Complementary Therapies in Cancer Care: Imagery and Visualization

An ongoing series highlighting complementary therapies, adapted from The Complete Guide to Complementary Therapies in Cancer Care

By Barrie R. Cassileth, MS, PhD, Chief, Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center

Complementary therapies are noninvasive, non-pharmacologic adjuncts to mainstream treatment. They improve patients’ strength and control of the physical and emotional symptoms associated with cancer and other illnesses. They provide self-help guidance to enhance body and soul at times when one feels vulnerable and life seems out of control. Complementary therapies are used as adjuncts to mainstream care of cancer and other illnesses, not as substitutes. They improve physical and emotional function and manage stress and symptoms of aging, regardless of health status. Complementary therapies are rational, evidence-based practices delivered or taught by trained practitioners. They include mind-body practices such as meditation and self-hypnosis; massage therapies; nutritional counseling; physical fitness, including programs such as aerobic exercise, qigong, tai chi, yoga, and many other practices; music therapy; and acupuncture.

Imagery and Visualization

You are lying on the floor or resting on a couch, eyes closed, breathing deeply. A soothing voice begins: “Imagine yourself floating, floating with no effort on a calm sea. You feel the water on your back and legs, the sun on your face and chest. You hear the gentle beating of the waves on the faraway shore…”

You have just been through an exercise in imagery, a technique its advocates claim can harness our imagination, memory, and senses—all to promote relaxation and improve control over life and health.

Imagery, rooted in centuries-old techniques, is based on the idea that our minds can influence the unseen processes of our bodies, such as the immune system. As do many other forms of “alternative” healing, imagery relies on the assumption of direct and powerful links between mind and body, some of which are neither proven nor real. John Milton, the great English poet, wrote that the human mind “can make a heaven of hell…” It is this power that imagery and visualization seek to tap.

What It Is

Imagery is a therapeutic process in which mental pictures play the central role. Imagination and memory are used to mentally taste, smell, see, and hear the images that you, or a guide, want to envision. Imagery has been used for medical purposes since at least the thirteenth century, when Tibetan monks meditated on statues of the Buddha, imagining the Buddha healing illnesses. Some imagery advocates believe that the technique was practiced by the ancient Greeks, Romans, and Babylonians as well.

Common imagery exercises include palming and guided imagery. In palming you place your palms over your closed eyes. You imagine your mind’s field of vision changing first to a color that you associate with stress and tension, such as red, and then to a color that you associate with calm and relaxation. Deep blue is an example of a color that many find calming. Visualization of colors that feel calming is thought to promote relaxation.

In guided imagery people visualize a goal that they want to achieve and then picture themselves achieving it. Guided imagery is not limited to medicine. Athletes often use it, believing that mentally rehearsing a performance increases the chances of success during actual competition. For example, a baseball player might imagine standing at bat, receiving a pitch, and making a hit. A gymnast might imagine going through a complicated routine of floor exercises, without even setting foot on the mat.

An example of guided imagery often used in medicine is the Simonton method. Developed in the early 1970s by radiation oncologist O. Carl Simonton and his wife, Stephanie Matthews-Simonton, the method involves cancer patients’ imagining a series of images of the body fighting tumor cells. A common exercise, which probably stems from the popular video game, is picturing the cells of the immune system as a Pac-Man character gobbling up and destroying cancer cells. It is important to note that the Simontons developed their method as a complementary therapy to be used along with, not instead of, mainstream cancer therapy. Their publications advise patients to continue conventional treatment.

Imagery exercises can be practiced by the individual alone or led by a health professional trained in the techniques. Most imagery sessions with a therapist last from 20 to 30 minutes. In self-guided sessions, people usually follow instructions from a book or audio recording.

What Practitioners

Say It Does

Imagery can serve as a relaxation technique similar to other mind-body approaches such as meditation and hypnosis. Unlike the latter two, which usually involve focusing attention on one thing for a period of time, imagery often involves frequent changes in focus. Advocates claim that imagery has physiological and psychological effects. Imagery’s physiological effects are similar to those of other relaxation techniques. It can lower blood pressure, alter brain waves, and decrease heart rate. Imagery is said to provide symptom relief of physical problems, such as pain, and emotional symptoms, such as anxiety. It also may improve the effectiveness of pharmacological or other therapies, as in the example of the Simonton method. If imagining a delicious platter of food evokes salivation, other mental images should have similar effects on other physiological events.

In addition to physiological results, imagery can lead to psychological and emotional breakthroughs. There are case studies of patients with physical ailments having no apparent medical cause who were able to substantially reduce their symptoms through a program of psychotherapy and imagery.

Beliefs on Which It Is Based

At the root of imagery is a belief common to all mind-body approaches: the idea that the mind influences the health of the body. Advocates extend the evidence of mind-body techniques that produce physical changes to what they see as its logical conclusion—that these techniques can contribute to the healing of disease, working as complementary therapies to enhance the effectiveness of mainstream treatments. Mind-body efforts, advocates say, can help conventional therapies work in less time, with fewer side effects, and with a better chance of success.

Lacking well-documented mechanisms to explain the effects of imagery, advocates speculate that the act of imagining an experience stimulates the same part of the brain as does the actual experience. For example, imagining a song and actually hearing the song both stimulate the same part of the brain. This hypothesis has been confirmed using positron emission tomography (PET) scans of the brain. Practitioners speculate that stimulation of higher brain functions leads to activation of the nervous and endocrine systems, which in turn affect body functions such as the immune system.

Research Evidence to Date

The best available research indicates that guided imagery has value as a relaxation technique and is therefore a useful complementary therapy. Carefully designed, scientifically valid studies, however, provide no evidence that guided imagery can help reduce disease or even influence the effects or action of conventional treatments in serious diseases such as cancer. The Simonton method, for example, has not been proven to increase survival time in cancer patients.

What It Can Do for You

Imagery fits the category and achieves the benefits of many other mind-body interventions. Many people find it relaxing. Some anecdotal evidence suggests that it may be able to do more than make people feel good, but scientific research has not validated imagery as a healing tool.

Where to Get It

Many therapists are trained to administer imagery techniques, and most explain, appropriately, that imagery does not cure illness but rather should be used as an adjunct or complement to conventional therapy. When seeking a therapist in your area, it may be helpful to obtain references from past patients. As when engaging any professional, question the therapist about experience, areas of specialization, and professional credentials.

Imagery is inexpensive, particularly if self-taught or self-administered. It is not difficult to learn, and it is safe. There are many books, CDs, DVDs, and websites devoted to the use of imagery.

Barrie R. Cassileth, MS, PhD, is Laurance S. Rockefeller Chair and chief of the Integrative Medicine department at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City. She has an extensive medical leadership career and is a recognized authority on complementary therapies and integrative medicine in oncology. Her work includes more than 170 publications in medical literature, more than 40 medical textbook chapters, and 22 books for physicians, patients, and families. She was a founding member of the Advisory Council to the US National Institutes of Health Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine; she previously served on the National and the NY-NJ Regional Boards of the American Cancer Society and on multiple national and international committees. She is a staunch opponent of cancer quackery. She is founding president of the Society for Integrative Oncology. Since joining MSKCC in 1999, Dr. Cassileth has established prototypic research, education, and clinical programs in integrative medicine. Her most recent book, The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors and Health Professionals, was published in 2011 by World Scientific Publishing Company.

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