Want Better Health? Use Your Head!

Research suggests that psychoeducational techniques like guided imagery can reduce pain and promote healing after surgery.


Research on psychoeducational care is confirming that the mind's workings can indeed influence the body's health. "Psychoeducational care" includes teaching patients such techniques as guided imagery, relaxation exercises, and hypnosis, as well as providing patients with information about procedures, pain, and recovery. One of the first psychooeducational techniques to show health-promoting potential is guided imagery. During guided imagery, patients think about what is happening to their bodies, and how their bodies should respond in order to be healthy. For example, in a classic study, psychologist Henry Bennett and colleagues gave three groups of spinal surgery patients three different sets of instructions before their operations. Patients in the control group learned only about some aspects of the surgery. Patients in the relaxation group also learned strategies for succumbing to and emerging from anesthesia. Patients in a third, "blood shunting" group not only learned these strategies, but were also taught the importance of not losing too much blood during the operation, and imagined that "the blood will move away" from the injury during surgery, but will return to the area after surgery. After all of the operations were completed, the researchers found that the patients who imagined the blood moving away from their injuries during surgery, but returning after surgery, lost only about half as much blood as patients who were not given these guided imagery instructions.

Neuropsychological studies give clues as to how guided imagery helps the brain heal the body. When people vividly imagine an event, their brains respond the same way as they would if the person were actually experiencing the event. So, when people imagine particular physical events happening in their bodies, it is possible that their bodies respond accordingly.

Two recent reviews confirm that many forms of pre-surgery psychoeducational care can lessen patients' need for pain medication, shorten their hospital stays, decrease their blood loss, and reduce their surgical complications (Devine, 1992; Dreher, 1998). These reviews of hundreds of studies also suggest that while some forms of psycheducational care are very promising, others may be duds. According to Dr. Bennett, for example, simple relaxation tapes are often ineffective, and sometimes even counterproductive. Instead, perhaps the most effective psychoeducational care combines several techniques to reduce patients' anxiety, to relax their bodies, and to engage their minds with guided imagery.


Dr. Elizabeth Devine's and Mr. Henry Dreher's recent reviews attest to the effectiveness of psychoeducational care. While these psychoeducational techniques are not a panacea, they are beginning to gain legitimacy as useful and cost-effective ways to improve surgery results. As health care practitioners adopt guided imagery as part of their patients' regimen, psychoeducational techniques are likely to become widespread.

Practical Application

Blue Shield of California is the first health plan in the U.S. to offer a guided imagery program to its surgical patients, and the results of a recent study of its effects are impressive. Blue Shield's program combines self-care, pre-surgical guided imagery exercises (via video and CD recordings) with one-on-one telephone support from a Blue Shield nurse health coach. According to Blue Shield, of 3500 patients sent guided imagery tapes before surgery, 75% listened to them. Patients who used the guided imagery tapes experienced less anxiety before surgery and less pain after surgery than did patients who did not use the guided imagery tapes. A full 20% of those who listened to the tapes chose to listen to them after surgery as well. From this study, a subsample of hysterectomy patients who listened to the tapes was compared with hysterectomy patients who did not use guided imagery. Those using guided imagery had hospital bills that were an average of 4.5% lower--an average savings of $654 per patient!

Blue Shield has received hundreds of calls in support of the program, and has therefore expanded their guided imagery program to include not just surgical patients, but also patients suffering from asthma and heart conditions, as well as those seeking to lose weight and stop smoking. Other organizations such as The Cleveland Clinic Foundation in Ohio and Einstein Hospital in Philadelphia are also beginning to offer patients guided imagery techniques, for use before, during, and after medical procedures. Moreover, the U.S. Department of Health and Human Services (DHHS) has included the use of relaxation techniques in their Clinical Practice Guidelines as recommended non-pharmacological interventions for pain.

Cited Research

Bennett, H. L., Benson, D. R., Kuiken, D. A. (1986). Preoperative Instructions for Decreased Bleeding During Spine Surgery. Anesthesiology, Vol. 65, A245.

Devine, E. C. (1992). Effects of psychoeducational care for adult surgical patients: A meta-analysis of 191 studies. Patient Education and Counseling, Vol. 19, pp. 129-142.

Dreher, H. (1998). Mind-body interventions for surgery: evidence and exigency. Advances in Mind-Body Medicine, Vol. 14, pp. 207-222.

 American Psychological Association, December 15, 2003

Additional Sources

US Department of Health and Human Services (1992). Clinical Practice Guideline, "Acute Pain Management: Operative or Medical Procedures and Trauma."

Mind & Body Newsletter