Background Anxiety occurs in hospitalized patients for many reasons including fear of specific procedures, worry about the future, and lack of control. Guided imagery is an intervention that can be delivered at the bedside in 10-15 minutes by a wide range of trained health care providers at a low cost (1). This Fast Fact will discuss guided imagery as an anxiety reduction technique.

The technique    Guided imagery is a mind-body exercise based on prompting patients to formulate meaningful mental pictures to achieve relaxation and reduce anxiety. Many guided imagery scripts include common elements such as asking the patient to sit or lie in a comfortable position, quieting the mind, removing negative thoughts and images, and calling to mind a vivid image or scenario that is calming and relaxing (a ‘safe place’). The content of a guided imagery script can include quiet and peaceful music with focus on a “safe place” where one feels secure and relaxed, or it may involve more active, physical sensations such as playing and winning a tennis match.  It can be performed by trained professionals or with the use of audio recordings and can be performed daily or as needed by the patient. An example of language used in a guided imagery exercise is: “Position yourself as comfortably as you can, shifting your weight so that you’re allowing your body to be fully supported by your chair or couch….  Take a deep, full, cleansing breath…inhaling as fully as you can…breathing deep into the belly if you can…and breathing all the way out…. Imagine a place where you feel safe and peaceful and easy…a place either make-believe or real….”   See reference (2) for an example of a full script.  Further training information about guided imagery can be found at http://academyforguidedimagery.com.

Research outcomes    Guided imagery has been shown to reduce anxiety and use of anxiolytics, and to improve patient satisfaction in a variety of medical settings (1,3). In separate studies it was shown to significantly reduce anxiety, worry, and post-procedural pain among patients facing surgery, dialysis, radiation therapy, or cardiac catheterization compared to usual care (3-7).  In a group of patients who had been hospitalized for more than two days, use of anxiolytic medication and heart rate were lower in the guided imagery group than in a control group (7). Similar results were found in a published quality improvement project in which hospitalized patients who utilized guided imagery felt more empowered (8). Guided imagery sometimes is combined with diaphragmatic breathing in these studies to augment its anxiolytic effect (6). Clinical experience and expert opinion support its helpfulness for advanced cancer patients, although there is little research yet in this population (9,10).

Limits and cautions     While a safe technique, guided imagery can rarely elicit negative emotional reactions, as well as create situations of patient vulnerability and susceptibility.  Due to this, guided imagery should be initiated in health care settings by a clinician who is trained in its proper use, who is comfortable with professional therapeutic boundaries, and who can respond appropriately to negative emotional reactions.  Guided imagery may trigger flashbacks in patients with post-traumatic stress disorder, and it is relatively contraindicated in these patients.  It is also contraindicated in patients who experience hallucinations, delusions, delirium, or severe obsessive-compulsive disorder. As with any intervention, there are some patients who do not benefit from this technique or who are unable to call to mind a relaxing image.

References 

1. Miller R. Nurses at community hospital welcome guided imagery tool. Dimensions Crit Care Nursing.  2003; 22(5):225-226.
2. Naparstek B. Staying Well with Guided Imagery. New York, NY: Warner Books; 1994: pp.76-79.
3. Felix MM, Ferreira MB, Oliveira LF, Barichello E, Pires PD, Barbosa MH. Guided imagery relaxation therapy on preoperative anxiety: a randomized clinical trial. Revista latino-americana de enfermagem. 2018 Nov 29;26:e3101.
4. Halpin LS, Speir AM, CapoBianco P, Barnett SD. Guided imagery in cardiac surgery. Outcomes Management. 2002; 6(3):132-137.
5. Beizaee Y, Rejeh N, Heravi-Karimooi M, et al. The effect of guided imagery on anxiety, depression and vital signs in patients on hemodialysis. Complementary therapies in clinical practice. 2018 Nov 1;33:184-90.
6. Alvarez-Garcia C, Yaban ZS.  The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: a meta-analysis.  Complementary Therapies in Clinical Practice 2020; 38.
7. Leon-Pizarro C, Gich I, Barthe E, et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality of life indices for gynecologic and breast brachytherapy patients.  Psycho-Oncology. 2007; 16:971-979.
8. Toth M, Wolsko PM, Foreman J, Davis RB, Delbanco T, Phillips RS. A pilot study for a randomized, controlled trial on the effects of guided imagery in hospitalized medical patients. J Alternative Complementary Med. 2007; 13(2):194-197.
9. Cole L. The impact of guided imagery on pain and anxiety in hospitalized adults. Pain Management Nursing. 2021 Aug 1;22(4):465-9.
10. Leon-Pizarro C, Gich I, Barthe E, et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality of life indices for gynecologic and breast brachytherapy patients.  Psycho-Oncology. 2007; 16:971-979.
11. Foley KM, Back A, Bruera E, et al, eds.  When the Focus is on Care: Palliative Care and Cancer. Atlanta, GA: American Cancer Society; 2005: p.176.

Author Affiliations:  University of Pittsburgh Medical Center, Pittsburgh, PA. 
Version History:   Originally published January 2009; copy-edited in July 2015; reviewed and updated again in June 2025.
Conflicts of Interest: None to report.