the Astonishing World of Guided Imagery
The first time I tried guided imagery, I expected a visit from some gauzy, Glinda the Good Witch figment of my imagination who would benignly advise me on fixing my out-of-whack life. All I knew about guided imagery was that it involved soothing myself into a relaxed state and then invoking an "inner adviser" with whom I'd have an imaginary conversation about a physical or emotional problem. Supposedly, this interior dialogue would give me vital information about healing—information that wasn't available to my chattering, overwrought conscious mind.
But instead of Glinda gliding onto the scene, a large, grinning, cornflower-blue bunny hopped into view. Somehow I knew his name was Woody, and my first impulse was to order him out of my sight. Woody exuded a kind of giggly, hail-fellow-well-met vibe that I found distinctly unappealing. I was looking for wisdom and serenity. What did I want with a grinning blue bunny?
Still, the reading I'd done so far about guided imagery stressed the importance of welcoming whatever inner adviser happened upon the scene and simply letting the counseling process unfold. So I silently communicated to Woody that I was so stressed out by work—too many deadlines and not enough time—that I could barely sleep at night. How, I asked him, could I get my work under control so I could get a decent night's rest?
In my mind's eye, Woody considered my dilemma, managing to look thoroughly goofy and deeply attentive at the same time. "You need more fun in your life," he finally offered, flashing me a loopy smile. I snorted impatiently. "You don't get it," I said, feeling my chest tighten. "I don't have time for fun. I've got deadlines! And wipe that grin off your face!"
Woody was unfazed by my outburst. "Well," he said, looking only a shade more serious, "you know, deep down, that you love to write. So why not go with that, and let the writing be fun?"
Almost imperceptibly, I felt something shift inside me. Oh. Could I possibly make writing an occasion of joy--the way I used to when I was a kid—rather than a cauldron of self-doubt and anxiety? As Woody and I continued to trade ideas and possibilities, I could feel tension begin to drain from my body. It was remarkable how real this encounter felt, as though I were communing with a warmhearted if slightly dorky friend who knew me better than I did.
My experience did not surprise Belleruth Naparstek, MS, author of Staying Well with Guided Imagery and a leading theoretician and practitioner of the approach. "Guided imagery is a directed, deliberate kind of daydream that mobilizes your unconscious to assist with conscious goals," Naparstek told me. "Imagery drops like a depth charge into the most primitive parts of your brain. You're fundamentally enlisting the power of your imagination to heal."
A growing body of evidence indicates that Naparstek's confidence in the power of imagery is well placed. In numerous studies, guided imagery has been shown to relieve many types of pain, stimulate immune activity in cancer patients, and even decrease blood loss during surgery. Other research suggests that imagery can help to reduce high blood pressure, ease premenstrual symptoms, promote weight loss, quell the urge to smoke, lessen anxiety and depression, lower rates of pregnancy and childbirth complications, cut down on bingeing and purging in bulimics, and diminish the frequency of colds.
For years the practice was marginalized as fringy and woo-woo, the province of ardent New Age types. But little by little, this low-tech approach to healing has begun to seep into the medical mainstream. Dozens of top-notch hospitals, including the Mayo Clinic, the Cleveland Clinic, and New York City's Columbia Presbyterian Medical Center, now make imagery recordings available to patients. Even the U.S. Department of Veteran's Affairs, a notably sober institution, has begun to use the technique to help veterans recover from post-traumatic stress disorder. All told, the U.S. Department of Health and Human Services estimates that more than six million Americans have tried out guided imagery.
A major attraction of imagery is its ability to help us figure out why we got sick in the first place—which in turn can offer important clues for healing, says David Bresler, PhD, a clinical health psychologist and president of the Los Angeles-based Academy for Guided Imagery, the field's foremost training and certification institute. "When you rely only on pills and procedures, you just pave over symptoms and shoot the messenger," he says. "Guided imagery listens to the messenger." For example, if you suffer from nagging back pain, these conversations with your inner adviser can help you find out whether buried anger or anxiety might be contributing to your pain. Imagery exercises can then guide you toward constructive ways of coping with those emotions that may lessen—or even eliminate—your back pain.
