1. INTRODUCTION:

Guided imagery (GI) a non-invasive, non-expensive and non-pharmacological method which is used for different healing purposes moreover reduction of pain, stress and anxiety. It is an effective method in which mind body mechanism is involved. This method treat only mind along with patient and not illness. it’s a very easy method suited for everyone who feel to use it .various methods adopted in guided imagery for different age groups are found to be successful .guided imagery can be practiced with some simple instructions and used at any time of need .

2. DEFINITIONS AND MEANING:

Guided imagery (GI) is a widely used complementary therapy, and its use for getting healed has increased over the past two decades. However, definitions of GI used in various health science disciplines are inconsistent. Here let’s see some of the meaningful definitions of guided imagery relevant to this article. Some of them are as follows: GI involves the generation or recall of different mental images, such as perception of objects or events, and can engage mechanisms used in cognition, memory, and emotional and motor control ^[1].The term “guided imagery” refers to a wide variety of techniques, including simple visualization and direct suggestion using imagery, metaphor and story-telling, fantasy exploration and game playing, dream interpretation, drawing, and active imagination where elements of the unconscious are invited to appear as images that can communicate with the conscious mind^[2].Any of various techniques (as a series of verbal suggestions) used to guide another person or oneself in imagining sensations and especially in visualizing an image in the mind to bring about a desired physical response (as a reduction in stress, anxiety, or pain)^[3].

As to begin with guided imagery and its overview, it finds as a need to know some important terms and definition which stay related to guided imagery and bring out the significance of guided imagery to the world

3. PAIN:

Pain is experienced by everyone. It is the most common reason for seeking health care. Pain is a two-edged sword. On the one hand it warns us that something is wrong in the body and influences us to seek medical attention. On the other hand, fear of pain may cause us to delay medical treatment. Pain management is considered such an important part of care that the ‘American Pain Society” coined the phrase “Pain: The 5th Vital Sign” to emphasize its significance and to increase the awareness among health care professionals of the importance of effective pain management ^[4].According to the International Association for Pain, it is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (2012).

4. ANXIETY:

We all experience some anxiety sometimes, but many people don't really know what it is. According to one dictionary definition, anxiety can be defined as a strong and unpleasant feeling of nervousness or distress in response to a feared situation, often accompanied by physiological effects such as nausea, trembling, breathlessness, sweating, and rapid heartbeat ^[5].

5. STRESS:

Stress is simply a reaction to a stimulus that disturbs our physical or mental equilibrium. In other words, it's an omnipresent part of life. A stressful event can trigger the “fight-or-flight” response, causing hormones such as adrenaline and cortisol to surge through the body ^[6].

6. WHAT IMAGERY IS? HOW IT’S HEALS? LET’S MOVE BIT SCIENTIFIC:

Imagery is a flow of thoughts you can see, hear, feel, smell, or taste. An image is an inner representation of your experience or your fantasies--a way your mind codes, stores, and expresses information. Imagery is the currency of dreams and daydreams; memories and reminiscence; plans, projections, and possibilities. It is the language of the arts, the emotions, and most important, of the deeper self. Imagery is a window on your inner world; a way of viewing your own ideas, feelings, and interpretations. But it is more than a mere window--it is a means of transformation and liberation from distortions in this realm that may unconsciously direct your life and shape your health.

