Imagery

Imagery is a nonphysiological (cognitive) relaxation technique that can be used to ease stress and
promote an overall sense of well-being. Imagery focuses on increasing cognitive, emotional, and
physical control by changing the focus of an individual’s thoughts. We all have daydreamed about
pleasant things that have distracted us and made us feel better. Imagery uses much the same process
but encourages positive adaptive “dreaming” that distracts and relaxes the individual. Imagery is
highly effective for depression and anxiety, as well as specific situations that require clarity, focus,
distraction, or feelings of mastery. The following are examples:

How Guided Imagery Works

Research has shown that the mind can actually affect how the body functions. It seems the body may
not know the difference between an actual event and a thought. Guided imagery uses the power of the
brain—images and the perception that you are either somewhere else or in a different state of mind—
to increase pleasant experiences and performance to promote wellness and health. On the flip side,
imagery helps to reduce stress tension and anxiety by changing thoughts and emotions or through
distraction.

Imagery is commonly referred to as guided imagery. Guided imagery refers to a process whereby you
facilitates or guide the initial images the patient uses. The following section describes how you can
guide the patient into the effective use of imagery for relaxation or performance improvement.

Step #1: Introduce Imagery.

Introduce imagery to the patient, pointing out the power of the brain or thoughts and how images,
when accessed correctly, can actually change physical and emotional states.

Step #2: Identify the Desired Outcomes, Such as Decreased Anxiety, Increased Focus,
Distraction.

Step #3: Develop an Image or Scene.

Work with the patient on the third step to identify a situation, either in the past or a place he/she
would like to be, that both you and the patient feel might benefit or produce the desired outcome.
Sample imagery scripts are provided below and can be used if the patient has difficulty creating a
personal situation. Selection of a powerful image is critical to the success of this technique. Selection
of an image that the patient is able to fully embrace increases the odds of treatment success. Selection
of a “weak” image (e.g., not viewed as important by the patient or unable to be fully visualized) will
likely lead to treatment failure.

Step #4: Increase Vividness of the Image.

To ensure that patients find a “strong” image, ask them to explore as many senses as possible to
increase vividness of the image. For example, when imagining a glass of lemonade, imagine holding a
glass that feels icy and cold, visualize the color of the lemonade, think of the fresh citrus smell, and
finally think of how the lemonade tastes. This is an example of imagery that uses multiple senses and
increases vividness of the image.

Increasing vividness is largely a matter of increasing the details the patient experiences. The more
details described by the patient, the more powerful the technique.
Step #5: Ask the Patient if He or She Notices Any Changes After the Imagery Exercise. Ask for
general feedback about the technique.

Step #6: Repeat the Imagery Exercise Until the Patient Reports Skill Understanding and Benefit.

Step #7: Ask the Patient to Identify Situations When Imagery Might Be Appropriate. Expand upon
the patient’s responses by adding other situations (e.g., how the technique can be used).

Step #8: Continue Practice Outside Session. Work with the patient to set a homework assignment that
encourages application of imagery to situations when the patient feels stress or feels that imagery
might be beneficial.

Other tips for imagery:

1) Pair up imagery with deep-breathing exercises.

2) Ask patient to close eyes during the exercise to increase vividness.

3) Interject during the imagery experience aspects that you feel might benefit the patient. For example,
a patient might use the beach image; and you might ask how the sun feels on the skin, whether he or
she hears anything, or what else he or she sees.

4) Help the patient focus on aspects of the image that will guide him/her towards the goal. Help the
patient to avoid too many unnecessary details that might distract from the goal.

5) Point out that imagery is a portable skill that the patient can use in a variety of situations and
completely without notice of others (PMR is less portable).

6) Avoid imagery with psychotic patients, who might confuse reality with images.

