Guided Imagery to Overcome Anxiety, Stress, and Pain

A Holistic Nurse’s Perspective

Jan 07, 2025

Being a nurse means standing at the intersection of science and humanity.

And let me tell you—no amount of cutting-edge medicine can erase the pain, anxiety and stress some patients experience especially after surgery.

I’ve seen it firsthand with patients who’ve had open-heart surgeries, liver transplants, even lung transplants. These aren’t your run-of-the-mill recoveries.

They come with intense incisional pain and, just as often, a kind of emotional or psychological pain that medications can’t touch.

Sure, we throw everything at them—IV painkillers for fast relief, oral meds to keep things steady. Anti-anxiety medications for the stress and anxiety, but it doesn’t last - none of them do.

Because sometimes, all the factors are relentless.

Meds barely scratch the surface, or worse, they knock the patient out completely, leaving them groggy and disconnected. Same with the other medications.

And honestly? That’s not the kind of healing anyone wants.

That’s when I turn to something different—something out of the box.

Guided imagery.

It’s a technique that might seem simple, even unconventional. But let me tell you… it works.

The Case That Proves It

One day, I walked past a patient’s room. She’d had major surgery—a complicated case with all the bells and whistles. Her nurse looked frustrated. “We can’t get her pain under control,” she said. “Nothing’s working.” Morphine, Dilaudid… you name it, they’d tried it.

So I asked, “Mind if I step in?”

Inside, the young woman looked like she’d been fighting a war with her own body. Her mother sat nearby, wringing her hands.

I introduced myself, sat at her bedside, and said, “I’ve got an idea. It’s different, but I’ve seen it work. Are you willing to give it a try?” She nodded as tears rolled down her face and fists clenched.

Before we started, I said, “I want you to pick your favorite place. Somewhere that feels peaceful, calm. A place you love.” She thought for a moment, then said, “The beach.”

“Perfect,” I said. “Let’s go there together.”

I dimmed the lights, closed the door, and started guiding her into that world.

“Close your eyes and picture yourself standing on a beach. The sun is warm on your face—not too hot, just perfect.

You can feel it soaking into your skin, loosening the tension in your body.

There’s a gentle breeze coming off the ocean, carrying the fresh, salty scent of the water. It brushes against your cheeks and plays with your hair.”

I paused, giving her time to settle into the scene and be aware of her breathing.

“Now, glance out at the waves. See how they rise and fall, like the rhythm of your own breathing. There are little whitecaps on the water, foamy and playful, dancing on the surface.

The tide is coming in, then gently pulling back out.

You can feel the cool, wet sand under your feet, grounding you, connecting you to the earth. It shifts slightly as the waves kiss your toes, leaving that soft, gritty texture behind as they recede.”

Her breathing slowed. Her shoulders dropped.

“You hear the sound of the waves as they roll in, steady and soothing, a natural rhythm that matches your heartbeat.

In the distance, there’s the faint call of seagulls, their wings cutting through the sky. You can see them gliding overhead, their movements effortless, free.

The horizon is endless—a place where the sky meets the water, stretching out forever, peaceful and still.”

By this point, her mother had stopped fidgeting. The room felt calmer, quieter, like the beach itself had seeped in.

“And now, you reach down and pick up a shell. Feel its texture in your hand—the ridges, the smooth curves. Listen as you hold it up to your ear. You can hear the ocean’s echo inside it, like a secret whisper, just for you.”

Another pause. Her face softened even more, her breathing now deep and even.

“You’re completely surrounded by this place. You’re not just there—you’re part of it. The sun, the breeze, the waves, the sand.

Even the air feels alive, carrying a quiet energy that flows through you. You know, deep in your core, that this is a place of peace and healing.

You feel safe here.

You feel whole.”

Within about twelve minutes, she was asleep. Not the restless, medicated kind of sleep, but the deep, restorative kind that heals.

Her mother looked over at me, tears in her eyes. She mouthed, “Thank you.”

It was one of those moments where words didn’t matter—her expression said it all. The tension that had gripped the room was gone, replaced by something softer, lighter.

Peaceful.

When I checked on her a few hours later, her pain, anxiety and stress - once a relentless 10 – was down to a manageable 2 or 3. She smiled when I walked in and said, “I feel so much better, can we do that again sometime?”

It wasn’t just the physical relief. You could see it in her eyes. She felt lighter, calmer, and more at ease with the world around her.

I could tell you thousands of stories like this one… are you relaxed?

What Makes Surgical Pain So Complex

Surgical pain isn’t one-dimensional. It’s a layered experience that affects not just the body, but the mind and spirit.

Patients recovering from surgeries like transplants or open-heart procedures often face a unique combination of physical and psychological challenges, each amplifying the other.

Let’s break it down:

1. Incisional Pain

Incisional pain is sharp, constant, and difficult to ignore.

It comes directly from the surgical site, where the body is working overtime to heal layers of tissue, muscle, and skin that have been cut, stretched, or manipulated.