7. IMAGERY AND PHYSIOLOGIC CHANGE:

Imagery in healing is probably best known for its direct effects on physiology. Through imagery, you can stimulate changes in many body functions usually considered inaccessible to conscious influence. A simple example: Touch your finger to your nose. How did you do that? You may be surprised to learn that nobody knows. A neuro anatomist can tell us the area of the brain where the first nerve impulses fire to begin that movement. We can also trace the chain of nerves that conduct impulses from the brain to the appropriate muscles. But no one knows how you go from thinking about touching your nose to firing the first cell in that chain. You just decide to do it and you do it, without having to worry about the details. Now make yourself salivate. You probably didn't find that as easy, and may not have been able to do it at all. That's because salivation is not usually under our conscious control. It is controlled by a different part of the nervous system than the one that governs movement. While the central nervous system governs voluntary movement, the autonomic nervous system regulates salivation and other physiologic functions that normally operate without conscious control. The autonomic nervous system doesn't readily respond to ordinary thoughts like "salivate." But it does respond to imagery. Relax for a moment and imagine you are holding a juicy yellow lemon. Feel its coolness, its texture, and weight in your hand. Imagine cutting it in half and squeezing the juice of one half into a glass. Perhaps some pulp and a seed or two drop into the glass. Imagine raising the glass to your lips and taking a good mouthful of the tart juice. Swish it around in your mouth, taste its sourness, and swallow. Now did you salivate? Did you pucker your lips or make a sour face when you imagined that? If you did, that's because your autonomic nervous system responded to your imaginary lemon juice.

SEE THIS:

If your mind is full of thoughts of danger, your nervous system will prepare you to meet that danger by initiating the stress response, a high level of arousal and tension. If you imagine peaceful, relaxing scenes instead, it sends out an "all-clear" signal, and your body relaxes ^[7]. The images are typically visualized within a state of relaxation, possibly with a specific outcome in mind (e.g., pain relief)^[8].Imagery of various types has been shown to affect heart rate, blood pressure, respiratory patterns, oxygen consumption, carbon dioxide elimination, brain wave rhythms and patterns, electrical characteristics of the skin, local blood flow and temperature, gastrointestinal motility and secretions, sexual arousal, levels of various hormones and neurotransmitters in the blood, and immune system function.' But the healing potentials of imagery go far beyond simple effects on physiology.

8. HOW DOES IMAGERY WORK?

The ultimate mechanisms of imagery are still a mystery. In most people, the left brain is primarily responsible for speaking, writing, and understanding language; it thinks logically and analytically, and identifies itself by the name of the person to whom it belongs. The right brain, in contrast, thinks in pictures, sounds, spatial relationships, and feelings. It is relatively silent, though highly intelligent. The left brain analyzes, taking things apart, while the right brain synthesizes, putting pieces together. The left is a better logical thinker, the right is more attuned to emotions. The left is most concerned with the outer world of culture, agreements, business, and time, while the right is more concerned with the inner world of perception, physiology, form, and emotion. The essential difference between the two brains is in the way each processes information. The left brain processes information sequentially, while the right brain processes it simultaneously. Imagine a train coming around a curve in the track. An observer is positioned on the ground, on the outside of the curve, and he observes the train to be a succession of separate though connected cars passing him one at a time. He can see just a little bit of the cars ahead of and behind the one he is watching. This observer has a "left-brain" view of the train. The "right-brain" observer would be in a balloon several hundred feet above the tracks. From here he could not only see the whole train, but also the track on which it was traveling, the countryside through which it was passing, the town it had just left, and the town to which it was headed. This ability of the right hemisphere to grasp the larger context of events is one of the specialized functions that make it invaluable to us in healing. The imagery it produces often lets you see the "big picture" and experience the way an illness is related to events and feelings you might not have considered important. You can see not only the single piece, but the way it's connected to the whole. This change of perspective may allow you to put ideas together in new ways to produce new solutions to old problems. A right-brain point of view may reveal the opportunity hidden in what seems to be a problem ^[7].

9. THREE PRINCIPLES OF GUIDED IMAGERY:

9.1 First Principle: The Mind-Body Connection:

First of all, to the body, images created in the mind can be almost as real as actual, external events. The mind doesn't quite get the difference. That's why, when we read a recipe, we start to salivate. The mind is constructing images of the food -- how it looks, tastes and smells; it might even be evoking the sounds of the food cooking or the feel of its texture as it's being chewed. And all the while, the body is thinking "dinner is served", and is responding by generating saliva and appetite. The mind cues the body especially well if the images evoke sensory memory and fantasy sights, sounds, smells, feel and taste and when there is a strong emotional element involved. So, for instance, a strongly evocative image might be remembering the sound and timbre of Daddy's smiling voice, telling you he's proud of you; or the internal bristling of energy all through your body as you realize that you are about to triumph at something that you are home free golden. These sensory images are the true language of the body, the only language it understands, immediately and without question.