How can such a noninvasive healing approach possibly wield measurable effects on so many physiological systems? "The key is the powerful link between our minds and our bodies," says Martin Rossman, MD, director of the Collaborative Medicine Center in Mill Valley, California, author of Guided Imagery for Self-Healing, and cofounder, with Bresler, of the Academy for Guided Imagery. By connecting us deeply to our senses and emotions, he says, imagery activates our autonomic nervous system, the central command post deep in the brain that regulates basic body functions.
If you're skeptical about the power of the mind-body connection, Rossman suggests taking a few deep, relaxing breaths, then picturing yourself holding a juicy yellow lemon in your hand. Now visualize cutting that lemon in half and squeezing the juice into a glass, raising the glass to your lips and taking a healthy swig. Let the lemon juice linger in your mouth, taste its sharp sourness, and swallow. Did you salivate? Did you pucker your lips or make a cringing face? If you did, says Rossman, "it's because your imagination has an enormous capacity to affect your body. But too often," he observes, "we use that capacity for ill instead of for good. Most of us have had the experience of worrying ourselves into headaches or back pain or stomach problems. Think about it: If you can worry yourself sick, why can't you also imagine yourself back into health?"
Imagery does more than tinker with our physiology. It can also connect us to desires, hopes, and creative solutions that are lodged in our unconscious minds. Rossman explains that when we merely "think about" a problem—whether it's trying to manage a physical symptom or get a grip on anxiety—we're operating out of the conscious part of the mind, which is big on logic and planning but can be pretty clueless about what we need to help ourselves. "Our unconscious minds are often much smarter and wiser than our conscious minds," says Rossman, "and guided imagery is a direct route to that unconscious wisdom."
For what it's worth, my initial experience with imagery excavated a piece of vital information that I didn't know I knew. When Woody suggested, "Howabout making your writing fun?" as he cavorted about, embodying merriment and joy in his bouncing blue being, all at once I got it. What I got, at some deep level that my thinking brain had never even come near, was that fun was the antidote to my anxiety. Not better deadline management, not writing faster or better. Fun was the ticket. As that insight seeped into my body, I actually felt my muscles begin to uncoil, my whole torso loosen and lighten. Within minutes, I was asleep.
Okay, you may say, but beating insomnia isn't all that earth-shattering—a whole raft of relaxation approaches are good at that. True enough, though I would argue that imagery gave me a twofer—not just better sleep but also the beginnings, at least, of a more lighthearted approach to life. Not long after my rendezvous with Woody, as I continued to labor over multiple writing projects, my husband, Dan, suggested that we take a brief, restorative Caribbean holiday. "No way!" I barked, conjuring up missed deadlines and frowning editors. But then I found myself asking: "What would Woody do?" Three weeks later, Dan and I were strolling down a seaside road in Jamaica, eating fresh pineapple with our fingers and contemplating an afternoon of serious sunbathing.
Guided imagery can handle far tougher problems. If you're facing surgery, imagery can help you experience less pain and recover faster. Provocative evidence comes from a recent study of 126 hysterectomy patients conducted by Blue Shield of California, one of the state's largest health insurers. Prior to surgery, approximately half the patients received a free guided imagery tape from Blue Shield entitled "Successful Surgery," followed by a phone call from a nurse explaining the benefits of the recording and encouraging patients to try it out. The other half of the group received only standard presurgical patient instructions.
The results were dramatic: The women who had listened to the guided imagery tape averaged fully $2,000 less, per person, in hospital costs than did the women in the control group. According to Deborah Schwab, RN, MSN, a lead researcher on the study, the hefty savings could be traced to the guided imagery group's lessened need for medication following surgery, as well as their quicker release from the hospital. "The women who used imagery reported much less anxiety about their operation than the others," Schwab says. "And we know that the more anxious a patient is, the more potential there is for surgery complications." Schwab, who directs new product development for Blue Shield of California, is now busy fielding requests from hospitals and physician groups around the country who want help in setting up their own guided imagery programs.
