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Guided imagery (also known as guided affective imagery, or katathym-imaginative psychotherapy (KIP)) is a mind-body intervention by which a trained practitioner or teacher helps a participant or patient to evoke and generate
mental image A mental image is an experience that, on most occasions, significantly resembles the experience of 'perceiving' some object, event, or scene, but occurs when the relevant object, event, or scene is not actually present to the senses. There are ...
s that simulate or recreate the sensory
perception Perception () is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information or environment. All perception involves signals that go through the nervous syste ...
of sights, sounds, tastes, smells, movements, and images associated with touch, such as texture, temperature, and pressure, as well as imaginative or mental content that the participant or patient experiences as defying conventional sensory categories, and that may precipitate strong
emotion Emotions are mental states brought on by neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is currently no scientific consensus on a definitio ...
s or
feeling Feelings are subjective self-contained phenomenal experiences. According to the ''APA Dictionary of Psychology'', a feeling is "a self-contained phenomenal experience"; and feelings are "subjective, evaluative, and independent of the sensation ...
s in the absence of the stimuli to which correlating
sensory receptor Sensory neurons, also known as afferent neurons, are neurons in the nervous system, that convert a specific type of stimulus, via their receptors, into action potentials or graded potentials. This process is called sensory transduction. The ...
s are receptive. The practitioner or teacher may facilitate this process in person to an individual or a group or you may do it with a virtual group. Alternatively, the participant or patient may follow guidance provided by a
sound recording Sound recording and reproduction is the electrical, mechanical, electronic, or digital inscription and re-creation of sound waves, such as spoken voice, singing, instrumental music, or sound effects. The two main classes of sound recording ...
,
video Video is an electronic medium for the recording, copying, playback, broadcasting, and display of moving visual media. Video was first developed for mechanical television systems, which were quickly replaced by cathode-ray tube (CRT) sy ...
, or
audiovisual Audiovisual (AV) is electronic media possessing both a sound and a visual component, such as slide-tape presentations, films, television programs, corporate conferencing, church services, and live theater productions. Audiovisual service ...
media comprising spoken instruction that may be accompanied by music or sound.


Mental imagery in everyday life


Two ways of generating mental imagery

There are two fundamental ways by which
mental image A mental image is an experience that, on most occasions, significantly resembles the experience of 'perceiving' some object, event, or scene, but occurs when the relevant object, event, or scene is not actually present to the senses. There are ...
ry is generated: voluntary and involuntary. The involuntary and spontaneous generation of mental images is integral to ordinary sensory perception, and
cognition Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, though ...
, and occurs without volitional intent. Meanwhile, many different aspects of everyday problem solving,
scientific reasoning Models of scientific inquiry have two functions: first, to provide a descriptive account of ''how'' scientific inquiry is carried out in practice, and second, to provide an explanatory account of ''why'' scientific inquiry succeeds as well as it ap ...
, and creative activity involve the volitional and deliberate generation of mental images.


Involuntary

The generation of involuntary mental imagery is created directly from present sensory stimulation and perceptual information, such as when someone sees an object, creates mental images of it, and maintains this imagery as they look away or close their eyes; or when someone hears a noise and maintains an auditory image of it, after the sound ceases or is no longer perceptible.


Voluntary

Voluntary mental imagery may resemble previous sensory perception and experience, recalled from
memory Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remember ...
; or the images may be entirely novel and the product of
fantasy Fantasy is a genre of speculative fiction involving magical elements, typically set in a fictional universe and sometimes inspired by mythology and folklore. Its roots are in oral traditions, which then became fantasy literature and d ...
.


Technique

The term ''guided imagery'' denotes the technique used in the second (voluntary) instance, by which images are recalled from long-term or
short-term memory Short-term memory (or "primary" or "active memory") is the capacity for holding a small amount of information in an active, readily available state for a short interval. For example, short-term memory holds a phone number that has just been recit ...
, or created from fantasy, or a combination of both, in response to guidance, instruction, or supervision. Guided imagery is, therefore, the assisted simulation or re-creation of perceptual experience across sensory modalities.


