Visualisation / Guided imagery

Visualisation and guided imagery belong to a branch of therapies known as complementary and alternative medicines (CAM).

Visualisation is based on the premise that the mind is the body's most powerful tool and that certain intense visualisation techniques persuade the body to translate these images into reality. For example, visualising yourself as pain-free or less fatigued can lead to a reduction in pain or fatigue symptoms.

A related technique that uses similar principles is motor imagery, where it is thought that mentally rehearsing a physical action, such as walking, may lead to an actual improvement in reality.

Sessions may be led by a therapist, be guided using an audio file or music, or can be self-directed. Participants are helped to create positive mental images of desired outcomes or states. The approach is often used to develop a sense of calm or relaxation, and is used alongside hypnotherapy​ by some practitioners.

Visualisation and guided imagery have been used to treat depression, fibromyalgia, anxiety and pain, with mixed results. A small study comparing visualisation to a journaling exercise for people with multiple sclerosis found small improvements in fatigue, mood and quality of life. However, there were large numbers of dropouts, who may have left the trial because they could see no benefit, leaving only the ones who enjoyed it or found benefit to be counted.

A study in Iran on 60 patients looked at the effectiveness of guided imagery on fatigue, stigma and mood. A 25-minute guided imagery audio file was used at home. A decrease in fatigue and stigma, and enhanced mood was seen in the participants who used guided imagery compared to the control group.

A review of the literature on the use of motor imagery showed that people with MS using the technique had significant improvements in walking speed and distance, fatigue and quality of life. Benefits were also seen in dynamic balance (being able to maintain your balance whilst moving) and perceived walking ability. There is also some evidence that in those with a low EDSS score, using music or verbal guides with motor imagery can have a positive effect on gait, fatigue and quality of life.

Although these trials have shown a positive effect of visualisation, guided imagery and motor imagery techniques it is thought that not all patients with MS will benefit from them. An analysis of 14 studies showed that cognitive impairment, cognitive fatigue and disability may impact on the usefulness of motor imagery. The effect of MS type, anxiety and depression was not clear.

Some researchers think that there is evidence that guided imagery and relaxation can affect the immune system, leading to a reduction in winter viral infections. The authors recognise a large variation between individuals in how well this approach might work.

An example of relaxation exercises that include elements of guided imagery

Find out more

Seebacher B, et al.
Factors and strategies affecting motor imagery ability in people with multiple sclerosis: a systematic review.
Physiotherapy 2023;118:64-78.
Summary (link is external)
Beitollahi M, et al.
Fatigue, stigma and mood in patients with multiple sclerosis: effectiveness of guided imagery.
BMC Neurology 2022;22(1):152.
Summary (link is external)
Gil-Bermejo-Bernardez-Zerpa A, et al.
Effectiveness of motor imagery on motor recovery in patients with multiple sclerosis: systematic review.
International Journal of Environmental Research and Public Health 2021;18(2):948.
Summary (link is external)
Case LK, et al.
Guided imagery improves mood, fatigue, and quality of life in individuals with multiple sclerosis: an exploratory efficacy trial of healing light guided imagery.
Journal of Evidence-Based Integrative Medicine 2018;23:25.
Full article (link is external)
Gruzelier JH.
A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health.
Stress 2002;5(2):147-63.
Summary (link is external)