I found myself wondering how a 20-minute tape could make such a difference. To get a firsthand feel for its impact, I recently listened to "Successful Surgery." Created and narrated by Belleruth Naparstek, the tape began with a lush, soothing soundtrack that nudged me to sink into my chair. Before long, Naparstek's lilting voice joined the music and began to lead me through a full-body relaxation exercise. Lulled by her plummy, reassuring tones, I felt myself enter a zone of calm.
Next, she invited me to visualize a safe place from which I could observe my upcoming surgery. I wasn't about to have any surgery soon, so I focused on an operation I'd had five years earlier that had caused me heart-pounding anxiety beforehand. Naparstek encouraged me to imagine several aspects of the surgery, including the ministrations of a highly capable staff, minimal bleeding, and a quick, comfortable healing process. As each of these images bloomed in my mind, I found myself growing in confidence: Why shouldn't surgery go well? I thought.
Yet the part of the tape that I found most affecting had nothing to do with actual operative procedures or their aftermath. About halfway through the recording, Naparstek encouraged me to picture a "magical band of allies"—people who loved me and who were rooting for my successful operation—filling up the entire operating room. When I visualized this cheering section of family and friends, I felt a sense of protection spread over me like a warm quilt. Later, Naparstek would tell me that such "heart moments" are a vital part of guided imagery's healing power. "Illness is lonely and scary," she said, "and imagining a roomful of supportive faces provides people with a huge amount of safety and nourishment, which we believe influence health outcomes."
"But we need to be very careful not to give false hope," says Lara Krawchuk, MSW, director of clinical services for the Conill Institute for Chronic Illness in Philadelphia. "If guided imagery has a physiological effect, that's wonderful, but it won't necessarily happen." Yet Krawchuk, who uses guided imagery in the support groups she leads for people with chronic illnesses, believes that the process "can help anyone regain a sense of control over an illness, which is a big issue for people dealing with pain or disability. Even if you're quite sick, imagery can provide a real sense of hope and well-being."
The emotional benefits of imagery were recently documented in a pilot survey of heart patients conducted by the Columbia University Integrative Medicine Program in New York City. In the aftermath of heart surgery, numerous studies have shown that people commonly feel helpless and dispirited. But among the 20 heart surgery patients who listened to a guided imagery tape on cardiac recovery, 83 percent reported a greater appreciation for being alive, 75 percent felt less depressed, and 68 percent said that guided imagery "helped me increase my commitment to reclaiming my life."
So far, it may seem as though guided imagery is all about popping a tape into a player and visualizing the change you're after. But for those who want to delve more thoroughly into a medical or personal issue, there's a newer option: working with your own guide in a process called interactive guided imagery. In every state in the U.S. as well as 20 countries worldwide, some 10,000 health professionals have been trained by the Academy of Guided Imagery to help people experience their own, self-created imagery. The distinctive element is an encounter with an "inner adviser," that deeply intuitive part of yourself with whom you explore goals, hopes, and avenues for change. Of course, I'd already tried this on my own with Woody, but he and I had been winging it. I was intrigued by the idea of getting some expert help in communing with my unconscious.
A week after my session with Woody, I found myself in the spacious therapy office of Bob Schoenholtz, MS, a Philadelphia art therapist and academy-trained guided imagery practitioner who believes that imagery is "a way to be in conversation with the wisest part of you." Tall and rangy, with curly gray hair and a warm, informal manner, Bob made clear to me at the outset that his role would be to facilitate that internal conversation, not to supply solutions. "You're in charge," he emphasized.
With that, I lay down on the couch, where Bob tucked a multicolored afghan around me and gave me a soft, plushy eye bag to shield my eyes from the afternoon sunlight. (He offered each of these comforts as options; I could have chosen instead to sit up and simply close my eyes.) Bob suggested that for this initial session, I not focus on any specific health or emotional issue but rather just "work with whatever emerges." He explained that such an open-ended exploration often unearths surprising--and surprisingly useful--knowledge about the self.