Nerve endings in the area send continuous pain signals to the brain, which can become overwhelming, especially in major surgeries where large incisions are involved.

Even the act of breathing or shifting in bed can aggravate this pain, creating a relentless “loop of discomfort”.

And while medications help, they often only mask the sensation temporarily, leaving patients trapped in a cycle of frustration.

2. Muscle and Fascia Pain

Beyond the incision, there’s the pain caused by the positioning during surgery.

Lying still for hours on a hard operating table puts significant strain on muscles, fascia, and joints.

After surgery, patients may feel like their entire body is sore, as though they’ve run a marathon.

This pain isn’t just localized to the surgical site—it radiates to surrounding areas, especially in procedures like open-heart surgery, where the chest and back muscles are stretched or compressed.

Fascia, the connective tissue that wraps around muscles and organs, becomes tight and restricted, amplifying the sensation of stiffness and discomfort.

Add to this the physical immobility post-surgery—patients are often confined to bed for long periods. This lack of movement can cause muscles to weaken, spasm, or cramp, further complicating recovery.

3. Psychological Pain

This is the layer of pain that medications often can’t touch.

Surgical pain comes with a heavy dose of psychological distress.

Patients may feel fear—of complications, of an uncertain recovery, of their body’s ability to heal.

There’s also the sense of vulnerability: being dependent on others for basic needs, losing control over one’s body, and navigating the mental strain of prolonged hospital stays.

These feelings can intensify physical pain, as stress and anxiety heighten the body’s perception of discomfort.

For many patients, there’s also a sense of grief or loss.

Major surgeries, especially transplants, are life-altering.

They can symbolize both hope and the loss of “normalcy,” as patients grapple with the reality of a changed body or lifestyle.

4. Inflammatory Response

After surgery, the body’s immune system kicks into high gear to repair the trauma caused by the procedure.

While this healing response is essential, it also contributes to pain.

Inflammation around the surgical site leads to swelling, heat, and additional pressure on nerves and tissues. This process, though necessary, can prolong discomfort and increase sensitivity.

5. Sensory Overload

Hospitals are not the most restful environments.

Bright lights, beeping monitors, and the constant interruption of medical care can exacerbate a patient’s stress and discomfort.

The sensory overload makes it harder for patients to focus on healing or relax enough to allow their body to recover effectively.

This overload compounds pain perception, creating a vicious cycle where stress fuels pain, and pain fuels stress.

The Compounding Effect

What makes surgical pain so complex is how these layers interact.

Incisional pain heightens muscle tension, which in turn intensifies nerve signals.

Psychological distress magnifies everything—studies show that anxiety and fear can make pain feel worse by increasing the brain’s sensitivity to it.

Meanwhile, inflammation and sensory overload leave the patient feeling trapped in a body and environment that seem to be working against them.

This is why guided imagery is so powerful.

It doesn’t just address one aspect of pain—it provides relief on every level, calming the mind, relaxing the body, and even modulating the body’s physiological stress response.

By interrupting the pain-stress-pain cycle, guided imagery offers a pathway to healing that traditional methods alone often can’t provide.

Why Guided Imagery Works

Guided imagery isn’t just about imagining peaceful scenes.

It’s a deeply therapeutic practice that rewires how your body and mind respond to pain and stress.

By engaging the senses and the imagination, it creates real, measurable changes in the brain and body.

Here’s how:

Pain Relief

Pain is more than a physical sensation—it’s a message sent from the body to the brain, filtered through emotions, thoughts, and even memories.

Guided imagery works by interrupting this pain signaling process. Here’s how it happens:

• Rewiring Pain Pathways: Pain signals travel along neural pathways to the brain, where they’re processed and interpreted.
Guided imagery redirects the brain’s focus to calming, pleasant thoughts and sensory experiences. This “distraction” reduces the brain’s perception of pain, lowering its intensity.
• Releasing Natural Painkillers: Engaging in guided imagery can stimulate the release of endorphins, the body’s natural pain-relieving chemicals.
These act like your body’s own morphine, dampening pain signals while enhancing feelings of well-being.
• Relaxing Tense Muscles: Pain often causes muscles to tighten, creating a feedback loop of tension and discomfort.
Guided imagery encourages deep relaxation, releasing tightness in muscles and fascia, which reduces pressure on nerves and improves circulation to promote healing.

Patients often describe feeling a “lighter” body or a significant reduction in pain, even after just a few minutes of guided imagery.

It’s not just temporary relief—it helps retrain the brain to respond differently to pain over time.

Stress Reduction

Stress triggers the body’s fight-or-flight response, flooding the system with stress hormones like cortisol and adrenaline.

While this response is useful in short bursts, prolonged stress wreaks havoc on the body, worsening pain, slowing healing, and impairing overall health.

