Guided Imagery and Visualization

A Self-healing Journey

Claudine J. PearsonPace University, Lienhard School of Nursing

Guided Imagery and Visualization:

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IntroductionLets face it, stress kills. The question is: How? Maybe the secret lies in mind-body-spirit imbalance?

FACTS:The physiological effects of the stress response are profound. Neuroendocrines, epinephrine, norepinephrine, cortisol, and aldosterone, are mediators of the psychophysiological impact of stressors. Without proper stress and anxiety management, over activity of stress hormones can contribute to pathophysiological processes such as hyperglycemia, high blood pressure, and excess fluid volume to name a few.

Mind-body-spirit medicine uses the mind to affect physical function and promote well being. Through guided imagery and visualization we test the human capacity to self-heal.

Case StudyJL is a 50 year-old African American office manager who suffers from primary hypertension, hyperthyroidism, and is prediabetic.

JL is anxious because her doctor warned that she is at high risk for diabetes. She maintains a low sodium diet and eats fresh fruits, nutritional supplements, and drinks filtered water. She does not smoke or drink alcohol, except for the rare social glass of wine.

Her dietary weaknesses are strawberry jam, peach-flavored jelly candies, and ice cream, periodically binging on any one of the aforementioned.

Case Study- Psychosocial ProfileJL is cautious and hypervigilant.

She worries something bad is going to happen to her or a loved one. This is a major source of stress in her life.

A landlady of a three family apartment home, JL is functional and independent. Her home appears to be uninhabited with nothing out of place and everything in mint condition.

She jokes she might have "a little OCD. She is a single parent of a 29 year-old daughter.

Case Study- Physical/ Physiological ProfileSigns & SymptomsOverweightHair lossPitting edema in bilateral ankles and feet Polyphagia, polyuria, and polydipsiaParesthesiaFatigueMedicationsAmlodipine and Hydrochlorothiazide

Chief complaint is fatigue, swelling of her ankles and feet, and paresthesia in her peripheries.

Clients Attitude (toward guided imagery therapy)

Has never considered complementary and alternative medicine as remedial options.

When presented with this therapy to improve her health, her immediate response was laughter and a brief pause. She replied, Why not, Ill try it.

It was evident that JL was skeptical about body-mind-spirit medicine.

Rationale for Using Guided ImageryGuided imagery/visualization was chosen for its mind-body-spirit benefits suitable for JLs comorbidities. It is a form of complementary and alternative medicine that has been proven to be therapeutically effective for various diseases including cancer, fibromyalgia, anxiety and depression (Dossey & Keegan, 2013).

Through therapeutic suggestion (guidance) the holistic nurse assists the client in forming mental images (imagery) to which the client has a physiological, psychological, and/or spiritual reaction.

With respect to JL's health condition, guided imagery/visualization therapy is ideal because of its focus on managing her stressors and the anxiety she experiences over her health, and barriers to exercising, and improving her health.

Guided imagery/visualization sessions will target stress and anxiety by promoting self-awareness and self-care to eradicate internal tension and diminish fears.

NANDA DIAGNOSISIneffective self-health management related to primary hypertension, hyperthyroidism, and diabetes as evidenced by +3 pitting edema, hypervigilance, and fatigue.

Fluid volume excess related to severe stress as evidenced by peripheral edema.

Review of LiteratureImagery, conscious mental visualization of stimuli without the presence of the stimuli, has been used to evoke innate healing powers since ancient times (Dossey & Keegan, 2013). In recent decades, there has been increased interest in the clinical benefits of guided imagery due to mounting evidence of positive health outcomes associated with it (Hart, 2008). According to Hart (2008), the theory behind guided imagery is that if a person can imagine negative or frightening images that increase pain or anxiety, then those images can be counteracted with positive or calming images, and the mind can be trained to focus on healing imagery (p. 296). Research has measured positive health outcomes of Guided Imagery/Visualization treatment for fatigue, high blood pressure, muscle tension, stress, immune system impairment, diabetes, fibromyalgia, and more.

PICO Question

In middle-aged African American females with essential hypertension and type II diabetes, does guided imagery, as compared to no mind-body intervention, help to improve stress and anxiety management to effect a reduction in blood pressure and blood glucose levels?

Implementation and ProcessMeeting with client was on Mondays and Fridays for four weeks. Initial meeting was 60 minutes; subsequent meetings were ~ 30 minutes.Goals: To elicit self-healing behaviors through conscious manipulation of mind-body-spirit awareness using guided imagery and visualization.Improve hypertension and blood glucose levels with the induction of positive and calming mental imagesObjectives:Client will learn brief historical, theoretical, research/evidence and methodological background of alternative healing modality to increase knowledge and confidence.Have client use audio script for self-induction and holistic self-care in her leisure time or when symptoms peak.Using induction script, guide the client into a state of deep relaxation allowing free-flow of soothing energy.Assist the client, through indirect therapeutic suggestion, in finding a mental sanctuary where she is devoid of stress and worry; where she feels bliss, tranquility, and pure.Observe for changes in posture, movement, energy, tone of voice, sociability and mood status post therapy session

Barriers and MotivationsMain barriers:JL had anxiety and fear in public places, and negatively thoughts in weeks 1-3, restricting three sessions to her home and caused the first session of week two to end abruptly.JLs multiple comorbidities made it difficult to pinpoint specific imagery.JL tendency to easy distraction.

