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A History of Guided Imagery & Cancer: We’ve Come a Long Way

17 Oct

When it comes to cancer and guided imagery, the past 30 years have seen some major shifts in attitude and the way we practice – much of it tied to larger forces of change.  It’s been a pretty fascinating ride.  

As late as the 80’s, guided imagery was seen in much of the oncology community as unmitigated fruitloopery – irresponsible, crunchy granola magical thinking that belonged in the same trash bin as crystals, laetrile and the Psychic Friends Network.

I remember when I was researching my first batch of scripts targeting health conditions like arthritis, asthma, cancer and AIDS/HIV, the only physicians who would help me – who would sit down with me and give me medical information - were the ones who lived on my block.  I’m sure they were rolling their eyes on the inside, but they couldn’t hold up under the social pressure of being my neighbor and knowing that if they turned me down, they were going to have to look me in the eye on a regular basis when we met on the tree lawn, taking out the trash.  That was in 1989.

By then, guided imagery had been capturing some positive attention as a promising technique for cancer patients, thanks to the groundbreaking work of Stephanie and Carl Simonton, Bernie Siegel, Larry LeShan, Jeanne Achterberg and some others.  As is often the case with an exciting new technique, the earliest enthusiasts pretty much oversold what guided imagery could do, based on anecdotal evidence, personal miracle stories and general missionary zeal. 

Some promoted it as a method that could heal cancer.  This, not surprisingly, alarmed the medical community, causing concern that patients would opt for guided imagery over conventional treatment. (Thus the term “Alternative Medicine” – a term, you will note, that has lost favor and has all but disappeared, replaced first by CAM – Complementary and Alternative Medicine, and now, all but replaced by Integrative Medicine (which in no way implies ‘instead of’ – and that’s the one that’s sticking.)  

And certainly some hard core patients did in fact see it, along with macrobiotic eating, herbal supplements, shark fins, and energy healing as a preferred option to what they felt was the indiscriminate slash-and-burn chemotherapy that was available at the time.  This was not the general wisdom, however. Most patients were encouraged to try it, along with their chemo or radiation or surgery.

There were other die-hard dicta going around back then, some of you will recall.  This was also the time when the dogma of “Positive Attitude” reached its zenith, mostly from people taking Bernie Siegel’s first book too literally.  Far too many patients and families somehow got it into their heads that if they had a fearful moment; if they became angry or resentful; or if out of their mouths came a discouraging word, they were making themselves sicker.  

Unkind and untrue.  We can’t legislate our feelings nor should we.  Our behavior, that we can legislate.  But feelings? Not so much.  To try to do so is the worst kind of self-bullying we can impose on ourselves.  Intra-personal imperialism, if you will.  And, as I said, destined to fail. Because the more we deny what we feel, the more those feelings push back, lock in and stay stuck, right there.  Rather than suppress them, we empower them and give them more juice.  

And ironically, it was putting on a fake happy face and denying their true feelings that was probably not doing those patients a whole lot of good emotionally or energetically.  We’ve come to understand that what serves a person’s sense of strength and wholeness and general coherence - their personal power and vitality - is to own whatever it is they feel and just breathe it out.  Bless it and release it, so to speak.  A very Buddhist, mindful, aware approach, as it turns out.  Notice it. Acknowledge it. Let it go…. No praise, no blame. (It takes practice, I know. That’s why they call it a practice).

It’s also worth mentioning that back then, the imagery experts – Siegel, Achterberg, Emmett Miller, Shakti Gawain, Larry LeShan and even Louise Hay - were talking about visualizing, literally.  Not guided imagery as we practice it today.  The process was visual - you imagined seeing white blood cells vanquishing your cancer cells; or else you saw a Pac-man munching up your symbolic cancer cells. You could also imagine seeing a tumor shrink or seeing yourself running around leading a healthy life.  It was all seeing.

The notable exception here is the work of Marty Rossman and David Bresler, who founded the Academy for Guided Imagery and created a training and certification process that provided critically important underpinnings and methodology for the technique.  And, as you can see from the name, they included all the senses in their protocols, shifting away from the dominant dependence on visual imagery. AGI has trained hundreds of practitioners in the U.S. and around the world.

