Advertisement

Guided Imagery as a Therapeutic Tool in Post-Traumatic Stress Disorder

  • Jennifer L. Strauss
  • Patrick S. Calhoun
  • Christine E. Marx
Chapter

Abstract

Guided imagery is a behavioral technique used to direct individuals to effectively create and manipulate mental representations to produce therapeutic changes. A growing empirical literature supports the use of these techniques in a variety of physical and emotional conditions. The focus of our research program is on applying these techniques to the treatment of post-traumatic stress disorder (PTSD). We have developed and piloted a clinician-facilitated, self-management intervention for PTSD called guided imagery for trauma (GIFT). We describe the rationale for this approach, its conceptual framework, and the treatment protocol. We present preliminary findings in a sample of women with PTSD related to military sexual trauma, which demonstrate feasibility, tolerability, and a large effect on PTSD symptoms. We also describe our current research efforts, including a randomized controlled trial of the GIFT intervention in women survivors of military sexual trauma, and the extension of this intervention to the treatment of combat-related PTSD.

Keywords

Guided imagery post-traumatic stress disorder self-administration self-management sexual trauma 

Notes

Acknowledgements

We acknowledge assistance from the Department of Veteran Affairs Research Career Development Award (J. L. S.), Samueli Foundation/VET-HEAL Award (J. L. S.); National Institute of Mental Health R03 Award (J. L. S.), Department of Veteran Affairs Advanced Research Career Development Award (CEM), and Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center. The views expressed are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. This chapter is presented in loving memory of Dr. Marian I. Butterfield, who died on June 26, 2006, after a courageous five-year battle with breast cancer. We wish to acknowledge her extensive contributions to the ideas and research presented and to celebrate her significant contributions to the field of psychiatry and to the care of our nation's veterans.