9.2 Second Principle: The Altered State:

Secondly, in the altered state, we're capable of more rapid and intense healing, growth, learning and performance. We are even more intuitive and creative. In this ordinary but profoundly powerful, immersive mind-state, our brainwave activity and our biochemistry shift. Our moods and cognition change. We can do things we couldn't in a normal, waking state lift a tree that has fallen on a child; write an extraordinary poem; replace our terror of a surgical procedure with a calming sense of safety and optimism; abate a life-threatening histamine response to a bee sting. We wander in and out of altered states all through the day, as a matter of course. Sometimes it's not a conscious choice, and we drive past our exit on the highway. At best, the altered state is a state of relaxed focus, a kind of calm but energized alertness, a highly functional form of focused reverie. Attention is concentrated on one thing or on a very narrow band of things .As this happens, we find we have a heightened sensitivity to the object of our attention, and a decreased awareness of other things going on around us, things we would ordinarily notice. We are so engrossed, we lose track of time or don't hear people talking to us. Or we are so focused on our tennis, we don't realize we were playing on a broken ankle, and the pain isn't perceived until the game is over. The altered state is the power cell of guided imagery. When we consciously apply it, we have an awesome ally, a prodigious source of internal strength and skill.

9.3 Third Principle: Locus of Control:

The third principle is often referred to in the medical literature as the "locus of control" factor. When we have a sense of being in control, that, in and of itself, is therapeutic, and can help us to feel better and do better.

Feeling in control is associated with higher optimism, self-esteem, and ability to tolerate pain, ambiguity and stress. Decades of research in ego psychology informs us that we feel better about ourselves and perform better when we have a sense of mastery over the environment. Conversely, a sense of helplessness lowers self-esteem, our ability to cope and our optimism about the future. Because guided imagery is an entirely internally driven activity, and the user can decide when, where, how and even if it is applied, it has the salutary effect of helping us feel efficacy and mastery; that we have some control. So, when you put all this together, you have a technique that generates an altered state, in which the mind is directed toward multi-sensory images that the body perceives as real. This is done exactly when, where and how the user wishes. And that's why it's so effective ^[9].

10. WHAT KINDS OF ILLNESSES CAN BE TREATED WITH IMAGERY?

Imagery can be helpful in so many ways that it is more accurate to think of it as a way of treating people than a way of treating illnesses. Imagery can help you whether you have simple tension headaches or a life-threatening disease. Through imagery, you can learn to relax and be more comfortable in any situation, whether you are ill or well. You may be able to reduce, modify, or eliminate pain. You can use imagery to help you see if your lifestyle habits have contributed to your illness and to see what changes you can make to support your recovery. Imagery can help you tap inner strengths and find hope, courage, patience, perseverance, love, and other qualities that can help you cope with, transcend, or recover from almost any illness ^[7].Weydert et al suggested that during GI, all the senses should be used because the more detail with which the image is sensed, the more potential for pain relief it has ^[10].There are, of course, certain symptoms and illnesses that seem to be more readily responsive to imagery than others. Conditions that are caused by or aggravated by stress often respond very well to imagery techniques. These include such common problems as headaches, neck pain, back pain, "nervous stomach," spastic colon, allergies, palpitations, dizziness, fatigue, and anxiety. Other major health problems including heart disease, cancer, arthritis, and neurological illnesses are often complicated by or themselves cause stress, anxiety, and depression. The emotional aspects of any illness can often be helped through imagery, and relieving the emotional distress may in turn encourage physical healing. ^[7]For instances even 10 minutes of imagery can reduce blood pressure, lower cholesterol and glucose levels in the blood, and heighten short- term immune cell activity. It can reduce blood loss during surgery and morphine use after it. It lessens headaches and pain. It can increase skill at skiing, skating, tennis, writing, acting and singing; it accelerates weight loss and reduces anxiety ; and it has been shown, again and again, to reduce the aversive effects of chemotherapy and radiation therapy, especially nausea, depression, soreness and fatigue ^[9].

