Imagery and of the Management of Patient Stress, Anxiety and Depression The use of imagery visualization and imagery therapy as an important part of the professional nurse repertoire has recently begun receiving attention in the Nursing profession as well as in other healing-related professions. As a caregiver the nurse makes use of various professional methods and therapies to promote the well-being of the patient. New approaches and "alternative modalities" of nursing practice and theory are explored in the Online Journal of Issues in Nursing. Dr. Noreen Frisch, in an article entitled, Nursing as a context for alternative/complementary modalities, reviews the incorporation of alternative and complementary models of care for Registered Nurses.

With increasing consumer and professional interest in alternative and complementary care, Registered Nurses (RNs) are incorporating alternative/complementary modalities into their practices. While these modalities give nurses additional tools to meet client needs, many of these modalities are taught and used by non-nursing professionals, leading nurses to question if and under what circumstances these modalities are included in the nursing scope of practice. (Frisch)

Frisch stresses the importance of the incorporation of alternative therapies for Registered Nurses.

With nationwide interest in complementary healthcare, nurses have actively incorporated alternative/integrative modalities into their practice. Registered Nurses regularly attend continuing educational sessions on techniques such as acupressure, guided imagery, humor, massage, meditation, and therapeutic touch/healing touch. (ibid)

The term 'alternative' is relatively new and became popular in the 1960's with the advent of the concept of holistic medicine. Alternative medicine and therapy was considered a new field and was usually not taught at medical schools. However, the situation has changed to a certain degree. While there are still those opposed to the implementation of alternative therapies, a greater number of professionals and critics are becoming aware of the positive aspects of alternative therapies, which often outweigh any negative aspects. Therapies such as imagery therapy are increasingly becoming part of the health care professional's repertoire.

The need to distinguish nursing as a holistic healthcare system is stressed in the following statement:

Many experts and theorists and the American Holistic Nurses Association, have all discussed the need to promote the holistic and caring approach in caring for the ill. These holistic nursing leaders all noted that nursing should be concerned with attending to the patient's holistic needs by fostering a healthy and healing environment that will care more instead of curing. They recommend the use of alternative therapeutic modalities such as therapeutic use of touch, massage (reflexology), aromatherapy (essential oils), nutrition, humor, yoga, meditation, proper lighting, herbs, aquatics, imagery, and music therapies to create the holistic healing environments for our patients. (Mammah)

Alternative therapies and imagery therapy are based on a holistic concept of healthcare. The use of the word 'alternative' became more well-known in the 1990s when holistic medicine became more widely accepted. Nursing is by nature a holistic profession, taking into account the complex and diverse yet interrelated needs of the patient. It is for this reason that alternative therapies are particularly applicable to the nursing profession.

It is because nursing is a holistic discipline that nurses have demonstrated great enthusiasm for the techniques and modalities associated with the field of complementary and alternative care as these techniques assist nurses to address the physical, mental, emotional, and spiritual dimensions of care. (Frisch)

Uses of Imagery in Healing

One of the most common applications of imagery in nursing is to reduce stress by promoting the creation of a healing environment. When a nursing professional identifies that a patient who is undergoing medical diagnostic procedures (such as an MRI) is showing signs of problem relates to fear "the nursing intervention is 'guided imagery to assist the client with relaxation and distraction during the procedure'. (ibid) The patient may also be put in a more relaxed frame of mind by explaining the basics of the medical procedure by means of imagery therapy. However, these aspects only cover a small degree of the potential for imagery therapy and the possibilities of healing through visualization.

In an article entitled, Trance and suggestion: Timeless interventions and implication for nurses in the new millennium, Rothlyn Zahourek outlines the advantages of imagery therapy.

Nurses increasingly use relaxation, touch, and imagery techniques in their regular practice. When their clients or patients are relaxed or in a state of revelry associated with these interventions, it is useful to phrase suggestions for positive desired outcomes. For example, a person who has developed chronic obstructive pulmonary disease (COPD) after years of heavy smoking anxiously awaits a bronchoscopy. You notice that he is having difficulty...