Clinical investigation and scientific research

Mental imagery can result from both voluntary and involuntary processes, and it comprises simulation or recreation of perceptual experience across all sensory modalities, including olfactory imagery, gustatory imagery, haptic imagery, and
motor imagery Motor imagery is a mental process by which an individual rehearses or simulates a given action. It is widely used in sport training as mental practice of action, neurological rehabilitation, and has also been employed as a research paradigm in cogn ...
. Nonetheless,
visual The visual system comprises the sensory organ (the eye) and parts of the central nervous system (the retina containing photoreceptor cells, the optic nerve, the optic tract and the visual cortex) which gives organisms the sense of sight ...
and auditory mental images are reported as being the most frequently experienced by people ordinarily as well as in controlled experiments, with visual imagery remaining the most extensively researched and documented in scientific literature. In
experimental An experiment is a procedure carried out to support or refute a hypothesis, or determine the efficacy or likelihood of something previously untried. Experiments provide insight into cause-and-effect by demonstrating what outcome occurs when a ...
and
cognitive psychology Cognitive psychology is the scientific study of mental processes such as attention, language use, memory, perception, problem solving, creativity, and reasoning. Cognitive psychology originated in the 1960s in a break from behaviorism, which ...
, researchers have concentrated primarily on voluntary and deliberately generated imagery, which the participant or patient creates, inspects, and transforms, such as by evoking imagery of an
intimidating Intimidation is to "make timid or make fearful"; or to induce fear. This includes intentional behaviors of forcing another person to experience general discomfort such as humiliation, embarrassment, inferiority, limited freedom, etc and the victi ...
social event, and transforming the images into those indicative of a pleasant and self-affirming experience. In
psychopathology Psychopathology is the study of abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era. Biological psychopathol ...
, clinicians have typically focused on involuntary imagery which "comes to mind" unbidden, such as in a depressed person's experience of intrusive unwelcome negative images indicative of sadness, hopelessness, and morbidity; or images that recapitulate previous
distressing Distressing (or weathered look) in the decorative arts is the activity of making a piece of furniture or object appear aged and older, giving it a "weathered look". There are many methods to produce an appearance of age and wear. Distressing is ...
events that characterize
posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threat ...
. In clinical practice and psychopathology, involuntary mental images are considered intrusive when they occur unwanted and unbidden, "hijacking attention" to some extent. The maintenance of, or "holding in mind" imagery, whether voluntary or involuntary, places considerable demands upon cognitive attentional resources, including
working memory Working memory is a cognitive system with a limited capacity that can hold information temporarily. It is important for reasoning and the guidance of decision-making and behavior. Working memory is often used synonymously with short-term memory, ...
, redirecting them away from a specific cognitive task or general-purpose concentration and toward the imagery. In clinical practice, this process can be positively exploited therapeutically by training the participant or patient to focus attention on a significantly demanding task, which successfully competes for and directs attention away from the unbidden intrusive imagery, decreasing its intensity, vividness, and duration, and consequently alleviating distress or
pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
.


