Emotional Intelligence and Work Performance among Executives


Europe’s Journal of Psychology, 6(4), pp. 227-237 

www.ejop.org 

 

 

Guided imagery as a psychotherapeutic mind-body intervention in 

health psychology: A brief review of efficacy research 

 

 

Öykü Özü      

Celal Bayar University, Demirci, Manisa, Turkey 

 

 

Abstract 

In this article the guided imagery technique, which is a therapeutic tool in counseling 

and allied fields using mental images produced by appropriate scripts, suggestions or 

affirmations by videos/tape records and by the client himself/herself, will be discussed.  

Guided imagination is a mind-body intervention. Mind-body interventions focus on the 

interactions among the brain, mind, body, and behaviour, and on the powerful ways in 

which emotional, mental, social, spiritual and behavioural factors can directly affect 

health. The technique, used in health psychology and counseling psychology, can be 

classified by the modality of its content: visual, verbal, auditory, olfactory, tactile, 

gustatory, or kinesthetic. It is a flexible intervention whose efficacy has been indicated 

through a large body of research in the field over many decades. As such, it has earned 

the right to be considered a research-based technique. This article will give a brief 

outline of guided imagery techniques, and examples of selected research indicating its 

efficacy.  

 

Keywords: guided imagery, health psychology, counseling psychology, mind-body 

interventions. 

  

 

Imagery, as a mind-body intervention in counselling health psychology, is a general 

name given to a series of cognitive processes. The procedures used in these 

processes are psychotherapeutic tools that help professionals change people‟s 

attitudes, behaviours, emotions and physiological reactions.  The cognitive element 

in the techniques of imagery is “the whole of thoughts which represent and interpret 

the context of perception” (Crawford, 1992). A revival of interest in imagery was an 

important component of the so called cognitive revolution in psychology during the 

1960s and early 1970s, a period when the behaviorist intellectual hegemony over the 

field was broken and the concept of mental representation was established as 

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Europe’s Journal of Psychology 

 

 
228 

central and vital to psychological theorizing (Kosslyn, 1980). Beginning in the 1960s, 

and perhaps stimulated by some of the research mentioned by Holt, there was also 

a growing interest in the application of imagery based techniques in psychotherapy 

and psychosomatic medicine (Assagioli, 1965, cited in Thomas, 2010).  It is sometimes 

claimed or implied that these sort of techniques are based on ancient oriental, and 

particularly Indian, spiritual practices (e.g., Samuels & Samuels, 1975; Gawain, 1982, 

cited in Thomas, 2010), and it thus may not be coincidental that a prominent figure 

in the psychotherapeutic imagery movement is a Pakistani born psychologist, Akhter 

Ahsen, known mostly but not exclusively for his clinical and theoretical work (e.g. 

Ahsen, 1965, cited in Thomas, 2010). Today it is believed that mental imagery is 

based on a theory which assumes that personality and consciousness are composed 

of images and that, when required to make a change in a person‟s consciousness 

level, the first thing to do is to „fix‟ his/her distorted images (Ahsen, 1968). This is allows 

the person to discover his/her inner „forms and symbols‟ and control his/her 

behaviors (Achterberg & Lawlis, 1982).  

 

Some of therapy models which use the tool of imagery are biofeedback, 

neurolinguistic programming (NLP), Rational Emotive Therapy (REBT), Gestalt Therapy 

and hypnosis; desensitization and counter-conditioning techniques also use imagery. 

Moreover, recently performed meditative interventions that follow mantra and 

relaxation techniques by using systematic guidance are said to be located in the 

framework of imagery techniques (Crawford, 1992).  

 

Using mind-body interaction in health psychology 

 

Guided imagery, based on the philosophy of general imagery techniques, is a 

method of mind-body interaction that includes some specific interventions made by 

health professionals. Like other mind-body interventions, guided imagery is also 

based on the assumption that the mind affects how the brain functions. Mind-body 

interventions focus on the interactions among the brain, mind, body and behaviour, 

and on the powerful ways in which emotional, mental, social, spiritual and 

behavioural factors can directly affect health (Astin, Shapiro, Eisenberg et al., 2003). 

