Addiction A-Z

Guided imagery therapy

Guided imagery therapy involves the therapeutic use of visualization and “guided images” to bring about positive changes in thoughts and behaviors, reduce symptoms, and improve coping skills.  The process is actually considered a specific form of hypnosis, as it requires getting into a highly relaxed state in order to access the subconscious mind by bypassing the conscious brain’s tendency to censor everything.

Although visualization plays a significant role in guided imagery therapy, the actually process involve much more than visualizing or imagining something in your mind.  Guided imagery works by utilizing the unique connection between your nervous system and your visual cortex. This connection impacts your emotional state, as well as your physical state and makes desired changes more possible.

Guided imagery has a fair amount of overlap with meditation. However, in guided imagery therapy, the therapist directly helps guide the image.  Guided imagery has been used effectively in the treatment of a wide range of physical, as well as emotional, disorders.  However, you don’t have to have a specific disorder in order to benefit from this treatment.  You may be facing a risk surgery, changing careers, or trying to handle the stress in your life more effectively.

There are three main components of this innovative type of therapy.  They are:

  • Stress reduction
  • Active visualization
  • Receptive imagery

How It Works

Guided imagery works by allowing therapy clients to carefully focus on whatever problem, faulty beliefs, or specific symptoms they have. Your subconscious mind recognizes imagery. The imagery that is used tackles the things that have previously been hindering your ability to make lasting, desired changes.  Imagery also enhances the body’s innate ability to heal itself and restore balance – crucial components of optimal functioning.

Although a form of hypnosis, guided imagery is different than other forms because it requires an intentional choice to go deeper within than is required for mere relaxation.  Healing and desired changes are brought about by focusing your concentration on specific areas.

Cognitive Imagery Techniques

Often, when people hear the term “guided imagery”, they imagine an Olympic athlete mentally rehearsing a medal-winning performance or someone relaxing while visualizing himself on a sandy beach looking out over a sparkling blue ocean.  However, those are just two types of imagery techniques that therapists use to bring about desired changes or help clients learn new behaviors or attitudes.

Positive imageryperhaps the most classic form of guided imagery, this technique involves the use of a pleasant image or scene (tranquil nature scenes are often used) that enables you to feel relaxed, calm, and grounded.  It can be utilized any time you need to switch from a state of anxiety to one of calm. 

Negative or aversive imagerythis is the opposite of positive imagery.  As the name suggests, aversive imagery involves the use of a highly unpleasant mental picture.  For example, a woman striving to overcome bad eating habits causing unwanted weight gain may picture herself as obese and struggling to fit her body into a small airplane seat – in between two thin people.  Aversive imagery is sometimes used in the treatment of alcoholism and other types of addiction.

Coping imageryAs the name suggests, this guided imagery method involves mentally rehearsing a new coping skill in order to better manage difficult people or situations.  For example, mentally rehearsing your response to an annoying coworker can help you respond effectively to him or her, rather than react in a manner you will likely regret.

Anti-future shock imageryThis particular guided imagery technique can be especially helpful for anyone who is facing an anxiety-provoking event at some point in the future.  For example, those who want to prepare themselves for the illness or death of a parent or spouse are instructed to imagine themselves coping effectively with the dreaded situation.   This imagery technique helps to minimize the “awfulness” attached to the future event.

Associated imagerySometimes we experience troubling emotions but can’t quite pinpoint why they’re occurring.  It involves thinking about the troubling feeling (e.g. guilt) and then make themselves feel it even more intensely. As they do this, they are to focus on the image (or images) that comes into their mind.  Studying the image(s) and looking at it from different viewpoints allows them track the unpleasant emotion and can help them understand its origin or meaning. 

Step-up techniqueThis imagery technique is designed to improve coping skills.  It involves imagining an anxiety-provoking situation but exaggerating it – stepping up the intensity – so that the situation elicits fear is even greater, and then picturing yourself coping with it effectively.  For example, if giving a presentation to a small group of co-workers causes a fair amount of anxiety, you could picture yourself giving it to an audience of 500 people – and picturing yourself coping with it very well.

Who Can Benefit?