Mental imagery and ill health

Mental imagery, especially visual and auditory imagery, can exacerbate and aggravate a number of mental and physical conditions. This is because, according to the principles of
psychophysiology Psychophysiology (from Greek , ''psȳkhē'', "breath, life, soul"; , ''physis'', "nature, origin"; and , '' -logia'') is the branch of psychology that is concerned with the physiological bases of psychological processes. While psychophysiology ...
and
psychoneuroimmunology Psychoneuroimmunology (PNI), also referred to as psychoendoneuroimmunology (PENI) or psychoneuroendocrinoimmunology (PNEI), is the study of the interaction between psychological processes and the nervous and immune systems of the human body. It is ...
, the way an individual perceives his or her mental and physical condition in turn affects
biological processes Biological processes are those processes that are vital for an organism to live, and that shape its capacities for interacting with its environment. Biological processes are made of many chemical reactions or other events that are involved in the ...
, including susceptibility to
illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
,
infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
, or
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
; and that perception is derived significantly from mental imagery. That is to say that in some cases, the severity of an individual's mental and physical
disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...
,
disorder Disorder may refer to randomness, non-order, or no intelligible pattern. Disorder may also refer to: Healthcare * Disorder (medicine), a functional abnormality or disturbance * Mental disorder or psychological disorder, a psychological pattern ...
, or
illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
is partially determined by his or her images, including their content, vividness or intensity, clarity, and frequency with which they are experienced as intrusive and unbidden. An individual can aggravate the
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
s and intensify the pain or distress precipitated by many conditions through generating, often involuntarily, mental imagery that emphasizes its severity. For example, mental imagery has been shown to play a key role in contributing to, exacerbating, or intensifying the experience and symptoms of posttraumatic stress disorder (PTSD), compulsive cravings,
eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating d ...
s such as
anorexia nervosa Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gre ...
and
bulimia nervosa Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eaten ...
,
spastic hemiplegia Spastic hemiplegia is a neuromuscular condition of spasticity that results in the muscles on one side of the body being in a constant state of contraction. It is the "one-sided version" of spastic diplegia. It falls under the mobility impairment u ...
, incapacitation following a
stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...
or cerebrovascular accident, restricted cognitive function and
motor control Motor control is the regulation of movement in organisms that possess a nervous system. Motor control includes reflexes as well as directed movement. To control movement, the nervous system must integrate multimodal sensory information (both ...
due to
multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This ...
, social anxiety or phobia,
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that last from days to weeks each. If the elevat ...
,
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social w ...
,
attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inap ...
, and depression.


Example conditions aggravated by mental imagery

The aforementioned challenges and difficulties are some of those for which there is evidence to show that an individual can aggravate the symptoms and intensify the pain or distress precipitated by the condition through generating mental imagery that emphasizes its severity. The following elaborates the way in which such mental imagery contributes to or aggravates four specific conditions: #
Posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threat ...
#
Social anxiety Social anxiety is the anxiety and fear specifically linked to being in social settings (i.e., interacting with others). Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disor ...
# Depression #
Bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that last from days to weeks each. If the elevat ...


Posttraumatic stress disorder

Posttraumatic stress disorder often proceeds from experiencing or witnessing a traumatic event involving
death Death is the irreversible cessation of all biological functions that sustain an organism. For organisms with a brain, death can also be defined as the irreversible cessation of functioning of the whole brain, including brainstem, and brain ...
, serious
injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...
, or significant
threat A threat is a communication of intent to inflict harm or loss on another person. Intimidation is a tactic used between conflicting parties to make the other timid or psychologically insecure for coercion or control. The act of intimidation for co ...
to others or oneself; and disturbing intrusive images, often described by the patient as 'flashbacks', are a common symptom of this condition across demographics of age, gender, and the nature of the precipitating traumatic event. This unbidden mental imagery is often highly vivid, and provokes memories of the original trauma, accompanied by heightened
emotion Emotions are mental states brought on by neurophysiological changes, variously associated with thoughts, feelings, behavioral responses, and a degree of pleasure or displeasure. There is currently no scientific consensus on a definitio ...
s or
feeling Feelings are subjective self-contained phenomenal experiences. According to the ''APA Dictionary of Psychology'', a feeling is "a self-contained phenomenal experience"; and feelings are "subjective, evaluative, and independent of the sensation ...
s and the subjective experience of danger and
threat A threat is a communication of intent to inflict harm or loss on another person. Intimidation is a tactic used between conflicting parties to make the other timid or psychologically insecure for coercion or control. The act of intimidation for co ...
to safety in the present "here and now".


