Guided imagery therapy
Guided imagery therapy is a cognitive-behavioral technique in which a client is guided in imagining a relaxing scene or series of experiences.
Numerous clinical observations suggest that an individual visualizing an imagined scene reacts as though it were actually occurring; therefore, "induced" images can have a profound effect on behavior. The usefulness of guided imagery techniques have been shown to be effective in helping individuals learn or modify behaviors such as:
- learning to relax
- changing or controlling their negative emotions in response to a particular situation, event (loss of a job), or belief
- preparing themselves for changes they are likely to have to deal with in the future (children leaving home, parent moving)
- eliminating or reducing undesirable behaviors (smoking, obesity)
- increasing effective pain management
- coping with difficult situations (a difficult boss)
- learning new and desirable behaviors (assertiveness)
- becoming more motivated (doing homework between therapy sessions) in dealing with their problems
- coping with how they behaved in an earlier situation (had a temper tantrum) in order to feel less shame or guilt
- experimenting with ways to manage stressful or anxiety-producing situations (giving a presentation in public) by mentally rehearsing the needed behavior(s)
Guided imagery techniques have been applied to— and found to be effective or show promise with—a variety of populations, including individuals with:
- phobias (including agoraphobia, social phobia, and specific phobias)
- mild to moderate depression
- generalized anxiety disorders
- post-traumatic stress disorder
- obsessive-compulsive disorder
- sexual difficulties
- habit disorders
- chronic fatigue syndrome
- children's behavioral disorders
- acute and chronic pain (and other physical disorders)
Guided imagery has also contributed to the achievement of skills and overcoming anxiety in normal life situations that include learning or improving motor skills, test taking, and public speaking. In addition, visualization and imagery, along with other behavioral techniques, have been applied to the fields of business, industry, child rearing, education, behavioral medicine, and sports.
Imagery techniques have been combined with a wide range of behavioral and cognitive procedures and treatment methods of some psychotherapeutic approaches, including behavior modification, cognitive processing therapy, rational emotive therapy, multimodal therapy, and hypnotherapy. Combinations of treatment methods among these approaches leads to the following general uses of imagery:
- antifuture shock imagery (preparing for a feared future event)
- positive imagery (using pleasant scenes for relaxation training)
- aversive imagery (using an unpleasant image to help eliminate or reduce undesirable behavior)
- associated imagery (using imagery to track unpleasant feelings)
- coping imagery (using images to rehearse to reach a behavioral goal or manage a situation
- "step-up" technique (exaggerating a feared situation and using imagery to cope with it)
An assessment of the individual's presenting problems is an essential part of treatment, both at the beginning of therapy and throughout the entire process. This is to ensure that the therapist has sufficient understanding of the client's situation and diagnosisof the problem(s). The assessment generally covers a variety of areas, such as developmental history (including family, education, employment, and social relationships), past traumatic experiences, medical and psychiatric treatments, and client goals. Often, clients have several problems, and both the therapist and the client work together on prioritizing specific treatment goals.
Following the assessment, the therapist will present a general rationale for the use of imagery. The therapist might explain that the client will learn techniques in which he or she imagines they or another person are performing a particular behavior. To enhance visualization, it is important to involve all senses in the image. For example, if the client is to be walking down a busy street, he or she is encouraged to imagine hearing sounds from traffic and other people, smell exhaust fumes from buses and aromas from a nearby bakery, and observe body movements and wind in the face. It is stressed to the client that the most critical aspect of imagining is the feeling of actually experiencing the scene—of being in it rather than just seeing oneself in it.
Both the therapist and the client construct a relaxing scene by discussing exactly what the client finds pleasant. It is better if the client chooses all images (positive or negative) and the therapist trains the client to visualize the selected images as vividly as possible.
Once a pleasant scene is decided upon, the client is asked to assume a relaxed position and with closed eyes, if this is comfortable, before being guided in visualization. A common beginning instruction may be: "Imagine you are lying on a warm sandy beach." The therapist continues to guide the relaxation by saying such phrases as: "Notice the texture of the sand and the color of the sky. Focus on the sounds you hear, and the smells..." The client is asked to practice the image at home between sessions. A tape of the guided imagery in the familiar voice of the therapist can be helpful to some clients in practicing at home.
During visualization, clients are given permission to take control if they need to by changing the image or stopping the activity completely. To help clients maintain control of the image, the therapist may also say to the client: "Take as long as you need to relax," and "Do whatever you need to do in order to feel safe." This empowers clients in using such techniques.
Length of treatment
Treatments using behavioral techniques tend to be relatively brief. However, many factors determine the length of therapy. Generally, treatment takes longer if target behaviors are more numerous and more difficult to specify. Some types of treatments require more sessions than others. For example, techniques using imagery require more sessions than treatments in which the client is exposed to the actual feared situations in real life.
Other factors that determine the length of treatment are the types of presenting disorders, the client's willingness to do homework, how long the client has had the problem, client financial resources, and whether there are supportive family members and friends. The therapist's style and experience may also affect the length of therapy. Clients may be seen several times (two to five times) a week at the start of therapy and then once weekly for several months, and every other month for follow-up for a few more months.
Guided imagery techniques have been taken from behavior therapy and are used by different psychological theories and systems of counseling and psychotherapy, including cognitive-behavioral therapy. Research has shown these techniques to be effective when applied to specific problems.
Depending on the combination of visualization and imagery techniques used, the therapeutic approach, and client problem(s), it is expected that clients will have positive changes in specifically defined target behaviors; a reduction in biases or distortions in thinking, resulting in more effective functioning that, in turn, leads to more positive feelings, behavior, and thinking; and experience less emotional disturbances, increased effective coping skills, decreased self-defeating behaviors, and less tension.
Guided imagery is not used in isolation but as a part of a therapeutic formulation and is appropriate for a range of problems and disorders. It is, however, thought that some techniques—such as imagery used in rational-emotive therapy—can trigger high levels of anxiety in some clients. Therefore, caution should be taken when using these techniques if clients have the following conditions:
- asthma attacks triggered by stress or anxiety
- seizures triggered by stress or anxiety
- cardiac condition or related conditions
- depression with suicidal ideation
- severe psychiatric disorders
In these instances, other strategies and techniques that do not trigger high levels of anxiety, such as relaxation exercises or coping imagery, should be considered. When working with clients with these conditions, the therapist should be in consultation with their medical provider.
Corey, Gerald. Theory and Practice of Counseling and Psychotherapy.6th ed. California: Wadsworth and Thomson Learning, 2001.
Dryden, Windy. "Rational Emotive Behaviour Therapy." In Handbook of Counselling and Psychotherapy,edited by Colin Feltham and Ian Horton. London: Sage Publications, 2000.
Lovell, Karina. "Behaviour Psychotherapy." In Handbook of Counseling and Psychotherapy,edited by Colin Feltman and Ian Horton. London: Sage Publications, 2000.
Mullin, Rian E., PhD. The New Handbook of Cognitive Therapy Techniques.New York: W. W. Norton and Company, 2000.
Anxiety Disorders Association of America. 11900 Parklawn Dr., Suite 100,Rockville MD 20852-2624. <http://www.adaa,org/>.
National Institute of Mental Health. 6001 Excutive Boulevard, Room 8184,MSC 9663, Bethesda MD 20892-9663. <http://www.nimh.nih.gov/>.
National Mental Health Association. 1021 Prince Street, Alexander, VA 22314-2071. <http://www.nmha.org>.
Janice VanBuren, Ph.D.