What the Evidence Says About Guided Imagery in Oncologic Care

January 18, 2021

By Jyothirmai Gubili, MS, Stacie Corcoran, RN, MS, and Ting Bao, MD, DABMA, MS

Imagery is a mind-body practice with deep historical roots. It uses imagination to recreate mental images, sounds, smells and even tastes to help achieve relaxation and to promote healing. Guided imagery can be learned in an interactive manner from a licensed practitioner or from books and self-help tapes. Repeating the practice results in a conditioning effect that can empower the individual to use it whenever needed.

What the Research Reveals

Guided imagery used in conjunction with cancer treatments was found (https://doi.org/10.1016/j.breast.2008.09.002) to improve patients’ quality of life (https://doi.org/10.1002/pon.889) and enhance (https://doi.org/10.1177/1099800407309374) immune function in those undergoing surgery. In a study of patients with breast or gynecologic cancer undergoing brachytherapy, guided imagery alleviated (https://doi.org/10.1002/pon.1171) anxiety, depression, and body discomfort. Presurgical use of guided imagery was shown (https://doi.org/10.1097/PSY.0b013e31820a1c26) to reduce mood disturbance and improve postsurgical immune parameters in patients with prostate cancer undergoing radical prostatectomy.

Data also suggest (https://doi.org/10.1016/j.ctcp.2016.07.002) utility of guided imagery for decreasing (https://doi.org/10.1177/1099800409347556) chemotherapy-associated nausea and vomiting and dyspnea in patients with advanced cancer. When combined with progressive muscle relaxation, guided imagery was associated (https://doi.org/10.1371/journal.pone.0156911) with reduction in pain, fatigue, nausea, vomiting, and retching improvement in mood, anxiety (https://doi.org/10.1155/2015/270876), and depression in patients undergoing chemotherapy (https://doi.org/10.1007/s00520-005-0806-7).

Guided imagery delivered by telehealth produced similar reductions (https://doi.org/10.1002/pon.3656) in fatigue, cognitive dysfunction and sleep disturbance scores in breast cancer survivors as in-person delivery.

Although clinical findings suggest benefits of guided imagery, the majority of the studies are limited by small sample sizes, poor design, and short period of implementation. Well-designed trials are needed to establish the intervention as a supportive therapy. Research is also required to determine the mechanisms underlying the effects of guided imagery. Neurophysiologic findings suggest that, guided imagery plays a prominent role in learning, memory, action, and information processing and elicits physiologic responses. For example, images that evoke calm and joy produce (https://doi.org/10.1097/01.naj.0000473313.17572.60) a relaxation response; those that conjure fear produce a stress response.

Adverse Effects

Guided imagery is a safe intervention, but it should be used cautiously in patients with past experiences of trauma, abuse, or mental illnesses such as psychosis. Patients with those conditions may have difficulty (https://doi.org/10.1097/01.naj.0000473313.17572.60) differentiating objective reality from subjective experience or may experience traumatic imagery, warranting further professional support.

What Oncology Nurses Need to Know

Accumulating evidence suggests that guided imagery is an effective, nonpharmacologic option for managing cancer-related symptoms such as pain, anxiety, depression, fatigue, and mood disturbance, thereby improving quality of life. Many cancer centers, clinics, and community centers offer the modality, which is easy to adopt with minimal instruction. Patients can passively follow the practitioner’s narration or actively shape the narrative and imagery to personalize their practice.

Knowledge of potential benefits and available resources allows nurses to include guided imagery as a symptom management option that can empower patients, enhancing health and healing. Oncology nurses and other healthcare providers can access information from the Academy for Guided Imagery, which offers a professional certification training program involving interactive guided imagery. 

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