Social anxiety

Individuals with social anxiety have a higher than normal tendency to
fear Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear ...
situations that involve public attention, such as speaking to an audience or being interviewed, meeting people with whom they are unfamiliar, and attending events of an unpredictable nature. As with posttraumatic stress disorder, vivid mental imagery is a common experience for those with social anxiety, and often comprises images that revive and replay a previously experienced stressful, intimidating or harrowing event that precipitated negative feelings, such as
embarrassment Embarrassment or awkwardness is an emotional state that is associated with mild to severe levels of discomfort, and which is usually experienced when someone commits (or thinks of) a socially unacceptable or frowned-upon act that is witnessed ...
,
shame Shame is an unpleasant self-conscious emotion often associated with negative self-evaluation; motivation to quit; and feelings of pain, exposure, distrust, powerlessness, and worthlessness. Definition Shame is a discrete, basic emotion, d ...
, or awkwardness. Thereby, mental imagery contributes to the maintenance and persistence of social anxiety, as it does with posttraumatic stress disorder. In particular, the mental imagery commonly described by those suffering from social anxiety often comprises what
cognitive psychologists Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought ...
describe as an "observer perspective". This consists of an image of themselves, as though from an observing person's perspective, in which those
suffering Suffering, or pain in a broad sense, may be an experience of unpleasantness or aversion, possibly associated with the perception of harm or threat of harm in an individual. Suffering is the basic element that makes up the negative valence of a ...
from social anxiety perceive themselves negatively, as if from that observing person's point of view. Such imagery is also common among those suffering from other types of
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, who often have depleted ability to generate neutral, positive, or pleasant imagery.


Depression

The capacity to evoke pleasant and positively affirming imagery, either voluntarily or involuntarily, may be a critical requisite for precipitating and sustaining positive moods or feelings and
optimism Optimism is an attitude reflecting a belief or hope that the outcome of some specific endeavor, or outcomes in general, will be positive, favorable, and desirable. A common idiom used to illustrate optimism versus pessimism is a glass filled w ...
; and this ability is often impaired in those suffering from depression. Depression consists of emotional distress and
cognitive impairment Cognitive deficit is an inclusive term to describe any characteristic that acts as a barrier to the cognition process. The term may describe * deficits in overall intelligence (as with intellectual disabilities), * specific and restricted defici ...
that may include feelings of hopelessness, pervasive sadness,
pessimism Pessimism is a negative mental attitude in which an undesirable outcome is anticipated from a given situation. Pessimists tend to focus on the negatives of life in general. A common question asked to test for pessimism is " Is the glass half emp ...
, lack of
motivation Motivation is the reason for which humans and other animals initiate, continue, or terminate a behavior at a given time. Motivational states are commonly understood as forces acting within the agent that create a disposition to engage in goal-dire ...
, social withdrawal, difficulty in concentrating on mental or physical tasks, and disrupted sleep. Whilst depression is frequently associated with negative rumination of verbal thought patterns manifested as unspoken inner speech, ninety percent of depressed patients reporting distressing intrusive mental imagery that often simulates and recollect previous negative experiences, and which the depressed person often interprets in a way that intensifies feelings of despair and hopelessness. In addition, people suffering from depression have difficulty in evoking prospective imagery indicative of a positive future. The prospective mental imagery experienced by depressed persons when at their most despairing commonly includes vivid and graphic images related to
suicide Suicide is the act of intentionally causing one's own death. Mental disorders (including depression, bipolar disorder, schizophrenia, personality disorders, anxiety disorders), physical disorders (such as chronic fatigue syndrome), and ...
, which some
psychologist A psychologist is a professional who practices psychology and studies mental states, perceptual Perception () is the organization, identification, and interpretation of sensory information in order to represent and understand the pre ...
s and
psychiatrists A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
refer to as "flash-forwards".


Bipolar disorder

Bipolar disorder is characterized by manic episodes interspersed with periods of depression; 90% of patients experience
comorbid In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...
anxiety disorder Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause phy ...
at some stage; and there is a significant prevalence of suicide amongst sufferers. Prospective mental imagery indicative of hyperactivity or mania and hopelessness contributes to the manic and depressive episodes respectively in bipolar disorder.