Mind-body medicine typically focuses on intervention strategies that are thought to 

promote health, such as relaxation, hypnosis, visual imagery, meditation, yoga, 

biofeedback, tai chi, qi gong, cognitive-behavioral therapies, group support, 

autogenic training, and spirituality (Astin, Shapiro, Eisenberg et al., 2003).. The field 

views illness as an opportunity for personal growth and transformation and health 

care providers as catalysts and guides in this process (National Center for 

Complementary and Alternative Medicine Reports, 2007). Guided imagery aims at 



 

 
Guided imagery as a psychotherapeutic mind-body intervention in health psychology 

 

 
229 

making the mind go on a journey with the help of multiple senses (the containing 

function of the five senses), and not at making it focus on a stimulant (an image or a 

word) (Lynn & Rhue, 1988). According to Lynn and Rhue (1988), the main purpose of 

guided imagery is firstly to calm a person‟s mind, secondly to enable him/her to face 

negative emotions like anxiety, fear or ambivalence and provide the person with an 

increased sense of consciousness with the help of the five senses. Lastly, this 

technique is teaching the patient to evoke his/her inner power, step by step, getting 

rid of the negative emotions that block behaviour and generate anxiety. With the 

help of guided imagery people can see, hear, feel, taste and smell „images‟. The 

reason why it is called „guided‟ imagery is that video, tape records or the 

professionals‟ instructions are used in the process.  This way, the patient becomes 

able to use the interaction of mind-body-spirit for healing purposes.  

 

The guided imagery process 

 

Relaxation techniques are used in the initial phase of guided imagery as they help 

the mind be open to experiences and consciousness and as they make knowledge 

more easily to be processed. They not only decrease the tension of muscles, but also 

help the images in the subconscious to emerge. Arthur Reber (1985) in Dictionary of 

Psychology defines the term “subconscious” as follows: 

 

 subconscious 1 n. In psychoanalytic theory, a level of mind through which 

 material passes on the way toward full consciousness. Note that, in fact, most 

 purists eschew the term as overly popularised and imprecise, preferring the 

 term preconscious. 2 n. In more general writings, an information store 

 containing memories that are momentarily outside of awareness but which 

 can easily be brought into consciousness. 3 adj. Characterising information 

 that is not part of one’s momentary awareness but which can, given the 

 proper circumstances, be made conscious. 4 adj. Descriptive of information or 

 stimuli that are at the margins of attention, events that one is only vaguely 

 aware of. It should not, in any circumstance, be used as a synonym for 

 unconscious.  

 

In this context, guided imagery can be seen as „playing pictionary with your sub-

conscious‟. The mind and the body, when relaxed, can process positive images 

more easily and this way physical and emotional healing is accelerated (Epstein, 

2009). Using guided imagery after relaxation is recommended since this way the 

positive messages are more easily transmitted from mind to the body. In fact, guided 

imagery can be considered as a „small journey of the mind‟. 

    



 

 

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230 

As discussed in Martin & Rossman (2000), a typical guided imagery session begins 

with relaxation techniques; the person closes his/her eyes and focuses on breathing. 

Secondly, some instructions are given by the therapist to the patient for helping 

him/her to be more relaxed and empty his/her mind. With these instructions, the 

patient is set on a journey to a place in which he or she can feel calm. During this 

journey the therapist gives other instructions to help the patient use all of the senses 

and help him/her face with the difficult issues in accordance with the treatment 

purposes, while also asking the patient what he/she feels and what comes to mind 

during these states (Horrigan, 2002). Consequently, the patient „migrates‟ to a 

different conscious level, uses his/her senses of the mind, feelings and body in 

interaction, gains the ability to see the problems he/she faces from a different 

perspective, and gains control over his/her body, mind and emotions by learning to 

heal himself or herself. In this process, videos and some other visual materials can be 

used alternative to the instructions of the therapist. The technique of guided imagery 

can sometimes be used as a mental rehearsal to balance emotional reactions 

which have been generated in an anxiety-provoking situation (Lascelles, 

Cunningham, McGrath & Sullivan, 1989) and also as a supporter of other therapeutic 

techniques that are used to increase patients‟ abilities in different domains (Morrison 

& Cometa, 1977). 

 

Usage in hospitals 

 

In studies researching the effectiveness of the guided imagery technique in mind 

and body health, it was found that it is used in hospitals and health centers for 

reduction of pain, anxiety and reducing the hospitalization time of the patients after 

surgeries; also for increasing patients‟ confidence of the medication for pain 

reduction and the level of benefit taken from the medication. Moreover, it is widely 

used in decreasing the level of anxiety before normal delivery by means of cognitive 

rehearsal (Oster, 1994; Manyende et all., 1995).  

 

The technique, employed as a tool to reduce the level of anxiety, is also used in the 

relaxation of patients before surgeries, increasing concentration, body awareness, 

and decreasing the level of anxiety (Oster, 1994). It had been used to increase 

psychological adaptation before surgeries for a long time but it has proved its 

effectiveness as a relaxation technique in clinical situations mostly since the 1980s. 

