chemotherapy, radiotherapy, and hormone therapy. Their experimental group was taught relaxation and guided imagery techniques and the patients kept journals documenting frequency and intensity of the imagery. After 10 weeks, the researchers found higher numbers of T-cells, and lymphokine activated killer cells in the guided imagery group. They concluded “relaxation training and guided imagery beneficially altered putative anti-cancer host defences [sic] during and after multimodality therapy” (2009, p. 17). 14 adult asthmatics received guided imagery and 15 received functional relaxation techniques and guided imagery in a 2009 study by Lahmann et al. They found that functional relaxation had the most effect on the respiratory tests they conducted and that guided imagery had a minimal positive effect (p. 233).

Twenty patients with Parkinson Disease (PD) with moderate to severe tremor participated in a relaxation guided imagery study by Schlesinger, Benyakov, and Suraiya in 2009. They found that for 15 of the patients, their tremor disappeared for 1-13 minutes. Overall, the level of tremor for the experimental group was greatly reduced using guided imagery and patients reported that the improvement lasted for 2-14 hours (p. 2062).

Schorn conducted a study in 2009 that looked at the effects that guided imagery might have on blood loss in the third stage of labor for pregnant women. 60 women participated in the study that found guided imagery had no significant effect on the experimental group versus the control and placebo groups (p. 863).

Weigensberg, Lane, Wright, and Goran investigated the use of interactive guided imagery as a stress-reduction technique for overweight Latino adolescents in 2009. Over the course of four weeks, 12 teens received 45-minute stress reduction interactive guided imagery (IGI) sessions and their cortisol levels were measured before and after each session. After four weeks, there was a significant reduction in cortisol levels of the IGI groups versus the control group. The authors concluded that further study will be needed to determine if IGI can reduce stress levels and have a long-term effect on chronic stress and obesity (p. 303).


Academy for Guided Imagery. (2009). What is Guided Imagery. Retrieved from

Apóstolo, J.L., & Kolcaba, K. (2009). The Effects of Guided Imagery on Comfort, Depression, Anxiety, and Stress of Psychiatric Inpatients with Depressive Disorders. Archives of psychiatric nursing, 23(6), 403-11.

California Pacific Medical Center (2007). Integrative Health Education. Retrieved from

Davenport, L. (2009). Healing and Transforming Through Self-Guided Imagery. Berkeley: Celestial Arts.

Eremin, O., Walker, M.B., Heys, S.D., Hutcheon, A.W., Sarkar, T.K., & Walker, L.G. (2009). Immuno-Modulatory Effects of Relaxation Training and Guided Imagery in Women with Locally Advanced Breast Cancer Undergoing Multimodality Therapy: A Randomised Controlled Trial. Breast, 18(1), 17-25.

Lahmann, C., Nickel, M., Sauer, N., Noll-Hussong, M., Nowak, D., & Loew, T. (2009). Functional Relaxation and Guided Imagery as Complementary Therapy in Asthma: A Randomized Controlled Clinical Trial. Psychotherapy and psychosomatics, 78(4), 233-9.

Micozzi, M. (2006). Fundamentals of Complementary and Integrative Medicine, 3rd Ed. St. Louis: Elsevier.

Naparstek, B. (1994). Staying Well with Guided Imagery. New York: Warner Books.

Schlesinger, I., Benyakov, O., & Suraiya, S. (2009). Parkinson's Disease Tremor Is Diminished with Relaxation Guided Imagery. Movement disorders : official journal of the Movement Disorder Society, 24(14), 2059-62.

Schorn, M.N. (2009). The Effect of Guided Imagery on the Third Stage of Labor: A Pilot Study. Journal of alternative and complementary medicine, 15(8), 863-70.

University of Michigan. (n.d.). Mind-Body Module: Guided Imagery Unit. Indications & Contraindications. Retrieved from

Weigensberg, M.J., Lane, C.J., Wright, T., & Goran, M.I. (2009). Acute Effects of Stress-Reduction Interactive Guided Imagery(SM) on Salivary Cortisol in Overweight Latino Adolescents. Journal of alternative and complementary medicine, 15(3), 297-303.



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