Guided imagery eases fear before surgery, but no good study shows it shrinks tumors

Key takeaways

• Guided imagery means using your “mind’s eye” on purpose, usually after relaxing first, and the person imagining stays in charge of the scene¹.
• A 2024 review of nine randomized trials found that most showed less anxiety around surgery or procedures with imagery, though several found no difference and the reviewers raised bias concerns².
• Since its 1973 start, the Simonton program has taught cancer patients to picture their bodies beating the disease, yet no controlled trial has tested whether it helps them live longer³.
• A 2020 Cochrane review of 25 trials found that adding mental practice to stroke rehab improved arm function, with moderate certainty⁴.
• People with psychosis, hallucinations or unprocessed trauma should use imagery only with extreme care or not at all, according to a VA guide¹.

In the early 1970s, O. Carl Simonton was chief of radiation therapy at Travis Air Force Base in Fairfield⁵. In 1973, he and his wife, Stephanie Matthews-Simonton, introduced a counseling method for people with cancer³.

One part of it taught patients to picture their bodies fighting cancer cells and winning³. Simonton went on to found a cancer counseling center in Fort Worth, Texas⁵. His 1978 book, Getting Well Again, written with Matthews-Simonton and others, spread the idea widely, and thousands of counselors have trained in his method⁵.

This is the hard part. In the half century since, no controlled trial has tested whether it helps people live longer, according to a 2023 review³.

Meanwhile, quieter research found jobs that imagery does well. It can take the edge off fear before an operation. It can ease distress during cancer care. In stroke rehab, it can even help an arm move better.

This article sorts the real uses from the oversold ones and gives you a 10-minute script to try.

Guided imagery is a daydream with a direction

A VA guide calls guided imagery a mind-body approach that uses the “mind’s eye” to support healing¹. A session usually starts with relaxation. Then you explore images, alone or with a guide, and you stay in control of where the scene goes¹.

It goes by other names, too: visualization, mental rehearsal and guided self-hypnosis among them, according to Memorial Sloan Kettering Cancer Center⁶. The National Center for Complementary and Integrative Health (NCCIH), part of the NIH, counts it among the relaxation techniques⁷.

More Americans are trying it. In 2022, 6.4% of U.S. adults used guided imagery, progressive muscle relaxation or both, up from 3.8% in 2002⁷.

Why would a picture in your head change your body? Imagery and real perception share much of the same brain machinery, Memorial Sloan Kettering notes⁶. A frightening image can set off a stress response, and a calm one can help you relax⁶.

Before surgery, a calm scene can take the edge off fear

Surgery is where imagery has been tested most. In 2024, researchers writing in the journal Surgery in Practice and Science reviewed nine randomized controlled trials, studies that assign people by chance to imagery or a comparison².

The trials covered a wide mix: burn dressing changes, weight-loss surgery, gallbladder removal, heart surgery, bone surgery in older adults, and more². Most found lower anxiety with imagery².

Not all did. In one trial, imagery made no difference to patients’ anxiety, pain or satisfaction². In another, patients didn’t feel calmer, but their surgeons did². A third found that patients felt better prepared, though no less anxious².

In their text, the reviewers rated three trials at high risk of bias and the other six as having some concerns, though one of their tables lists different ratings². They didn’t pool the results into one number, and they said their review gave no hard evidence that imagery cuts pain medicine use or speeds recovery².

Some hospitals offer imagery recordings anyway, since the risks are low. The NIH Clinical Center’s patient library, for example, offers a recording called Guided Meditations to Promote Successful Surgery⁹. Kaiser Permanente has shared a similar pre-surgery program in podcast form¹⁰.

Both come from Health Journeys, a company that publishes recordings narrated by Belleruth Naparstek⁹¹⁰. The Kaiser script says research at UC Davis Medical Center and the Cleveland Clinic found benefits, with people listening a few times over the two to three days before surgery¹⁰. It cites no studies, so treat that as the maker’s claim. The script also suggests asking your surgical team whether you can listen on headphones during the operation¹⁰.

In cancer care, imagery eases distress, not the disease

Imagery’s best-supported cancer use is comfort. In 2005, a review by L. Roffe, K. Schmidt and Edzard Ernst looked at six randomized trials¹¹. Three found that imagery helped with anxiety, comfort or emotional reactions to chemotherapy, and two found no difference¹¹.

