Guided imagery

March 22, 2017


Guided imagery

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Biofeedback, Bonny method, direct suggestion, drawing/active imagination, dream interpretation, fantasy, game playing, imagery, interactive guided imagery, meditative relaxation technique, metaphor, story telling, visualization.


  • Throughout history, many cultures have used imagery for therapeutic purposes, including the Navajo, ancient Egyptians, Greeks, and Chinese. Religions such as Hinduism and Judaism have also practiced imagery. In modern times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery.

  • Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style to encourage patients to find solutions to problems by exploring their existing inner resources. Biofeedback is sometimes used with imagery to enhance meditative relaxation. Interactive guided imagery groups, classes, workshops, and seminars are available, as well as books and audiotapes.


  • It is theorized that the process of visualizing images can evoke sensory memory, strong emotions, or fantasy that in turn may affect the mind and body in beneficial ways. Imagery techniques have been proposed to cause a number of changes in body functions, including alterations in breathing, heart rate, blood pressure, metabolism, and the gastrointestinal system, immune system, and endocrine system. Practitioners often aim to use a variety of senses, including touch, smell, sight, and sound, to achieve a tranquil state by decreasing negative physical symptoms.

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.



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. Further study is needed before a strong conclusion can be drawn.



Early research suggests that guided imagery may help reduce cancer pain, intravenous needle pain, nerve pain from spinal cord damage, or lower postoperative pain ratings in children. Further research is needed to confirm these results.


Anxiety and wound healing after surgery

Initial evidence suggests that guided imagery relaxation audiotapes may reduce anxiety after surgeries, and may improve healing. More study is needed before a strong recommendation can be made.


Anxiety/depression in multiple sclerosis

Early research suggests 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.


Bulimia nervosa

Evidence from early 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.



Initial research suggests possible reductions in pain and improvements in functioning.


General health maintenance

Although guided-imagery meditation is popularly used with yoga for general health maintenance, there is not enough scientific evidence in this area.



Early research supports the value of combined pharmacotherapy and relaxation training in the treatment of insomnia. Further research is necessary in order 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.



Early research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.



Early research suggests a reduction in pain and mobility difficulties in patients with osteoarthritis. Further research is needed before a firm conclusion can be drawn.


Quality of life in cancer patients

Preliminary studies suggest that quality of life and sense of comfort may be improved by guided imagery techniques such as relaxation/imagery training tapes. Further research is needed before a firm conclusion can be drawn.


Quality of life in HIV patients

Initial evidence suggests that occasional use of guided imagery techniques may improve quality of life in people with HIV. Additional research is needed in this area before a recommendation can be made.


Relaxation in chronic obstructive pulmonary disease (COPD)

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.


Smoking cessation

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.


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.


Catheterization / percutaneous coronary intervention

Masked prayer, music, imagery, and touch (combined) therapy did not significantly improve clinical outcome after elective catheterization or percutaneous coronary intervention in a recent study.


Congestive heart failure

Preliminary research reports no benefits of guided imagery in congestive heart failure.


*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Academic performance, addiction, allergies, angina, arthritis, asthma, athletic performance enhancement, bacterial infections, bone and wound healing, cancer, chemotherapy related nausea, chronic bronchitis, controlling blood pressure, creative thinking stimulation, depression, diabetes, dyspnea, eating disorders, emphysema, fungal infections, gastrointestinal motility and secretion, glaucoma, herpes simplex virus, high cholesterol, immune system enhancement, increasing breast milk, lung disease, mood enhancement, nausea/vomiting, nightmares, obesity, obsessive compulsive disorder (OCD), phobias, postpartum depression, post-traumatic stress disorder (PTSD), premenstrual syndrome (PMS), psoriasis, psychological disorders, relationship conflicts, relaxation, self-esteem improvement, sexual function/impotence, skin conditions, spastic colon, stress, well-being, viral warts.


Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • Serious adverse effects have not been reported in the available scientific literature. Theoretically, intense inward focusing may cause pre-existing psychological problems or personality disorders to surface. Guided imagery should not be relied upon as a sole therapy for potentially serious medical problems. Guided imagery is usually used as a supplemental technique to other treatments, not as a replacement.

  • Guided imagery techniques should not be practiced while driving or during other activity requiring strict attention. Guided imagery may trigger physical symptoms that can be brought about by stress, anxiety, or emotional upset. If practicing guided imagery produces anxiety, a qualified healthcare professional should be consulted. Similarly, people with a history of trauma or abuse should speak with a healthcare professional before using this technique.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. 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. View Abstract

  2. Carr RR, Nahata MC. Complementary and alternative medicine for upper-respiratory-tract infection in children. Am J Health Syst Pharm 2006 Jan 1;63(1):33-9. View Abstract

  3. Chen KM, Chen MH, Hong SM, et al. Physical fitness of older adults in senior activity centres after 24-week silver yoga exercises. J Clin Nurs 2008 Oct;17(19):2634-46. View Abstract

  4. 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. View Abstract

  5. Fried RG, Hussain SH. Nonpharmacologic management of common skin and psychocutaneous disorders. Dermatol Ther 2008 Jan-Feb;21(1):60-8. View Abstract

  6. Klaus L, Beniaminovitz A, Choi L, et al. Pilot study of guided imagery use in patients with severe heart failure. Am J Cardiol 7-1-2000;86(1):101-104. View Abstract

  7. Kshettry VR, Carole LF, Henly SJ, et al. Complementary alternative medical therapies for heart surgery patients: feasibility, safety, and impact. Ann Thorac Surg 2006 Jan;81(1):201-5. View Abstract

  8. Louie SW. The effects of guided imagery relaxation in people with COPD. Occup Ther Int 2004;11(3):145-159. View Abstract

  9. Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. J Altern Complement Med 2006 Jan-Feb;12(1):23-30. View Abstract

  10. Moseley GL. Using visual illusion to reduce at-level neuropathic pain in paraplegia. Pain 2007 Aug;130(3):294-8. View Abstract

  11. Munsch S, Michael T, Biedert E, et al. Negative mood induction and unbalanced nutrition style as possible triggers of binges in binge eating disorder (BED). Eat Weight Disord. 2008 Mar;13(1):22-9. View Abstract

  12. 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):194-7. View Abstract

  13. Trakhtenberg EC. The effects of guided imagery on the immune system: a critical review. Int J Neurosci. 2008 Jun;118(6):839-55. View Abstract

  14. 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. View Abstract

  15. Wynd CA. Guided health imagery for smoking cessation and long-term abstinence. J Nurs Scholarsh 2005;37(3):245-50. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


March 22, 2017