Imagery: Example Scripts/Guides for Therapists

Script #1: Generic Example

Once your whole body feels relaxed, travel to your favorite place... it can be any time period or any place. This
place is calm and safe... there are no worries here... Look around this place. What do you see? Do you hear the
sounds around you? What are some of the sounds you hear in this place you are imagining? How does this
special place smell? Walk around a little, and take in all the wonderful sights... Feel the air around you and
relax.... The air is fresh, and it’s easy to breathe here. Pay attention to how your body feels..... Say to yourself, “I
am totally relaxed... without worries... all the tension has drained away from my body.” Take a moment to fully
experience your favorite place.... Notice the sounds, the sights, smells, and how it feels to be in this very special
place. Remember that you can visit this place as often as you want and that it is wonderful. Say to yourself, “I
am relaxed here... this place is special and makes me feel at peace.

When you are done with your visit to this special place, open your eyes and stay in your comfortable position.
Continue to breathe smoothly, in a relaxed and rhythmic fashion. Take as long as you want to enjoy and relax.
Feel at ease knowing your special place is always available to you, and find that you feel relaxed, even after you
leave.

Script #2 – The Beach:

Imagine yourself walking down a sandy beach. The sand is white and warm between your toes. You are looking
out over the calm, blue water. The waves are gently lapping at the shore. You feel the pleasant warmth of the
sun on your skin... it’s a perfectly comfortable temperature outside. Breathe in deeply. There is a gentle breeze,
and the sun is shining. Big, cotton-like clouds drift by as you hear sea gulls in the distance. You taste traces of
salt on your lips. You are completely relaxed... there are no worries on this beach. There is nothing to distract
you from feeling tranquil. Worries drift away. Notice the sounds, sights, smells, and how it feels to be in this
very special place.

Feel the sand under your feet... you decide to stretch out on the warm, fine, white sand... breathe deeply... feel
the warm air. Your body is completely relaxed, and you have an overall feeling of warmth and comfort. You
look up at the clouds pass by slowly across the beautiful blue sky. You are feeling rejuvenated and completely at
peace. Remember that you can visit this place as often as you want and that it is wonderful. Say to yourself, “I
am relaxed here... this place is special and makes me feel peaceful and content.”

When you are done with your visit, open your eyes and stay in your comfortable position. Continue to breathe
smoothly, in a relaxed and rhythmic fashion; take as long as you want to enjoy and relax. You feel at ease
knowing your special place is always available to you, and you find that you feel relaxed even after you leave.

Script #3 – The Meadows:

Imagine yourself walking through a lovely meadow. The breeze feels pleasant against your skin. You are
looking out over the calm, beautiful green grass. The blades of grass are gently swaying in the breeze. You feel
the pleasant warmth of the sun on your skin... it’s a perfectly comfortable temperature outside. Breathe in
deeply. There is a gentle breeze, and the sun is shining. Big, cotton-like clouds drift by as you hear birds in the
distance. You hear the wind blow gently through the trees. You taste the sweet summer air on your lips. You are
completely relaxed... there are no worries in this meadow. There is nothing to distract you from feeling tranquil.
Worries drift away. Notice the sounds, the sights, the smells, and how it feels to be in this very special place.

Feel the cool grass under your feet... you decide to stretch out on the soft, cushiony grass... breathe deeply... feel
the warm air. Your body is completely relaxed, and you have an overall feeling of warmth and comfort. You
look up as the clouds pass by slowly across the beautiful blue sky. You are feeling rejuvenated and completely
at peace. Remember that you can visit this place as often as you want and that it is wonderful. Say to yourself, “I
am relaxed here... this place is special and makes me feel peaceful and content.”

When you are done with your visit, open your eyes and stay in your comfortable position. Continue to breathe
smoothly, in a relaxed and rhythmic fashion; take as long as you want to enjoy and relax. You feel at ease
knowing your special place is always available to you, and you find that you feel relaxed even after you leave.

Other Guided Imagery Scene Suggestions:

 A garden where you watch big, beautiful clouds in a blue sky, while you inhale the scent of flowers and
feel a gentle breeze on your skin as the sunshine warms you.
 A mountain scene where you feel calm and relaxed as you look out over the valley. Just you and the
vegetation and you dip your feet into a cool mountain stream; and let your foot rest on a big, slippery
stone as the sunshine warms you and the wind blows through the trees.
 Advanced scenarios developed with assistance of patient (family, past experiences, etc).