Tools to Keep Guided Imagery a Deep Healing Experience for Trauma Survivors; Ways to Prevent Triggering
I am very interested in the effects of guided imagery on people who have been traumatized. I can see how guided imagery can be difficult to handle and create more anxiety. I can also see how it could be helpful when done in a safe way.
Do you have any suggestions or thoughts on how to teach guided imagery to a person with a history of trauma?
Hello, Eloisa. I appreciate the question.
You're of course right on both counts – guided imagery can trigger some distress in trauma survivors and an upsurge in symptoms (almost always temporary); and it can also be healing – sometimes even extraordinarily healing - for other people. The good news is, it's more frequently the latter.
And yes, there are safeguards we can add, which I’ll go into.
But first I want to say the obvious: that it's not going to be the treatment of choice for everyone, no matter what. Then again, how many things are? A one-size-fits-all treatment for posttraumatic stress is about as easy to find as a unicorn in the forest.
And it’s useful to note that even for a population that’s untraumatized, there’s likely to be 10-12% who aren’t well wired for guided imagery, or who just don’t like it. They might prefer biofeedback or mindfulness meditation or EMDR. Fortunately, there are many routes to positive outcomes.
1. Take the time to let people acquire some quick, reliable, self-soothing techniques that work well for them.
Okay. So that said, one of the best things we can do for safeguarding against inadvertently catalyzing distress, is to first take the time to let people acquire some quick, reliable, self-soothing techniques that work well for them. Sometimes that’s a simple mantra meditation; or kirtan chanting; or meditating on a candle flame; or using the breath for self-calming. You’re probably familiar with Andy Weil’s simple, popular, 4-7-8 breathing technique. We have it as one of the quick meditations on our “Take 5” streaming pages.
Sometimes it’s a simple, heart-based loving-kindness meditation, or body scanning from head to toe or using 3 minutes of tone therapy with a set of N.O.W.’s, or even good, old-fashioned, slightly boring, progressive muscle relaxation. Rest assured, there’ll be something in your mind-body bag of tricks that will suit, and that can be their go-to when they start to feel like they’re getting triggered or even mildly agitated.
2. Teach people to pay careful, respectful attention to their own internal reactions and responses, feelings, and body sensations.
And that in fact leads to another safeguard – teaching people to pay careful, respectful attention to their own internal reactions and responses, feelings, and body sensations, so they can be proactive in heading off distress before it has a chance to gain purchase and gather steam.
Because truly, it’s by helping people focus their attention inward, to become more and more attuned to their own internal signals, that we help them foster and grow their capacity to take better care of themselves. (And of course, this applies especially to trauma survivors, who are far more likely to dissociate, disconnect from their bodies and their emotions, and not notice danger signals of all kinds, internal or external.)
3. Start out with simple, non-threatening, calming guided imagery.
Once the survivor has picked their reliable self-soothing practice, then you can proceed with some guided imagery. When starting out, another safeguard is to start out with simple, non-threatening content - emotionally neutral or mildly positive imagery – a classic is going to a favorite, safe place (real or imaginary, memory, or fantasy - it doesn’t matter; the impact is the same).
4. Take a step back when anxiety is triggered, using the identified, go-to, self-soothing practice.
But even with neutral content, if some triggering or even mild anxiety shows up, we just take a step back and do some self-soothing, using the identified go-to practice. After all, what’s the hurry? We get there however and whenever we get there – the receiver leads the way. Our job is to pay attention and try to keep up (or slow down).
5. Go deeper with more targeted, intense guided imagery as you feel ready.
From there we can either go deeper with more targeted imagery for greater healing; or we can hold steady because at the current plateau, the person has what they need and they’re not interested in doing more.
One thing that’s important to note: we can't always predict who will be triggered and who won't; who will thrive from guided imagery and who may not.
Sometimes a survivor of early childhood sexual abuse, whom you would expect to be triggered by the sound of a soft, inviting voice (easily misinterpreted as seductive, manipulative, or dangerous by a survivor of CSA) will dive right in and gain powerful healing at the Speed of Grace. When that happens, it's something to witness.
Why does this happen? Perhaps the pain has been seasoned over the intervening years, and the timing and current safe, stable life circumstances lend themselves to an absolutely prime readiness for healing.
Others need to take it slowly and incrementally, and they too can get to the same place, just more slowly and less dramatically. As therapists and healthcare providers, we must pay careful attention, assume nothing, and take our cues from the person we’re working with.
And just after a traumatic event – a natural disaster, a violent encounter, a hideous car crash, an agonizing loss, watching something horrifying happening to someone else - is probably not the time for deep healing and psychological investigation – just the self-soothing is plenty. And sometimes that alone ends up being enough. We won’t know until some time has passed and the survivor has settled down and can take stock.
So, you can see from this overlong answer of mine that it’s complicated!
But we have many tools and have even managed to accrue research data and clinical wisdom over the years. And beyond technique alone, if we are seen as trustworthy allies, who have genuine empathy, some decent expertise, emotional connection with our survivors, and confidence in their ability to grow and heal – that tends to be plenty good enough.