Not everyone who seeks help or wants to make a positive change in life has a specific “symptom” or diagnosable disorder.  Guided imagery is often used to change a specific behavior or help change your  mindset or perspective regarding a particular situation.  Guided imagery can help you:

  • Eliminate bad habits or unwanted behaviors
  • Increase motivation
  • Feel more optimistic about the future
  • Achieve goals that you’ve set for yourself
  • Manage chronic pain more effectively
  • Learn to self-soothe and relax, particularly when feeling a bit stressed or anxious
  • Prepare yourself for a difficult or challenging situation or event (e.g. starting a new job, coping with the impending loss of an ill loved-one)
  • Manage negative emotions triggered by specific situations
  • Let go of regret and learn to forgive yourself for past mistakes
  • Mentally rehearse a desired behavior or skill in order to master it or feel more comfortable engaging in it
  • Increase self-control
  • Learn to manage your emotions more effectively
  • Change negative emotional responses to or unhealthy beliefs about a person, event, or situation (e.g. an overly-demanding boss; dealing with your ex during the divorce process)
  • Learn to cope with upcoming and inevitable changes in a healthy manner (e.g. retirement)
  • Explore new ways to handle challenging situations
  • Increase self-confidence
  • Become more proactive and less reactive in stressful situations
  • Learn to respond to others in ways that enhance your interactions

Other Therapies That Work Well with Guided Imagery

Guided imagery therapy may be used on its own, although it’s most frequently used in combination with other forms of psychotherapy.  For example, for individuals suffering from PTSD, guided imagery combined with healing touch therapy can be very effective.  Other therapies that guided imagery therapy works particularly well with include:

  • Cognitive behavioral therapy
  • Exposure therapy
  • Behavioral therapy
  • Rational emotive therapy
  • Cognitive processing therapy
  • Expressive arts therapies (e.g. music therapy, art therapy)
  • Other forms of hypnotherapy   

What to Expect In a Guided Imagery Session

Initially, you and your therapist will discuss what it is you hope to achieve during the session.  Once that’s determined, he or she will work with you to create an image that fits with the specific type of imagery technique you’re using (e.g. positive, aversive, coping).

One of the key components of effective guided imagery is that you’re comfortable and relaxed, so once you’ve selected your image you’ll get into a relaxed, comfortable position (usually sitting in a chair) with your eyes closed.  The therapist will guide you through the visualization process, encouraging you to incorporate all of your senses – sight, smell, touch, etc. – as you imagine the scene.  For example, if you’re using pleasant imagery, the therapist may instruct you to notice the fragrance and vivid colors of the flowers, or the salty smell of the ocean and the feel of warm sand beneath your toes.

Remember that you’re in charge of the visualization process.  If an image starts to make you really anxious or uncomfortable, you don’t have to continue with it.  The therapist may encourage you to relax and stick with it if you can; however, he or she won’t force you and will remind you that if you need to stop or change visualization, it’s up to you – you’re in control.  Having this control often makes it easier for clients to focus on the guided imagery process.  Simply knowing you can stop at any time makes it easier to relax and feel comfortable, which in turn enhances the process.

It’s common for the imagery process to be taped so you can continue using it at home in between sessions.  Since guided imagery is designed to make changes at a subconscious level, visualizing the image frequently will help facilitate the desired changes.

Advantages of Guided Imagery

There are many positive aspects of guided imagery therapy.  These include:

  • The client is in control of the imagery, which can be very empowering; if something doesn’t feel right or safe during the process, the client can stop or change the imagery
  • Effectiveness in reducing troubling symptoms, particularly those associated with anxiety and depression
  • Sessions don’t have to take a full hour; brief sessions make it easier to fit them into a busy schedule
  • The techniques are relatively simple and easy to learn
  • The techniques, once learned, can be applied to a wide range of challenges to effectively reduce negative feelings and improve coping
  • Guided imagery can be easily combined with other forms of psychotherapy to enhance treatment
  • The methods can be used effectively in the treatment of a wide range of life challenges, mental health disorders, and physical health issues and symptoms

Disadvantages of Guided Imagery

As with all forms of therapy, guided imagery has its limitations and disadvantages.

While it can be effective when used on its own to help relatively high functioning people improve various aspects of their lives, or reduce mild symptoms of depression, anxiety, and other disorders, it’s not intended to be a stand-alone therapy for those struggling with chronic disorders, or whose symptoms are in the moderate to severe range.  It’s not meant to be a replacement or substitute for psychotherapy or medication.

Some techniques, particularly aversive imagery, can trigger significant anxiety and other emotional reactions for some people.  Clinicians must be qualified and prepared to deal with these reactions when they occur, and must use extreme caution in continuing with guided imagery with these individuals.

The empirical evidence that shows guided imagery’s effectiveness for treating depression (and many other disorders) exists, but it’s still quite limited.  However, that’s not to say it’s not effective.  Not to mention, anecdotal evidence is not lacking.