Principles

The therapeutic use of guided imagery, as part of a multimodal treatment plan incorporating other suitable methods, such as
guided meditation Meditation is a practice in which an individual uses a technique – such as mindfulness, or focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally cal ...
, receptive music therapy, and
relaxation technique A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Rela ...
s, as well as
physical medicine and rehabilitation Physical medicine and rehabilitation, also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions s ...
, and
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
, aims to educate the patient in altering their mental imagery, replacing images that compound pain, recollect and reconstruct distressing events, intensify feelings of hopelessness, or reaffirm debilitation, with those that emphasize physical comfort, functional capacity, mental
equanimity Equanimity (Latin: ''æquanimitas'', having an even mind; ''aequus'' even; ''animus'' mind/soul) is a state of psychological stability and composure which is undisturbed by experience of or exposure to emotions, pain, or other phenomena that may ...
, and optimism. Whether the guided imagery is provided in person by a facilitator, or delivered via
media Media may refer to: Communication * Media (communication), tools used to deliver information or data ** Advertising media, various media, content, buying and placement for advertising ** Broadcast media, communications delivered over mass e ...
, the verbal instruction consists of words, often pre-scripted, intended to direct the participant's
attention Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Att ...
to imagined visual, auditory,
tactile Tactile may refer to: * Tactile, related to the sense of touch * Haptics (disambiguation) * Tactile (device), a text-to-braille translation device See also * Tangibility, in law * Somatosensory system In physiology, the somatosensory system ...
, gustatory or olfactory sensations that precipitate a positive psychologic and
physiologic Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical a ...
response that incorporates increased mental and physical relaxation and decreased mental and physical stress. Guided imagery is one of the means by which therapists, teachers, or practitioners seek to achieve this outcome, and involves encouraging patients or participants to imagine alternative perspectives, thoughts, and behaviors, mentally rehearsing strategies that they may subsequently actualize, thereby developing increased coping skills and ability.


Stages

According to the computational theory of imagery, which is derived from
experimental psychology Experimental psychology refers to work done by those who apply experimental methods to psychological study and the underlying processes. Experimental psychologists employ human participants and animal subjects to study a great many topics, in ...
, guided imagery comprises four phases: # Image generation # Image maintenance # Image inspection # Image transformation


Image generation

Image generation involves generating mental imagery, either directly from sensory data and perceptual experience, or from memory, or from fantasy.


Image maintenance

Image maintenance involves the volitional sustaining or maintaining of imagery, without which, a mental image is subject to rapid decay with an average duration of only 250 ms. This is because volitionally created mental images usually fade rapidly once generated in order to avoid disrupting or confusing the process of ordinary sensory perception. The natural brief duration of mental imagery means that the active maintenance stage of guided imagery, which is necessary for the subsequent stages of inspection and transformation, requires cognitive concentration of attention by the participant. This concentrative attentional ability can be improved with the practice of mental exercises, including those derived from guided meditation and supervised meditative praxis. Even with such practice, some people can struggle to maintain a mental image "clearly in mind" for more than a few seconds; not only for imagery created through fantasy but also for mental images generated from both long-term memory and short-term memory. In addition, while the majority of the research literature has tended to focus on the maintenance of visual mental images, imagery in other sensory modalities also necessitates a volitional maintenance process in order for further inspection or transformation to be possible. The requisite for practice in sustaining
attentional control Attentional control, colloquially referred to as concentration, refers to an individual's capacity to choose what they pay attention to and what they ignore. It is also known as endogenous attention or executive attention. In lay terms, attention ...
, such that attention remains focused on maintaining generated imagery, is one of the reasons that guided meditation, which supports such concentration, is often integrated into the provision of guided imagery as part of the intervention. Guided meditation assists participants in extending the duration for which generated mental images are maintained, providing time to inspect the imagery, and proceed to the final transformation stage of guided imagery.


Image inspection

Once generated and maintained, a mental image can be inspected to provide the basis for interpretation, and transformation. For visual imagery, inspection often involves a scanning process, by which the participant directs attention across and around an image, simulating shifts in perceptual perspective. Inspection processes can be applied both to imagery created spontaneously, and to imagery generated in response to scripted or impromptu verbal descriptions provided by the facilitator.


