Holistic Health Show with Carl Helvie logoIn 1999, Walker et al studied the influence of visualization and relaxation on cancer patients receiving chemotherapy to see if they would improve the quality of life and the treatment responses. Ninety-six women with newly diagnosed advanced breast cancer took part in a prospective, randomized controlled trial where they were randomly placed in a control group (standard care) or experimental group (standard care plus relaxation training and imagery). Psychometric tests to evaluate mood and quality of life were carried out before each of the six cycles of chemotherapy and 3 weeks after cycle 6 and tests of personality and coping strategy were carried out prior to cycles one and six. Clinical response to chemotherapy was evaluated after six cycles using standard UICC criteria and pathological response was assessed from the tissue removed at surgery. As hypothesized, patients in the experimental group were more relaxed and easy going during the study as measured on the Mood Rating Scale. Quality of life was also better in the experimental group based upon results of the Global Self-Assessment and Rotterdam Symptom Checklist. Visualization also reduced emotional suppression as reported on the Courtauld Emotional Control Scale. In addition, the incidence of clinically significant mood disturbance was very low and similar in both groups. Lastly, the two groups did not differ for pathological response to chemotherapy. These simple, inexpensive and beneficial interventions should be offered to patients wishing to improve quality of life during primary chemotherapy according to the researcher.

In 2001, Burns evaluated the effects of guided imagery and music on mood and quality of life for a small group of 8 post cancer patients who were assigned to either a experimental group or a wait list (control group). For 10 weeks the experimental group took part in individualized weekly sessions that combined guided imagery and music. All subjects completed the Profile of Mood States (POMS) and Quality of Life-Cancer (QOL-CA) questionnaires pretest, posttest, and at a 6 week follow up. Results showed that individuals who participated in the guided imagery sessions score better on both the mood scores and quality of life scores at post test than those participating in the control group. In addition, mood and quality of life scores continued to improve in the experimental group, even after the sessions were completed. Results indicate that guided imagery and music was effective in improving mood and quality of life in these cancer patients.

In  2002, a small study at the Oregon Health and Science University was carried out with 25 women with stage I and II breast cancer to determine the influence of guided imagery on their immune system and emotional state. To evaluate this they were led through individual hypnotic-guided imagery sessions and encouraged to imagine certain kinds of protective immune system cells — called natural killer cells — finding, destroying, and removing cancer cells. After taping the initial session of guided imagery the women used the tape to practice the guided imagery 3 times a week for 8 weeks at home. The women’s immune function and emotional state were measured 3 times: before the program began, after the 8-week program, and 3 months after the program ended. Results showed that that the women had much less depression and higher natural killer cell counts after the intervention. .In addition, although the women had more natural killer cells, the activity of those cells was not very different than it had been originally.

In 2003, Kwekkeboom et al carried out a pilot study to test a model to predict success with guided imagery for pain A sample of 62 hospitalized cancer patients currently experiencing pain rated ≥3 on a 0 to 10 scale completed questionnaires and used an audiotaped imagery intervention. Researchers found that using guided imagery audiotapes helped reduce pain intensity and that patients with greater visualization abilities may be more likely to experience pain reduction when using guided imagery.

In 2005, Yoo et al assess the effectiveness of progressive muscle relaxation training (PMRT) and guided imagery (GI) in reducing the anticipatory nausea and vomiting (ANV) and post chemotherapy nausea and vomiting (PNV) of patients with breast cancer and to measure the effects on the patients’ quality of life of the interventions. Thirty breast cancer patients were treated with chemotherapy alone and another 30 were given progressive muscle relaxation training (P)MRT) and taught to practice guided imagery during their 6 months of chemotherapy. Results showed the group practicing PMRT and guided imagery experienced less nausea and vomiting, and were less anxious, depressed, and irritable than the group receiving chemotherapy alone. Six months after treatment ended, the PMRT and guided imagery group was still experiencing a better quality of life than the group that didn’t receive these interventions.

In 2007, Hudacek assessed the immunological effects of hypnotic guided imagery as adjuvant therapy in the treatment of breast Two  studies assessing the immunological effects of hypnosis in patients with early stage breast cancer were evaluated: These included an experiment that taught hypnotic guided-imagery therapy to patients and a second one that provided participants with home visits and autogenic training. Both investigations demonstrated improvement in depression and increased natural killer (NK) cell counts after 2 months of hypnosis treatment.. Hudacek concluded that hypnotic imagery yielded a significantly heightened count of “natural killer” or NK cells.

In 2008, Trakhtenberg  reviewed the research on the effect of guided imagery (GI) on the immune system and concluded that guided imagery (GI) can reduce stress and elevate the immune system. 

