Imagery involves the use of mental visualization and imagination to enhance relaxation and alter specific experiences. It may include direct suggestion. Individuals may use recorded scripts to guide the creation of mental images. Guided imagery can integrate techniques founded in multiple psychological theories and hypnotherapy, and it is often combined with the technique of progressive muscle relaxation. Imagery alone has been examined for effectiveness in patients with cancer for chemotherapy-induced nausea and vomiting, chronic pain, sleep-wake disturbances, and cognitive impairment.
Miller, M., & Kearney, N. (2004). Chemotherapy-related nausea and vomiting—Past reflections, present practice and future management. European Journal of Cancer Care, 13(1), 71-81.
Support for the use of nonpharmacologic interventions for the treatment of chemotherapy-induced nausea and vomiting (CINV) was weak.
Many studies were flawed because of small sample sizes and confounding variables (e.g., stage of disease, various chemotherapy regimens, culture, patient compliance).
Preliminary available evidence suggests positive benefits through nonpharmacologic techniques; however, larger randomized trials are needed to demonstrate the exact benefits, including economic.
Hosseini, M., Tirgari, B., Forouzi, M. A., & Jahani, Y. (2016). Guided imagery effects on chemotherapy induced nausea and vomiting in Iranian breast cancer patients. Complementary Therapies in Clinical Practice, 25, 8–12.
To evaluate the effects of guided imagery on chemotherapy-induced nausea and vomiting (CINV) among patients with breast cancer
Women who experienced nausea and vomiting within 24 hours after the first course of chemotherapy were assessed before and after the second course of chemotherapy. For the third course of therapy, participants listened to two audio recorded guided imagery scripts. One had mixed nature sounds as background and the other track instructed listeners to imagine feeling better within a pleasant setting of their choice. Patients listened to the first track the night before the third course of treatment. Prior to chemotherapy, severity and frequency of nausea and vomiting were measured.
PHASE OF CARE: Active antitumor treatment
Quasiexperimental
Morrow Assessment of Nausea and Vomiting
Pre- and post nausea and vomiting scores were lower in the third treatment cycle compared to those in the second cycle of chemotherapy (p = 0.0001).
Guided imagery may be helpful for reducing CINV.
The findings suggest that guided imagery might be helpful to reduce CINV symptoms. This study and report do not provide strong evidence because of multiple limitations. Additional research is needed to determine efficacy. Guided imagery is a very low-risk intervention that might be helpful to some patients, but the appropriate timing of such an intervention related to timing of chemotherapy administration needs to be determined in future research.
Karagozoglu, S., Tekyasar, F., & Yilmaz, F.A. (2013). Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting. Journal of Clinical Nursing, 22, 39–50.
To examine effects of music and visual imagery on anxiety and chemotherapy-induced nausea and vomiting (CINV) in patients receiving chemotherapy
Patients were assigned to the control group during their second cycle of chemotherapy and to the experimental condition during the third cycle of chemotherapy. Anxiety and CINV were measured before and after chemotherapy administration. Nature paintings were used for visual imagery, and instrumental Turkish music was selected for each image. Patients selected the image that was most appealing to them and were told to imagine being in the location of the painting. Patients were given the related music CD to listen to during chemotherapy with headphones.
The study was conducted at a single site, outpatient setting in Turkey.
Patients were undergoing active antitumor treatment.
A pre- and post-test repeated measures, single-group design was used.
Anxiety declined from prechemotherapy to postchemotherapy administration in both conditions. Both pre- and postchemotherapy state anxiety levels were lower during the intervention course of treatment. CINV declined over time for both pre- and postchemotherapy administration. Both pre- and postchemotherapy CINV levels were significantly lower during the intervention condition.
This study does not provide any clear conclusions about the effects of music and visual imagery.
Findings are inconclusive regarding the efficacy of music and visual imagery for anxiety and CINV during chemotherapy administration because of numerous study design and analysis limitations.
Sahler, O.J.Z., Hunter, B.C., & Liesveld, J.L. (2003). The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: A pilot feasibility study. Alternative Therapies, 9(6), 70–74.
A 45-minute music-assisted intervention with relaxation imagery sessions was provided twice a week by a trained therapist from the date of enrollment in the study to discharge.
The study was conducted at a university bone marrow transplant center.
Patients were undergoing the active treatment phase of care.
The study had a case-controlled, nonrandomized convenience sample design.
Patient self-reported pre- and postintervention nausea and pain on a 0–10 scale. Time to engraftment also was measured.
Nausea, pain, and time to engraftment decreased from pre- to postintervention.
The intervention was implemented successfully with a very ill population (i.e., transplant environment).
Troesch, L.M., Rodehaver, C.B., Delaney, E.A., & Yanes, B. (1993). The influence of guided imagery on chemotherapy-related nausea and vomiting. Oncology Nursing Forum, 20, 1179-1185.
Guided imagery was added to a standard antiemetic regimen; subjects in the experimental group listened to a 20-minute audiotape during chemotherapy administration, and the control group received standard antiemetic regimen alone. The intervention was done over three cycles of chemotherapy. The 20-minute tape was listened to 60 minutes prior to cisplatin, the following morning before breakfast, and the following evening at bedtime.
Subjects were recruited from one oncologist’s practice (inpatients and outpatients) in a large, Midwestern teaching center.
The study included a convenience sample and was nonrandomized.