At the time, we didn’t know that only 55% of the population is strongly wired for visual sensing, imagining, fantasizing and remembering.  We didn’t know that to cover everyone, and cover them well, we needed to have the imagery engage all the senses…. Imagine sounds, smells, tastes, and kinesthetic feel, inside and outside the body… and imagine emotion, too.  In order to properly enter the lush magic of the imaginal world, we need to engage all our fabulous sensory equipment.  Nor did we realize that kinesthetic imagery - felt sense in the body – was probably going to wind up being the most potent sense for most people, especially when it came to healing the physical body.  So we got a lot better at creating equal opportunity guided imagery in the intervening years, and, you’ll note, the term “visualization” has pretty much faded away.

So that was where things stood, pretty much in the 80’s and 90’s. And in spite of some spectacular anecdotal reports of extraordinary healing with imagery, the general research back then didn’t bear out the primary assumption - that imagery - or visualization, really - could make a dent on the disease itself.

What the clinicians and researchers could claim and prove, was that guided imagery could reduce the unpleasant side effects of the disease and its treatment (nausea, fatigue, anxiety, pain, stress, depression, fear of medical procedures)… And that it could beef up coping ability, quality of life, energy, hopefulness, confidence and motivation.  

The data kept coming in; and after a couple of decades, guided imagery went from being something cranky, demanding, annoying patients insisted on bringing with them to treatment, to becoming a respectable, recommended mind-body therapy - and a legitimate adjunct to treatment.  

Hospitals tripled their adoption rates of offerings like guided imagery (also massage therapy, meditation and Healing Touch or Reiki) over the last decade, from 2000 to 2010.  And although late to the party, the American Cancer Society now describes imagery as a useful adjunct to help people cope on its website.  The webpage that talks about imagery was last updated in 2008.

And that’s important to note, because 2008 was just about the time when there was an upsurge in far more sophisticated and expensive research, involving state-of-the-art blood assays and brain scans.  This was a reflection of a general trend in research, thanks to our better understanding of neuroscience, brain plasticity and cell biochemistry, and some much improved equipment to measure all that.  

And it was in 2008 that several exciting studies were published, showing that yes, guided imagery could indeed produce changes in immune activity on the cellular level.  (So did hypnosis and meditation).

Data analysis from the University of Pennsylvania School of Medicine (Hudacek) concluded that hypnotic imagery yielded a significantly heightened count of Natural Killer or NK cells.   

A piece in the International Journal of Neuroscience (Trakhtenberg) described how guided imagery elevated immune system functioning, and how cell-specific imagery affects corresponding White Blood Counts, Neutrophils and Lymphocytes.  

A small but well designed study with breast cancer patients(Lengacher et al)  in that same year – 2008 - by a group of researchers from the University of South Florida showed that guided imagery produced significant effect sizes, with increased Natural Killer Cell activity and cytotoxicity, and increased activation of Interleukin-2.

A year later, a larger randomized, controlled study out of the UK with breast cancer patients (Eremin, Walker et al) revealed big differences in activated T-cells, Natural Killer Cells and Lymphokine-activated Killer Cells, concluding that guided imagery up-regulated anti-cancer host defenses during and after chemotherapy and radiotherapy.  

And just this year, a randomized, controlled study out of M.D. Anderson (Cohen et al) with men with prostate cancer showed that those who used diaphragmatic breathing and guided imagery had significantly higher levels of natural killer cell cytotoxicity, higher levels of circulating pro-inflammatory cytokines, and higher tumor necrosis factor-α.  And the immune parameters got better and better for the intervention group, while they decreased or stayed the same for the controls.   

So, are we back to where we started, when people were claiming that guided imagery heals cancer?  No.  We’ve got evidence of increased immune function on many levels and with many indicators; but so far, that hasn’t translated into changes in clinical outcomes with cancer per se.

It could eventually, as we get more and more sophisticated about what kinds of imagery are most powerful for which people, and what other modalities it should be combined with, for maximum impact.

  • Does imagery that targets the cells work better than imagery that’s more general, relaxing and inspirational? 

  • Does imagery combined with massage or acupoint tapping increase the therapeutic impact of both?
  • Does doing brief segments of imagery 5 times a day work better than longer segments once or twice a day?  

We don’t know.  But we will in the next few years… just as we’ll have better ways to measure these outcomes.  So stay tuned.  These are promising times.

In the meantime, is it a good idea to use this simple, portable, user-friendly intervention to pump up immune function and de-stress at the same time?  Oh, I think so.  It might make as much sense as taking low dose aspirin every day.  Can’t hurt.  Could help.  

Take care and be well,

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award