11. IMAGERY FOR OUR CHILDREN: A MAGICAL HEALING GARDEN:

Spring is a time of new beginnings: flowers blooming and seeds blossoming into lush plants that we've nurtured and cultivated earlier. Spring can also be a time of renewal for our children - to open their hearts, to share their hopes, and to expand their dreams. We can guide our children toward their right path by helping them connect with their own inner seeds - of peace - of joy - of love. We can teach them how to the heal hurts of their personal dark winter - in the present, and from the past. And, we can support our children in developing their potential. The impact of positive images while in a relaxed state is tremendous. After one group session using the magic garden and healing pond imagery, three boys were relieved of the pain of their stomachache, headache, and canker sore respectively. During another group, an adolescent girl with a pounding headache eliminated her pain without medication, and later successfully taught the simple imagery technique to her friends at school. To inspire and to start you using imagery with the kids you work or live with right away, here are three brief guided imageries. First, use "a rainbow light" to reach a very deep relaxed state; second, bring in "a magic garden" to help grow inner seeds; and third, make use of "a healing pond" to heal physical and emotional hurts. They can be used separately or together, based on your goals with the children. An animal friend (or wizard) is used as a guide and helper, a valuable tool to access unconscious wisdom. "Gifts" are used as unique ways to receive power and assistance. If you choose to use the following imageries, you may find your kids feel healthier and happier, while learning to expand their own healing capabilities. You'll be surprised at what wise answers their inner guides offer, what gifts they receive, and what awareness they develop that can be applied to their everyday world. Use your most soothing, slow voice with soft music in the background if possible.

11.1 A Relaxing Rainbow:

"Allow your eyes to gently close and focus on your breathing we're letting all our troubles float away in beautiful rainbow balloons. Imagine a beautiful colored rainbow floating above your head the purples and the blues the greens and the yellows the oranges and the reds and maybe some gold and silver Notice what colors your special rainbow is And as you breathe, this beautiful rainbow grows larger and larger and starts to gently wash over you to help you relax And to go inside and find that special calm place that waits for you each day." You might now suggest the child relax each part of his/her body as the rainbow light moves through. And then...

"As you breathe you are totally safe in the rainbow light totally safe totally protected very, very comfortable."

11.1.1 Creating Your Magic Garden:

"You find yourself surrounded by the rainbow light as you walk on a special path there are beautiful rainbow flowers around you and birds singing . In front of you is a large stunning gate. It is a gate that leads you to your own magic garden. And there is a key to open this magnificent gate It's found under a rock Notice whether your key is gold or silver or copper The key has your initials carved in it so you know this is your gate and your key And one of your special animal friends now appears from around the rock. It is an animal friend that is very wise and very loving, and is here to help you build and grow your magic garden. At this point have the child enter the gate and create their magic garden. You may suggest any plants, trees, flowers, fruits, etc.

"Anything you want you can plant in this magic garden You may even plant seeds of peace and of joy and happiness and of calmness or any other qualities you would like to increase or bring in your life This is your own space This is a very magical time."