Main motivations: Evidence of guided imagerys ability to promote self-healing based on literature reinforced compliance.Guided imagery is a convenient tool to use as coping mechanism against stress and anxiety.JL personal experience with Diabetes and motivation to get well.

Evaluation and RecommendationsEvaluationLess noticeable peripheral edema, especially in upper extremities,Slight improvement in paresthesia of feet; client still must sleep with feet elevated,More relaxed postured, mellow tone of voice, self-motivated and cheerful client status post mind-body therapy, and More energetic and less days of feeling somnolent.From the clients account, she was better able to manage stressful situations and reduce perceived stressors in her life using guided imagery. Client reported seeing an improvement in her attitude and behaviors toward her diabetes, and belief she will control it. Overall, the client learned a useful new self-care skill which increased her self-awareness, stress management, and optimism to get well.

RecommendationsThe author recommends mind-body-spirit and holistic healing as an adjunct therapy for healthcare providers to offer patients because of its ease, cost effectiveness and efficacy. The authors contention is that clients can feel empowered through education and awareness, and control over their own lives by managing their anxiety and fears, and changing behavior.

Conclusion Stress and anxiety are important mediators of neuroendocrine cascades. Banasik and Copstead (2013) stated, The activation of both the sympathetic-adrenal-medullary system and the HPA axis occurs withphysical, mental, and psychosocial stressors (p. 16). Although we cannot always control the stressors in our lives we can control how stress impacts us. By simply looking deep within, with self-awareness; learning how to forge our own mental paradise, we will in turn produce stress relief and better health. Hatler (1998) cited eight clinical evaluations on guided imagery in which diastolic and systolic blood pressure decreased, stress and anxiety showed reduced scores, and when combined with music, cortisol levels and fatigue were decreased. Guided imagery is easy to learn, economic, practical, and effective (Hart, 2008; Hatler, 1998; Jallo & Menzies, 2011; Jallo et al. 2015; Weigensberg et al., 2009).

ReferencesBanasik, J., & Copstead, L., (2013). Homeostasis and adaptive responses to stressors. In D. A. Jansen & R. J. Emerson (Eds.),Pathophysiology(pp. 12 - 24). St. Louis,MO: Elsevier Saunders.Dossey, B. M., & Keegan, L., (2013). Imagery. In B. G. Schaub & M. McInnis (Eds.), Holistic nursing: A handbook for practice(pp. 361- 394).Burlington, MA: Jones & Bartlett Learning.Hart, J. (2008). Guided imagery. Alternative and Complementary Therapies. 14(6), 295-298. doi: 10.1089/act.2008.14604Hatler, C. W. (2010). Using guided imagery in the emergency department. Journey of Emergency Nursing, 24(6), 518-522.Jallo, N., & Menzies, V. (2011). Guided imagery as a treatment option for fatigue. Journal of Holistic Nursing, 29(4), 279-286.Jallo, N., Salyer, J., Ruiz, R. J., & French, E. (2015). Perceptions of guided imagery for stress management in pregnant african american women. Archives of Psychiatric Nursing, 29, 249-254. Weigensberg, M. J., Lane, C. J., Winners, O., Wright, B. S., Nguyen-Rodriguez, S., Goran, M., & Spruijt-Metz, D. (2009). Acute effects of stress-reduction interactive guided imagery on salivary cortisol in overweight latino adolescents. The Journal of Alternative and Complementary Medicine, 15(3), 297-303. doi:10.1089/acm.2008.0156

AppendixInduction and Imagery Script Make yourself comfortable and close your eyes, place your hands gently on your lower abdomen, just below your navelBring all your attention to the sensation in your handsNotice the slight rise and fall of your hands as they move with your breathesNotice the tactile sensations of the surfaces of your hands and fingersBring all you awareness into these sensations Now notice the temperature of your hands notice their weightNow notice any sensation inside the skin, perhaps tingling, or pulsing Now bring you attention to the center of your chest and be aware of the sensations notice the movement of your chest with each breath Notice the slight cool sensations of the air blowing against the inside of your nose.Special or Safe Place Imagery Let your imagination choose a place that is safe and comfortable A place where you can retreat at any time This is your very special, secret place Notice the tranquility you feel when you are there The freedom and peace you feel You can feel yourself light as a feather Without a worry or care in the world You have everything you want and need here This is a healthy technique for you to learn This place will help you with your daily stressors (Dossey & Keegan, 2013).Self- healing Imagery Imagine the warm feeling you get when you are in your special place or eating your favorite dish or simply at peacefeel the surge of warmth from the crown of your head flowing downward into your core as it disperses into your arms and legsto your hands and feet coming to rest in your fingertips and toes. This warmth represents the powerful energy within your bloodthe potent healing power surging through your system feel it as if it is real.