Chapter 21 1. Define imagery or visualization 2. Practice imagery, using the tart lemon exercise 3. Discuss the history of the use of imagery 4. Identify uses of imagery in clinical practice 5. Identify brief imagery exercises to cope with stressful situations 6. Discuss the use of imagery techniques to improve communication skills 7. Participate in selected exercises to build skills in using imagery to increase feelings of confidence and competence in communication When you use imagery you are deliberately using your imagination for success or wellness (Naparstek, 2008). An image is defined as a mental picture (Merriam-Webster Online Dictionary, 2011a). The term visualization is interchangeable with the term imagery. To visualize is to see or image mentally (Merriam-Webster Online Dictionary, 2011b). We use the term to mean creating an image of something invisible, absent, or abstract. As you read this chapter, begin to create an image of yourself as a confident, successful nurse, communicating assertively, gaining respect, and becoming a dedicated patient advocate. Imagery or visualization is a process of mentally picturing an event we wish will occur in the present or future. It is a process of actually experiencing a picture that we hold in our mind’s eye. In visualizing our picture, we may incorporate our senses to taste it, smell it, and feel it, and imagine the sounds and emotions associated with it. For example, when we visualize a freshly baked apple pie, we can actually smell it, taste the apples, and visualize eating the pie. We might evoke an image in vivid sensory detail of an absent loved one for extra emotional comfort. We might mentally rehearse a nursing procedure before performing it. As part of our fitness training, we might mentally rehearse running a 5K run or a marathon, envisioning being at the finish line successfully and proudly (Naparstek, 2008). How does imagery work? Research shows that the neurophysiology of the brain does not distinguish between an image and the experience of the imagined place or situation as demonstrated through dimensional brain studies (Sternberg, 2010). “The body does not know the difference between what one is thinking and what is actually happening. The image or thought is experienced with one or more of the senses with an associated emotion linking the mind with a feeling state and the body with a resulting physiologic change” (Reed, 2007, p. 262). For example, beginning to worry about an examination, thinking about being unsuccessful, and thinking about the consequences cause the body to respond with a cascade of chemicals of the stress response, adrenaline and cortisol, interfering with immune function and our ability to cope (Reed, 2007). Imagery may be the oldest healing technique used by humans. Early records of this technique have been found on cuneiform tablets from Babylonia and Sumeria. Greek, Egyptian, Asian, and ancient Indian civilizations used visualization. Even today, Navaho Indians and Canadian Eskimos practice imagery for healing purposes (Johnston, 2002). In all these cultures, disease was seen as a supernatural force that had incorporated itself into the ill person’s being. The shaman, or physician-priest, would heal through rituals or ceremonies by confronting the disease-causing demon with a positive force and exorcising the demon from the patient. The shaman derived his power from visualization of a higher authority, god, or spirit. At that time, medicine was controlled by religion, mysticism, and magic (Johnston, 2002). Paracelsus, a Renaissance physician, is known as the father of scientific medicine and modern drug therapy. A man opposed to the notion of separating the healing process from the spirit, he said: “The spirit is the master, imagination the tool, and the body the plastic material. The power of the imagination is a great factor in medicine. It may produce diseases in man and in animals, and it may cure them. . . . Ills of the body may be cured by the physical remedies or by the power of the spirit acting through the soul” (Hartmann, 2007). The views of Paracelsus differed from those of the early shamans because Paracelsus believed that people’s own thoughts, as well as gods and spirits, could be healing (Samuels and Samuels, 1975). The mind–body dichotomy was first conceived during the Renaissance. The French philosopher Descartes helped establish the split with his attempts to free scientific questions from arguments concerning God. Scientists could then be concerned about the body without theological debate, and the philosophers and theologians were left to study the spirit and mind (Flynn, 1980). After the Renaissance, techniques of healing were divided into two systems: scientific and religious. Our Western society has adopted scientific healing—surgery and drug therapy. With increasing scientific investigation and medical specialization, the body–mind–spirit split continued into the twentieth century. By 1900, however, a number of medical scientists had begun investigating how the mind affects the body and healing (Samuels and Samuels, 1975). Jacobson (1942), searching for effective methods of relaxation, demonstrated that the imagery we use in thought processes produces a muscular reactivity that resembles what occurs during the actual performance of the imagined act. That is, if we imagine ourselves in our mind’s eye as running, the muscles we normally use when we run contract slightly. Many scientists, as well as members of the medical profession, have continued to accept that the autonomic nervous system is unconscious, automatic, and not within conscious