Clinical:Case Study: Guided Imagery Part II: Use in Life-Threatening Circumstances

Original materials created in August 1999 by Belleruth Naparstek, MA, LISW

History

L.M., retired home economics teacher, championship golfer, wife, and mother of two girls, had survived breast cancer twice and was battling ovarian cancer when she came to see me. She had been told her chances were not the best. She had been treated with chemotherapy followed by a temporary abdominal implantation of radioactive pellets. She wanted to learn imagery to help beat her cancer. We talked a lot about why she wanted to stay alive. Soon her most passionate reason was clear. She had a seriously learning disabled daughter in fifth grade who was teased mercilessly, and this drove Laura “wild.” She was determined to get that child through high school with her self esteem intact, even if it meant tutoring her for three exasperating hours every night.

The imagery Laura and I created was about attending this daughter’s high school graduation, sitting in proud anticipation, with her husband and younger daughter in the auditorium. In her imagination she could hear the squeaky, dissonant sounds of the high school orchestra tuning up. She could smell the leather seats that had absorbed decades of teenage sweat, and the many perfumes and shaving lotions in the air. She could see her friends waving to her as they arrived, many of them aware of how hard she had worked for this day. She was aware of her daughter’s name, standing out on the program, noting with satisfaction the asterisk that denoted a special sports award. She leaned happily into her husband, and he gratefully squeezed her shoulder — for him, a wildly expressive gesture. They are very happy.

Laura worked with this imagery with the same relentless drive that she played golf. Then I lost touch with her until last summer, when I saw her again. She looked great, vital, sexy, very alive. She was back to golf and teaching part time. Her kids were doing well in high school. This was the woman who was supposed to be dead, but had some serious tutoring to do, and had a graduation to get to, one that she had already been to, hundreds of times, in her imagination.

Discussion

Guided imagery is a gentle but powerful technique that focuses and directs the imagination. Although it has been called “visualization” and “mental imagery,” these terms are incomplete. Guided imagery involves far more than just the visual sense - and this is a good thing, given only about 55%of people have vision as their primary imaginative skill. Instead, guided imagery involves all the senses and is accessible to almost anyone. Neither is it strictly a “mental” activity - it involves the whole body, the emotions, and all the senses, and it is precisely this bodybased focus that creates its powerful impact.

Because guided imagery is a right-brain function,evoking it also often will access contiguous functions: emotion, intuition, empathy, laughter, sensitivity to music, and openness to spirituality.

Over the past 24 years the effectiveness of guided imagery has been established by research findings that demonstrate its positive impact on health, creativity, and performance. We now know that even ten minutes of imagery can reduce blood pressure, lower cholesterol and glucose levels, and heighten shortterm immune cell activity. It can reduce blood loss during surgery and postoperative morphine use. It can lessen headaches and pain. It can increase skill at skiing, skating, tennis, writing, acting and singing; it accelerates weight loss and reduces anxiety; and it has been shown, again and again, to reduce the adverse effects of chemotherapy, especially nausea, depression, and fatigue.

When properly constructed, guided imagery has the built-in capacity to deliver multiple layers of complex, encoded messages through simple symbols and metaphors. And because it mobilizes both unconscious and pre-conscious processes to assist with conscious goals, it can access more of a person’s strength and motivation. As subtle and gentle as this technique is, it can be very powerful, especially over time. One of the most appealing and forgiving features about imagery is that almost anyone can use it. Although children and women probably have a slight advantage, imagery skips across the barriers of age, race, class, gender and education - a truly equal opportunity, natural gift.

Guided Imagery Research

Cancer

A study by Fawzy Fawzy, MD and his colleagues on the effects of support groups that use imagery and relaxation with early stage melanoma patients, showed that after six months these patients had significantly decreased negative mood states and significantly increased natural killer cell activity. Dr.Fawzy’s study reinforced David Spiegel’s findings,published in Lancet in 1989, that showed in a similarly-designed study with breast cancer patients, support groups that taught relaxation and imagery prolonged patients’ lives significantly. (Malignant Melanoma: Effects of Early Unstructured Psychiatric Intervention; Recurrence and Survival 6 Years Later. Archives of General Psychiatry: 1003;50)

Surgery

Henry Dreher demonstrated in three metaanalyses that preoperative mind-body interventions have been proven consistently effective in improving postoperative medical and psychological outcomes. In the largest metaanalyses (191 studies with more than 8,600 patients) psychosocial/behavioral interventions showed improved recovery, pain reduction, and reduced psychological stress. Length of hospital stay was decreased an average of 1.5 days. These studies have shown reduced blood loss and postoperative pain, and improved wound healing, and speed of recovery. (Tusek, DL et al: Guided Imagery: A Significant Advance in The Care of Patients Undergoing Elective Colorectal Surgery. Dis Colon Rectum, 1997; 40:172-178)

Asthma

James Halper at Lenox Hill Hospital studied the effect of guided imagery on asthma patients, and showed that although imagery did not decrease measurable asthma symptoms, significantly more patients were able to discontinue their medication. Not surprisingly, he also found significantly less depression and anxiety in the guided imagery group than in the control group. (Halper, L. Alternative Health Practitioner: The Journal of Complementary and Natural Care, vol.3(3), Fall/ Winter, 1997)

Resources

Alternative Therapies in Health and Medicine A peer reviewed journal, Innovisions Communications: phone 800-899-1712 email alttherapy@aol.com BelleRuth Naparstek’s web site www.healthjourneys.com/research.html and her electronic consumer newsletter: ImageryNews@healthjourneys.com (Imagery News)

Correction July 1999 ITC Part I Guided Imagery: Jeanne Achterberg is a past President of the Association for Transpersonal Psychotherapy. She is now with Saybrook Institute and is on sabbatical from Alternative Therapies in Health and Medicine.