A seismic shift

At the forefront of this shift in thinking are certain technological advances that have been crucial in imagery's advancement. "What we now know from functional MRI testing-where scientists can actually watch what's happening in the brain-is that imagery activates the parts of your brain that process the type of information you are imagining," Rossman says. For instance, when you are told to hear birds chirping, the auditory part of your brain gets active; when you are told to feel the warmth of the sun, the sensory part of your brain gets active. "Then all of these different areas in the cortex of your brain send messages to the more primitive parts of your brain," he adds. "Since the image looks, sounds and feels like a safe place, your body interrupts the stress response and goes into relaxation." Once in this relaxed state, you can then use directed and purposeful daydreaming-tapping into the imagination through guided imagery. This form of purposeful daydreaming is more than just a relaxed state, however; it has been proven to shift mood, improve circulation, enhance immune responsiveness, lower heart rate and decrease blood pressure, among other things. "For most Western people, guided imagery is the fastest, most effective and most direct way to use the mind-body connection," Rossman says.

Jeremiah Pattillo, a 55-year old psychologist living in Bolinas, Calif., suffers from an autoimmune disease called nephritic syndrome, which causes the kidneys to stop functioning. After starting chemotherapy, he sought out Rossman. "I was getting good medical care but felt the mind-body integration was an aspect of treatment that was missing," Pattillo says. After an extensive medical review, the doctor facilitated a guided-imagery session that started with a basic relaxation technique and included focused breathing.

Rossman then led Pattillo through an exercise during which he recalled a special, safe place. While in this place, he directed Pattillo to look inside his kidneys and ask them what they needed. "My sense of what my kidneys needed in that moment was light and space," Pattillo says. So Rossman suggested he imagine warm, white light on that area. "The source of the light was coming from me, and I could somehow direct it," Pattillo adds. "I don't know how it happened, I don't really care, but I've been feeling significantly better since that day. I don't know if it was the imagery, but it feels like it was a big part of it. I've been amazed."

Scientific Backup

A turning point for the medical community's interest in imagery occurred in the late '90s, with research that revolved around surgery: Time after time, studies showed that pre- and post-surgery patients who used imagery had a shorter than average length of stay and decrease in pain and anxiety, and they used fewer pain drugs. A few years later, a much-referenced Blue Shield of California study done with hysterectomy patients again showed shorter stays, less pain and a dramatic decrease in anxiety, but also another important finding-those who used imagery reduced the insurance company's bill by 14 percent.

"This was stunning; it totally turned me around," says Brad Larsen, a nurse anesthesiologist at Kaiser Permanente, Santa Rosa, Calif., who helped implement a groundbreaking guided-imagery program there. "This isn't just a minimal intervention-it's major and has a dramatic effect."

Cumulatively, these studies created a greater awareness, which led to the hundreds of studies being conducted today in areas that go far beyond pre-surgery patients. The most comprehensive studies concern anxiety, pain management and oncology, but research has been conducted on allergies, carpal tunnel syndrome, geriatric insomnia, herpes, hypertension, menopause and others. "Guided imagery research is making an entrance into conventional medical consciousness," Rossman says. "People are starting to think, 'Oh, this is a real thing,' even though the imagination is invisible and seems ethereal. After all, the imagination is probably the most powerful human function-skyscrapers, CAT scans, every single object that humanity has ever produced is because of imagery."

Beyond the hard facts, experts say imagery plays a crucial role in a medical setting by empowering patients to take charge of their health. Instead of being prodded by doctors and told what to do, patients can feel a sense of satisfaction by participating in their own healing. "The work with the imagery gave me a sense of agency," Pattillo says. "I can do it at home, and I'm really doing something that directly impacts my disease. It's not something I'm getting from a doctor. It's in me, for me and gives me some sense that I'm a participant in this. So it's empowering and encouraging in that way."

Models of care

Visionaries like Kaiser's Brad Larsen often start imagery programs in hospitals that have an interest in complementary medicine. After reading some of the scientific research, Larsen applied for a grant and used the money to buy CDs to hand out to surgery patients. Through word of mouth, patient surveys and implementation studies, the results astounded him: "Almost everyone said they would use it again or recommend it to a friend," he says. Recently, Larsen has championed the Preparing for Successful Surgery Program in which every patient is given a guided-imagery CD during a pre-operative visit. In fact, his group just secured funding for the program to expand throughout all Kaiser hospitals in northern California. At his hospital, imagery use extends beyond surgery: Patients who come into the hospital can simply check out a portable CD player and a guided-imagery CD for whatever condition they have, use it during their stay and return it before they go home.

