INTERACTIVE GUIDED IMAGERY IN CANCER CARE
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Presenter: Martin Rossman, M.D.
Moderator: Carol Goldberg, M.A., L.G.S.W.
Session: Sa6; June 12, 1999I. Abstract
Dr. Rossman presented an introduction to the benefits of interactive guided imagery as a therapeutic treatment for cancer patients. Dr. Rossman is the co-director of the Academy for Guided Imagery located in Mill Valley, California. He presented extensive personal experience as well as research evidence describing the benefits of guided imagery. Interactive guided imagery relies on the individual to shape the experience, whereby strong personal benefits can be achieved. Furthermore, in his presentation, Dr. Rossman gave a short guided imagery session so that the observer could experience first hand the benefits of interactive guided imagery.
II. Cancer-Related Issue Addressed
This session provided insight into the field of interactive guided imagery for cancer patients. Interactive guided imagery has extraordinary potential for advancements in the treatment of cancer patients. Its uses include: pain control, reduced hopelessness, anxiety reduction, reaching treatment decisions, spiritual advancement, etc.
III. The Program
A. Philosophical Background
One of the most powerful components of interactive guided imagery is the notion that the power rests in the patients themselves. As the treatment is interactive, the patient actually chooses their own journey, and shapes their own experience. In this manner, patients experience the healing power they personally are needing, or seeking. The practitioner is involved in guiding the experience, but the patient is responsible for creating it. Thus, interactive guided imagery relies on the patient to create their own experience, whereby they are able, with the help of a trained practitioner, to find within the needed cure, assistance, or comfort.
B. Details
From a practitioner’s standpoint, the experience begins with foresight. Here, the practitioner and the patient explore the reasons for the visit, both emotional and physical. During this preliminary consult, the practitioner is able to gain an understanding of the patient’s expectations and goals of the visit. Next, the experience moves on to insight. It is during this portion of the experience that the actual imagery takes place. The practitioner guides the experience by utilizing feedback from the patient. It is important to allow the patient to create his/her own image. Providing an image imposes a unnecessary notion of the practitioner upon the experience. As the patient is guided through their own image, they achieve positive results including empowerment, creating a treatment which they can take home, or engendering a trust in their own inner healing power. Finally, the last step of the experience is hindsight, during which the practitioner and the patient reflect on the experience. The results again are quite personal, as each patient creates their own experience so do they create their own results.
C. Mechanism of Action
The mechanism of action is still being investigated, however a number of hypotheses exist. One of the important components of interactive guided imagery is the involvement of multiple senses. The experiences are the most effective when they integrate all five senses, and this suggests that involvement of multiple areas of the cortex increases the desired response. There is tremendous unexplored territory regarding a person’s ability to control unconscious activities. Since imagery is the most accessible entrance to the unconscious, it provides a potential conduit for investigation.
Furthermore, brain wave studies show that images are the most accessible in the theta wave state, one of the physiological stages of sleep. Therapeutic benefits of the theta wave state have been studied in different arenas. For example, a shaman healer is able to achieve the theta wave state, and in some way achieve a healing power. Thus, the connection between the theta wave state is suggested, but yet to be proven.
D. Research
The research studies cited by Dr. Rossman include:
- Carl and Stephanie Simonton’s observational report of 59 people who show more unexpected remissions among those using imagery compared to those who did not. A linear relationship was observed.
- Dean Shrock reported that a three week treatment of breast and prostate cancer patients using Simonton based imagery intervention provided significant survival benefits among the treatment group.
David Spiegal’s report of positive results among breast cancer patients within a support group compared to those not participating.
Karen Ulnis’s study, at the University of Indiana, investigating the increased immune response among 18 of 22 patients utilizing interactive guided imagery.Dr. Rossman specifically addressed the difficulties of research based evidence within this treatment for a number of reasons. Studies are questioned because of the extreme difficulty in controlling the studies for imagery among other lifestyle contributions. Furthermore, he questioned the desired endpoint of scientific research. Is it necessary to prove increased life expectancy when the quality of life is increased? Furthermore, Dr. Rossman pointed out the difficulty associated with completing clinical research when the treatment is independent of drug companies. Since drugs are unrelated to the treatment, the incentive for investment decreases. Not surprisingly, it is quite difficult to obtain financial support for research initiatives.
IV. Limitations
Interactive guided imagery presents difficulties for the scientific community because of its lack of conclusive scientific research. Since it is so difficult to isolate imagery from other lifestyle factors, it will always be difficult to conclusively prove the benefits of imagery. Furthermore, it is difficult to assign one specific goal to imagery, as it is such a personal journey that achieves personal results. However, as is true with other therapies, the positive benefits are well documented. Therefore, interactive guided imagery deserves attention.
V. Commentator’s comments
Dr. Rossman repeatedly emphasized the importance of the interactive nature of this imagery technique. In this therapy, the facilitator provides a means for the patient to access his/her own unconcious. Even though the exact clinical benefits of interactive guided imagery are yet unclear, it is a positive step for the patient to learn the language of their body. This is particularly important considering the potential for obtaining control of the disease from the language of imagery.
VI. Resources
Interactive guided imagery provides tremendous therapeutic effects for a variety of patients. Its uses include: pain control, reduced hopelessness, anxiety reduction, reaching treatment decisions, spiritual journey, and others. The benefits of interactive guided imagery include: the therapy is effective in a short time period, the patient is able to access his/her emotions, the patient can potentially make a connection with an independent entity, and the results are custom tailored to the individual. As described already, the positive benefits of imagery are quite personal, but are derived from a person’s awareness of their unconscious self, which will be different for different individuals. Additional resources may be found at http://www.healthy.net/agi.
VII. Audience Questions
What is the danger of transferring authority from the practitioner to the patient? How can we as practitioners protect the patient from guilt?
By leaving the decision up to the patient, regarding the path of the imagery experience, the person is thus able to define their own journey and find their own results.
What about the fear of failure? What if I put all of my energy into this experience and I fail?
So what? If what you are seeking is up to you, then you will get what you want, but if it is not up to you, then it is not up to you. There is no answer to the involvement of a higher power, and the best we can do is what we can. Although this is a fine line between personal will and outside power, it exists throughout mind body medicine, and at some level it must be accepted as something we do not fully understand nor are able to fully control.