References

  1. 1.
    Graffam, S., and Johnson, A. (1987) A comparison of two relaxation strategies for the relief of pain and its distress. J Pain Symptom Manage 2, 229–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Syrjala, K. L., Donaldson, G. W., Davis, M. W., and Kippes, M. E., and Carr, J. E. (1995) Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Pain 63, 189–98.PubMedCrossRefGoogle Scholar
  3. 3.
    Lyles, J. N., Burish, T. G., Krozely, M. G., and Oldham, R. K. (1982) Efficacy of relaxation training and guided imagery in reducing the aversiveness of cancer chemotherapy. J Consult Clin Psychol 50, 509–24.PubMedCrossRefGoogle Scholar
  4. 4.
    Auerbach, J. E., Oleson, T. D., and Solomon, G. F. (1992) A behavioral medicine intervention as an adjunctive treatment for HIV-related illness. Psychol Health 6, 325–34.CrossRefGoogle Scholar
  5. 5.
    Eller, L. S. (1995) Effects of two cognitive-behavioral interventions on immunity and symptoms in person with HIV. Ann Behav Med 17, 339–48.CrossRefGoogle Scholar
  6. 6.
    Mannix, L. K., Chandurkar, R. S., Rybicki, L. A., Tusek, D. L., and Solomon, G. D. (1999) Effect of guided imagery on quality of life for patients with chronic tension-type headache. Headache 39, 326–34.PubMedCrossRefGoogle Scholar
  7. 7.
    McKinney, C. H., Antoni, M. H., Kumar, M., Tims, F. C., and McCabe, P. M. (1997) Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychol 16, 390–400.PubMedCrossRefGoogle Scholar
  8. 8.
    Hammer, S. E. (1996) The effects of guided imagery through music on state and trait anxiety. J Music Ther 33, 47–70.Google Scholar
  9. 9.
    Schandler, S. L., and Dana, E. R. (1983) Cognitive imagery and physiological feedback relaxation protocols applied to clinically tense young adults: a comparison of state, trait, and physiological effects. J Clin Psychol 39, 672–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Gordon, J. S., Staples, J. K., Blyta, A., and Bytyqi, M. (2004) Treatment of posttraumatic stress disorder in postwar Kosovo high school students using mind-body skills groups: a pilot study. J Trauma Stress 17, 143–47.PubMedCrossRefGoogle Scholar
  11. 11.
    Krakow, B., Hollifield, M., Johnston, L., et al. (2001) Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA 286, 537–45.PubMedCrossRefGoogle Scholar
  12. 12.
    Root, L. P., Koch, E. I., Reyntjens, J. O., Alexander, S. K., and Gaughf, N. W. (2002) Trauma-specific guided imagery: a systematic evaluation of an adjunct intervention to group psychotherapy. Abstract presented at International Society for Traumatic Stress Studies annual meeting; Baltimore, MD; November.Google Scholar
  13. 13.
  14. 14.
    Foa, E. B., Keane, T. M., and Friedman, M. J. (2000) Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press.Google Scholar
  15. 15.
    Foa, E. B., and Rothbaum, B. O. (1998) Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD. New York: Guilford Press.Google Scholar
  16. 16.
    Ehlers, A., Clark, D. M., Hackmann, A., et al. (2003) A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Arch Gen Psychiatry 60, 1024–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Horvath, A. O., and Bedi, R. P. (2002) The alliance. In: Norcross, J. C., Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients. New York: Oxford University Press; pp. 37–69.Google Scholar
  18. 18.
    Horvath, A. O., and Symonds, B. D. (1991) Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Counsel Psychol 38, 139–49.CrossRefGoogle Scholar
  19. 19.
    Martin, D. J., Garske, J. P., and Davis, M. K. (2000) Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 68, 438–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Orlinsky, D. E., Grawe, K., and Parks, B. K. (1994) Process and outcome in psychotherapy—noch einmal. In:Bergin, A. E., and Garfield, S. L., eds., Handbook of Psychotherapy and Behavior Change. New York: Wiley; pp. 270–376.Google Scholar
  21. 21.
    Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., and Koffman, R. L. (2004) Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med 351, 13–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Miller, W. R., and Rollnick, S. (2002) Motivational Interviewing: Preparing People for Change. 2nd ed. New York: Guilford Press.Google Scholar
  23. 23.
    Von Korff, M., Gruman, J., Schaefer, J., Curry, S. J., and Wagner, E. H. (1997) Collaborative management of chronic illness. Ann Intern Med 127, 1097–1102.PubMedGoogle Scholar
  24. 24.
    Barlow, D. H. (1993) Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. 2nd ed. New York: Guilford Press.Google Scholar
  25. 25.
    Beck, A. T., Rush, A. J., Shaw, B. F., and Emery, G. (1979) Cognitive Therapy for Depression. New York: Wiley.Google Scholar
  26. 26.
    DeBusk, R. F., Miller, N. H., Superko, H. R., et al. (1994) A case-management system for coronary risk factor modification after acute myocardial infarction. Ann Intern Med 120, 721–29.PubMedGoogle Scholar
  27. 27.
    Rich, M. W., Beckham, V., Wittenberg, C., Leven, C. L., Freedland, K. E., and Carney, R. M. (1995) A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333, 1190–95.PubMedCrossRefGoogle Scholar
  28. 28.
    Wasson, J., Gaudette, C., Whaley, F., Sauvigne, A., Baribeau, P., and Welch, H. G. (1992) Telephone care as a substitute for routine clinic follow-up. JAMA 267, 1788–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Strauss, J. L., Marx, C. E., Morey, R. A., (2007) A brief, transportable intervention for women veterans with PTSD related to military sexual trauma. Paper presented at 10th Annual Force Health Protection Conference; Louisville, KY; August.Google Scholar
  30. 30.
    Strauss, J. L., Marx, C. E., Oddone, E. Z., O'Loughlin, S. H., and Butterfield, M. I. (2006) A transportable PTSD intervention shows promise for women veterans with military sexual trauma. Abstract presented at American Psychiatric Association Annual Meeting; Toronto, Canada; May.Google Scholar
  31. 31.
    Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Charney, D. S., and Keane, T. M. (1998) Clinician-Administered PTSD Scale for DSM-IV. Boston: National Center for Posttraumatic Stress Disorder.Google Scholar
  32. 32.
    Bradley, R., Greene, J., Russ, E., Dutra, L., and Westen, D. (2005) A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 162, 214–27.PubMedCrossRefGoogle Scholar
  33. 33.
    Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., and Forneris, C. A. (1996) The psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34, 669–73PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jennifer L. Strauss
    • 1
  • Patrick S. Calhoun
    • 2
  • Christine E. Marx
    • 2
  1. 1.HSR&D (152)
  2. 2.Mental Health Service Line (116A)North Carolina

Personalised recommendations