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Dr. Alan Watkins states that every idea, thought and belief has a
neurochemical consequence, which is what makes imagery such a
significant mind-body bridge. He writes that the flow of
neuropeptides from the CNS, which enhances or inhibits one’s
immunology through two major neuro immuno modulatory pathways;
neuroendocrine and autonomic, are critically important in
maintaining health and fighting disease [Watkins A 1997 Mind-body
medicine. Churchill Livingstone, NY].
D. L. Tusek and R. E. Cwynar of Ohio acknowledged that patients
often describe the experience in a hospital as overwhelming, evoking
fear, anger, helplessness, and isolation. Tusek and Cwynar view
guided imagery as one of the most well-studied complementary
therapies being used that can improve the patient experience and
outcome by providing a significant source of strength, support, and
courage as they prepare for a procedure or manage the stresses of a
hospital stay [AACN Clin Issues 2000 Feb; 11(1): 68-76].
V. W. Donaldson in NC at the Center for Stress Management examined
the effects of mental imagery on the immune system response, and
specifically, on depressed white blood cell (WBC) counts. Results
indicated significant increases in WBC count for all patients over a
90-day period, even when possessing disease and illnesses that would
have predicted a decrease in WBC count [Appl Psychophysiol
Biofeedback 2000 Jun; 25(2): 117-28].
L. M. Troesch et al. of the Arthur G. James Cancer Hospital and
Research Institute at Ohio State University in Columbus found that
those patients using a chemotherapy-specific guided-imagery
audiotape expressed a significantly more positive experience with
chemotherapy, finding guided imagery to be an effective intervention
to promote patient involvement in self-care practices and to
increase patient coping abilities during symptom occurrence [Oncol
Nurs Forum 1993 Sep; 20(8): 1179-85].
D. S. Burns at the Group/Walther Cancer Institute found that
individuals who participated in guided imagery sessions scored
better on both mood scores and quality of life scores than those who
did not. Interestingly, these scores continued to improve in the
experimental group, even after sessions were complete, indicating
that guided imagery is effective in improving mood and quality of
life in cancer patients [J. Music Ther. 2001 spring; 38(1) :51-65].
Gaston-Johansson et al. of Johns Hopkins University School of
Nursing in Baltimore, Maryland showed significant benefits from the
use of information, cognitive restructuring, and relaxation with
guided imagery in those patients with breast cancer who underwent
autologous bone marrow/peripheral blood stem cell transplantation.
This strategy was found to be effective in significantly reducing
anxiety, nausea, and nausea combined with fatigue 7 days after
surgery when the side effects of treatment are usually the most
severe [Cancer Nurs 2000 Aug; 23(4):277-85].
Researchers at Ohio State University in Columbus, Ohio found that
people with cancer who used imagery while receiving chemotherapy
felt more relaxed, better prepared for their treatment and more
positive about care than those who didn't use the technique. They
also found it can help chemotherapy patients cope with one of the
most severe side effects of their treatment.
Howard Hall, measuring the effects of healthy people imagining their
White blood cells as strong as powerful sharks, found a number of
subjects could demonstrate an increase in the number of lymphocytes
as well as an increased responsiveness of the immune system after
the session as compared to before [Hall H R 1983 Hypnosis and the
immune system. American Journal of Clinical Hypnosis, 25:92-103].
C. H. McKinney et al. from the University of Miami found that 13
weeks of guided imagery and music showed significant decreases in
cortisol level (the “stress hormone” strongly correlated with mood
disturbances, as well as demonstrating a significant reduction in
depression, fatigue, and total mood disturbance.) The study also
[Health Psychol 1997 Jul; 16(4): 390-400].
FEAR
L. Baider, et al. examined the long-term effects of relaxation and
guided imagery on patients recently diagnosed with cancer at
Hadassah University Hospital. Results showed a decrease in
psychological distress and an increase in the patient's sense of
internal control [Gen Hosp Psychiatry 2001 Sep-Oct; 23(5): 272-7].
A study by J. A. Royle, et al. of Ontario, found that guided imagery
was the intervention best used by nurses to decrease patient anxiety
[Can Oncol Nurs J 1996 Feb; 6(1): 20-5].
DEPRESSION
Fawzy et al. found that information on the cancer and training in
stress
management and coping skills, showed participants exhibiting less
fatigue, depression, mood disturbances, as well as increased vigor [Fawzy
F I, Kemeny M E, Fawzy N W et al. 1990 A structured psychiatric
intervention for cancer patients: II. Changes over time in
immunological measures. Archive of General Psychiatry 47:729-35].
