Journal of Behavioral Medicine

, Volume 37, Issue 1, pp 70–80 | Cite as

Effects of guided imagery on biobehavioral factors in women with fibromyalgia

  • Victoria MenziesEmail author
  • Debra E. Lyon
  • R. K. ElswickJr.
  • Nancy L. McCain
  • D. Patricia Gray


Women diagnosed with fibromyalgia (N = 72) participated in a 10-week randomized trial to examine the effectiveness of guided imagery on self-efficacy, perceived stress, and selected biobehavioral factors (FMS symptoms; immune biomarkers). Participants in both guided imagery and usual care control conditions completed measures and donated 3 cc of blood at baseline, 6- and 10-weeks. A mixed effects linear model to test for differences between groups for all behavioral and biologic variables demonstrated that after 10 weeks of daily intervention use, guided imagery participants reported statistically significant increases in self-efficacy and statistically significant decreases in stress, fatigue, pain, and depression. There were no statistically significant changes in biomarker levels, although total group C-reactive protein was elevated at baseline (4.7 mg/L), indicating an inflammatory process. Subsequent studies should be undertaken to more fully elucidate the biobehavioral aspects of nonpharmacological intervention effectiveness.


Fibromyalgia Guided imagery Self-efficacy Stress Pain Cytokine C-reactive protein 



Supported by the National Institute of Nursing Research through Grant #P30 NR011403 M. J. Grap (PI). This work was supported, in part, by award number UL1RR031990 from the National Center for Research Resources and NIH Roadmap for Medical Research, National Institutes of Health.