control. In the late 1960s, physiologists DiCara and Miller demonstrated that parts of the autonomic nervous system can be conditioned and controlled. They determined that rats could learn how to alter their stomach acidity, brain wave patterns, blood pressure, and blood flow (Miller, 1969). Furthermore, in their work with humans, scientists have verified that yogis have the ability to control specific processes of the body such as metabolic rate and heart rate (Lauria, 1968). “Imagery creates a bridge between mind and body, linking perception, emotion, and psychological, physiological, and behavioural responses” (Apostolo and Kolcaba, 2009, p. 410). Helms describes guided imagery as a complementary intervention to help the mind “see” positive images of desired outcomes to influence health and well-being, part of the content in the development of the NCLEX-RN (2006). Imaging positive results can have the opposite effect of the stress response: promoting relaxation; helping control blood pressure; helping to control pain and anxiety; facilitating the action of medication and treatments; minimizing side effects; promoting coping with chronic illness; optimizing healing; and promoting comfort during and after procedures (Reed, 2007; Lewandowski et al, 2005; Mezies et al, 2006; Lewandowski, 2004; Lang, 2000; Kreitzer and Snyder, 2002; McCaffrey and Taylor, 2005; Wynd, 2005). Imagery techniques include end state, which involves the image of a healed state; process, which involves imaging step-by-step to a goal, such as successful, comfortable completion of a procedure; receptive, in which images for healing arise from the person’s own mind; active, which involves a conscious choice of a healing image, such as a healing white light directed to the affected area; and anatomic, such as imaging of the opening of constricted vessels (Schaub and Dossey, 2009). Here is a specific example: a client with excessive gastric secretions was asked to gaze at the dryness and texture of blotting paper while imagining absorbent dryness. Tests indicated that after 10 days of performing these visualizations, the client’s excessive secretions normalized (Luthe, 1969). The use of imagery empowers the client to promote wellness when disease produces a sense of loss of control. One hypothesis is that the feelings of hope and anticipation are recorded by the limbic system in place of hopelessness and despair. Psychoneuroimmunology is the study of the “multidirectional interactions among behavioral, neuroendocrine, and immunologic process of adaptation. Thoughts, emotions, and information are reciprocal stimuli to sensory and motor neurons, glandular tissues, and immune cells via chemical transmitters” (Giedt, 1997). Clients who are enthusiastic about feeling better using imagery and who explicitly follow instructions show dramatic relief of their symptoms and marked improvement in their conditions. How does the knowledge that it is possible to voluntarily affect the autonomic nervous system using visualization influence us in our nursing care? First, we as nurses can adopt a holistic philosophy of body, mind, and spirit integration. A holistic perspective emphasizes the interrelationship of the parts that make up the whole person. It acknowledges that the mind affects the body and vice versa. Accepting this notion of interdependence means understanding the power that exists within our whole body–mind–spirit beings to heal ourselves. This internal power can be used to maintain and increase our level of wellness, either alone or in conjunction with an external source of healing (Samuels and Bennett, 1974). The American Holistic Nurses Association offers a forum for the discussion of the research and practice of holistic nursing, and nurses in other states conduct workshops on interventions such as therapeutic touch. A simple application of imagery in nursing is the use of alternative language when performing procedures, language that, although still truthful, suggests a different sensation than anticipated. When giving an injection, say, “You may feel a stick.” This language decreases anxiety and shifts the pattern from response to “pain” to response to “a stick” (Kron and Johnson, 1983). The use of imagery is also gaining increasing acceptance in the areas of corporate finance and sports. Researchers have discovered, for example, that a frequent characteristic of executives of major U.S. corporations is that “these people knew what they wanted out of life. They could see it, taste it, smell it, and imagine the sounds and emotions associated with it. They prelived it before they had it. And that sharp, sensory vision became a powerful driving force in their lives” (Mayer, 1984). In an experiment conducted at the University of Western Australia, one basketball team practiced 20 minutes longer a day, whereas a second team used this 20 minutes to imagine themselves playing the game and mentally correcting themselves each time they missed a basket. After a period of weeks, the group that physically practiced the game improved 24%, and the group visualizing themselves as practicing improved 23% (Mayer, 1984). Professional golfer Jack Nicklaus uses visualization to improve the muscle memory and motor skills involved in golf. Nicklaus has said that good golf requires one-half mental rehearsal and one-half physical coordination. He never hits a shot without first seeing a sharp, clear picture of that shot in his mind’s eye (Mayer, 1984).
Imagery
Definition of imagery
Try this experiment: the tart lemon
History of imagery
Application of imagery in healthcare
Implications of imagery
Imagery