The studies were generally low quality¹¹. The team found no convincing evidence that imagery eased physical symptoms such as nausea and vomiting¹¹. Memorial Sloan Kettering reads the evidence a little more hopefully, noting small studies that suggest imagery may ease treatment-related nausea⁶.

A 2025 meta-analysis in Supportive Care in Cancer, a study that pools other studies, pulled together nine trials with 837 people¹². Imagery lowered anxiety and depression and improved quality of life, by large amounts¹². The authors noted there’s no standard dose for session length or frequency¹².

Those are big effects from fairly small trials, and the abstract reports no measure of how much the trials disagreed. In our view, expect more modest benefits in everyday life.

The 1970s promise that imagery could beat cancer

The Simonton program combined belief work, relaxation, meditation and imagery, often taught at a five-day “Getting Well Again” retreat³. Simonton said his own research showed that adding counseling to medical treatment doubled survival time for people with advanced cancer⁵.

The only clinical study of the method was one uncontrolled study of 245 patients treated from 1974 to 1978, according to a 2023 summary by the CAM Cancer Collaboration³. The patients’ median survival was compared with national figures, not with a matched group³. The patients were self-referred and highly selected, their disease stage wasn’t reported, and all had required one-on-one therapy.

The summary judged the study’s methods low quality³.

In 1981, the American Cancer Society found no scientific support for the idea that psychological factors alter how cancer progresses³. A 2001 overview in the Western Journal of Medicine found evidence insufficient that relaxation or imagery prolongs life⁸.

The program did offer something real: emotional support at a frightening time⁵. If imagery helps you feel braver during treatment, that’s worth having. Your feelings aren’t the reason a cancer grows or shrinks, a point our article on the mind-body connection explores.

Imagined workouts added strength in small studies, but pair them with real ones

The strangest imagery finding involves muscles. In a 2004 study by Ranganathan and colleagues, 30 untrained adults imagined contracting certain muscles, five days a week for 12 weeks¹³.

Their little-finger strength rose 35%, and their elbow-bending strength rose 13.5%, without lifting anything¹³. A 2016 review credited such gains mainly to the nervous system: the brain learns to send a stronger signal to the muscle¹³.

That review gathered 27 studies with 811 people¹³. Imagery added to physical practice worked at least as well as physical practice alone, and sometimes better¹³. Imagery also seemed to limit the strength people lose while a limb is immobilized or after a knee ligament injury¹³.

The studies were of modest quality and mostly involved students or untrained people¹³. So treat imagined reps as an extra, especially useful when you can’t train normally, not a replacement for lifting.

One practical tip comes from a 2013 pilot with just six people per group¹⁴. Imagining the feeling of the muscle working, from the inside, raised strength 10.8% in six weeks. Watching yourself as if on video raised it 4.8%, a gain too small to rule out chance¹⁴. The two styles didn’t differ clearly, and the authors said larger studies must confirm the pattern¹⁴.

Stroke rehab: the best-supported use of imagined movement

After a stroke, therapists sometimes add mental practice, rehearsing a movement in your mind, to physical therapy. A 2020 Cochrane review pooled 25 trials with 676 people from nine countries⁴.

Adding mental practice improved arm function and movement compared with therapy alone, with moderate-certainty evidence⁴. Low-certainty evidence suggests it may not help everyday tasks such as dressing, and it’s unclear whether mental practice works on its own⁴. The trials didn’t report on harms⁴.

Sleep, nightmares and the gut: where imagery shows up elsewhere

For sleep, NCCIH reports that a 2015 review found guided imagery or autogenic training shortened the time to fall asleep, but no more than a placebo did⁷. Our article on relaxation before bed covers imagery for sleep, and our nighttime anxiety article covers a nightmare treatment that rewrites bad dreams.

For the gut, imagery is part of gut-directed hypnotherapy for irritable bowel syndrome. In children with recurring belly pain, NCCIH says guided imagery and hypnotherapy may ease pain in the short term, though the research is low quality⁷. Our gut-brain and IBS articles weigh the adult trials.

For arthritis, the VA guide rated its confidence moderate that imagery helps with rheumatic disease outcomes, and low for most other uses¹.

