Teaching Guided Imagery to Patients

Specialties Psychiatric

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Specializes in Med-Surg/Oncology, Psych.

I work on a short-stay inpatient psych unit. Because our patients usually stay with us from 3-7 days, much of our treatment is group-oriented as opposed to engaging in a lot of 1-to-1 therapy. I have been trying to think of ideas to make our groups more effective and how we can provide stress-reducing techniques to patients that they can use long after they leave the inpatient environment. I thought that doing a group on guided imagery would be great for those with anxiety disorders or those who have a lot of stressors in their lives. My problem is that I don't have much experience leading groups, and I don't know much about how to conduct guided imagery sessions/teach others about it. Can anyone please recommend some resources for me? Thanks from me and my patients!

Erin

Specializes in psych, addictions, hospice, education.

I'm wondering if you have a music therapist or if the social worker might use guided imagery. If you have those people, check with them, since they might have lots of resources for guided imagery as well as other types of groups you might do. (art therapist too)

Specializes in Med-Surg/Oncology, Psych.

Thanks for the reply! Unfortunately, at this point, we don't have the budget to have therapists as part of our staff, so it's up to the nurses and mental health assistants to develop and lead groups. :crying2: If anyone could suggest books/websites/seminars/etc. it would be very much appreciated. Thanks again!

Guided imagery is much more appropriate for the nonCMI population. For the patients in need of short-term stabilization it's generally noneffective and can actually elevate the symptoms and stress. A focus on symptom management, self-monitoring, CBT and didactic presentations on stress management would be a better approach.

Specializes in psych, addictions, hospice, education.

I disagree with David. I agree that if the patient hallucinates, guided imagery could be counter-productive, but if the patient is depressed and/or anxious without psychosis, it can be very helpful.

Specializes in Med-Surg/Oncology, Psych.

Thank you both for your replies. Looking back on my post, I realize that I didn't do a good job of describing the types of patients on my unit. About half of our patients come to our unit after a suicide attempt, be it an overdose, cutting, whatever. All of the patients are medically cleared before they are admitted to the unit. Other patients come for alcohol or opiate detox. Some are hospitalized for bipolar d/o. Others for depression and/or anxiety disorders. We do work with schizophrenic patients and others with psychosis as part of their dx, but all of our groups are voluntary and patients may leave at any time if they feel at all uncomfortable. Most of our patients love the yoga and relaxation groups (we turn off the lights in one of the group rooms at HS and allow pts to bring pillows and blankets and listen to quiet music), and that's what prompted me to think about guided imagery. Thank you to anyone who is willing to offer input!

Specializes in psych, addictions, hospice, education.

The problem with guided imagery for those with schizophrenia is that they are hallucinating and TRYING to see things in their mind complicates what's already going on there. Bipolar, depressed, and patients in withdrawal can also hallucinate. Even if patients can leave groups if they choose, that doesn't mean they would. How about progressive relaxation (tightening muscles one by one and then releasing them) instead?

As a general rule, guded imagery relies on the patients internal state to influence the content and "feel" of their imagery experience. For a patient that is in acute distress, this is generally an unpleasant "place" to go.

Using some abreviated imagery as a cue for relaxation could be helpful especially if paired with breathing exercises and Jocobsonian progressive muscle relaxation. Frequently, asking a patient to close his eyes or turning off the lights can elevate stress......several patients could be OK with this but it can be difficult to "read" who's not doing well. In the presence of delerium, dementia, or acute psychosis I would see it as a "risky" intervention.

There's a book by John Stevens titled "Awareness" that has several good imagery techniques. It's been out of print but you may find a used copy on the internet somewhere.

Specializes in Med-Surg/Oncology, Psych.

Thank you both for bringing up excellent points that hadn't initially occurred to me. Progressive muscle relaxation would be well-suited to our unit. I've found a copy of Awareness on Amazon for $4! :up:

Specializes in mental health; hangover remedies.

I'm kind of curious as to the nature of the unit - 3-7 days is very short stay - considering the conditions are all chronic in nature.

What is the clinical functional purpose of the unit and on what evidence/theory is that based?

Specializes in Med-Surg/Oncology, Psych.

Hi Ian,

Our unit is an acute crisis-type facility. Most patients come to us because they are posing some kind of danger to themselves, be it r/t suicidal ideation, ETOH detox, inability to care for themselves in terms of ADLs, etc. The primary goals of our unit are 1) to keep patients safe by preventing them from harming themselves, facilitating safe detoxes, etc. and 2) to develop a structured plan that will meet the patient's needs after they leave our unit. There are a number of inpatient and outpatient options. I do wish that I had an article or mission statement I could share with you to support the evidence/theory behind the short-stay nature of the unit, but unfortunately I think that much of it has to do with insurance.

Specializes in mental health; hangover remedies.

Well I'm aware of some evidence for brief-intervention therapy; but I'm surprised to see it applied across such a wide range of presentations.

Do you have any community follow up?

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