In casual conversation he tells you how much he has wanted to stop smoking and how he worries he has cancer.
Zahourek)

Zahourek continues to describe in detail how the use of images helps the patient cope with his health problem.

As you describe the relaxation-imagery exercise to him, you ask if he would like some positive words about stopping smoking; he enthusiastically replies "yes." You describe a pleasant mountain scene he chose as a relaxing place. In the scene he sits by a gurgling brook and breathes cool fresh air. He hears the wind blow softly through the surrounding pine trees. While you are helping him visualize you ask him, "review all the positive reasons you have to stop smoking. Imagine yourself strong and able to say no to urges and cravings; strong and able to ride out cravings; strong in your motivation to accomplish your goal of stopping smoking now. Imagine feeling so good about yourself, and your new accomplishments. Imagine yourself free and happy, comfortable and relaxed. (ibid)

One of the factors found in the use of imagery therapy is the increase in the immune defense system of the patient. Imagery has been found to have a positive affect on the autoimmune system and immune defenses in many patients. "Imagery can trigger brainwave shifting that might be crucial to several behaviors, including learning, memory consolidation, and immune enhancement www.questia.com/PM.qst?a=o&d=95143272" (Rider, 1992, p. 152)

Imagery and healing have a long history in so-called primitive culture and in ancient Shamanic perceptions and healing. Modern scientists and healthcare experts have begun to realize the importance of these previously ignored and often misunderstood forms of healing and medicine. An expert in the field of alternative health therapies, especially imagery healing, Dr. Jean Achtenberg, has provided an extensive analysis of Shamanic imagery and its impact on health and alternative medicine. The importance of "pre-verbal imagery" is stressed in which "imagination acts directly on the physical substrate, including tissues, organs, and cells. This type of communication may occur outside of deliberation and consciousness."

(Winkelman, 2000, p. 86)

Achterberg also identified a second type of healing imagery, which she has termed transpersonal. This form of imagery utilizes symbols that are universal and reflect the action on the collective unconscious (or neuro-gnostic structures). The symbolic encounter in visionary experiences involves linking the mundane world with the unconscious and transcendent aspects of consciousness. In linking together symbols of the cosmological order, the mind, the unconscious, and the social world, Shamanic activities provide a means for manipulation and integration of the psyche and the bodies of clients. Images play a central role in muscular control, reflecting the widely distributed effects of conscious images. www.questia.com/PM.qst?a=o&d=14303122" (Winkelman, 2000, p. 86)

Significantly, Winkelam states that Shamanism and Shamanic imagery is directly related to healing and stress reduction.

Shamanism emerged because of numerous adaptive consequences of its practices, including enhancement of representation, healing, stress reduction, and information integration. www.questia.com/PM.qst?a=o&d=14303143" (Winkelman, 2000, p. 107)

Dr. Jeane Achterberg analyses the process of healing though imagery as follows. At least three levels of description can be used to help understand the long and persistent use of symbolism or imagery healing: biological, psychological, and transpersonal. Firstly, the image or imagery function has a biological base.

The image, or imagery function, appears to have an intimate and primal association to the physical body via direct neural connections that "link areas of the brain that process the image to other areas of the brain involved in emotion, and also to areas of the body involved in immunity, such as the thymus. www.questia.com/PM.qst?a=o&d=95141229" (Achterberg, 1994, p. 149)

Achteberg maintains that images can be conceived as a bridge. The image can be "between functions of mind and body, interpreting and transmitting information from psyche to soma and vice versa. Images that evoke an emotional response (fear, anger, anxiety, depression, calm, elation, and so forth) are accompanied by corresponding physical changes."

And;

Biologically-based imagery (i.e., images that are representative of actual body functions) have been shown to correlate with numerous components of the immune system."

(Achterberg, 1994, p. 149)

Achterberg continues to explain the psychological basis for healing though imagery or visualization.

The image or symbol serves as a link between the known and the unknown and between the inner mysterious worlds of experience and the conscious expression of those experiences. As such, it is like a midwife who assists at the birth of meaning. Giving meaning to a life crisis is, in itself, a healing (or "making whole") function, as the crisis is rewoven…