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From the Townsend Letter
February / March 2010

Pathways to Healing
Guided Imagery Aids US Troops
by Elaine Zablocki

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Belleruth Naparstek, LISW, has been using guided imagery for 20 years to help people cope with a wide range of physical and emotional problems. In recent years, as US troops return from Iraq and Afghanistan with post­traumatic stress disorder (PTSD), researchers at the Veterans Administration and Duke University tested guided imagery to help them heal from nightmares, flashbacks, insomnia, agitation, numbness, isolation – the symptoms of post­traumatic stress. They discovered that it is extremely effective for veterans and for others, such as the September 11 emergency responders, whose work leads them into extreme situations.

In a 2004 book, Invisible Heroes: Survivors of Trauma and How They Heal, Naparstek describes the physical, cognitive, emotional, and behavioral effects of trauma, which often include flashbacks, intrusive memories, chronic pain, nightmares, panic attacks, a pattern of disrupted relationships, and the use of alcohol or drugs in an attempt to regulate overwhelming feelings.

She explains how and why guided imagery can be used to heal extreme trauma. "Guided imagery is a form of deliberate, directed daydreaming – a purposeful use of the imagination, using words and phrases designed to evoke rich, multi-sensory fantasy and memory, in order to create a deeply immersive, receptive mind state that is ideal for catalyzing desired changes in mind, body, psyche, and spirit," she writes. Imagery can be used: to help the user return to calm, when disturbing images and memories intrude into consciousness; to help the user reestablish a connection with the world of feelings, face down unpleasant symptoms, and cognitively and emotionally integrate what has happened; and after core difficulties have been healed, to address longer-term fallout from the trauma, including lack of self-esteem and difficulties with relationships.

The methods described in Naparstek's book, and available via CD from Health Journeys, start out with basic guided imagery to help users ground themselves; they offer temporary relief and the ability to get a good night's sleep. "Second-stage imagery is for delving deeper, whenever the survivor is ready to go beyond managing symptoms in coping with distress to directly pursue healing," Naparstek writes. These methods include imagery to support awareness of feelings, face down anxiety, soften pain, ease depression, and release grief.

Trauma takes its toll, and long after the core trauma has been healed, people are still coping with aftereffects. For the stage of cleanup and renewal, Naparstek offers guided imagery for developing confidence, for dealing with anger and forgiveness, and for looking more deeply at the self.

Studies Demonstrate Imagery Effective in Response to Trauma of War
Several studies are under way testing guided imagery to aid returning troops and veterans, and also to offer self-care to soldiers on active service. Jennifer L. Strauss, PhD, associate professor of psychiatry and behavioral sciences at Duke University Medical Center, is conducting randomized clinical trials on guided imagery for women veterans with PTSD related to military sexual trauma, and additional research on male and female veterans with combat-related PTSD. The studies have been funded by various government agencies, and will eventually be published in the clinical literature.

"These studies have shown that veterans prefer audio download interventions as a form of treatment," says Naparstek. "Their second preferred choice is medication, and counseling is last on the list." She thinks veterans relate well to guided imagery, in part because it protects their privacy. "They don't have to show vulnerability to anyone; it doesn't label them as having PTSD. It's easy for them to use audio downloads, and they are effective. We find that their symptoms decline 80% after using guided imagery half an hour a day, five times a day, for six weeks."

Another study underway at the Scripps Center for Integrative Medicine combines healing touch with guided imagery. "Researchers are finding that the combination yields great outcomes," Naparstek says. "I suspect that healing touch puts users into a profoundly receptive state."

How can guided imagery be so effective in situations where conventional talk therapy often has limited usefulness? According to Naparstek, imagery goes to the primitive, survival-based structures in the brain that are affected by PTSD, while talk therapy sails above that level and doesn't do much for these symptoms.

Several studies have experimented with varying treatment periods, ranging from six to 12 weeks. Some have used relatively brief, neutral guided imagery, while others use more powerful, intense "healing trauma" imagery. One study will use blood work and functional MRIs to document the results of the intervention. But the headline, Naparstek says, is that these methods work, and their effectiveness can be documented scientifically. "It works, it's cheap, it's portable, it's scalable and user-friendly. The troops and vets will actually use it, unlike counseling," she says. "You can't do better than this."

Follow Naparstek on Facebook and Twitter
Nowadays Naparstek uses social media to connect with the community of people who've been using her guided imagery for years. She relies on Twitter to get news from people who are doing interesting work, and to send out links to her readers. Look for her personal page as well as the Health Journeys page on Facebook. The posts cover a wide range of subjects ... a woman whose journey with cancer taught her to nurture her own creativity, a woman who used guided imagery for fertility issues and hopes to soon use it for healthy pregnancy, and a person who used guided imagery to prepare for spine surgery. The posts also include links to fascinating research on topics such as EEG biofeedback in the treatment of attention deficit hyperactivity disorder. "The great thing about Facebook is that you can actually have long conversations," Naparstek says.

Guided imagery is a valuable resource for any clinician treating patients who are dealing with reactions to stress. In fact, guided imagery is a valuable resource for any clinician treating patients whose emotional and psychological issues have been a factor leading to disease, or patients who need help coping with the emotional and psychological byproducts of disease. "Guided imagery elevates immune cell activity, lowers blood cholesterol and blood pressure, lowers hemoglobin A1c levels in diabetic patients and reduces length of stay for surgery patients," Naparstek says.

Equally, guided imagery is a valuable resource for any individual who is dealing with disease, or with extreme stress related to unusual work, or with normal stress related to living in this difficult period of time. In fact, it seems that almost everyone would benefit from closing the door, taking time to listen one of Naparstek's CDs, and using her voice as an opportunity to touch the peaceful, self-healing core of their being.

Invisible Heroes: Survivors of Trauma and How They Heal, by Belleruth Naparstek. Bantam; ISBN 0553803506.

The Health Journeys website: This includes links to many resources, including a free guided imagery download, electronic and print newsletters, and icons that take you to Naparstek's Facebook and Twitter accounts. In particular, look for two guided imagery CDs:
Guided Meditation for Healing Trauma (PTSD). Item 2120.
Mind-Body Exercises for Stress Hardiness Optimization: for Military Personnel, Early Responders, and Others Engaged in Intense Work Situations. Item 2150.

Another way to follow Naparstek's continuing work is to look for her blog posts on the Huffington Post website. See and

Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.



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