B. L. Rees reported that patients receiving 4 weeks of relaxation
and guided imagery scored significantly lower on trait anxiety,
state anxiety, and depression, while scoring significantly higher on
measurements of self-esteem [J. of Holistic Nursing. 13(3): 255-267.
Sept. 1995].
C.L. Norred at the University of Colorado Health Sciences Center
Department of Anesthesiology in Denver found that guided imagery may
be an integrative therapy that can minimize preoperative anxiety [AORN
J 2000 Nov; 72(5): 838-40, 842-3].
S.A. Lambert found that guided imagery and relaxation therapy
significantly lowered postoperative pain ratings and shortened the
hospital stays, as well as decreased the postoperative anxiety [J
Dev Behav Pediatr 1996 Oct; 17(5): 307-10].
ANXIETY-QUALITY OF LIFE
C. H. McKinney et al. from the University of Miami found that 13
weeks of guided imagery and music showed significant decreases in
cortisol level (the “stress hormone” strongly correlated with mood
disturbances, as well as demonstrating a significant reduction in
depression, fatigue, and total mood disturbance. The study also
[Health Psychol 1997 Jul; 16(4): 390-400].
B. L. Rees reported that patients receiving 4 weeks of relaxation
and guided imagery scored significantly lower on trait anxiety,
state anxiety, and depression, while scoring significantly higher on
measurements of self-esteem [J. of Holistic Nursing. 13(3): 255-267.
Sept. 1995].
L. G. Walker et al. of the University of Aberdeen Medical School
found that cancer patients receiving standard care plus relaxation
training and imagery were more relaxed and easy going during the
study, experiencing a higher quality of life overall during primary
chemotherapy [Br J Cancer 1999 Apr; 80(1-2): 262-8].
A study by J. A. Royle, et al. of Ontario, found that guided imagery
was the best intervention used by nurses to decrease patient anxiety
[Can Oncol Nurs J 1996 Feb; 6(1): 20-5].
SIDE EFFECTS-PAIN
K.L. Syrjala et al. of the Fred Hutchinson Cancer Research Center in
Seattle, WA concluded in their study that stand-alone relaxation and
imagery training reduces cancer treatment-related pain [Pain 1995
Nov; 63(2): 189-98].
R.Sloman from the University of Sydney in Australia observed that
progressive muscle relaxation combined with guided imagery has the
potential to promote relief of cancer pain. The techniques appear to
produce a relaxation response that may break the
pain-muscle-tension-anxiety cycle and facilitate pain relief through
a calming effect. This technique seems to provide a self-care
strategy that, to a limited extent, shifts the locus of control from
clinician to patient [Nurs Clin North Am 1995 Dec; 30(4): 697-709].
R. J. Moore and D. Spiegel from the Anderson Cancer Center in
Houston, TX observed a desire for and a benefit from patients being
able to attach meaning to the disease and its treatment. They felt
that this is why many are drawn to guided imagery as a tool in the
management of cancer-related anxiety and pain by using it to
reconnect to the self, to make sense of their experiences with
breast cancer, and for managing cancer pain in a manner that
increases one’s sense of control, thereby alleviating the suffering
of the survivor [1096-2190 2000 Mar 21; 2(2): 115-126].
D.L. Tusek, R. Cwynar, and D.M. Cosgrove studied the effect of
listening to taped guided imagery for patients undergoing
cardiovascular surgeries and concluded that guided imagery can
decrease length of stay, pain, and anxiety [J of Cardiovascular
Management. 22-28. March-April 1999].
C Renzi et al. found that listening to guided imagery tapes before,
during, and after surgery showed results in which there was a trend
for reduction in pain following surgery and a significant
improvement in the quality of sleep [Int J Colorectal Dis 2000 Nov;
15(5-6): 313-6].
Omlor et al. found that preoperative relaxation techniques
significantly reduced the number of postoperative hematomas as well
as the amount of pain medication being required after surgery [Zentralbl
Chir 2000; 125(4): 380-5; discussion 385-6].
Journal of Consulting and Clinical Psychology: 1991 Aug; 59(4):
518-25 concluded that relaxation therapy is effective in reducing
adverse consequences of chemotherapy, for a study involving 81
cancer patients showed relaxation therapy to decrease nausea and
anxiety during chemotherapy.
K. L. Kaufman et al. at Ohio State University tried a self-hypnotic,
cue-controlled relaxation, and guided imagery intervention that
showed a marked and clinically significant reduction in nausea and
vomiting as well as a concurrent increase in sleep duration [J
Adolesc Health Care 1989 Jul; 10(4): 323-7].
IMMUNE RESPONSE
K. Glaser and R. Glaser, studying a group of elderly people, found
that over a month of relaxation training three times per week
significantly increased their natural killer lymphocytes and T cell
activity [Cousins N 1989 Head first. Dutton, NY].
