Guided imagery

Relaxation and imagery research in the early twentieth century

A 2018 mini review in Frontiers in Psychology describes Edmund Jacobson as a physiologist who earned a doctorate at Harvard in 1910 and taught physiology in Chicago until 1937. His name is strongly linked to progressive relaxation, cited in the review to a 1929 work. The authors add that his experiments on motor imagery, reported mainly in 1930 and 1931, were largely overshadowed by that association. Relaxation served as the control condition in those experiments, and the review does not mention guided imagery.

Imagery in psychotherapy

Two dated records show imagery being directed within psychotherapy. A 1969 article by H. Leuner in the American Journal of Psychotherapy is titled Guided affective imagery (GAI): a method of intensive psychotherapy, and a 1978 French-language article in Psychotherapy and Psychosomatics concerns the evolution of the Desoille practice of the controlled waking dream. Only titles and publication details were available for both, so the content of the methods is not established here.

Growth of trials and use

A 2017 scoping review searched for randomized trials of guided imagery in adults from 1960 to June 2013, screened 1,935 publications and included 320 trials published in 216 journals. It does not identify the earliest trial or the origin of the term. The same review, citing US national survey data for 2002 to 2012, states that about 5 million adults reported using guided imagery, mainly for stress reduction.

The sources reviewed for this page do not give dated, verifiable accounts of the work of Carl Simonton on cancer imagery, of David Rossman and Belleruth Naparstek on interactive and audio-recorded imagery, or of how guided imagery entered hospital and nursing settings. Those lineages are therefore not described here.

Guided imagery, visualization and mental rehearsal

The National Center for Complementary and Integrative Health (NCCIH) lists guided imagery, also called visualization, among relaxation techniques and describes it as picturing objects, scenes or events associated with relaxation or calmness. The 2017 scoping review defines it as controlled visualization of detailed mental images and adds that it is also known as visualization or mental rehearsal. Reviews commonly shorten the term to GI.

Imagery as a mental process

A 2015 cognitive-science review defines mental imagery as the representation of sensory information, with its accompanying experience, recalled from memory without a direct external stimulus. Imagery in this sense can be voluntary or involuntary, and it occurs with or without a facilitator. Guided imagery is one structured way of directing it. The review also describes separate imagery-based psychotherapy methods, imaginal exposure and imagery rescripting, which are not relaxation sessions.

Overlap with neighboring practices

Research does not always separate guided imagery from related methods. A fibromyalgia review pooled trials labeled hypnosis and guided imagery, and a Cochrane review of children with recurrent abdominal pain grouped hypnotherapy, including guided imagery, as one category. Findings from such pooled categories cannot be assigned to guided imagery alone. Guided Meditation, Hypnotherapy and Guided Visualization have separate pages on Machipedia.

Delivery formats

In a systematic review of seven trials in adults with arthritis and other rheumatic diseases, all interventions used guided imagery scripts delivered through audio technology, and programs ranged from a single exposure to 16 weeks. The 2017 scoping review states that guided imagery can be delivered by web and telephone, with mobile applications being tested. A review of scripted protocols developed at the University of North Carolina describes fully scripted courses delivered in a fixed series of sessions over two to three months for functional abdominal pain.

What a session involves

At overview level, trials describe a facilitator or recording that directs attention to imagined scenes or body sensations, often in a quiet setting. In one pregnancy trial reviewed by Cochrane, women used guided imagery for 15 minutes at least twice daily for four weeks, and the comparison was quiet rest. Another trial combined imagery with blood pressure self-monitoring and thermal biofeedback relaxation training, so the effect of imagery could not be isolated.

Imagery used with cancer patients was given alone or combined with progressive muscle relaxation in a 2025 meta-analysis, and no standard session length or frequency was found. The sources reviewed do not define interactive, receptive or performance-oriented formats as separate trial categories, although sport skills appear among the outcomes in the scoping review. Those labels are therefore not described further.

What participants may experience

The cognitive-science review reports that imagery elicits stronger emotion than verbal processing of the same content, so a person may notice emotional responses during a session. A person can ask what the imagery will involve beforehand and can pause or stop if the content becomes distressing.

Uses that have been studied

The 2017 scoping review of 320 trials lists coping with pain, stroke recovery, anxiety, coping with stress and sport skills among major outcomes. It also lists conditions including posttraumatic stress disorder, several cancers, arthritis and rheumatic diseases, asthma, substance use, surgical anxiety, blood pressure and pregnancy and childbirth. Systematic reviews have separately examined pain, cancer care, palliative care, surgery, labor, fibromyalgia and functional abdominal pain.