A 10-minute “safe place” script

This script is our own. Read it slowly into your phone and play it back, or read a line, close your eyes, and follow it. You can keep your eyes open the whole time if that feels safer.

Minutes 0 to 2: arrive. Sit or lie down. Let your out-breath be a little longer than your in-breath. Feel the chair or bed holding your weight.

Minutes 2 to 4: Choose your place. Picture somewhere you feel safe and at ease. It can be real or made up: a porch at dusk, a quiet chapel, a riverbank, a grandparent’s kitchen. If no place comes, picture a favorite color filling the room.

Minutes 4 to 7: Fill in the senses. Look around. What’s the light like? What do you hear, close by and far away? Is the air warm or cool? Is there a smell, such as bread, rain or pine? Notice what’s under your feet.

Minutes 7 to 8: Add a cue. Choose a small gesture, such as pressing your thumb and finger together, and link it to the calm you feel here. Later, the gesture can help you recall the scene.

Minutes 8 to 10: return. Know you can come back any time. Count slowly from five to one. Wiggle your fingers and toes, open your eyes and name three things you see in the room.

Old memories can surface during imagery¹. If an unpleasant image or memory appears, open your eyes, look around and feel your feet on the floor. You can stop at any point. You don’t need to push through.

Imagery fits natural-health values well. It’s drug-free, costs nothing and draws on the oldest tool you have, your own imagination. Use it alongside medical care, never instead of it.

Choosing a recording: who makes them and what to check

Many recordings come from a handful of producers. Health Journeys supplies programs used by the NIH Clinical Center and Kaiser Permanente⁹¹⁰. The VA guide lists other options, including recordings from UCSF’s Osher Center for Integrative Health and short exercises from Dartmouth College’s student wellness center¹.

Before you pick one, run through these questions:

• Who made it? Look for a named narrator with real training, or a hospital, university or VA source.
• Does it let you choose the place? Scripts that let you pick your own scene are easier to adapt than ones that insist on a beach or forest.
• Does it promise to cure a disease? Skip anything that says imagery shrinks tumors or replaces treatment³.
• Can you exit easily? Good scripts remind you that you can open your eyes and stop.
• Is the length right? Ten to 20 minutes fits most days.
• Is it safe to use where you are? Never play imagery while driving¹⁰.
• What does the app collect? Free apps may gather data. Our wellness apps article explains what to check.

What the evidence says, rated

Use	What studies found	Evidence level
Anxiety before surgery or procedures	Most of nine trials helped; several found no difference; bias concerns2	Promising but early
Less pain medicine or faster recovery after surgery	Not shown in the 2024 review2	Not enough evidence
Anxiety and mood in cancer care	Benefits in small trials; large pooled effects in 20251112	Promising but early
Chemotherapy nausea	No convincing evidence in a 2005 review11	Not enough evidence
Living longer with cancer, or shrinking tumors	No controlled trial; one weak uncontrolled study38	Not enough evidence
Building strength	27 studies of modest quality; best as an add-on13	Promising but early
Arm function after stroke, added to rehab	25 mostly small trials; moderate certainty4	Promising but early
Falling asleep faster	No better than placebo in a 2015 review7	Not enough evidence

Who should be careful, and when to get help

Imagery is low risk for most people. The VA guide says it isn’t advised, or should be used with extreme care, for people with psychosis, hallucinations or delusions, and for people with delirium or dementia¹. It adds that some religious beliefs may conflict with imagery, and that unprocessed trauma can surface during a session¹.

Memorial Sloan Kettering advises people with a history of trauma, abuse or mental illness to work with a therapist⁶. NCCIH notes rare reports of relaxation techniques worsening symptoms in people with epilepsy, some psychiatric conditions, or past abuse or trauma⁷.

If imagery stirs up a painful memory, stop and use the grounding steps in the script. Then consider talking with a licensed mental health professional¹⁶.

The National Institute of Mental Health (NIMH) says to seek help after a traumatic event if your reactions don’t ease over time or get in the way of daily life¹⁵. Signs include flashbacks, frightening thoughts, nightmares, avoiding reminders, pulling away from loved ones, and being easily startled¹⁵.

