Guided Imagery Research on Mental Health


Listen Up, HR Program Managers and Mental Health Innovators! 

Behold Boatloads of Compelling Guided Imagery Research on Improving Stress, Anxiety, Depression, and Quality of Life! 

Well, the ammunition I longed for in 1987 is here.  Lots of it.

Having advocated for guided imagery with mixed success in the 1980’s, when there wasn’t enough research to cobble together anything as sophisticated as a Systematic Review (or even a colorful Bubble Map), I find it supremely gratifying to report on the emergence of studies like the one that follows – one of many, I should add.

And not coincidentally, it’s easy these days to champion the adoption of guided imagery in hospitals, health plans, military installations, universities, and corporate wellness departments.

A recent article in the prestigious journal, Lancet Psychiatry, supports making guided imagery a regular addition to standard psychological treatment, and points to its facility for accelerating the reduction of anxiety and depression.  

This Systematic Review[i] by Victoria Pile and her colleagues from King’s College in London and the Karolinska Institute in Stockholm identified 86 papers covering a wide range of guided imagery interventions, focusing on what they refer to as emotional mental imagery.

By that they mean imagery designed to generate positive feelings, (think contentment, gratitude, inspiration, confidence, love, optimism, trust…} or, alternatively, imagery designed to subvert or redirect negative feelings (think fear, shame, anger, resentment, bitterness, self-criticism, hopelessness, self-doubt…).

The authors identified three imagery techniques that emerged as particularly efficacious. They were: 

  • imagery techniques that guided the listener to re-live or fantasize places, people or experiences that generated positive feelings
  • imagery re-scripting therapy – re-writing history in the imagination with a remediating, positive slant, to overtake and supplant the painful charge of a traumatic or disturbing memory
  • imagery-enhanced protocols, such as EMDR, Prolonged Exposure, Imagery Rehearsal Therapy, and the like

And there’s much more. Another seminal, oft-cited guided imagery study is a major Scoping Review by Peter Giacobbi and colleagues[ii]. After reviewing 320 randomized clinical trials that appeared in 216 peer-reviewed journals and included a total of 18,000 adult subjects, Giacobbi and his team from West Virginia University found major benefits in reducing anxiety, stress, and pain; and enhancing progress with rehabilitation and sport skills.

Most of the recent studies on guided imagery’s positive impact look at how it mediates stress and enhances feelings of mastery and self-esteem during specific challenging situations, such as scary medical procedures or intimidating performance demands. 

Happily, there are far too many studies to describe without putting you, Dear Reader, into a stupor. But a representative sampling will show the breadth and range of impressive outcomes, most of them getting ink over the last decade. Citations are in the endnotes.

  • A Randomized, Controlled Trial[iii] shows that guided imagery significantly reduced anxiety and muscle pain, as well as improved vital signs, in patients with COVID-19.
  • A Systematic Review of randomized, controlled trials[iv] (RCT’s) shows guided imagery had beneficial effects on mood, anxiety, and depression (as well as on nausea and vomiting, heart rate, blood pressure, cortisol, and immunity) in cancer patients undergoing chemotherapy.
  • A review[v] of the benefits of guided imagery for sports injuries establishes that guided imagery helps reduce depression, anxiety, and fear of re-injury in athletes, and helps keep them on track with their rehab.
  • A Systematic Review[vi] of RCT’s by Giacobbi concludes that guided imagery is beneficial for anxiety, depression, and general quality of life (as well as reducing pain and improving function) in adults with Rheumatoid Arthritis.
  • An Integrative Review[vii] explores the power of guided imagery to reduce performance anxiety in musicians. Similar results are found for test anxiety, social anxiety, sports anxiety, and general performance anxiety.

I could easily go on for a dozen pages. Suffice it to say there’s a lot more where these came from, and the count multiplies monthly.

One takeaway: for a simple, accessible, reliable mental health intervention in an organization, consider evidence-based guided imagery tools, easily delivered to an infinite number of ears through a portable app or streaming page, available 24/7.

And many thanks to all the researchers and analysts (- all those Giacobbi’s!! -) who are filling in our knowledge gaps with their excellent research, findings, and data analysis, to enrich the field and support mental health in such actionable, meaningful ways.



[i] Pile V, Williamson G, Saunders A, Holmes EA, Lau JYF. Harnessing emotional mental imagery to reduce anxiety and depression in young people: an integrative review of progress and promise. Lancet Psychiatry. 2021 Sep;8(9):836-852. doi: 10.1016/S2215-0366(21)00195-4. PMID: 34419188.


[ii] Giacobbi PR Jr, Stewart J, Chaffee K, Jaeschke AM, Stabler M, Kelley GA. A Scoping Review of Health Outcomes Examined in Randomized Controlled Trials Using Guided Imagery. Prog Prev Med (N Y). 2017 Dec;2(7):e0010. doi: 10.1097/pp9.0000000000000010. PMID: 29457147; PMCID: PMC5812272.


[iii] Parizad N, Goli R, Faraji N, Mam-Qaderi M, Mirzaee R, Gharebaghi N, Baghaie R, Feizipour H, Haghighi MM. Effect of guided imagery on anxiety, muscle pain, and vital signs in patients with COVID-19: A randomized controlled trial. Complement Ther Clin Pract. 2021 May;43:101335. doi: 10.1016/j.ctcp.2021.101335. Epub 2021 Feb 20. PMID: 33647676; PMCID: PMC7982304.


[iv] Kapogiannis A, Tsoli S, Chrousos G. Investigating the Effects of the Progressive Muscle Relaxation-Guided Imagery Combination on Patients with Cancer Receiving Chemotherapy Treatment: A Systematic Review of Randomized Controlled Trials. Explore (NY). 2018 Mar-Apr;14(2):137-143. doi: 10.1016/j.explore.2017.10.008. Epub 2017 Dec 21. PMID: 29506956.


[v] Covassin T, Beidler E, Ostrowski J, Wallace J. Psychosocial aspects of rehabilitation in sports. Clin Sports Med. 2015 Apr;34(2):199-212. doi: 10.1016/j.csm.2014.12.004. Epub 2015 Jan 24. PMID: 25818709.


[vi] Giacobbi PR Jr, Stabler ME, Stewart J, Jaeschke AM, Siebert JL, Kelley GA. Guided Imagery for Arthritis and Other Rheumatic Diseases: A Systematic Review of Randomized Controlled Trials. Pain Manag Nurs. 2015 Oct;16(5):792-803. doi: 10.1016/j.pmn.2015.01.003. Epub 2015 Jul 11. PMID: 26174438; PMCID: PMC4605831.


[vii] Finch K, Moscovitch DA. Imagery-Based Interventions for Music Performance Anxiety: An Integrative Review. Med Probl Perform Art. 2016 Dec;31(4):222-231. doi: 10.21091/mppa.2016.4040. PMID: 27942702.