Image transformation

Finally, with the assistance of verbal instruction from the guided imagery practitioner or teacher, the participant transforms, modifies, or alters the content of generated mental imagery, in such a way as to substitute images that provoke negative feelings, are indicative of suffering, or that reaffirm disability or debilitation for those that elicit positive emotion, and are suggestive of resourcefulness, ability to cope, and an increased degree of mental and physical capacity. This process shares principles with those that inform the
clinical psychology Clinical psychology is an integration of social science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and persona ...
techniques of "imagery restructuring" or "imagery re-scripting" as used in
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
. While the majority of research findings on image transformation relate to visual mental imagery, there is evidence to support transformations in other sensory modalities such as auditory imagery. and haptic imagery.


Outcome of image generation, maintenance, inspection, and transformation

Through this technique, a patient is assisted in reducing the tendency to evoke images indicative of the distressing, painful, or debilitative nature of a condition, and learns instead to evoke mental imagery of their identity, body, and circumstances that emphasizes the capacity for
autonomy In developmental psychology and moral, political, and bioethical philosophy, autonomy, from , ''autonomos'', from αὐτο- ''auto-'' "self" and νόμος ''nomos'', "law", hence when combined understood to mean "one who gives oneself one' ...
and
self-determination The right of a people to self-determination is a cardinal principle in modern international law (commonly regarded as a '' jus cogens'' rule), binding, as such, on the United Nations as authoritative interpretation of the Charter's norms. It sta ...
, positive proactive activity, and the ability to cope, whilst managing their condition. As a result, symptoms become less incapacitating, pain is to some degree decreased, while coping skills increase.


Requisite for absorption

In order for the foregoing process to take place effectively, such that all four stages of guided imagery are completed with therapeutic beneficial effect, the patient or participant must be capable of or susceptible to
absorption Absorption may refer to: Chemistry and biology *Absorption (biology), digestion **Absorption (small intestine) *Absorption (chemistry), diffusion of particles of gas or liquid into liquid or solid materials *Absorption (skin), a route by which s ...
, which is an "openness to absorbing and self-altering experiences". This is a further reason why guided meditation or some form of meditative praxis, relaxation techniques, and
meditation music Meditation music is music performed to aid in the practice of meditation. It can have a specific religious content, but also more recently has been associated with modern composers who use meditation techniques in their process of composition, or w ...
or receptive music therapy are often combined with or form an integral part of the operational and practical use of the guided imagery intervention. For, all those techniques can increase the participant's or patient's capacity for or susceptibility to absorption, thereby increasing the potential efficacy of guided imagery.


