Guided Visualization

What the sources reviewed can and cannot date

A reference entry in the Gale Encyclopedia of Alternative Medicine describes guided imagery as the use of relaxation and mental visualization to improve mood or physical wellbeing, and links one healing-imagery technique to traditional Chinese medicine through the idea of imagined energy flow as a metaphor. The entry gives no dates and names no founder, so it cannot be used to date the practice or to show a continuous lineage from older traditions.

A 1978 French-language article in Psychotherapy and Psychosomatics is titled as an analysis by means of the controlled waking dream and the evolution of the Desoille practice. Its title indicates that a guided waking-dream method associated with Robert Desoille was in clinical use and had developed over time by 1978. Only the title and publication details were available, with no abstract, so the method's content and Desoille's own dates are not established here.

Imagery in cognitive science and behavioral therapy

A 2015 review in Trends in Cognitive Sciences states that research on mental imagery has had to overcome both disbelief that the phenomenon exists and methodological limits. It describes visual mental imagery as working like a weak form of perception, and reports that clinical research has made imagery a focus in the understanding and treatment of several mental disorders. This is a cognitive-science background to the practice, not a history of guided relaxation scripts.

Entry into supportive-care research

By 2005 a systematic review could identify six randomized trials of guided imagery as a sole adjuvant therapy for people with cancer, which shows that controlled studies of the practice in supportive care were being reported before that date. The review does not trace when or where such use began, and the sources reviewed for this page do not give a dated account of how guided imagery spread through nursing and hospital settings.

Guided imagery, visualization and related labels

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 Gale encyclopedia entry uses imagery and visualization interchangeably and names relaxation imagery, healing imagery, pain control imagery and mental rehearsal as types.

Research mostly uses the label guided imagery. A PubMed search run for this page on 2026-10-11 returned about 1,076 records with the phrase guided imagery in the title or abstract and about 84 with guided visualization. This page keeps the name Guided Visualization and treats the two labels as covering the same practice, as the sources above do.

Mental imagery as a process, and neighboring practices

The 2015 cognitive-science review defines mental imagery as the representation of sensory information, mainly recalled from memory, that a person experiences without a direct external stimulus. Imagery in this sense is a general mental process that occurs with or without a facilitator. Guided visualization is one structured way of directing it, and imagery-based psychotherapies such as imaginal exposure and imagery rescripting are separate clinical methods.

Research does not always separate guided imagery from related practices. One fibromyalgia review pooled trials of guided imagery and hypnosis, so its findings cannot be assigned to either alone, whereas an earlier pain review excluded trials of hypnosis and motor imagery. Guided meditation and hypnotherapy have their own pages, and findings for them should not be carried over to this one.

Format and delivery

The Gale encyclopedia entry describes a two-part process: first relaxation through breathing and muscle relaxation, then the imagery itself. In a systematic review of seven trials in adults with arthritis and other rheumatic diseases, every intervention used a guided imagery script delivered by audio technology, and programs ranged from a single exposure to 16 weeks. Sessions can therefore be live, recorded or self-directed, and formats vary widely.

Content and combination with other techniques

The imagery used differs by purpose, for example calming scenes, images related to pain, or rehearsal of an upcoming event. A review of guided imagery in cancer care included trials in which it was given alone or combined with progressive muscle relaxation, and a preoperative review compared it with conventional preoperative nursing care. Combined packages make it hard to attribute any result to the imagery alone.

What participants may experience

The Gale entry notes that the relaxed state can cause sleepiness and advises against using guided imagery while driving or operating heavy machinery. The 2015 review reports that imagery tends to produce stronger emotion than verbal processing of the same content. A person can ask what the imagery will involve and can choose to pause or stop if the content becomes distressing.

Uses that have been studied

Controlled studies of guided imagery have concentrated on anxiety before surgery and on postoperative pain, on anxiety, depression and quality of life in people with cancer, and on chronic pain conditions including fibromyalgia, arthritis and other rheumatic diseases. The Gale entry states the general aim as improving mood or physical wellbeing.

Claims beyond the research reviewed

Popular accounts of visualization also describe goal achievement, performance preparation and influence over the course of disease. The sources reviewed for this page do not evaluate goal or performance outcomes. For cancer, a systematic review found no compelling evidence of effects on physical symptoms such as nausea and vomiting, and the reviews found for this page concern symptoms and coping, not disease course.

The sources reviewed also do not document why people in everyday life seek guided visualization, or how often it is used outside clinical settings. This section therefore records research targets and stated aims only, and should not be read as a description of typical use.

Perioperative anxiety and pain

A 2019 meta-analysis of randomized trials compared preoperative guided imagery with conventional nursing care. It found 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); effects on children's postoperative pain and adults' state anxiety were not significant. Only eight trials entered the meta-analyses, and only the abstract was read.

Cancer care

A 2025 meta-analysis of nine randomized trials (837 adults with cancer, searched to December 2024) reported lower anxiety (SMD -1.30, 95% CI -1.98 to -0.63), lower depression in seven trials and better quality of life in four. The authors note no standard session length or frequency and call for long-term data. An earlier review of six trials of guided imagery alone rated quality as low on average, with mixed results.

Pain conditions

A review of 15 trials in non-musculoskeletal pain judged quality generally poor; 11 found less pain and 4 found no change against relaxation, standard care or no treatment. A review of seven trials in rheumatic disease found significant improvements in all, with low or unclear risk of bias in six. A review of seven fibromyalgia trials (387 people) pooled guided imagery with hypnosis and found a benefit at the end of therapy, but no trial reported safety. A review of 26 chronic non-cancer pain trials, mostly at moderate to high risk of bias, found three guided imagery trials with reduced pain intensity.

Reported effects and cautions

NCCIH states that most studies of relaxation techniques reported no negative side effects, but that some people reported increased anxiety, intrusive thoughts or fear of losing control. It adds that rare reports describe symptoms caused or worsened in people with epilepsy, certain psychiatric conditions or a history of abuse or trauma, without singling out guided imagery. Reporting of harms in the trials above is thin; the fibromyalgia review found no study reporting safety.

Imagery, emotion and memory

The 2015 cognitive-science review reports that imagery can intensify emotion, that repeatedly imagining a future event can make it seem more likely and raise anxiety, and that imagined rehearsal may promote harmful behavior 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. These laboratory findings concern imagery used to explore the past, not relaxation scripts, so applying them to routine sessions 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 visualization, and no statutory regulation or training standard was found. Guided imagery does not replace assessment by a medical or mental health professional, or prescribed treatment. Severe or long-lasting distress during or after practice is a reason to consult a health care professional, as NCCIH advises for relaxation techniques generally.