Guided Imagery and Relaxation Therapy for Anxiety

Simple techniques with wide-ranging benefits.

Posted Aug 14, 2018

Applied relaxation is a general term for mind-body exercises used to diminish generalized anxiety. Relaxation techniques include sustained deep breathing, progressive muscle relaxation, guided imagery, and systematic desensitization. The physiology of relaxation has been studied for many decades. Different models have been proposed to explain its anxiety reducing effects including Benson’s “relaxation response,” Selye’s “general adaptation syndrome,” and others. One model posits that anxiety is associated with muscle tension, and is reduced by behaviors or thoughts that diminish tension and autonomic arousal. Regular relaxation is an important mainstream treatment of anxiety, and has established beneficial effects on specific phobias (e.g. fear of heights, fear of flying, fear of spiders), social phobia, and generalized anxiety. 

In a five-month prospective study, generally anxious patients randomized to a relaxation group or a group treated with a prescription medication and relaxation all experienced equivalent and significant improvements in state anxiety levels by the end of the trial. In a small controlled trial, 36 anxious adult outpatients randomized to 12 weekly sessions of applied relaxation or cognitive therapy experienced significant and comparable reductions in anxiety (Ost, 2000). A systematic review and meta-analysis of all studies done between 1997 and 2007 on relaxation training for anxiety disorders found consistent and significant efficacy of relaxation training in reducing anxiety (Manzoni, 2008).

Guided imagery is a widely used self-directed treatment of anxiety and is often practiced together with meditation or mindfulness training. Guided imagery can be individualized to fit the specific anxiety symptoms of each patient, and has well-known beneficial effects on the immune system, physiological stress responses and general mental-emotional functioning. The regular practice of mental imagery is beneficial for many anxiety problems, including generalized anxiety, panic attacks and traumatic memories. Imagery and relaxation techniques are often used together to induce hypnotic trance states resulting in a dramatic reduction in symptoms of generalized anxiety.

Combining relaxation with guided imagery is probably more effective than either approach alone. In an open trial, 60 women reporting anxiety and postpartum depressed mood experienced significant reductions in both anxiety and depressed mood using a combined relaxation-guided imagery protocol during the first four weeks after childbirth. In contrast to the largely beneficial effects of relaxation on generalized anxiety symptoms, panic attacks are sometimes reported by individuals diagnosed with Panic Disorder during applied relaxation exercises. 


Ost, L Breitholtz E Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder Behavior Research and Therapy 2000 Aug 38:8 777-90.

Relaxation training for anxiety: A 10 years systematic review with meta-analysis