  1. Abeles, A. M., Pillinger, M. H., Solitar, B. M., & Abeles, M. (2007). Narrative review: The pathophysiology of fibromyalgia. Annals of Internal Medicine, 146, 726–734.PubMedCrossRefGoogle Scholar
  2. Antoni, M. H., Cruess, D. G., Cruess, S., Lutgendorf, S., Kumar, M., Ironson, G., et al. (2000). Cognitive-behavioral stress management intervention on anxiety, 24-hr urinary norepinephrine output, and t-cytotoxic/suppressor cells over time among symptomatic hiv-infected gay men. Journal of Consulting and Clinical Psychology, 68, 31–45.PubMedCrossRefGoogle Scholar
  3. Apóstolo, J. L. A., & Kolcaba, K. (2009). The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders. Archives of Psychiatric Nursing, 23, 403–411.PubMedCrossRefGoogle Scholar
  4. Arnold, L. M. (2010). The pathophysiology, diagnosis and treatment of fibromyalgia. Psychiatric Clinics of North America, 33, 375–408. doi: 10.1016/j.psc.2010.01.001.PubMedCrossRefGoogle Scholar
  5. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.PubMedCrossRefGoogle Scholar
  6. Bandura, A. (1992). Self-efficacy mechanism in psychobiologic functioning. In R. Schwarzer (Ed.), Self-efficacy: Thought control of action (pp. 355–394). Bristol, PA: Taylor & Francis.Google Scholar
  7. Beal, C. C., Stuifbergen, A. K., & Brown, A. (2009). Predictors of a health promoting lifestyle in women with fibromyalgia syndrome. Psychology, Health & Medicine, 14, 343–353.CrossRefGoogle Scholar
  8. Bennett, R. M., & McCain, G. A. (1995). Coping successfully with fibromyalgia. Patient Care, 29, 29–32.Google Scholar
  9. Bradley, L. A. (1989). Cognitive-behavioral therapy for primary fibromyalgia. Journal of Rheumatology, 16, 131–136.Google Scholar
  10. Breen, E. C., Reynolds, S. M., Cox, C., Jacobson, L. P., Magpantay, L., Mulder, C. B., et al. (2011). Multisite comparison of high-sensitivity multiplex cytokine assays. Clinical and Vaccine Immunology, 18, 1229–1242. doi: 10.1128/CVI.05032-11.PubMedCrossRefGoogle Scholar
  11. Buckelew, S. P., Conway, R., Parker, J., & Kay, D. R. (1998). Biofeedback/relaxation training and exercise interventions for fibromyalgia: A prospective trial. Arthritis Care & Research, 11, 196–209.CrossRefGoogle Scholar
  12. Buckelew, S. P., Huyser, B., Hewett, J. E., Parker, J. C., Johnson, J. C., Conway, R., et al. (1996). Self-efficacy predicting outcome among fibromyalgia subjects. Arthritis Care & Research, 9, 97–104.CrossRefGoogle Scholar
  13. Clauw, D. J. (2009). Fibromyalgia: An overview. The American Journal of Medicine, 122, S3–S13.PubMedCrossRefGoogle Scholar
  14. Cleeland, C. S. (1989). Measurement of pain by subjective report. In C. R. Chapman & J. D. Loeser (Eds.), Advances in pain research and therapy: Issues in pain management (pp. 391–403). New York: Raven Press.Google Scholar
  15. Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont symposium on applied social psychology (pp. 31–67). Newbury Park, CA: Sage Publications, Inc.Google Scholar
  16. Crimmins, E. M., Johnston, M., Hayward, M., & Seeman, T. (2003). Age differences in allostatic load: An index of physiological dysregulation. Experimental Gerontology, 38, 731–734.PubMedCrossRefGoogle Scholar
  17. Curtis, K., Osadchuk, A., & Katz, J. (2011). An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. Journal of Pain Research, 4, 189–201.PubMedCentralPubMedCrossRefGoogle Scholar
  18. Dadabhoy, D., Crofford, L. J., Spaeth, M., Russell, I. J., & Clauw, D. J. (2008). Biology and therapy of fibromyalgia: Evidence-based biomarkers for fibromyalgia syndrome [Electronic version]. Arthritis Research and Therapy, 10, 211.PubMedCrossRefGoogle Scholar
  19. Dobkin, P. L., Liu, A., Abrahamowicz, M., Ionescu-Ittu, R., Bernatsky, S., Goldberger, A., et al. (2010). Predictors of disability and pain six months after the end of treatment of fibromyalgia. Clinical Journal of Pain, 26, 23–29.PubMedCrossRefGoogle Scholar
  20. Fors, E. A., & Götestam, K. G. (2000). Patient education, guided imagery, and pain related talk in fibromyalgia coping. European Journal of Psychiatry, 14, 233–240.Google Scholar
  21. Fors, E. A., Sexton, H., & Götestam, K. G. (2002). The effect of guided imagery and amitriptyline on daily fibromyalgia pain: A prospective, randomized, controlled trial. Journal of Psychiatric Research, 36, 179–187.PubMedCrossRefGoogle Scholar
  22. Freeman, L. W., & Welton, D. (2005). Effects of imagery, critical thinking, and asthma education on symptoms and mood state in adult asthma patients: A pilot study. The Journal of Alternative and Complementary Medicine, 11, 57–68. doi: 10.1089/acm.2005.11.57.PubMedCrossRefGoogle Scholar
  23. Gür, A., & Oktagolu, P. (2008). Status of immune mediators in fibromyalgia. Current Pain and Headache Reports, 12, 175–181.PubMedCrossRefGoogle Scholar
  24. Haase, O., Schwenk, W., Hermann, C., & Müller, M. (2005). Guided imagery and relaxation in conventional colorectal resections: A randomized, controlled, partially blinded trial. Diseases of the Colon and Rectum, 48, 1955–1963.PubMedCrossRefGoogle Scholar
  25. Institute of Medicine (IOM). (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Retrieved from Washington, DC: National Academies Press.
  26. Jallo, N., Bourguignon, C., Taylor, A. G., Utz, S. W., & Snyder, A. E. (2008). Stress management during pregnancy: Designing and evaluating a mind-body intervention. Family & Community Health, 31, 190–203. doi: 10.1097/01.FCH.0000324476.48083.41.CrossRefGoogle Scholar