Claims beyond the research reviewed

Popular accounts describe imagery as influencing the course of disease or immune function. The reviews cited on this page assess symptoms, coping and quality of life, and none of them establishes an effect on disease course. A reader should treat such claims as beliefs held by some practitioners rather than tested findings.

Cochrane reviews

A 2019 Cochrane review of guided imagery for hypertension in pregnancy included two small trials with 99 women, compared with quiet rest. Neither trial reported the review's primary outcomes, such as severe hypertension, and low-certainty evidence from one trial suggested little or no difference in antihypertensive drug use. The authors concluded that there was insufficient evidence to inform practice.

A 2018 Cochrane review of relaxation techniques for labor pain included 19 studies with 2,519 women, assessed the evidence as low to very low quality, and noted that most trials did not report safety. Its abstract does not name guided imagery as a separate intervention, so it cannot be read as evidence for it. A 2017 Cochrane review of psychosocial interventions for recurrent abdominal pain in children found, for hypnotherapy including guided imagery, lower pain intensity (SMD -1.01, four studies, 146 children), rated as low-quality evidence.

Surgery, cancer and palliative care

A meta-analysis comparing preoperative guided imagery with conventional nursing care reported lower preoperative state anxiety in children (d -3.71), lower trait anxiety in adults (d -0.64) and lower postoperative pain in adults (d -0.24), with other outcomes not significant. Only eight of 21 trials entered the meta-analyses.

A 2025 meta-analysis of nine randomized trials in 837 adults with cancer reported lower anxiety (SMD -1.30), lower depression in seven trials and better quality of life in four, with no standard session length. A 2024 review of 14 trials in life-limiting illness rated four at high risk of bias, nine as raising some concerns and one at low risk, and found symptom relief in 10 of 14. The unusually large effects, and the lack of masked participants, call for caution.

Pain conditions and functional gut disorders

A review of 15 trials in non-musculoskeletal pain judged methodological quality generally poor, with 11 finding less pain and four no change. A seven-trial review in rheumatic disease reported significant improvements in every study, with low or unclear risk of bias in all but one. A fibromyalgia meta-analysis of six trials (239 people) pooling hypnosis and guided imagery found lower pain at the end of treatment (SMD -1.17, 95% CI -2.21 to -0.13), but linked this to low methodological and treatment quality.

A narrative review by developers of scripted protocols reports response rates of 53% to 94% in clinical trials of hypnosis and guided imagery for bowel symptoms. It is not a systematic review, and its authors describe their own research program.

Limits of the evidence

In a sample of 13 trials from integrative health journals, the 2017 scoping review found 10 at high risk of bias for blinding, and the authors state that blinding participants is probably not feasible. Trial reports often lack harms data, and imagery is often given with other relaxation methods. Comparisons with attention-matched controls are scarce in the reviews cited, so how much of any benefit reflects expectation is unresolved.

Reported effects and cautions

NCCIH states that relaxation techniques are generally considered low risk for healthy people, that some people report increased anxiety, intrusive thoughts or fear of losing control, and that rare reports describe symptoms caused or worsened in people with epilepsy, certain psychiatric conditions or a history of abuse or trauma. These cautions cover relaxation techniques as a group rather than guided imagery alone. The 2017 Cochrane review of children with abdominal pain reported no adverse effects, whereas the 2018 labor review noted that most trials did not report safety.

Imagery, emotion and memory

The 2015 cognitive-science review reports that imagery can intensify emotion, that repeatedly imagining a future event raises its perceived likelihood and can raise anxiety, and that imagined rehearsal can be maladaptive in some disorders. A 2021 systematic review of 59 experimental articles found that free and guided imagery and suggestive statements induced false beliefs or memories about past events in 20% to 50% of participants on average. Those findings concern imagery used to explore the past in laboratory settings, so applying them to relaxation scripts is an inference.

Training, regulation and care boundaries

The sources reviewed do not identify a professional register, protected title or training standard specific to guided imagery, and no statutory regulation or training standard was found. The scoping review reports that clinicians cited lack of training and knowledge among barriers to use. Guided imagery does not replace assessment by a medical or mental health professional, or prescribed treatment. Persistent or severe distress during or after practice is a reason to consult a health care professional.