11.1.2 Discovering the Healing Pond:

For the healing pond, you can adjust the message depending if the child has physical or emotional hurts, or if your focus is on building their capabilities. "Now there's a part of this garden that has a wonderful healing pond. So you go over to it and this too is a magical place. As you step in the water which is the perfect temperature for you there is a beautiful long rock with soft, fluffy moss on it so you can lie with your head out of the water where you're totally comfortable And as you lie in the healing waters they wash over you and soothe your body and soothe your feelings and any pains or tightness melts away And it's a wonderful place to be as your garden grows. Your little animal friend has helped prepare some magic healing herbal tea for you so that when you drink it any sadness or hurts inside your body disappear and melt away so that all the goodness and all the health and all the joy that you deserve now appears."

11.1.3 The Blossoming Of the Garden:

"And when you are ready step out of the healing pond and dry off Your garden has turned into the most magnificent magical place that you can imagine. See what you have created the beauty the magnificence everything . How incredible and important you are for being able to plant seeds that grow to be tall and healthy just like you are growing. Know that when you take the time to plant seeds and the time to care for them wonderful things can grow."

11.1.4 The Wisdom of the Animal Friend:

"Your special animal friend points out that there is one very precious flower that is calling to you and you lean down near the flower and you smell it it smells wonderful. And notice what color it is … and how big it is and it's special shape. And the flower seems to be talking to you and it tells you something very important for you to know now in your life. To help your own magic grow within yourself. To help all the seeds within you and all your goodness come out. And when you look inside this flower there is a beautiful gift that springs up toward you Something to help you remember your own special growth And to know how wonderfully you're doing."

11.1.5 The Return:

Now you can lead the child back out of the garden with the suggestion that they can return when they want.

"When you're ready you'll come back here slowly feeling your body feeling refreshed and remembering all good things . remembering that wonderful magic garden and all the things you grew and saw and heard and felt remembering everything ."

If you are assisting a group, you have the option to work interactively with individuals after the guided section. This allows you to receive their feedback and provides them an opportunity to further generate their own ideas, delve deeper into their imagery, or help clarify any questions or concerns with your guidance. If you have been working with one child alone all along, feel free to interact with them throughout their imagery once you know they are quite relaxed. At the conclusion, you may permit them to continue to rest. Or, you may suggest that the children draw any images that have come up during the imagery and share their experiences. Pictures can reveal what words do not, and the very process of drawing is often cathartic. Sharing with the group is supportive for each other and helps you as the leader notice any areas that still need to be addressed. It is not necessary to have the perfect script, or years of experience for facility with this work. What is important is your sincerity, your respect for the children, and perhaps most significant, is your allowing these kids to touch their natural inner light of love and healing and bring it forth ^[11].