Over at the California Pacific Medical Center's Health and Healing Center in San Francisco, Leslie Davenport, the former chaplain who is now the clinical education manager, conducts one-on-one imagery sessions with people like Gail Van Dyke. A few years back, after a directive from hospital administrators to "humanize medicine," Davenport secured funding for guided imagery to control pain, deal with anxiety, manage nausea and strengthen the immune system. As the demand grew, she eventually developed an internship program for students. Today, the Health and Healing Center has a yearlong training program and a team of eight students who specialize in imagery.

And as others begin to hear of guided imagery's successes, more and more people call existing programs for advice; Davenport gets so many inquiries that the center has set up a consultation service to help other institutions get programs started on their own turf.

Going mainstream

Until recently, nurses, social workers and pastors have been the champions of imagery's cause. "We are still in a stage where most doctors aren't aware of the research," Rossman says, "partly because there hasn't been a product to sell. If a drug company had a pill for what guided imagery did in surgery, they would've put $40 million into an advertising campaign."

Although it hasn't reached critical mass, some doctors-like the well-known cardio thoracic surgeon Mehmet Oz, at Columbia Presbyterian Medical Center in New York who gives imagery to his patients-have created large pockets of interest. "We had to tread carefully in the early days, but it's much more open [now], and there is a lot more support," Davenport says. "Patients have been educating their physicians about its successes."

Indeed, word of mouth has created a kind of tipping point for doctors with regard to imagery. The fact that hospitals and medical centers are using guided imagery is also a big step. But the interest from health insurance companies like Blue Shield-as well as the big pharmaceutical companies-is simply groundbreaking. With studies showing that imagery saves money, has no clinical risk and can be administered without a practitioner, companies like Blue Shield of California have fully embraced the idea. In June 2000, Blue Shield launched a Pre-Surgery Guided Imagery Program for members pre-approved for major surgery-the first health plan to develop a comprehensive program like it.

"I was worried it would be perceived as too 'new agey' for a traditional insurance company," says Dana Davies, a consultant for new-product development at Blue Shield. "But we were surprised at the strong body of literature indicating the efficacy of guided imagery for surgery." After she gave a big presentation to hospital administration, "there was really no resistance, so we decided to launch the program," she says.

Today the program includes guided imagery for any surgery patient who wants it; they can download CDs from the Blue Shield website. "This type of intervention is ideal for an insurance company," Davies says. The benefit is that the people most appropriate for guided imagery are targeted and told the CDs are available. Following suit, several other carriers, like Aetna, U.S. Healthcare and the U.S. Veteran's Administration, are now adding guided imagery to their programs. Pharmaceutical companies such as Amgen, GlaxoSmithKline, Ortho Biotech and Roche are also offering imagery CDs for a variety of conditions.

Future thinking

The consensus is clear: Guided imagery is here to stay. "It's not a little niche thing now; it's what everyone is exploring and thinking about," Larsen says. "How can you ignore the mind-body connection and the powerful effect that imagery has on the body? This is going to become more and more mainstream."

So far, it's been a win-win situation for everybody. Patients are happy. Hospitals improve patient care. Insurance companies save money. For Gail Van Dyke, her cancer is now behind her. Although it's impossible to say guided imagery cured her cancer, it has helped her emotionally and psychologically. "I know that no matter what comes up, I'm OK and I can deal with it," says Van Dyke, who also used imagery to prepare for knee replacement surgery. "It gives you a strength you didn't know you had. Not only do you get more relaxed and centered, your own inner wisdom comes to the surface."

Imagery advocates feel optimistic that the word will continue to spread: "In 10 years, I hope everybody takes guided imagery for granted," Rossman says. "I hope that doctors don't just reach for the prescription pad. Or if they do, they write this: 'Practice guided imagery three times a day and come back.' I think there is a good potential for that happening."

Nora Isaacs is a freelance writer living in San Francisco.