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Cancer Treatment Side Effects & Supportive and Palliative Care

Guided Imagery, Visualization and Hypnosis

Guided imagery, visualization and hypnosis are cognitive-behavioral techniques in which the patient is guided to imagine relaxing scenarios or a series of experiences. Research using fMRI has shown that when a person visualizes an image of an action, areas of the brain are activated in a manner similar to the actual action (i.e. if the person imagines moving the arm, the motor centers that would be involved in arm movement would light up). In a similar fashion, imagining a relaxing scenario would trigger the physiology of a relaxation response.

Guided imagery, visualization and hypnosis have been shown to be effective in helping oncology patients decrease anxiety), cope better during stressful medical procedures, increase relaxation and well being, enhance pain management, and recover from surgery quicker and with fewer complications.

The main difference between imagery and hypnosis is the emphasis of hypnosis on providing positive mental suggestions to the patient. During hypnosis, the patient is induced into a state of deep relaxation by using imagery and then offered positive suggestions (i.e. if the patient has undergone surgery, the suggestions may involve statements such as "you will recover quickly and will walk within 3 hours of your surgical procedure.") The principles of hypnosis state that in such state of deep relaxation, the person becomes highly receptive to mental suggestions and whatever enters the subconscious mind in that state, is likely to be acted up by the person.

Randomized clinical trials have shown that hypnosis may be effective in oncology surgery for procedural and pre-surgical anxiety and distress; decreasing pain, nausea, fatigue, and discomfort after surgery; decreasing antiemetic medication usage and reducing anticipatory nausea during chemotherapy.

Guided imaging (GI) has been reported to improve outcome following colorectal surgery. For example, a randomized trial using guided imagery tapes before, during and after surgery and compared to a control (standard of care) group showed reduction in pain following anorectal surgery and significantly improvement in sleep quality.

Another study compared oral mucositis pain levels in 94 patients receiving bone marrow transplants (BMT). Patients were assigned to one of 4 groups: (1) treatment as usual control, (2) therapist support, (3) relaxation and imagery training, and (4) training in a package of cognitive-behavioral coping skills which included relaxation and imagery. Patients who received either relaxation and imagery alone or patients their package of cognitive-behavioral coping skills reported less pain than patients in the other 2. An RCT involving 90 patients showed that a brief pre-surgery hypnosis intervention was effective in controlling presurgical distress in women awaiting diagnostic breast cancer surgery.

In a RCT of 200 patients scheduled to undergo excisional breast biopsy or lumpectomy, patients were assigned to a 15-minute pre-surgery hypnosis session conducted by a psychologist or non-directive empathic listening (attention control). Patients in the hypnosis group required less propofol and lidocaine than patients in the control group. Patients in the hypnosis group also reported less pain intensity, less pain unpleasantness), less nausea, less fatigue, less discomfort and less emotional upset. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group, mainly due to reduced surgical time.

Safety

Because of the emphasis on breathing deeply, guided imagery should be used with care in patients who have a history of asthma attacks, who are suffering from lung tumors or breathing-related or cardiac conditions. In these patients, the focus on the breathing may trigger anxiety if not handled properly.

Recommendation

Guided imagery, visualization and hypnosis are highly recommended as preparation for surgical procedures as well as to improve post-surgical outcomes in oncology care. It is also recommended for the co-management of chemotherapy related nausea and vomiting, particularly when offered as preventative before beginning chemotherapy.

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