12. EVIDENCES FOR THE EFFECTIVENESS OF GUIDED IMAGERY:

Guided imagery can be used very effectively in children and adolescent group but it also has healing effects in other age groups also. Children below five years are not recommended to guided imagery, because the imaginative capacity should be fully developed. Children has more imaginative power. Children are less able to communicate their pain. So it is more advisable to use non pharmacological methods like guided imagery than pharmacological method in management of any illness ^[12].Chinese parents use guided imagery for reliving the post-operative pain in their children and found it very effective and suggest that it is a very useful technique to relive pain in children ^[13]. A retrospective chart review of children between 2001 and 2002. 18 patients with chronic abdominal pain caused by FGIDs, guided imagery and progressive relaxation techniques, change in abdominal pain And quality of life, evaluated by the Pediatric Quality of Life Scale (PedsQL®)., Guided imagery and progressive relaxation can safely and effectively reduce chronic abdominal pain in children With FGIDs. This treatment also improved social functioning and school attendance ^[14]. Randomized clinical trial with breathing exercises alone or guided imagery with progressive muscle relaxation 22 Children reported the abdominal Pain. Breathing exercises VS guided imagery Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary. Rate the intensity .Children used the FACES scale. Documented any days the child missed a normal activity because of abdominal pain. Monthly phone calls to the children Guided imagery techniques along with progressive muscle relaxation is more effective than breathing and relaxation techniques for reducing pain episodes and missed activities in children with Recurrent abdominal pain ^[15]. A Pilot Study 34 children with physician diagnosis of functional abdominal Pain. standard medical care with or without home based, Guided imagery treatment.(1)Questionnaires(2) 25-minute, instructional DVD, (3)3biweeklysessions, including 1 booster session (4) a calendar; and (5) a portable CD player, to enable the children to listen to the CDs in a comfortable place at home. Guided imagery treatment plus medical care was superior to standard medical care only for the treatment of abdominal pain, and treatment effects were sustained over a long period ^[16]. A quasi-experimental interrupted time-series design 20 children with sickle cell disease effects of guided imagery training Pain Assessment Tool (PAT), for visual imaging ability using the Kids Imaging Ability Questionnaire (KIAQ), for sickle cell disease– specific self-efficacy using the Sickle Cell Self-Efficacy Scale (SCSES). Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy Guided imagery is an effective technique for managing and limiting sickle cell disease-related pain in a pediatric population ^[17]. In a systematic Review of Randomized Clinical Trials. The evidence for guided imagery effectiveness was checked in alleviating non-musculoskeletal pain and it was founded to be beneficial in reducing the pain level in non musculo skeletal pain ^[18]. A study investigation was to evaluate the effects of guided imagery on postoperative outcomes in patients of 18 and above undergoing same-day surgical procedures. Forty-four adults scheduled for head and neck procedures were randomly assigned into 2 groups for this single-blind investigation. Anxiety and baseline pain levels were documented preoperatively. Both groups received 28 minutes of privacy, during which subject’s in the experimental group listened to a guided imagery compact disk (CD), but control group patients received no intervention The change in anxiety levels decreased significantly in the guided imagery group the guided imagery group reported significantly less pain. The use of guided imagery in the ambulatory surgery setting can significantly reduce preoperative anxiety, which can result in less postoperative pain ^[19].A quality-improvement study, following the PDCA (plan-do-check-act) methodology, compared the effectiveness of teaching mental imagery (MI) for pain management versus conducting a detailed inquiry (DI) about pain-related experiences with acutely injured PICU patients. Methods Participants included 44 hospitalized children and adolescents assigned to one of two intervention groups. Pain was assessed pre and post-intervention using the Wong-Baker Faces Pain Rating Scale and a 0–10 Likert pain rating scale, and the Pediatric Trauma Score was utilized to assess the severity of each child’s injuries. Results showed Boys in the MI condition exhibited a significant decrease in average pain ratings. Girls in the MI condition exhibited a non-significant decrease in average pain ratings. Thus concluded that teaching children the use of MI for pain management in an intensive-care setting was supported ^[20].

13. ARE THERE ANY SIDE EFFECTS OR INDICATIONS WHERE GUIDED IMAGERY SHOULD BE AVOIDED?

There are no known contraindications for using guided imagery. This is not a technique, however, that should be incorporated into patient care when a client is uncomfortable about using it for personal or spiritual reasons. Mind-body approaches should be used in conjunction with, and not in place of, indicated physical therapies ^[21].

14. CONCLUSIONS:

Guided imagery is a noninvasive, non-expensive and non-pharmacological measure which can be applied in any situation of pain ,stress and anxiety. it can be used by both a health professional and a common man ,which make it significant than other methods. Once you got a minimum knowledge or training about it you can practice it by your own as well as on others. It can be suggested to teach parents, children and multidisciplinary professionals about guided imagery because it will help your children at time of need. The evidence suggests that it is a safe and cost-effective treatment modality for children. Further research is needed regarding the effects of guided imagery in such a way that it can be mandatorily used along with medical treatment, for children.

15. ACKNOWLEDGMENTS:

The authors wish to thank their respective Departments for continued support and encouragement in the investigation of the efficacy and mechanisms of action of guided imagery.

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Received on 31.03.2016 Modified on 23.04.2016

Asian J. Nur. Edu. and Research.2017; 7(1): 79-85.

DOI: 10.5958/2349-2996.2017.00017.9