  27. Klaus, L., Beniaminovitz, A., Choi, L., Greenfield, F., Whitworth, G. C., Oz, M. C., et al. (2000). Pilot study of guided imagery use in patients with severe heart failure. American Journal of Cardiology, 86, 101–104.PubMedCrossRefGoogle Scholar
  28. Lewandowski, W., Jacobson, A., Palmieri, P. A., Alexander, T., & Zeller, R. (2011). Biological mechanisms related to the effectiveness of guided imagery for chronic pain. Biological Research for Nursing, 13(4), 364–375. doi: 10.1177/1099800410386475.PubMedCrossRefGoogle Scholar
  29. Lomi, C., Burckhardt, C., Nordholm, L., Bjelle, A., & Ekdahl, C. (1995). Evaluation of a Swedish version of the arthritis self-efficacy scale in people with fibromyalgia. Scandinavian Journal of Rheumatology, 24, 282–287.PubMedCrossRefGoogle Scholar
  30. Lorig, K., Chastain, R. L., Ung, E., Shoor, S., & Holman, H. R. (1989). Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis and Rheumatism, 32, 37–44.PubMedCrossRefGoogle Scholar
  31. M. D. Anderson Cancer Center Pain Research Group. (2009a). Brief Fatigue Inventory, 2009, from
  32. M. D. Anderson Cancer Center Pain Research Group. (2009b). Brief Pain Inventory, 2008, from
  33. McCain, N. L., Gray, D. P., Walter, J. M., & Robins, J. (2005). Implementing a comprehensive approach to the study of health dynamics using the psychoneuroimmunology paradigm. Advances in Nursing Science, 28, 320–332.PubMedCrossRefGoogle Scholar
  34. McCarberg, B. H. (2012). Clinical overview of fibromyalgia. American Journal of Therapeutics, 19(5), 357–368.PubMedCrossRefGoogle Scholar
  35. Mease, P., Arnold, L. M., Bennett, R., Boonen, A., Buskila, D., Carville, S., et al. (2007). Fibromyalgia syndrome. The Journal of Rheumatology, 34, 1415–1425.PubMedGoogle Scholar
  36. Mendoza, T. R., Wang, X. S., Cleeland, C. S., Morrissey, M., Johnson, B. A., Wendt, J. K., et al. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the brief fatigue inventory. Cancer, 85, 1186–1196.PubMedCrossRefGoogle Scholar
  37. Menzies, V., & Jallo, N. (2011). Guided imagery as a treatment option for fatigue: A literature review. Journal of Holistic Nursing,. doi: 10.1177/0898010111412187.PubMedCentralPubMedGoogle Scholar
  38. Menzies, V., & Kim, S. (2008). Relaxation and guided imagery in Hispanic persons diagnosed with fibromyalgia: A pilot study. Family and Community Health, 31, 204–212.PubMedGoogle Scholar
  39. Menzies, V., & Lyon, D. (2010). Integrated review of the association of cytokines with fibromyalgia and fibromyalgia core symptoms. Biological Research for Nursing, 11, 387–394. doi: 10.1177/1099800409348328.PubMedCentralPubMedCrossRefGoogle Scholar
  40. Menzies, V., Lyon, D. E., Elswick, R. K., Jr., Montpetit, A. J., & McCain, N. L. (2011). Psychoneuroimmunological relationships in women with fibromyalgia. Biological Research for Nursing, 000, 1–7. Advance online publication. doi: 10.1177/1099800411424204.
  41. Menzies, V., & Taylor, A. G. (2004). The idea of imagination: An analysis of “imagery.”. Advances in Mind-Body Medicine, 20, 4–10.PubMedGoogle Scholar
  42. Menzies, V., Taylor, A. G., & Bourguignon, C. (2006). Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia. Journal of Alternative and Complementary Medicine, 12, 23–30.CrossRefGoogle Scholar
  43. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). (2009). Questions and answers about fibromyalgia. Retrieved from
  44. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  45. Ridker, P. M. (2007). Inflammatory biomarkers and risks of myocardial infarction, stroke, diabetes, and total mortality: Implications for longevity. Nutrition Reviews, 65, S253–S259.PubMedCrossRefGoogle Scholar
  46. Schmidt-Wilcke, T., & Clauw, D. J. (2011). Fibromyalgia: From pathophysiology to therapy. Nature Reviews Rheumatology, 7, 518–527.PubMedCrossRefGoogle Scholar
  47. Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. British Medical Journal, 340, c. 322. doi: 10.1136/bmj.c332.CrossRefGoogle Scholar
  48. Sloman, R. (2002). Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nursing, 25, 432–435.PubMedCrossRefGoogle Scholar
  49. Smyth, J., & Nazarian, D. (2006). Development and preliminary results of a self-administered intervention for individuals with fibromyalgia syndrome: A multiple case control report. EXPLORE: Journal of Science and Healing, 2, 426–430.CrossRefGoogle Scholar
  50. Üçeyler, N., Hauser, W., & Sommer, C. (2011). Systematic review with meta-analysis: Cytokines in fibromyalgia syndrome. BMC Musculoskeletal Disorders, 12, 245. doi: 10.1186/1471-2474-12-245.PubMedCentralPubMedCrossRefGoogle Scholar
  51. Üçeyler, N., Valenza, R., Stock, M., Schedel, R., Sprotte, G., & Sommer, C. (2006). Reduced levels of antiinflammatory cytokines in patients with chronic widespread pain. Arthritis and Rheumatism, 54, 2656–2664.PubMedCrossRefGoogle Scholar
  52. Wallace, D. J. (2006). Is there a role for cytokine based therapies in fibromyalgia. Current Pharmaceutical Design, 12, 17–22.PubMedCrossRefGoogle Scholar
  53. Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., et al. (1990). The American college of rheumatology 1990 criteria for the classification of fibromyalgia. Report of the multicenter criteria committee. Arthritis and Rheumatism, 33, 160–172.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Victoria Menzies
    • 1
    Email author
  • Debra E. Lyon
    • 1
  • R. K. ElswickJr.
    • 1
  • Nancy L. McCain
    • 1
  • D. Patricia Gray
    • 1
    • 2
  1. 1.School of NursingVirginia Commonwealth UniversityRichmondUSA
  2. 2.School of NursingVirginia Commonwealth UniversityRichmondUSA

Personalised recommendations