How do experts use guided imagery? - CancerChoices

This mind-body therapy uses your imagination to help you relax, relieve symptoms, stimulate your body’s healing responses, access inner strengths and resources, and tolerate procedures and treatments better.

How do experts use guided imagery?

Both medical groups and integrative experts provide recommendations for guided imagery in treating people with cancer. Learn more about the approaches and meanings of recommendations: Integrative Oncology Programs and Expert Guidelines ›

Clinical practice guidelines

The 2016 clinical practice guideline for managing chronic pain in adult cancer survivors concluded that benefits of guided imagery outweigh harms, with intermediate-quality evidence. The guidelines give a moderate recommendation for guided imagery to manage chronic pain.

The version 1.2016 guidelines for nausea and vomiting state that guided imagery has “shown to be helpful for anticipatory nausea and vomiting.”

Society for Integrative Oncology

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment ›

This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).1Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.

The 2017 clinical practice guidelines regarding breast cancer patients found insufficient evidence to recommend guided imagery to manage quality of life.

Researchers from these organizations came to consensus on these recommendations:

  • Guided imagery with progressive muscle relaxation may be offered to patients experiencing general pain from cancer treatment (weak recommendation).
  • Insufficient evidence exists to make recommendations for guided imagery with progressive muscle relaxation to treat procedural or surgical pain or pain during palliative care.

Published protocols, programs, and approaches

Guided imagery is used in programs, approaches, and protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care from these integrative oncologists, drawing from both scientific research and observations from years or even decades of treating people with cancer.

Lise Alschuler, ND, FABNO, and Karolyn Gazella

Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions such as insulin resistance.

Keith Block, MD

Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.

The integrative Block Program has recommendations to people who are at different places along the cancer continuum:

  • Those who’ve been recently diagnosed
  • Those in treatment
  • Those who’ve concluded treatment and need to remain vigilant to prevent recurrence

Gerald Lemole, MD; Pallav Mehta, MD; and Dwight McKee, MD

Lemole GM, Mehta PK, McKee DL. After Cancer Care: The Definitive Self-Care Guide to Getting and Staying Well for Patients with Cancer. New York, New York: Rodale, Inc. 2015.

These doctors present easy-to-incorporate lifestyle changes to help you “turn on” hundreds of genes that fight cancer, and “turn off” the ones that encourage cancer, while recommending lifestyle approaches to address each type.

Barbara MacDonald, ND, LAc

MacDonald B. The Breast Cancer Companion—A Complementary Care Manual: Third Edition. Self-published. 2016.

Naturopathic physician Barbara MacDonald provides information about breast cancer, its conventional treatment, and natural approaches to enhancing treatment, managing side effects, reducing risk of recurrence, and healthy living after cancer treatment is completed.

Other expert assessments

Current Oncology Reports

An expert review of evidence suggests that guided imagery “might have a potential role in alleviating cancer-related fatigue.”2David A, Hausner D, Frenkel M. Cancer-related fatigue-is there a role for complementary and integrative medicine? Current Oncology Reports. 2021 Nov 7;23(12):145.

Expert commentary

Martin Rossman, MD: Imagery is the natural language of the human subconscious, a rich, sensory-based and emotional coding language of the brain/mind that shows itself in human culture through art, poetry, and drama. It is the language of dreams, visions, insights, intuitions and creativity. Imagery allows us both to become aware of and change our perceptions of our external and internal environments. It is central to mind/body healing because the body both responds to imagery-based suggestions, and also communicates to the conscious mind through images and symbols.

One of the reasons mental imagery is so important in healing is that the body responds much more quickly to images than it does to verbal requests or suggestions. For instance, if I asked you to salivate right now, you might be able to produce a little saliva. But if I asked you to vividly imagine sucking on a lemon you will salivate much more. If I asked you to imagine sitting in front of your favorite meal, and imagine how it looks, and smells, and what it will taste like, your stomach and intestines will begin to secrete digestive juices and begin to move. Sexual fantasy will get you physiologically aroused. And when you learn to use images as multi-sensory suggestions of healing responses in the body, your body will respond with changes in muscle tension, blood flow, immune activity, better sleep and better digestion.

Imagery is not only an effective form of suggestion to the body, it is also a symbolic language that can allow your unconscious to communicate to you what it may be feeling and how it perceives situations including your health. In a very real way, imagery is like the Rosetta Stone of body/mind/spirit communication.

When I work with patients in my practice, the focus is always on what the most important issues are to that patient at that time. In cancer care, if a patient has been recently diagnosed, the initial focus is on making sure they have the best oncological and support care, and on helping them learn ways to manage the fear and other strong emotions that almost always accompany a cancer diagnosis. I invite them to create a simple image that represents the outcome they would have if it were up to them. This image serves as a touchstone and guiding light for them as they navigate the complex world of treatment decisions, tolerating treatments, and learning about supporting their innate abilities to heal.

A woman I once worked with was an advanced skier. When I invited her to allow an image to form that would help her through her cancer journey, she imagined herself at the top of a very challenging ski run. As she surveyed the imaginary slope in front of her, noticing the trees and rocks she would have to avoid, she said, “It’s important to know what to avoid, but once I push off, the only place to look is where I want to go, never where I don’t want to go.”

Most people dealing with cancer can learn simple, straightforward imagery techniques to relax, reduce anxiety and fear, reduce or relieve side effects like nausea from chemotherapy, prepare for and recover from surgery, reduce pain and discomfort, and help themselves sleep. The easiest way to learn these skills is to listen to audios that guide you through the process, like the ones recommended in our More Information section.

If you are the kind of person to whom it’s important to explore the meaning of life events, or find the best you can make from them, imagery can allow you to explore your experience of cancer in this light. Usually it’s best to do this with an experienced and trusted therapist or guide familiar with imagery.

One other aspect of guided imagery I want to mention is that images may be unintentionally conveyed to you in your interactions with your doctors or other health professionals. The fact that both the patients’ and physicians’ expectations impact treat­ment effects is the reason that we go to the immense trouble and expense to do double-blind studies. Although researchers want to eliminate the effect that patient beliefs have on their experience and outcome, patients and clinicians want to maximize its benefit and use it to therapeutic advantage. An effective oncologist is someone who will treat cancer expertly but also treat you respectfully, encourage your participation in your healing efforts, and be mindful of what they are communicating through their words and expressions.

CancerChoices staff: No evidence yet shows that a patient can directly affect the tumor or its microenvironment through guided imagery, such as by reducing blood flow to tumors or turning off oncogenes. However, these images serve as autosuggestions representing potential mechanisms of resisting or overcoming cancer. As long as they are not substituted for more definitive or effective treatment, clinically, we conclude it is ethical and reasonable to encourage patients to imagine healing in a way that has meaning for them. 

Investigators have concluded that people with cancer should not be denied programs, including guided imagery, that improve quality of life and well-being simply because we are uncertain about whether such programs might also lengthen lifespans.3Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. Journal of the American Board of Family Practice. 2003 Mar-Apr;16(2):131-47.

Keep reading about guided imagery


Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher

Martin L. Rossman, MD

Co-founder of the Academy for Guided Imagery, physician, acupuncturist, and author
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Martin L. Rossman is a physician and acupuncturist who has practiced holistic medicine for over 30 years. He is co-founder of the Academy for Guided Imagery and the author of the award-winning Guided Imagery for Self-Healing and Fighting Cancer from Within.

Martin L. Rossman, MD Co-founder of the Academy for Guided Imagery, physician, acupuncturist, and author


Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Last update: May 9, 2024

Last full literature review: October 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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