Preliminary research indicates that guided imagery may improve immune function in people with cancer. In a 2008 pilot study of 28 breast cancer patients, for instance, those who took part in a guided imagery and relaxation program prior to undergoing surgery experienced increased activity in natural killer cells (known to play a key role in immune defense).                                                   

In 2008, Lengacher et al studied the use of guided imagery with breast cancer patients to determine its effectiveness to reduce stress and improve immune functioning. Twenty eight breast cancer patients, aged 25 to 75, with a diagnosis of stage 0, 1 or 2 breast cancer were given a pre-test and post-test. The experimental group received a relaxation and guided imagery intervention and the control group received standard care. Significant differences between the two groups were found at 4 weeks postsurgery. T-tests showed increased NK cell cytotoxicity for the intervention group at 100:1, 50:1, and 25:1 effector cell: target cell ratios (E:T) (p < .01 to p < .05) and increased activation for IL-2 at 100:1, 50:1, 25:1, and 12.5:1 (E:T) (p < .01 to p < .05) for the intervention group as compared to the control group. Thus, results showed that guided imagery produced significant effect sizes, with increased natural killer cell activity and cytotoxicity, and increased activation of Interleukin-2.

In 2009, Eremin et al studied eighty women undergoing multimodality treatment for large (>4 cm) or locally advanced (T3, T4, Tx, N2), breast cancers who participated in a randomized controlled trial (RCT) to evaluate the immuno-modulatory effects of relaxation training and guided imagery. These women had undergone chemotherapy followed by surgery, radiotherapy, and hormone therapy. Those in the intervention group were taught relaxation and guided imagery and kept diaries of the frequency of relaxation practice and imagery vividness. On 10 occasions during the 37 weeks following the diagnosis, blood was taken for evaluation. The control group received standard care. Results revealed big differences in activated T-cells, natural killer cells and lymphokine-activated killer cells in the two groups. Researchers concluded that guided imagery up-regulated anti-cancer host defenses during and after chemotherapy and radiotherapy.

In 2009, Cohen et al, studied the effects of stress management including diaphragmatic breathing and guided imagery before surgery of prostate cancer patients on quality of life and mood. For the randomized study, 159 early stage prostate cancer, radical prostatectomy patients were assigned to receive either: 1) two 60-90 minute sessions of pre-surgical stress management intervention and brief booster sessions the morning of, and 48 hours following surgery including diaphragmatic breathing and relaxing guided imagery and cognitive therapy taught by a psychologist; 2) two 60-90 minute individual supportive attention sessions and boosters similar to the stress management group with the same psychologist but sessions were more general, and centered around open discussions;  3) or standard care where no behavioral therapy was provided.

Results in terms of short-term effects, at one week before and the morning of surgery, men in the stress management group had the lowest levels of mood disturbance followed by those in the supportive attention group, with patients in the no therapy group having the highest level, with the difference between the stress management and standard care groups being statistically significant Results at long-term follow-up, at six weeks, six and 12 months, patients in the stress management group reported a higher level of physical functioning and aspects of quality of life than patients in the other two cohorts; the difference between the stress management and standard care groups was also statistically significant. The largest difference between the groups was at the 12-month follow-up, when the standard care group reported lower levels for physical functioning than those who received the stress management intervention.

Cohen and his team also analyzed immune function and stress hormone levels from collected blood samples. Results showed that those who used diaphragmatic breathing and guided imagery had significantly higher levels of natural killer cell cytotoxicity, higher levels of circulating pro-inflammatory cytokines, and higher tumor necrosis factor-α. And while the immune parameters got better and better for the intervention group, they decreased or stayed the same for the controls

In 2010, King evaluated and summarized studies performed from 2001 to 2008, which investigated the use of guided imagery GI for relief of cancer pain.  Over half of the patients diagnosed with cancer suffer from pain, and analgesic medications may not provide complete relief.  Thus,  alternative measures are sought. Mind—body techniques such as guided imagery (GI) have been thought to be helpful and used as an adjuvant to pain relief. Electronic databases were searched with the keywords cancer pain, visualization, and guided imagery, for any studies utilizing GI with an outcome measure of pain. Five studies included pain as either a primary or a secondary outcome measure. In three of those, pain intensity and pain-related distress decreased in the GI intervention  group versus the control. Inconsistency in the methodological qualities of these trials indicate a need for further research to provide better evidence for the use of GI in cancer pain.

In 2012, Serra et al studied the outcomes of breast cancer patients using guided imagery while receiving radiation.  Patients receiving guided imagery were monitored with biofeedback, blood pressure, respiration rate, pulse rate, and skin temperature before and after each radiation session. In addition, the EuroQoL Group’s EQ-5D questionnaire was used for to collect a subjective assessment and a satisfaction survey was used for patient feedback at the end of radiation therapy.  Measured parameters revealed statistically significant improvement from baseline, with decreases noted in respiration rate and pulse rate as well as systolic and diastolic blood pressure. Their skin temperature increased, indicating more peripheral capillary flow secondary to a decrease in the sympathetic response. In addition, 86% of participants described the guided imagery sessions as helpful, and 100% said they would recommend the intervention to others.