J. Pennebaker found that “confessional writing,” of the type that
occurs when journaling, led to salubrious changes in the immune
system and better health in general. He felt that there is
structuring and resolving of the harmful effects of those “hidden”
feelings and images going on through the process of writing. [Pennebaker
J W 1990 Opening up: the healing power of confidence in others.
Avon, NY].
Danish researchers found increased natural killer cell activity
among ten college students who imagined that their immune systems
were becoming very effective. Natural killer cells are an important
part of the immune system because they can recognize and destroy
virus-infected cells, tumor cells and other invaders.
A group of metastatic cancer patients using daily imagery for a year
achieved significant improvements in NK cell activity and several
other measures of immune functioning.
C. Holden-Lund found that the use of an audiotape series employing
relaxation with guided imagery demonstrated significantly less state
anxiety, lower cortisol levels one day following surgery, and less
surgical wound erythema than the control group. Thus, the guided
imagery tapes demonstrated stress-relieving outcomes closely
associated with healing [Res Nurs Health 1988 Aug; 11(4):235-44].
GUIDED IMAGERY RESEARCH
D.A. Rapkin, M. Straubing, and J.C. Holroyd from the University of
California, Los Angeles explored the value of imagery-hypnosis on
recovery from head and neck cancer surgery and found there were
fewer surgical complications and less blood loss during surgery [Int
J Clin Exp Hypn 1991 Oct; 39(4): 215-26].
L. LeShan found that psychological conditions had an enormous
influence not only on the production of cancer, but also on the
disease’s evolution and even on the person’s response to a
particular treatment (LeShan L, Worthington R 1956 Personality as a
factor in the pathogenesis of cancer: a review of the literature.
British Journal of Medical Psychology 29:49-56).
K. Kolcaba and C. Fox measured the effectiveness of customized
guided imagery for increasing comfort in early stage cancer. They
found that listening to a guided imagery audiotape once a day for
the duration of the study indicated a significant overall increase
in comfort over time, and was especially salient in the first three
weeks of therapy. [Oncol Nurs Forum 1999 Jan-Feb; 26(1): 67-72].
M. Jasnoski of George Washington University, Washington, D.C., is
examining the effects of imagery on the immune system, with
potential implications for use in cancer and AIDS.
Blair Justice of the University of Texas Health Sciences Center in
Houston was funded to conduct a controlled study examining the
effects of a group imagery/ relaxation process on immune function
and quality of life in breast cancer patients
ARTICLES ON GUIDED IMAGERY
Strategies For Implementing A Guided Imagery Program To Enhance
Patient Experience
Reviews the use of and research about guided imagery in surgery, and
describes how to implement a program.
2000 AACN Clin Issues 11; 1:68-76
Tusek, D. L. and Cwynar, R. E.
Imagine This! Infinite Uses Of Guided Imagery In Women's Health
Reviews use of guided imagery in outpatient, inpatient, chronic care
and home care settings related to women's health.
1999 J Holist Nurs 17; 4:317-30
Bazzo, D. J. and Moeller, R. A.
The Value Of Imagery In Preoperative Nursing
Review of interactive imagery with an institutional implementation
plan.
1998 Semin Perioper Nurs 7; 2:108-13
Miller, T.
Guided Imagery. A Psychoneuroimmunological Intervention In Holistic
Nursing Practice. Use of guided imagery as an intervention in
nursing practice, and its impact on psychoneuroimmunology.
1997 J Holist Nurs 15; 2:112-27
Giedt, J. F.
Coping, Life Attitudes, And Immune Responses To Imagery And Group
Support After Breast Cancer Treatment / Richardson MA. Altern Ther
Health Med 1997; 3(5): 62-70.
The Effects Of Guided Imagery On Comfort Of Women With Early Stage
Breast Cancer Undergoing Radiation Therapy / Kolcaba K, Fox C. Oncol
Nurs Forum 1999; 26(1): 67-72.
Imagery And Hypnosis In The Treatment Of Cancer Patients / Spiegel
D. Oncology (Huntingt) 1997; 11(8): 1179-89; discussion 1189-95.
Psychological, Clinical And Pathological Effects Of Relaxation
Training And Guided Imagery During Primary Chemotherapy / Walker LG,
Walker MB, et al. Br J Cancer 1999; 80(1-2): 262-8.
Relaxation And Imagery For Symptom Management: Improving Patient
Assessment And Individualizing Treatment / Van Fleet S. Oncol Nurs
Forum 2000; 27(3): 501-10.
Use Of Relaxation For The Promotion Of Comfort And Pain Relief In
Persons With Advanced Cancer / Solman R. Contemp Nurse 1994; 3(1):
6-12.
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