The usage of therapeutic communication and guided imagery interactively can be 

seen as a mechanism which changes people‟s perceptions, emotions and body 

reactions. A mechanism like this accelerates patients‟ recovery processes, increases 

their physical and psychological control over pains and helps decrease patients‟ 



 

 
Guided imagery as a psychotherapeutic mind-body intervention in health psychology 

 

 
231 

level of anxiety to an optimum level. In a study conducted by Norred (2000), a 

psychotherapy including guided imagery was given to a group of patients for 6 days 

before and after their colorectal surgeries. Results indicated that the level of anxiety 

of the patients who had attended the therapies before and after the surgeries was 

lower than that of the control group patients. Also, they had less pains after the 

surgeries. In another study made at California University (2000) results indicated that 

guided imagery sessions decreased surgery complications and the level of anxiety 

and pains before and after surgeries. For this reason the use of special videos and 

tape records of guided imagery in the hospital became more spread (Trump, 2004). 

To conclude, there are indications that guided imagery techniques can be effective 

for pain control among patients (Deisch, Soukup, Adams & Wild, 2000; Dreher, 1998). 

One of the reasons for his is that the technique increases the endorphin secretion of 

patients (Thomas, 1991). Moreover, the interaction of guided imagery and relaxation 

techniques with cognitive behavioral and biofeedback methods have been proven 

to be effective in increasing the general well being of hospitalized patients in several 

studies (Devine & Cook, 1986; Dreher, 1998). 

 

Guided imagery in oncological studies 

The guided imagery technique as a psychotherapeutic intervention is based on the 

idea that personal images affect physical and psychological health directly or 

indirectly (Lascelles et al., 1989). Because of this, the technique is widely used in 

integration with other mind and body techniques and Hypno-REBT, especially as 

fortification and improvement of bodily health. The usage of the technique in this 

field was accelerated by studies of oncologist Carl Simonton on cancer (Lemonick, 

2001). A series of studies reported the efficacy of some psychotherapeutic 

techniques in decreasing, at least for a short time, the psychological disorders of 

cancer patients. Among these, guided imagery is the most popular one (Baider, 

Uziely & De-Nour, 1994). The results of a study made at the Hebrew University on 56 

people with advanced cancer who were experiencing anxiety and depression was 

conducted by Sloman (2003). The study aimed at establishing the effectiveness of 

progressive relaxation and guided imagery techniques in decreasing the depression 

and anxiety levels of advanced cancer patients. Patients were randomly assigned 

to one of four treatment conditions: (1) progressive muscle relaxation training, (2) 

guided imagery training, (3) both of these treatments, and (4) the control group. 

Results showed that progressive muscle training and guided imagery training 

together decreased the depression levels of the patients while they increased the 

patients‟ quality of life. In another study made by Hammond (2004a), which aimed 

at exploring which cancer patients benefited more from the use of the guided 

imagery technique as a strategy for controlling aches, 62 hospitalized cancer 



 

 

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232 

patients who were complaining  about pains were sampled. The results showed that 

the patients who had believed in the effectiveness of the techniques benefited 

more than the patients who did not believe in it. The results  also  showed  that  the  

ability  of  the  patients  to image predicted the level of pain, the  perceived control 

over the pain and also positive emotions.  Accordingly, the ability of the patient to 

image affected the level of benefit taken from using the technique. Results of 

Cassel‟s (1991) longitudinal study, which sampled five year old cancer patients, 

showed that the 70% of the children‟s complains about pains, nausea and anxiety 

were decreased after a year of systematic guided imagery process. As it is seen from 

this research, guided imagery can potentially impact on many aspects of your body. 

During guided imagery patients are taught how to control their breathing and relax 

their muscles. They learn to focus on something specific – such as the therapist‟s 

voice or the instructions given on a DVD or audio tape. They enter into a state of 

deep relaxation, success, and wholeness – similar to meditation. In guided imagery 

patients consciously imagine something – and that something depends on what the 

goal of the therpay is (Lynn & Rhue, 1988).  If the goal has to do with healing from 

cancer, for instance, patients would be asked to visualise their cells and organs as 

strong, powerful, and healthy. If it is stress reduction before surgery, they would 

imagine the surgery from beginning to end – with a capable surgeon, caring nurses, 

and successful outcomes (Martin & Rossman (2000). 

Guided imagery for stomach and migraine pains 

 

Searching the literature it was also found that guided imagery is widely used in 

decreasing stomach and migraine pains for both children and adolescents. 

Hammond‟s (2004b) pilot study for example aimed at determining if guided imagery 

was effective for decreasing stomach pains in the case of children. The sample was 

made up of ten children who had been complaining about stomach pains. They 

attended guided imagery sessions for four weeks (50 min. every week). The results 

indicated that the interaction of the two techniques decreased about 67% of 

children‟s pains. Migraines like headaches affect children‟s daily functions 

negatively, and decrease their attendance to school.  In the literature it is seen that 

relaxation and guided imagery techniques are effective for also decreasing 

migraine in children and adolescents (Penzien & Holroyd, 1994; Baumann, 2002). 