As a mind-body intervention

The United States
National Center for Complementary and Integrative Health The National Center for Complementary and Integrative Health (NCCIH) is a United States government agency which explores complementary and alternative medicine (CAM). It was initially created in 1991 as the Office of Alternative Medicine (OAM), ...
(NCCIH), which is among twenty-seven organizations that make up the
National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the lat ...
(NIH), classifies guided imagery and guided meditation, as
mind–body interventions Mind–body interventions (MBI) or mind-body training (MBT) are health and fitness interventions that are intended to work on a physical and mental level such as yoga, tai chi, and Pilates. The category was introduced in September 2000 by the U ...
, one of five domains of medical and health care systems, practices, and products that are not presently considered part of conventional medicine. The NCCIH defines mind-body interventions as those practices that "employ a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms", and include guided imagery, guided meditation and forms of meditative praxis,
hypnosis Hypnosis is a human condition involving focused attention (the selective attention/selective inattention hypothesis, SASI), reduced peripheral awareness, and an enhanced capacity to respond to suggestion.In 2015, the American Psychologica ...
and
hypnotherapy Hypnotherapy is a type of mind–body intervention in which hypnosis is used to create a state of focused attention and increased suggestibility in the treatment of a medical or psychological disorder or concern. Popularized by 17th and 18th c ...
, prayer, as well as
art therapy Art therapy (not to be confused with ''arts therapy'', which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art the ...
,
music therapy Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music t ...
, and
dance therapy Dance/movement therapy (DMT) in USA/ Australia or dance movement psychotherapy (DMP) in the UK is the psychotherapeutic use of movement and dance to support intellectual, emotional, and motor functions of the body. As a modality of the creativ ...
. All mind–body interventions, including the aforementioned, focus on the interaction between the
brain A brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as Visual perception, vision. I ...
, body, and behavior and are practiced with intention to use the mind to alter physical function and promote overall health and
wellbeing Well-being, or wellbeing, also known as wellness, prudential value or quality of life, refers to what is intrinsically valuable relative ''to'' someone. So the well-being of a person is what is ultimately good ''for'' this person, what is in th ...
. There are documented benefits of mind-body interventions derived from scientific research firstly into their use in contributing to the treatment a range of conditions including
headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...
s,
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pl ...
and
chronic pain Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between acute and chronic pain is sometimes determined by the amount of time since onset. Two commonly used markers are pain that continue ...
; secondly in ameliorating the symptoms of chemotherapy-induced
nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ...
,
vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenter ...
, and localised physical pain in patients with
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
; thirdly in increasing the perceived capacity to cope with significant problems and challenges; and fourthly in improving the reported overall
quality-of-life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standard ...
. In addition, there is evidence supporting the brain and central nervous system's influence on the
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
and the capacity for mind-body interventions to enhance immune function outcomes, including defense against and recovery from infection and disease. Guided imagery has also demonstrated efficacy in reducing postoperative discomfort as well as chronic pain related to cancer,
arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In som ...
, and physical injury. Furthermore, the non-clinical uses for which the efficacy of guided imagery has been shown include managing the stress of public performance among musicians, enhancing athletic and competitive sports ability, and training
medical students A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, MB ...
in surgical skills. The evidence that it is effective for non-musculoskeletal pain is encouraging but not definitive.


Evidence and explanation

Evidence and explanations for the effectiveness and limitations of
creative visualization Creative visualization is the cognitive process of purposefully generating visual mental imagery, with eyes open or closed, simulating or recreating visual perception, in order to maintain, inspect, and transform those images, consequently modi ...
come from two discreet sources: cognitive psychology and psychoneuroimmunology.


Cognitive psychology

Guided imagery is employed as an adjunctive technique to psychological therapies in the treatment of many conditions, including those identified in the previous sections. It plays a significant role in the application of cognitive approaches to psychotherapy, including cognitive behavioral therapy,
rational emotive behavior therapy Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioral prob ...
, schema therapy, and mindfulness-based cognitive therapy. These therapies derive from or draw substantially upon a model of mental functioning initially established by Aaron T. Beck, a psychiatrist and psychoanalyst who posited that the subjective way in which people perceive themselves and interpret experiences influences their emotional, behavioral, and physiological reactions to circumstances. He additionally discovered that by assisting patients in correcting their Cognitive distortion, misperceptions and misinterpretations, and aiding them in modifying unhelpful and self-deprecating ways of thinking about themselves and their predicament, his patients had more productive reactions to events, and developed a more positive self-concept, self-image, or perception of themselves. This use of guided imagery is based on the following premise. Everyone participates in both the voluntary and involuntary spontaneous generation of visual, auditory and other mental images, which is a necessary part of the way in which a person solves problems, recollects the past, predicts and plans the future, and formulates their self-perception, self-image, or the way they 'view' and perceive themselves. However, this self-image can be altered and self-regulated with the aid of mind-body interventions including guided imagery, by which an individual changes the way he or she visualizes, imagines, and Self perception theory, perceives themselves generally, and their physical condition, body image, and mental state specifically.


