Menzies, V., & Jallo, N. (2011). Guided imagery as a treatment option for fatigue: a literature review. Journal of Holistic Nursing, 29, 279–286.

To explore research literature related to the use of guided imagery as an intervention for fatigue.

Databases searched were MEDLINE, CINAHL, PsycARTICLES, PsycINFO, and Psychology and Behavioral Sciences Collection from 1980 through 2008, as well as the Cochrane Database of Systematic Reviews and a review of reference lists.

Search keywords were fatigue, tiredness, imagery, guided, and guided imagery.

Inclusion critieria were not specified.

Studies were excluded if they

• Were dissertations
• Used music alone or in combination with guided imagery
• Used hypnosis
• Had relaxation as a keyword.
   

A total of 5,968 references were retrieved. No quality rating was used. A narrative approach was used.

• A total of eight studies were included in the final analysis, with 364 patients (223 in three studies involved patients with cancer).
• The sample range across studies was 8 to 139 patients.
• Of the studies included, two included women with breast cancer, one included patients with colon cancer prior to surgery, one included patients with HIV, one included patients with asthma, one included patients with multiple sclerosis, and one included patients with chronic obstructive pulmonary disease (COPD).
   

Five studies showed no effect, one showed mixed effect, and two demonstrated a statistically significant positive effect in patients with asthma or HIV. Effect sizes from the studies were not reported. Studies varied in measures of fatigue used and intensity of the intervention. The types of images used also varied substantially, which can be expected to influence the results. Study lengths ranged from a single session to multiple daily use for six weeks. The authors noted that the studies that demonstrated significant improvement included the greatest total duration of exposure to guided imagery.

The findings were inconsistent across the studies, and those including patients with cancer did not show a significant effect. Duration of exposure may influence effectiveness. This review did not support the effectiveness of guided imagery alone for fatigue in patients with cancer. 

• The study included a small number of studies with varied sample characteristics, different study measures, and intensity of interventions studied.
• Studies were eliminated that included relaxation because guided imagery and progressive muscle relaxation often are used together.

Insufficient evidence exists from this review to recommend use of guided imagery alone. Additional well-designed research and evidence synthesis encompassing the combination of relaxation and guided imagery are needed.