After leading me through a relaxation exercise, Bob asked me to imagine a "safe place" where I felt peaceful and secure. Almost immediately, I found myself perched on the edge of a dock overlooking the northern New Jersey lake where my family used to vacation when I was a kid. In my imagination, I watched the morning sun dance on the lake; I heard swallows and nuthatches twittering; I inhaled the scents of wood and water. Within a few minutes, I felt quietly happy.
"Now," said Bob, "why don't you invite an inner adviser into your safe place?"
Within moments, from behind a grove of trees at the lake's edge, a serious-looking man emerged. He was dressed in robes of pale blue and cream, and his dark, rather stringy hair framed a bearded face. I noticed that his feet were bare.
My heart sank to my toes. I was pretty sure I knew who he was, and I didn't like it one bit. "I'm not ready for this," I told Bob, who was sitting in a chair a few feet away. "I think I've got Jesus."
Bob was unfazed. "Just welcome him in," he advised. "Ask him what he'd like you to know."
"You don't understand," I protested. "I'm a survivor of Catholic schools, and I haven't been to church in 20 years. This will not work."
"Try and see," urged Bob.
I took a long breath. "Okay," I silently communicated to the man in robes. "Come on in. So what do you have to tell me?"
In my mind's eye, the man continued to stand at the edge of the grove, as though not wanting to invade my space. Then he said: "Love." At that, my body went on red alert. My chest began to pound and I trembled all over. I was still lying under an afghan in Bob's office, but I was really somewhere else—someplace very dangerous, and I didn't know where or why. I told Bob what was happening. "What should I do now?" I asked him anxiously.
His response was simple: "Ask your inner adviser what you should do." When I did, the man told me to put my hand on my heart. It helped a little. He then told me, very calmly, that he loved me.
"Come on," I snapped. "You tell everybody that."
"It's true," he admitted. "But that doesn't change anything." He paused, considering me through his grave brown eyes. "Just so you know, I love you without you having to do anything."
Tears sprang to my eyes. I could tell that he meant it. I also knew—don't ask me how—that what this inner adviser had come to tell me had nothing to do with formal religion. His message to me was more primal, more vital, than that. I felt my body begin to quiet down. And I realized then that I had a request.
"Look," I said, "I'm having a lot of trouble dealing with you as—you know. It would really help if I could give you a new name." He looked receptive, so I plunged ahead. "Can I call you Jack?"
When I looked at the man in robes again, he was sporting a painter's cap, and had morphed into a down-home kind of guy. My body calmed down some more; it felt, somehow, both liquid and solid at the same time. I breathed deeply, and after a little more conversation, Jack and I bid each other goodbye. I watched as he disappeared back behind the grove of trees. What lingers is the fiercely felt experience: first, a mysterious terror and then a small opening, a toe dipped into something warm and welcoming. These still uncharted regions of self, I'll admit, make me a little nervous. But I'm intrigued, too. I want to learn more.
When I do, I suspect I'll discover that Jack and Woody, style differences notwithstanding, have a lot in common. Each of these guides, I think, is nudging me to consider the same possibility—that the world may be more trustworthy, and more generous, than I've ever dared imagine. What would happen if I allowed myself to take in this more openhearted view of life? I'm not sure, but it doesn't seem so far-fetched to imagine that this faith might seep down into my customarily clenched muscles and vigilant psyche, and begin to work some quiet medicine on my body and spirit.
It is reassuring to know that if I want to continue this interior journey, guided imagery stands ready to accompany me. After my first session with Bob, he assured me that I could get back in touch with Jack or Woody through further interactive sessions or my own, self-directed imagery. "Once you've developed a relationship with your inner guides, you can consult them any time," Bob said. "Wherever you are, whenever you need some guidance, you can just relax, visualize one of them, and ask, 'What do I need to know about this?'"
And here, perhaps, lies the real promise of guided imagery—the power it gives us to contact the forces for healing that live within each of us, just waiting to be awakened and stirred into action. "All of our lives," says Martin Rossman, "we've been told that when we have a problem, the best we can do is go to an expert and then sit on the sidelines and root for the expert to cure us." Guided imagery flips that old assumption on its head. "Imagery gets you off the bench," says Rossman. "You're back in the game."Just imagine.