Visual imagery involves the mental visualization and imagination to enhance relaxation and alter specific experiences and may or may not include direct suggestion. It may differ from guided imagery in that the process may not be highly specific and aimed at imagining a relaxed setting or memory. Relaxation may involve breathing exercises but not the specific process of progressive muscle relaxation.
Naaman, S.C., Radwan, K., Fergusson, D., & Johnson, S. (2009). Status of psychological trials in breast cancer patients: A report of three meta-analyses. Psychiatry, 72, 50–69.
To determine the overall efficacy and magnitude of clinical benefit of psychological interventions in patients with breast cancer, specifically looking at three outcome variables: anxiety, depression, and quality of life (QOL)
Databases searched were MEDLINE (1966–January 2004), EMBASE (1980–2004), Cochrane Controlled Trials Register (1985–February 2004), PsycLit (1973–2004), Biological Abstracts (1990–December 2003), CancerLit (1975–October 2002), CINAHL (1982–December 2003), and Health Star (1975–January 2004).
Search keywords were randomized clinical trial and breast cancer and psychological interventions (cognitive behavioral therapy, group psychotherapy, relaxation, supportive therapy, visual imagery) and psychological adjustment (anxiety, depression, maladjustment, distress, quality of life).
Studies were included in the review if they
Trials examining efficacy of interventions designed to assuage surgical distress were excluded.
Cook, T.D., & Campbell, D.T. (1979). Quasi-experimentation: Design and analysis issues for field settings. Boston, MA: Houghton Mifflin.
Anxiety
Depression
Quality of Life
Overall ES trends among the three outcomes show that more reliable studies were associated with smaller gains. Interventions targeted to patients with clinically important levels of anxiety or depression tended to reap the most benefit, compared to patients who undergo treatment on a prophylactic basis. Group psychotherapy appears to be superior to individual therapy in the treatment of both anxiety and depression. However, a direct impact of group therapy on QOL was not supported in this analysis. CBT interventions appeared to be equally as effective as supportive-experiential therapies. Interventions need not span beyond 20 hours to produce statistically significant ES.
The quality of most studies was not high.
Future trials in psychosocial oncology should incorporate methodological features to enhance internal validity. Evaluation of statistically significant findings on psychometric testing may not reflect clinically significant findings and vice versa. This underscores the need for incorporating qualitative analysis in future studies. There is an absence of studies examining the efficacy of short-term interventions on QOL in advanced breast cancer and should be addressed in future research. Short-term, group interventions may provide the best utilization of scarce resources for the most effect; however, they should be targeted to those patients experiencing clinically important levels of distress. Findings point to the need for higher quality research design and reporting in this field.
León-Pizarro, C., Gich, I., Barther, E., Rovirosa, A., Farrús, B., Casas, F., . . . Arcusa, A. (2007). A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Psycho-Oncology, 16, 971–979.
The intervention consisted of relaxation and guided imagery provided to patients during hospitalization. The intervention group received training in relaxation and guided imagery for 10 minutes and was given an individualized cassette for use at home and at the hospital. The recording on the cassette consisted of instructions on head-to-toe relaxation and breathing techniques. Patients were then given descriptions of pleasing images (mountains, beach, etc.) based on information gathered from the patients prior to recording of the cassette. Patients in both groups received training regarding brachytherapy, but only study group patients received training in relaxation and guided imagery.
Two hospitals in Spain
A randomized controlled trial design was used.
The intervention group demonstrated a statistically significant reduction in anxiety (p = 0.008) compared with the control group.
Serra, D., Parris, C. R., Carper, E., Homel, P., Fleishman, S. B., Harrison, L. B., & Chadha, M. (2012). Outcomes of guided imagery in patients receiving radiation therapy for breast cancer. Clinical Journal of Oncology Nursing, 16, 617–623.
To examine the effects of guided imagery on patient distress and symptoms during radiotherapy.
Patients received instruction on guided imagery during the first few days of radiotherapy treatment and participated in sessions with a nurse immediately prior to radiotherapy treatments. Sessions lasted about 30 minutes and involved relaxation and breathing exercises with visualization of a calming experience and setting. Patients were provided with a CD for home practice. Study measures were performed at baseline and at the end of radiotherapy treatments. Pre- and postsession pulse, blood pressure, and thermal biofeedback measures were obtained.
A quasiexperimental design was used.
EQ-5D subscale scores for anxiety and depression declined from a mean of 1.42 to 1.26 by the end of treatment (p = 0.01). There was a decline in overall distress scores (p = 0.04), but no significant changes occurred in depression, sleep, or fatigue scores. Patients showed immediate postsession reduction in respiratory rate and blood pressure but no significant differences in thermal biofeedback findings.
The findings suggest that relaxation and imagery can be helpful to patients during radiotherapy.
Findings suggest that relaxation therapy and imagery can be helpful to patients during radiotherapy treatment; however, this study had substantial design limitations that limited the strength of the evidence. Relaxation and imagery, and particularly patients’ use of these techniques on their own, pose no patient risks and can be a practical intervention that is helpful to patients during active treatment.