Psychoneuroimmunology

The term "psychoneuroimmunology" was coined by American psychologist Robert Ader in 1981 to describe the study of interactions between psychological, neurological, and immune systems. Three years later, Jean Achterberg published a book called ''Imagery in Healing'' that sought to relate and correlate contemporaneous evidence from the then emerging scientific study of the way mental processes influence physical and physiological function, with particular emphasis on mental imagery, to the folklore she extrapolated from a set of diverse ancient and geographically indigenous practices previously described as 'shamanism' by the historian of religion and professor at the University of Chicago, Mircea Eliade; and a number of Anthropology, anthropologists and Ethnology, ethnologists. The fundamental hypothesis of psychoneuroimmunology is concisely that the way people think and how they feel directly influences the electrochemistry of the brain and central nervous system, which in turn has a significant influence on the immune system and its capacity to defend the body against disease, infection, and ill health. Meanwhile, the immune system affects neurochemistry, brain chemistry and its electrical activity, which in turn has a considerable impact on the way we think and feel. Because of this interplay, a person's negative thoughts, feelings, and perceptions, such as pessimistic predictions about the future, regretful ruminations upon the past, low self-esteem, and depleted belief in self-determination and a capacity to cope can undermine the efficiency of the immune system, increasing vulnerability to ill health. Simultaneously, the biochemical indicators of ill health monitored by the immune system feeds back to the brain via the nervous system, which exacerbates thoughts and feelings of a negative nature. That is to say, we feel and think of ourselves as unwell, which contributes to physical conditions of ill health, which in turn cause us to feel and think of ourselves as unwell. However, the interplay between cognitive and emotional, neurological, and immunological processes also provides for the possibility of positively influencing the body and enhancing physical health by changing the way we think and feel. For example, people who are able to deconstruct the cognitive distortions that precipitate perpetual pessimism and hopelessness and further develop the capacity to perceive themselves as having a significant degree of self-determination and capacity to cope are more likely to avoid and recover from ill health more quickly than those who remain engaged in negative thoughts and feelings. This simplification of a complex interaction of interrelated systems and the capacity of the mind to influence the body does not account for the significant influence that other factors have on mental and physical well-being, including exercise, diet, and Social relation, social interaction. Nonetheless, in helping people to make such changes to their habitual thought processes and pervasive feelings, mind-body interventions, including creative visualization, when provided as part of a multimodal and interdisciplinary treatment program of other methods, such as cognitive behavioral therapy, have been shown to contribute significantly to treatment of and recovery from a range of conditions. In addition, there is evidence supporting the brain and central nervous system's influence on the immune system and the capacity for mind-body interventions to enhance immune function outcomes, including defense against and recovery from infection and disease.Sources: *Ernst, E., Pittler, M.H., Wider, B., and Boddy, K., Mind-body therapies: are the trial data getting stronger? Alternative Therapy in Health and Medicine, Vol. 13, No. 5, 2007, pp. 62–64. *Rutledge, J.C., Hyson, D.A., Garduno, D., Cort, D.A., Paumer, L., and Kappagoda, C. T., Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Journal of Cardiopulmonary Rehabilitation, Vol. 19, No. 4, 1999, pp. 226–234. *Wahbeh H., Elsas, S. M., Oken, B.S., Mind-Body Interventions: applications in neurology. Neurology, Vol. 70, No. 24, 2008, pp2321–2328. *Rutledge, J.C., Hyson, D.A., Garduno, D., Cort, D. A, Paumer, L., and Kappagoda, C. T., Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Journal of Cardiopulmonary Rehabilitation Vol. 19, No. 4, 1999, pp. 226–234. *Mundy, E.A,. DuHamel, K.N., Montgomery, G. H., The efficacy of behavioral interventions for cancer treatment-related side effects. Seminars in Clinincal Neuropsychiatry, Vol. 8, No. 4, 2003, pp. 253–275. *Astin, J. A., Shapiro, S. L., Eisenberg, D. M., and Forys, K. L., Mind-body medicine: state of the science, implications for practice. Journal of the American Board of Family Practice, Vol. 16, No. 2, 2003, pp. 131–147. *Irwin, M. R., Human psychoneuroimmunology: 20 years of discovery. Brain, Behavior, and Immunity, Vol. 22, No. 2, 2008, pp. 129–139. *Ader, R., and Cohen, N., Behaviorally conditioned immunosuppression. Psychosomatic Medicine, Vol. 37, No. 4, 1975, pp. 333–340.


See also

* Creative visualization * Guided meditation * Mental image * Psychoneuroimmunology * Tulpa


References

{{Dreaming Hypnosis Mind–body interventions Psychotherapies Imagination Alternative medicine