Imagine you are a ballet dancer. You are lean, toned, strong, and graceful. Your daily life consists of hours of technique training, pointe classes, stretching and conditioning, rehearsals, and performances. You are a member of the corps de ballet and you want to be promoted to a principal dancer. As the day of the performance draws closer, you spend half an hour visualizing yourself dancing the elegant movements required of your career each morning. You notice every movement, where it originates in your body, and imagine yourself performing with confidence and precision. As the time for the actual performance draws closer, your nerves are eased, you feel more relaxed, and you have a sense of self-efficacy before beginning the first number.
Athletes, performers, and artists have been using guided imagery, or visualization, techniques for many years. As noted by Cumming and Williams (2012), “Imagery is one of the most popular mental techniques used by athletes and coaches to enhance performance and frequent use of imagery is a characteristic of those most successful in sport.” Guided imagery, or visualization, is commonly used in psychological treatment of pain, anxiety, and trauma (Thomas, 2014). For individuals living with chronic pain, guided imagery is a technique that is cost-effective and can be done anywhere with minimal preparation or equipment required (a recording, app, or video can often be used).
Guided imagery involves creating an internal reality for the self without any external stimulus. These techniques can be self-taught or guided by a professional. In a systematic review on guided imagery for rheumatic conditions, all seven studies included supported guided imagery as a useful modality for treating pain, with positive effects on psychological well-being, mobility, anxiety, and improved self-efficacy in managing pain and symptoms (Giacobbi et al., 2015).
We know that guided imagery works for treating chronic pain. Guided imagery can be combined with body scan meditations, deep breathing, and musical interventions. Guided imagery is not only visual; it involves the use of all of the senses. Some goals of guided imagery in healthcare interventions could be the reduction of pain severity, reduction in stress levels, and reduction in anxiety.
Guided imagery places our mind into a state of deep relaxation, reducing the presence of stress hormones, decreasing muscle tension, and ultimately shifting our attention away from pain. Our imagination allows us to create positive, pleasant images. These images distract us from pain and provide us with a sense of control and further understanding of the mind-body connection. There are a few different types of guided imagery. We can imagine healthy cells fighting diseased cells. We can reframe thoughts and emotions using imagery. We can imagine peaceful scenes. We can also use guided imagery through imagining accomplishing a specific motor task.
Prior to engaging in a guided imagery activity, rate your pain severity on the present day on a scale of 0 (no pain) to 10 (extreme pain), for example. Begin each guided imagery exercise with two minutes of deep breathing. Follow the guided imagery script or the clinician-led script. You can close your eyes during these exercises if it helps to engage your senses and your imagination. Discontinue the exercise if you experience an increase in pain severity or excessive emotional discomfort. Following the exercise, re-rate your pain severity and record it somewhere so that you can track your progress and the effectiveness of guided imagery on your pain.
The following is an example of a guided imagery script, recommended by Dossey (1995) for pain relief, involves fully recognizing the experience of pain before making attempts to decrease it through imagery. Engage in deep breathing. You must begin by scanning your body for pain and discomfort. Then, imagine gathering that pain into a “red ball.” Play around with the size of the ball, make it larger and smaller in your mind, and allow it to take any shape that presents itself in your mind. See how small you can make it. Now move it slowly further and further away from your body each time you exhale.
Continue to repeat this exercise, noticing the experience of your breath as you move the ball and change its shape, pushing this mental image of pain further away from yourself. Imagine different shapes for the ball of pain and different methods to get rid of it (exploding, disappearing, crumbling, or whatever comes to mind). Remember to re-rate your pain intensity after completing the exercise. Repeat this a number of times throughout the day, calling to mind the shape of the pain and creating distance between yourself and the pain.
Think of a task that you would like to complete with ease and decreased pain. Bring awareness to the senses – what do you feel, what do you see, what can you hear, touch, and taste? The mind is a powerful tool that can be used to create or re-imagine yourself coping well and living with minimal pain. You can also try picturing different parts of the body, and imagine the pain flowing out of them like an orb or light, or imagine yourself running or walking through a calming river scene without pain.
Imagine yourself strong and healthy. Imagine being near a beach, laughing and spending time with a loved one, swimming in the ocean. Imagine how you would act, behave, and think if your life was without the burden of pain. You can take your mind in any direction. Use your imagination, have fun, be creative, and explore how neuroplasticity and the power of the mind-body connection can positively influence your quality of life and perception of pain.
- Cumming, J., & Williams, S. E. (2013). Introducing the revised applied model of deliberate imagery use for sport, dance, exercise, and rehabilitation. Movement & Sport Sciences-Science & Motricité, (82), 69-81. https://www.researchgate.net/publication/258285423_Introducing_the_revised_applied_model_of_deliberate_imagery_use_for_sport_dance_exercise_and_rehabilitation
- Dossey, B. (1995). Complimentary modalities/Part 3: Using imagery to help your patient heal. The American Journal of Nursing, 95(6), 40-47. https://www.jstor.org/stable/i278635
- Thomas NJT. Zalta EN, editor. Mental Imagery. The Stanford Encyclopedia of Philosophy. 2014 (Fall, 2014 ed.) https://plato.stanford.edu/entries/mental-imagery/
- Giacobbi, P. R., Jr, Stabler, M. E., Stewart, J., Jaeschke, A. M., Siebert, J. L., & Kelley, G. A. (2015). Guided Imagery for Arthritis and Other Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials. Pain management nursing : official journal of the American Society of Pain Management Nurses, 16(5), 792–803. doi:10.1016/j.pmn.2015.01.003 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605831/