Guided imagery counters this in several ways:

• Activating the Relaxation Response: Guided imagery shifts the nervous system from the sympathetic (fight-or-flight) to the parasympathetic (rest-and-digest) state.
This physiological shift slows the heart rate, lowers blood pressure, and reduces cortisol levels.
• Breathing and Visualization Synergy: The deep breathing often used in guided imagery enhances oxygen flow to the brain and body, further calming the nervous system.
Visualization adds another layer of relaxation, helping the body release stored tension.
• Stress Hormone Regulation: Chronic stress causes the brain’s amygdala—its fear center—to go into overdrive.
Guided imagery reduces activity in the amygdala while increasing activity in the prefrontal cortex, the part of the brain responsible for rational thought and emotional regulation.

Patients report feeling more “in control” after guided imagery, which is key to managing stress. The practice provides not only calm in the moment but a tool to navigate future stressors.

Emotional Healing

Pain and stress are rarely just physical—they carry a heavy emotional burden. Guided imagery taps into the emotional self, addressing fears, anxieties, and even unresolved trauma.

Here’s how:

• Reframing Negative Thoughts: Chronic pain and stress can create a loop of negative thinking (“I’ll never feel better,” “This pain will never end”).

Guided imagery replaces those thoughts with positive, empowering imagery, helping patients reframe their inner narrative.

• Creating Safe Spaces: For patients facing major surgeries, illnesses, or life changes, guided imagery provides a mental “escape” to a place of peace and safety.

This sense of security helps reduce fear and fosters emotional resilience.

• Tapping Into the Subconscious: Imagery has a unique way of bypassing the logical mind and reaching deeper parts of the subconscious.

This can release pent-up emotions, offering patients a sense of relief or clarity that’s hard to achieve through words alone.

• Promoting Gratitude and Joy: The practice often includes visualizing pleasant memories or peaceful settings.

This can evoke feelings of gratitude, happiness, and even hope, which are powerful antidotes to emotional pain.

Physiological Changes on a Cellular Level

Guided imagery doesn’t just feel good—it creates measurable changes in the body that support healing:

• Improved Immune Function: Studies show that guided imagery can enhance the activity of natural killer cells, which are critical for fighting infections and promoting healing after surgery.

It’s a subtle but important way to give the body a boost.

• Reduced Inflammation: By lowering stress hormones like cortisol, guided imagery indirectly reduces inflammation, which is a major contributor to pain and slowed healing.

• Optimizing Circulation: The relaxation it promotes improves blood flow to tissues, delivering oxygen and nutrients where they’re needed most.

Sensory and Neurological Rewiring

Guided imagery engages all the senses, creating a vivid, immersive experience that the brain treats as real.

This sensory engagement is key to its effectiveness:

• Visual Stimulation: Seeing a calm, peaceful scene in your mind can activate the visual cortex, which then communicates with other parts of the brain to reinforce “feelings of calm and safety”.

• Auditory and Kinesthetic Elements: Incorporating imagined sounds (like ocean waves or rustling leaves) and physical sensations (like warm sun on your skin) creates a multi-sensory experience that deepens relaxation.

• Neurological “Reprogramming”: Over time, repeated use of guided imagery can rewire the brain to be less reactive to pain and stress, creating lasting changes in how the body and mind respond.

Empowerment and Self-Control

Perhaps one of the most overlooked benefits of guided imagery is the “sense of empowerment” it gives patients.

Surgery, chronic pain, and stress can leave people feeling helpless, like they’ve lost control of their bodies and lives.

Guided imagery puts some of that control back in their hands:

• Active Participation in Healing: Instead of passively waiting for meds or procedures to work, patients become active participants in their own recovery.

This mental shift is huge—it fosters confidence and resilience.

• A Lifelong Tool: Guided imagery isn’t just a one-time solution.

Once patients learn how to use it, they have a tool they can use anytime, anywhere, to manage pain, stress, and anxiety.

The Whole-Person Impact

Guided imagery is more than a relaxation technique—it’s a holistic approach that addresses the full complexity of pain, stress, and emotional strain.

By calming the nervous system, rewiring the brain, and empowering the patient, it provides relief on multiple levels.

It’s not just about surviving the pain, stress and anxiety, it’s about creating an environment where the body and mind can truly thrive.

Out of the Box Healing: How to Use Guided Imagery

Whether you’re a nurse, caregiver, or someone managing your own recovery, guided imagery is worth adding to your toolbox.

Here’s how to start:

1. Set the Mood: Find a quiet space. Dim the lights. Minimize distractions. This isn’t about perfection; it’s about creating a moment of calm.

2. Start with Breath: Encourage slow, deep breathing. Inhale for four counts, hold for four, exhale for four. This calms the nervous system.

3. Choose a Journey: Ask, “Where do you feel safe? What’s a place that makes you happy?” Let them pick—this is key to making the experience personal.

4. Guide the Scene: Paint the picture with your words. “Feel the sun on your face. Hear the rustle of leaves. Smell the salty air. Notice how your body feels lighter, more relaxed.”

5. Keep It Simple: Five to ten minutes is enough. Let the body and mind do the rest.