What Can 1 Week of Guided Imagery Do for the Misery of Nausea and Vomiting during Pregnancy?

Morning sickness in the first trimester of pregnancy is pretty commonplace, typically showing up after 6 weeks, with the yuckiness peaking around week #9 and usually fading by week #12, at the end of the first trimester.  It’s likely the result of a sudden rise in pregnancy hormone levels – estrogen and hCG, (human chorionic gonadotropin).

And although it’s no day at the beach to feel seasick for weeks, it’s nothing like Hyperemesis Gravidarum (HG), a truly nasty condition that affects maybe 1-2% of pregnant women. It means persistent, severe nausea and vomiting, so intense that it can lead to weight loss and dehydration. Some women have to be hospitalized so fluids can be replenished with an IV tube. And they feel unspeakably horrible.

Morning sickness in the first trimester of pregnancy is pretty commonplace, typically showing up after 6 weeks, with the yuckiness peaking around week #9 and usually fading by week #12, at the end of the first trimester.  It’s likely the result of a sudden rise in pregnancy hormone levels – estrogen and hCG, (human chorionic gonadotropin).

And although it’s no day at the beach to feel seasick for weeks, it’s nothing like Hyperemesis Gravidarum (HG), a truly nasty condition that affects maybe 1-2% of pregnant women. It means persistent, severe nausea and vomiting, so intense that it can lead to weight loss and dehydration. Some women have to be hospitalized so fluids can be replenished with an IV tube. And they feel unspeakably horrible.

Some people are more prone to HG.  There’s a hereditary component to it and a couple of genes associated with it.  Also, carrying more than one fetus means more hormones rising, and that’s associated with a greater probability of HG.  And, if it’s a young girl who is pregnant, HG is more likely to rear its ugly head.

The condition became better known when the press covered Kate Middleton, Duchess of Cambridge, suffering mightily from it with all three of her royal pregnancies.

Now, we already know from multiple studies that guided imagery can reduce nausea and vomiting when it shows up as a side-effect of chemotherapy. But a recent study out of Iran (where they seem to have a soft spot for guided imagery and study its efficacy a lot) shows that it can help with HG, too.

Researchers from Zahedan University evaluated the effects of relaxation and guided imagery, which they call “psycho-education”, on Hyperemesis Gravidarum, with a quasi-experimental study using a pre- and post-test design.[1]

They randomly split up 100 pregnant women suffering from HG into an intervention group and a treatment-as-usual control group.  All had their symptoms measured by the Pregnancy-Unique Quantification of Vomiting and Nausea (PUQEN) scale. 

The women in the intervention group got 3 sessions of relaxation and guided imagery training in the course of one week.  Four weeks after the training was over (and before the 16th week of pregnancy), all the women were again assessed on the same measuring instrument.

Analysis showed that although there was no difference in degree of HG between the intervention group and the controls before the training, the scores afterward on the 4-week follow up test showed that the women trained in relaxation and guided imagery were significantly less symptomatic than the controls (p = 0.035).

So, there you have it – data showing that a “psycho-education” of relaxation and guided imagery had a positive and significant effect on reducing the intensity of HG.

Oh, and need I say the obvious? Once again, we see positive findings from a really brief guided imagery protocol, delivered over a mere one week.  And yet it kept producing results many weeks later.  That’s consistent with scores of other findings on several kinds of meditation, and it’s hugely encouraging.


[1] Shakiba MParsi HPahlavani Shikhi ZNavidian A. The Effect of Psycho-Education Intervention Based on Relaxation Methods and Guided Imagery on Nausea and Vomiting of Pregnant Women. Journal of Family & Reproductive Health 2019 Mar;13(1):47-55.