The Efficacy of Using Guided Imagery
for Preoperative and Postoperative Healing
Angela G. Bowers, Ph.D.

Surgery is a threatening experience for most people. The anticipation of unknown and painful procedures, worries of survival, separation from family, and a myriad of other reasons makes this experience one of the most stressful ones that a person can undergo.

Although the use of psychological preparation for surgery has been documented for over forty years, it appears to have become much more prevalent within the last ten to fifteen years. Specifically, guided imagery as a form of relaxation has received much support in the research since the late 1980's. Although studies abound regarding its effectiveness, it is still not used routinely in most clinical/hospital settings. Most patients are unaware of its benefits, in part because these studies have been published mainly in academic and professional journals.

However, patients are much more willing now than ever to take responsibility for their health and to be in partnership with their healthcare providers. As people become more aware of the benefits of relaxation in maintaining and restoring their health, they will create their own healing process by requesting these services, or providing their own.

Guided imagery is a powerful process that encourages people to form pictures in their minds of relaxing places or things. Through being led by specific instructions, people can form images that promote relaxation, concentration, body awareness, and distraction from unpleasant circumstances. The more practice one has with imagery, the better one becomes. So even people who claim to have difficulty imaging can perform this skill, and improve over time.

One of the reasons that guided imagery is so effective for surgical patients is that it lowers anxiety. Stress causes the body to send chemical messengers such as hormones, immunomodulators and neuropeptides, causing such effects as increased heart rate, blood pressure, cardiac output, oxygen consumption and a host of other symptoms, which interfere with healing and well-being.

Anxiety also delays wound repair because elevations of glucocorticoids can suppress the manufacturing of interleukin 1 and other important substances that the body makes to heal. Furthermore, anxiety interferes with deep sleep which the body needs in order to heal, and in order to make appropriate amounts of growth hormone for wound repair.

Research has shown that guided imagery is so successful for patients because there is a decreased need for pain medication, and a significant reporting by patients of less surgical discomfort. Again, anxiety contributes to postsurgical pain, but guided imagery works by giving people more of a sense of control, distraction from their discomfort and a reduced state of anxiety. The use of less pain medication decreases the risk of side effects such as nausea, vomiting, pruritus, or obstruction of the intestines.

Patients who are less anxious are reported to be more compliant with postoperative instructions, so they typically fair better by following physicians' recommendations. They are also more likely to leave the hospital earlier than patients not using this relaxation technique. In one 2002 study of cardiac patients, those who used guided imagery before, during and after surgery left an average of 1.5 days earlier than patients who did not have the benefit of learning this skill.

Guided Imagery is a wonderful technique that promotes a sense of peace, tranquility and control. It allows for the patient to confront their fears and anxiety by creating a focused state of concentration, which typically elicits positive and powerful memories and feelings. This process then encourages the patient to be more optimistic, which is another contributor to successful surgical outcome, and it gives the patient a productive way to be an active contributor in their overall surgical experience.

Patients using guided imagery report more satisfaction in their care during hospitalization and in their recovery. They report quicker return to normal functioning, both physiologically and psychologically, which is of great benefit to the patient, as well as to the caregiving families.