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8 Articles in Volume 5, Issue #6
Botox Treatment of Chronic Refractory Low Back Pain
DEA Enforcement versus Pain Practice
Group Psychotherapy for Chronic Pain Patients
How Expert Testimony Distorts the Standard of Care
Neurostimulation in Chronic Pain Patients
Physiological Consequences of Guided Imagery
The Role of Tertiary Gain in Pain Disability
Treating Muscular Dysfunction of Upper Limbs

Physiological Consequences of Guided Imagery

What every pain therapist should know about guided imagery.
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“Imagination is more important than knowledge...”

- Albert Einstein

Mental images, formed long before we learn to understand and use words, lie at the core of who we think we are, what we believe the world is like, what we feel we need and deserve, and how motivated we are to take care of ourselves. They strongly influence our beliefs and attitudes about how we fall ill, what might help us get better, and whether or not any medical and/or psychological interventions will be effective or even helpful. For these reasons, learning how to guide our patients’ imagery can be an enormously helpful tool for modern pain therapists.

A mental image can be defined as a thought with sensory qualities. It is something we mentally see, hear, taste, smell, touch, or feel. The term “guided imagery” refers to a wide variety of mind/body techniques, including simple visualization and direct suggestion using imagery, metaphor and story-telling, fantasy exploration, 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.

Once considered “mumbo-jumbo,” or at best, an “alternative” or “complementary” approach, guided imagery is finding widespread scientific1 and public2 acceptance, and nearly ever bookstore now offers guided imagery, self-help CDs, or tapes.3 Guided imagery and other mind/body techniques are now being taught to medical students and residents and, in a survey of 53 medical schools conducted in 2000, 66% taught meditation and relaxation, 37% taught guided imagery, and 34% taught biofeedback.4

Because it is simple and highly cost effective to provide imagery tapes or CDs, many health professionals have begun recommending or using them to help relieve their patient’s symptoms, teach stress management and psychophysiologic relaxation, prepare patients for surgery, enhance tolerance to procedures, alleviate anxiety and depression, improve sleep, wean patients from medications, enhance treatment compliance, promote rehabilitation, and accelerate healing responses in the body.

Pain therapists utilize imagery in nearly every interaction with patients (whether aware of it or not). Table 1 summarizes the author’s personal list of what every contemporary pain therapist should know about guided imagery.

  1. Historically, more people have been treated using guided imagery than by any other therapeutic intervention.
  2. Patients (and pain therapists) use imagery all the time.
  3. Imagery has powerful physiological consequences.
  4. Words can evoke healing or hurting images.
  5. Guided imagery is a low risk, low cost alternative for helping patients control painful symptoms.
  6. Guided imagery can greatly enhance pain tolerance.
  7. Guided imagery can help better prepare patients for surgery or invasive procedures.
  8. Guided imagery can enhance compliance with treatment recommendations.
  9. Guided imagery can help motivate and track progress of patients in rehabilitation.
  10. Guided imagery is most effective when utilized interactively.

Table 1. What every contemporary pain therapist should know about guided imagery.

Historical Perspective

Despite guided imagery’s recent emergence as a therapeutic tool, its roots date as far back as the very first healing prayers and rituals. Such ceremonies use imagery (either overtly or covertly) to represent and evoke hopes, beliefs, attitudes, and expectations, so in a sense, imagery can be considered the oldest and most ubiquitous form of therapy.

The imagery-laden healing rituals of ancient cultures must have had a certain level of efficacy or they wouldn’t have persisted over time. Today, while we may dismiss the therapeutic power of “faith healings” as a “placebo effect,” the benefits are real and measurable with important implications for our understanding of how healing occurs.

Anton Mesmer’s ‘magnetic passes’ evoked remarkable and well documented healings in early 19th century France. The scientific basis underlying these healings was attributed by the French Academy of Sciences to “the effects of the imagination.” Later, Charcot and his student, Sigmund Freud, further developed hypnosis and free association as a way of exploring the subconscious mind.

Modern psychotherapists have since utilized a variety of imagery techniques to tap the contents of the subconscious. Hermann Rorschach, the Swiss psychiatrist, used standardized ink-blot designs to examine the psychological relevance of various non-descript images to his patients’ mental states. Carl Jung contended that the unconscious was also the repository of our intuition, creativity, compassion, and our deepest, most positive hopes for fulfillment and self-actualization, and utilized attention to spontaneous images as a way of connecting with it’s wisdom. Roberto Assagioli, an Italian psychiatrist and contemporary of Freud and Jung, developed Psychosynthesis, which extensively utilizes sophisticated imagery techniques.

Patients and pain therapists use imagery all the time. The most common way we use imagery is by worrying. Where does worrying occur? Mainly in your imagination. The two most common worries are regretting the past and fearing the future. In the first case, we bring images from the past into our imagination to analyze like an instant replay over and over again. In the second case, we create fictional future scenarios that only happen in our imagination. As has been said, “yesterday is history, tomorrow’s a mystery. Today’s a gift. That’s why it’s called “the present.”

We also use imagery whenever we mentally plan or prepare for anything. If you’ve ever remodeled a room, or figured out which would be the fastest way home, you’ve used mental imagery to compare possible alternatives.

Between worrying and planning, a great deal of attention is focused on the “movies” we write, produce, direct, and act out in our imagination. It’s also helpful to remember that whatever you give attention to grows, whether it’s your garden, your children, or your worries and fears. Thus, instead of promoting worrying by focusing patients’ attention on what they can’t do (e.g., by listing disabilities and limitations, writing restrictions, etc.), perhaps they should be encouraged to imagine all that they might be able to do in time, over time.

Imagery has powerful physiological consequences. The body tends to respond to mental imagery exactly as it would to a genuine external experience. Numerous studies have shown that imagery can affect almost all major physiologic control systems in the body, including respiration, heart rate, blood pressure, metabolic rates in cells, gastrointestinal motility and secretion, sexual function, cortisol levels, blood lipids, and even immune responsiveness.5

Last updated on: December 22, 2011
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