Guided Imagery in Eating Disorder Treatment

Guided Imagery is a type of therapy that involves visualization and guided images to create positive changes in thoughts, behaviors, reduce symptoms of the eating disorder, and improve coping skills [2].

Visualization is a primary component to practicing guided imagery and works by connecting in your brain, your nervous system, and visual cortex to create a feeling of relaxation and a sense of being grounded.  By activating these connections, it can impact your emotional, and physical state [2].  Guided imagery also utilizes meditation.

In the therapy session, the therapist will assist with guiding the image.  It has three main components to the therapy.  These are:

• Stress reduction
• Active visualization
• Receptive imagery

Guided Imagery in Eating Disorder Treatment works by allowing the person to specifically focus on the issues, faulty beliefs, or specific current symptoms.  Imagery can be powerful in that it is used to address the barriers to changes, and permit the body to heal itself and restore balance [2].  Guided imagery is considered a form of hypnosis, but it is the intentional choice of the individual to use the visualization and meditation at will.  

Tools Used For Guided Imagery

Imagery techniques are based in cognitive therapy. Some of these tools are:

1. Positive imagery where the person uses a pleasant image or scene to help feel relaxed, calm and grounded.
2.  Negative (or aversive) imagery is a second techniques sued. It involves highly unpleasant mental images. This is often more used in the treatment of addictions and substance use.
3. A third tool is coping imagery where the person mentally rehearses a new coping skill to better manage triggers or urges.
4. Anti-future shock imagery can be used when individuals are anticipating high anxiety situations.
5. Associated imagery is working through difficult or ignored emotions. It focuses on giving attention to these emotions and looking at it in an objective way to understand its meaning.
6. Lastly Step-up techniques is used to improve on existing coping skills. It will work to intensify emotions and practicing coping with the situation or event effectively.

Guided Imagery in Eating Disorder Treatment can help reduce unwanted behaviors, increase motivation, achieve goals, learn self-soothing and relaxation skills, prepare for challenging or difficult situations, manage negative emotions, increase self-control, explore new ways to handle situations and increase self-esteem [2].

When using mindfulness in visualization it can create changes in metacognitions related to emotions and memories [5]. In other words, it can help distance you from your emotions to look at them more objectively, and question negative or faulty thoughts. Meditation is striving for self-acceptance where you can observe yourself in the movement without judgement.
In a study that looked at the effectiveness of mindfulness/guided imagery in Binge Eating Disorder patients, it found that symptoms reduced significantly [3].

18 women were followed and participated in a 6 week meditation based group. At the end of the 6 weeks, researchers found that anxiety decreased significantly, and a sense of control increased. Binging episodes decreased from 4 per week to 1.5 per week and also decreased in severity. This study shows that meditation in conjunction with guided imagery can help promote self-regulation and provide insight into the psychological, emotion, cognitive, and behavioral aspects of eating disorders.

The Role of Guided Imagery In Eating Disorder Treatment

Guided imagery is typically conducted within the therapeutic setting, individually or in a group setting. The role of this technique is to enhance relaxation, through meditative breathing and practice. It can provide a source of soothing, and comfort allowing for the individual to manage painful emotions. Many therapists use a transitional object, or recordings, written scripts, or recalled imagery exercises that can be used between sessions [1].

Imagery works with the language within all of us. It creates personal, unique images, metaphorical themes and is unique to each individual. Guided Imagery enhances self-awareness, and self-reflection, and allows for identification and expression of emotions. Expression of the emotions can be furthered through additional experiential and art exercise such as writing, drawing, or acting [1].

Guided imagery works well when combined with other therapies, such as, Cognitive Behavioral Therapy (CBT), Exposure Therapy, Behavioral Therapy, Rational Emotive Therapy, Cognitive Processing Therapy, and Expressive Art Therapies [2].

There are various advantages to using Guided Imagery in treatment [3]. When engaging in guided imagery the client is in control. This can be empowering due to the fact that the client has the say in when to start, stop, or change the image. It is effective in reducing problematic symptoms and guided imagery sessions do not have to run the full session time. It is relatively easy to learn and portable, meaning you can practice some of the skills learning outside of sessions.

The techniques learned are also applicable to other areas of a person’s life. Persons who struggle with an eating disorder often times display ‘false selves’ to the world, which refers to the person we show to others versus the person that we internally hide. The false-self works to protect the inner self from being revealed, which can result in feelings of numbness, emptiness, and a state of feeling void of emotion or spontaneity [1, 5]. Using guided imagery with those struggling with an eating disorder can help to break down false self and give awareness to the internal true self.

In conclusion, Guided Imagery in Eating Disorder Treatment can be significantly beneficial. It can aid in learning relaxation and mindfulness skills, improve emotional regulation, identify and observe emotions, thoughts, and past behaviors, and provide a way for clients to practice distressing situations in a safe and calm setting.

Community Discussion – Share Your Thoughts Here!

If you have used Guided Imagery in your treatment, what would you say to someone who is considering trying it for the first time?

About the Author: Libby Lyons, MSW, LCSW, CEDS is a specialist in the eating disorder field. Libby has been treating eating disorders for 10 years within the St. Louis area, and enjoys working with individuals of all ages.

References:

[1]: Epslen, M., & Garfinkel, P. (1998). Guided Imagery Treatment to Promote Self-Soothing in … Retrieved June 3, 2017.
[2]: Guided imagery therapy | Definition and facts. (n.d.). Retrieved December, 2016, from https://www.addiction.com/a-z/guided-imagery-therapy/
[3]: Kristeller, J. L., & Hallett, C. B. (1999). An Exploratory Study of a Meditation-based Intervention for Binge Eating Disorder. Journal of Health Psychology,4(3), 357-363. doi:10.1177/135910539900400305
[4]: Slyter, M. (n.d.). Treating Eating Disorders With the Buddhist Tradition of Mindfulness . Retrieved December, 2016, from http://www.counseling.org/resources/library

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Reviewed By: Jacquelyn Ekern, MS, LPC on June 28, 2017.
Published on EatingDisorderHope.com