If you’re thinking about suicide or harming yourself, call or text the 988 Suicide & Crisis Lifeline at 988¹⁵. In a life-threatening emergency, call 911¹⁵.

Questions readers ask

The bottom line

Guided imagery is a simple, low-risk way to feel calmer before surgery and during cancer care, though the trials are small and mixed. Imagined practice can add some strength, and added to stroke rehab it improves arm function, the best-supported result in this field.

The 1970s promise that picturing your cells could beat cancer was never backed by a controlled trial. Use imagery for comfort, courage and rehab, and choose recordings from trustworthy sources. If old pain surfaces, stop and get support.

Related reading

• The viral “military sleep method” hasn’t been tested in trials, unlike older relaxation methods
• Worry gets louder at 3 a.m., and a few tested tricks can turn it down
• Stress can reach your immune cells, but positive thinking still can’t cure cancer
• Your gut and brain really talk, but many mood claims started in mice
• The relaxation response turned 50, and its most-quoted numbers need fine print

Sources

1. Singles J, Mirgain S. “Guided Imagery.” VA Whole Health Library, U.S. Department of Veterans Affairs, written 2014, updated 2023. va.gov:443
2. Arjmandy Anamagh M, Shafiei Kouhpayeh M, Khezri S, et al. “The effect of Guided imagery on perioperative anxiety in hospitalized adult patients: A systematic review of randomized controlled trials.” Surgery in Practice and Science, 2024;18:100255 (PMC full text). pmc.ncbi.nlm.nih.gov
3. CAM Cancer Collaboration (Mora and Wider). “Simonton Method.” NAFKAM (CAM Cancer), August 31, 2023. nafkam.no
4. Barclay RE, Stevenson TJ, Poluha W, Semenko B, Schubert J. “Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke.” Cochrane Database of Systematic Reviews, 2020, Issue 5, CD005950 (abstract). cochranelibrary.com
5. Nelson VJ. “Cancer therapy proponent O. Carl Simonton.” Los Angeles Times, republished by The Bulletin (Bend, Oregon), July 3, 2009. bendbulletin.com
6. Memorial Sloan Kettering Cancer Center. “Guided Imagery.” Integrative Medicine, updated July 28, 2022. mskcc.org
7. National Center for Complementary and Integrative Health. “Relaxation Techniques: What You Need To Know.” NIH, updated June 2021. nccih.nih.gov
8. Vickers A, Zollman C, Payne DK. “Hypnosis and relaxation therapies.” Western Journal of Medicine, 2001;175(4):269-272 (PMC full text). pmc.ncbi.nlm.nih.gov
9. NIH Clinical Center Patient Library. Guided imagery and meditation audio (“Healing Streams” page; audio by Belleruth Naparstek, © 2022 Health Journeys). NIH. cc.nih.gov
10. Kaiser Permanente. “Pre-Surgery Imagery” (Healthy Living To Go podcast transcript, narrated by Belleruth Naparstek; transcript © Health Journeys). espanol.kaiserpermanente.org
11. Roffe L, Schmidt K, Ernst E. “A systematic review of guided imagery as an adjuvant cancer therapy.” Psycho-Oncology, 2005;14(8):607-617 (University of Southampton record). pubmed.ncbi.nlm.nih.gov
12. Bozkurt-Duman C, Arici-Turk H, Erbay-Dalli O, Yildirim Y. “The effectiveness of guided imagery on psychological outcomes and quality of life in cancer patients: a systematic review and meta-analysis.” Supportive Care in Cancer, 2025;33(11) (Bursa Uludağ University record). pubmed.ncbi.nlm.nih.gov
13. Slimani M, Tod D, Chaabene H, Miarka B, Chamari K. “Effects of Mental Imagery on Muscular Strength in Healthy and Patient Participants: A Systematic Review.” Journal of Sports Science and Medicine, 2016;15:434-450. jssm.org
14. Yao WX, Ranganathan VK, Allexandre D, Siemionow V, Yue GH. “Kinesthetic imagery training of forceful muscle contractions increases brain signal and muscle strength.” Frontiers in Human Neuroscience, 2013;7:561. frontiersin.org
15. National Institute of Mental Health. “Coping With Traumatic Events.” NIH, reviewed May 2024. nimh.nih.gov