Another field in which guided imagery has proved to be effective is that respiratory 

disorders, especially asthma, in the case of children and adolescents. The study of 

Castes, Hagel, Palenque, Canelones, Corao and Lynch (1999) focused on the usage 

of RGI (relaxation guided imagery technique) on children and adolescents 

complaining about asthma. The study indicated that the children who had 

attended RGI sessions had less complains and less need for medications than the 

http://behavioural-psychology.suite101.com/article.cfm/coping_with_stress_and_anxiety


 

 
Guided imagery as a psychotherapeutic mind-body intervention in health psychology 

 

 
233 

ones who had not.  Peck, Bray and Kehl‟s (2003) study showed that the RGI 

techniques were also effective in increasing the self esteem of children and 

adolescents with asthma. This may result from the fact that two dimensions of 

temperament (negative reactivity and task persistence), as well as perceived 

coping efficacy and self-esteem, play a significant role in influencing the 

psychological adjustment of children with asthma (Lima, Guerra & de Lemos, 2010). 

There are also authors who consider the importance of studying self-esteem in 

children with chronic illness, believing that it may act as protective factor or rather 

that children who have a „healthy‟ self-esteem are less likely to suffer as much from 

their illnesses and to adapt more easily (Barros, 1999, cited in Lima, Guerra & de 

Lemos, 2010). 

 

Other fields of usage  

 

The literature shows that guided imagery can also be used effectively in 

remembering and reconstructing traumatic memories (Loftus, 1993; Hyman & 

Pentland, 1996). But some don‟t support these conclusions because with this 

technique people can remember false memories, memories of events that they had 

not lived before (Heaps & Nash, 1999; Paddock, 2001).   

 

The studies that focused on the usage of the technique in anxious and depressed 

patients have showed that the technique can be used effectively in interaction with 

other psychotherapy techniques (Turner, Calhoun & Adams, 1992). At the same time 

it is well known that alternative psychotherapy techniques like guided imagery, 

meditation and yoga require people‟s belief in the effectiveness of the techniques 

(Martin & Rossman, 2000). The literature that supports the effectiveness of these 

techniques in severe psychiatric disorders is still limited.  A study conducted by 

Russinova and Wewiorski (2002) investigating 157 severe psychiatric patients showed 

that guided imagery techniques decreased these patients‟ emotional and cognitive 

distortions, and affected their social and spiritual development positively. But, the 

effectiveness of guided imagery in the case of psychotic patients is not supported 

yet widely supported by the literature.   

 

Conclusion 

 

Mind-body techniques have potential benefits and advantages in counseling and 

health psychology. Importantly, the physical and emotional risks of using these 

interventions are minimal. Moreover, once tested and standardized, most mind-body 

interventions can be taught easily. Finally, future research focusing on basic mind-

body mechanisms and individual differences in responses is likely to yield new insights 



 

 

Europe’s Journal of Psychology 

 

 
234 

that may enhance the effectiveness and individual tailoring of mind-body 

interventions. In the meantime there is considerable evidence that mind-body 

interventions, even as they are being studied today, have positive effects on 

psychological functioning and quality of life (National Center for Complementary 

and Alternative Medicine, 2007) and may be particularly helpful for patients coping 

with chronic illness and in need of palliative care. 

 

Evidence has shown so far that guided imagery, as a psychotherapeutic tool used in 

health psychology, can be effective in changing negative bodily reactions faced in 

somatic and psychosomatic disorders for more positive ones using the body-mind 

interaction. Major clinical chronic illnesses had increased by over 250% in the 1900s-

and cancer and cardiovascular disorders are first in the list (Cassel, 1991). The studies 

focusing on preventing and treating these disorders are more and more numerous. 

From this perspective, guided imagery technique can continue to prove its 

effectiveness through its support for mind-body interaction and its focus on a holistic 

approach within counseling and health psychology research.                  

 

 

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About the author: 

 

Öykü Özü had graduated from Istanbul Bilgi University, Psychology Dept.  She had her 

master‟s degree at Ege University in Guidance and Psychological Counseling. She is 

currently enrolled as a PhD student in the same department at Ege University in Turkey. In 

her research she focuses on stress and anxiety; holistic therapies, psychodrama and art 

therapy in counseling/psychotherapy.  
 

Address for correspondence: Öykü Özü, Department of Psychology, İstanbul Bilgi 

University, Santral Campus, Eski Silahtarağa Elektrik Santrah, Kazım Karabekir Cad. 

No: 2, 34060 Eyüp / ISTANBUL 

E-mail: oykuozu@gmail.com