Guided imagery and visualisation: how it works, the evidence and who should be careful

NHS inform describes a visualisation exercise as using an image as a way to focus your mind. You mentally retreat to a calming location, and the focus of attention on that image draws you away from worry and tension.

In guided imagery proper, a facilitator or recording talks you through the scene, often prompting you to notice colours, sounds, temperatures and smells. In the self-led version, you choose the scene yourself. Either way, the technique depends on regular practice rather than special talent for imagining.

The NHS inform exercise follows a short sequence that you can try seated in a quiet place.

• Picture a place where you feel relaxed, either somewhere you know or one that you invent.

• Add sensory detail: imagine the sounds, the smells and the small details of the place.

• Close your eyes and breathe slowly through your nose.

• Hold the image in mind while breathing out through your mouth.

• Continue for 10 to 20 minutes, returning to the image whenever your attention drifts.

The US National Center for Complementary and Integrative Health lists six main relaxation approaches: progressive relaxation, autogenic training, guided imagery, biofeedback-assisted relaxation, self-hypnosis and breathing exercises. NHS inform lists visualisation within a set of nine breathing and relaxation exercises that also includes belly breathing, grounding and progressive muscle relaxation.

These techniques share a purpose. They aim to switch on what NCCIH calls the relaxation response, with slower breathing, lower blood pressure and a reduced heart rate, and they are usually learned and then used on demand when tension builds.

The evidence below applies to relaxation techniques as a group rather than guided imagery alone, so it should not be over-read for any single method. NCCIH describes strong evidence for lowering blood pressure with slow breathing, for anxiety disorders and general stress, for dental and surgical anxiety, and for labour pain.

It describes moderate evidence for headaches and migraine, low-back pain, post-surgical pain and arthritis-related pain, and limited or mixed evidence for sleep quality, fibromyalgia pain and cancer-related symptoms. The NHS lists relaxation techniques alongside cognitive behavioural therapy among the approaches that may help prevent migraine attacks, to be pursued with help and advice from a GP.

Relaxation techniques are generally considered safe for healthy people. NCCIH notes rare reports of problems in people with epilepsy, certain psychiatric conditions or a history of trauma, so vivid imagery or deep relaxation may not be right for everyone.

If a scene brings up distressing memories, panic or a sense of detachment, stop, open your eyes, ground yourself by noticing what you can see and hear in the room, and raise it with a GP or therapist. People with these conditions are better served by guidance from a clinician than by self-directed audio.

NHS inform advises speaking to your GP if panic significantly disrupts daily life, if self-care becomes difficult, or if managing responsibilities feels overwhelming.