Visualization and Guided Imagery: Evidence and Safety
What guided imagery and visualization are, what reviews found for anxiety before surgery, arthritis and pregnancy blood pressure, and the trauma-related cautions to know.
Content last updated . This page has not been medically reviewed.
What it is
In guided imagery, also called visualization, you picture objects, scenes or events linked with relaxation or calm and try to produce a similar feeling in your body. [1] It is usually led by a recording or a trained guide. NCCIH lists it with progressive muscle relaxation, autogenic training, biofeedback, self-hypnosis and breathing exercises as a relaxation technique. [1] In the 2022 US National Health Interview Survey, 6.4 percent of adults used guided imagery and/or progressive muscle relaxation. [1]Guided imagery is not identical to meditation. Many meditations ask you to observe whatever arises, while imagery asks you to create a scene on purpose. They overlap in practice, for example in guided body scans and yoga nidra, see yoga nidra, types of meditation and meditation, relaxation and breathing compared.
What research shows
Most trials cannot hide the technique from participants, and many use usual care as the comparison, so expectation may account for some of the benefit. Quality is often low. Labels below are our summary of what the sources say.| Use | What the source found | Label |
|---|---|---|
| Anxiety and pain around surgery | A meta-analysis of eight trials found lower preoperative anxiety in children (d -3.71) and in adults (trait anxiety, d -0.64), and less postoperative pain in adults (d -0.24), compared with usual preoperative care. Adult state anxiety and children's pain did not differ significantly [2] | Promising but limited |
| Arthritis and rheumatic disease | A review of seven randomized trials (306 adults) using audio-delivered scripts reported improvements in the outcomes measured; NCCIH summarizes this as imagery that "may be beneficial" [3][1] | Promising but limited |
| Fibromyalgia | A single session helped pain immediately, but results of longer programs were conflicting [1] | Mixed |
| Children's recurrent abdominal pain | Two small studies suggested short-term pain relief; quality was low [1] | Insufficient evidence |
| Falling asleep | A 2015 review found autogenic training or guided imagery shortened time to fall asleep, but no better than placebo; studies were small and low quality [1] | Insufficient evidence |
| High blood pressure in pregnancy | A Cochrane review found only two small trials (99 women); evidence was insufficient to guide practice [4] | Insufficient evidence |
For anxiety disorders in general, I did not find an imagery-specific review that I could read. The related NCCIH review of relaxation therapy reported lower anxiety symptoms in 16 studies of people with anxiety disorders, and noted relaxation was less effective than cognitive behavioral therapy for PTSD and obsessive-compulsive disorder, with high risk of bias in most studies. [1] That finding is about relaxation therapy as a group, not imagery alone.
What a session involves
Typically you sit or lie comfortably while a voice describes a calm place or sequence. A review of imagery for arthritis found the scripts in all trials were delivered by audio, from a single exposure up to 16 weeks. [3] NCCIH does not give a standard length. Listening on a recording is low cost, but check who made the recording and what it asks you to imagine.Safety and who should take extra care
- NCCIH says relaxation techniques are generally safe for healthy people, but occasionally people report increased anxiety, intrusive thoughts or fear of losing control. [1]
- There have been rare reports that certain relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma. [1]
- A 2024 paper on yoga nidra, which uses visualization, says adverse reactions such as overwhelming flashbacks, emotional distress and extended dissociation have been reported, and proposes trauma-informed practices such as autonomy, consent and careful visualizations. [5] This is expert guidance about a related practice and not a trial result.
- If a scene feels frightening or brings back memories, stop, open your eyes, look around the room, and choose a different practice. See trauma-sensitive mindfulness and who should check with a clinician before meditating.
- Imagery is a support and not a treatment for high blood pressure, arthritis or anxiety disorders. Keep following your care plan. [6]
If depression or anxiety persists, NCCIH advises seeing a qualified health care professional. [1] In the US, call or text 988 in a mental health crisis.
Related reading: relaxation techniques for stress, progressive muscle relaxation and autogenic training.
Frequently asked questions
What is the difference between visualization and guided imagery?
The terms are used interchangeably by NCCIH, which describes guided imagery as picturing calming scenes to produce a similar feeling in the body. [1]
Does guided imagery reduce anxiety before surgery?
A meta-analysis found lower preoperative anxiety in children and trait anxiety in adults compared with usual care, but not significantly lower adult state anxiety. [2]
Can guided imagery help with pain?
Evidence is limited. It reduced postoperative pain in adults in one meta-analysis, and helped fibromyalgia pain immediately after a single session, but longer programs gave conflicting results. [2][1]
Can it help me sleep?
A 2015 review found it shortened time to fall asleep but was no better than placebo, and the studies were small and low quality. [1]
Is it safe after trauma?
It can bring distress for some people. Reports of flashbacks and dissociation exist for related imagery-based practices, so use trauma-informed options and talk with a clinician. [5]