Disorders, Symptoms, and Problems That Can Benefit From Guided Imagery Therapy

Guided imagery therapy can be beneficial for individuals who are struggling with a variety of physical as well as mental health disorders and related symptoms, , and life challenges.  These include (in no particular order):

  • Hypertension
  • Insomnia and sleep disorders
  • Depression (mild to moderate)
  • Anxiety disorders
  • Obsessive-compulsive disorder
  • Addiction
  • Unresolved trauma
  • Posttraumatic stress disorder (PTSD; particularly when used with healing touch therapy)
  • Skin problems (e.g. hives, rashes)
  • Chronic allergies
  • Muscle tension
  • Irritable bowel syndrome
  • Autoimmune disorders (e.g. Crohn’s disease, rheumatoid arthritis)
  • Acute and chronic pain
  • Asthma
  • Difficulties relaxing and managing stress
  • Specific phobias
  • Social anxiety disorder
  • Compromised immune functioning
  • Somatic complaints
  • Performance anxiety
  • Anger problems
  • Relationship problems
  • Couple’s and family conflict
  • Parenting problems
  • Low self-esteem
  • Grief and loss
  • Difficulties with forgiveness
  • Pessimism
  • Chronic fatigue
  • Behavioral problems in children
  • Compulsive disorders
  • Sexual problems
  • Mind-body problems
  • Stuttering
  • Preparation for and recovery from surgery and other medical procedures
  • Coping with serious health issues
  • Terminal illness
  • Challenges and concerns associated with aging
  • Weight loss and weight management
  • End of life care
  • Cancer treatment
  • Fertility issues
  • Problems associated with pregnancy
  • Childbirth concerns
  • Medication compliance
  • Headaches
  • Finding meaning and purpose in life

Potential Contraindications

Since some guided imagery techniques can cause some individuals to experience significant anxiety, considerable caution should be used in individuals who:

  • Have a severe psychiatric disorder (e.g. severe major depression, PTSD with severe symptoms, psychotic disorders)
  • Are experiencing suicidal thoughts
  • Are prone to stress-induced asthma attacks
  • Have a history of seizures triggered by anxiety or stress
  • Are pregnant
  • Has any kind of heart condition (or related condition)
  • Have strong objections to the process due to religious or personal beliefs

Other types of intervention may be more appropriate with these individuals.  For example, relaxation exercises such as progressive muscle relaxation and deep breathing can be taught and used by individuals who have difficulties managing stress and anxiety, or who are prone to anxiety-induced asthma or seizures.  Once they learn to use self-calming techniques effectively, they may be appropriate for guided imagery.  Before starting however, it’s important to have their current physician or primary therapist on board.

Other Applications

Guided imagery therapy and techniques have been used with good results in a variety of non-clinical settings, particularly when combined with behavioral methods. For example, athletes can improve their performance by using imagery and visualization. Parents can use these techniques to improve their parenting skills and interactions with their kids.  Those required to speak publicly or give presentations often benefit from visualization and guided imagery.  The methods have also been used effectively in business settings.

Benefits of Guided Imagery

Following are just some of the potential benefits you may experience with guided imagery therapy:

  • Effective emotional regulation and mood management
  • Improved ability to transfer learned skills to a variety of settings and situations as needed
  • Increased ability to self-soothe in stressful or anxiety-provoking situations
  • Increase self-confidence
  • Greater self-control
  • Greater sense of optimism
  • Improved relationships and interpersonal skills
  • Better overall coping skills
  • Improved ability to self-motivate
  • Fewer emotional upheavals
  • Increased self-awareness
  • Less likeliness to engage in self-destructive or self-defeating behaviors
  • More positive, rational patterns of thinking
  • Less need for pain medication (for acute and chronic pain sufferers)
  • Decrease in recovery time following surgical procedures
  • Stronger immune functioning

Finding a Qualified Guided Imagery Therapist

The Academy for Guided Imagery (AGI) offers a certification and training program in guided imagery (or, more specifically, in Interactive Guided Imagery(SM) . You can use the AGI website to connect with therapists in your area who are qualified to provide this particular type of treatment.

Keep in mind that many different types of mental health professionals and other healthcare professionals effectively use guided imagery in their practice, even though they haven’t received training or certification from the Academy for Guided Imagery. However, only those clinicians who’ve received their certification from AGI can refer to themselves as a practitioner of Interactive Guided Imagery(SM).

Guided imagery may be just what’s needed to get you out of your rut, break bad habits, and move you towards a life that is more fulfilling and comfortable.   A benign form of treatment, you have nothing to lose in trying it – and much to gain!

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