Guided Imagery and the Immune System
Guided imagery, a mind-body modality, improves the immune system of cancer patients! That’s nuts, right? How could “Training focused on concentration and visualization of the immune cells destroying… cancer cells”1 (p. 208) have an impact on a body system out of voluntary control?
At first glance, mind-body regulation of the immune system seems to good to be true! If this were the case, all breast cancer patients should be sitting around, practicing mind-body medicine, listening to mellow background music while a soothing voice instructs breast cancer patients to imagine an optimal functioning immune system, right? So let’s put Lengacher et al.’s1 hypothesis that guided imagery improves the immune system’s ability to fight cancer into context.
Lengacher et al. (2008)1 conducted an interesting randomized study to get to the bottom of this mind-body modality. Let’s start with the obvious. Diagnosis of breast cancer is a major stressful live event. Breast cancer patients may experience chronic stress, anxiety and ineffective coping which prevents the immune system from doing its job1. Mind-body interventions, such as guided imagery, target breast cancer cancer patients’ psychosocial lives and help cope with the stress of cancer.
- Stress affects the immune function, such as NK cell cytotoxicity1
- Breast cancer patients have significantly reduced NK cell cytotoxicity2.
- Cancer growth and progression relates to a reduction in NK cells and NK cell cytotoxicity3.
- Decreased NK cell activity leads to increased metastases in humans4.
- Increased NK activity leads to cancer regression in humans4,5.
- Cytokines regulate NK cell cytotoxic function, and the effects of stress on these cytokines ultimately leads to changes in NK cell functioning seen in stressed persons1.
- Decreasing the effects of stressors on cytokines will improve NK cell activity and ultimately improve patients’ ability to resist the progression of disease processes such as cancer.
- Reducing stress through a relaxation intervention such as guided imagery increases NK cell activity1.
Lengacher et al. recruited 32 (28 completed the entire study) breast cancer patients and randomly assigned them into an experimental group and a control group. The experimental group received training in guided imagery and relaxation while the control group received standard care.
The study aimed at evaluating NK cell cytotoxicity (the ability to detect cancer cells) and interleukin-2 (IL-2) enhanced NK cell (a.k.a. lymphokine activated killer cell or LAK). A word about the cytokine IL-2. The cytokine IL-2 has documented ability to enhance antitumor activity and is capable of modulating NK cells, acting as stimulators of NK cell’s increasing their ability to detect cancer cells. IL-2 does so by aiding expression of cytolytic factors, increasing the cancer cell detecting ability of NK cells1.
There was no difference between the experimental group and the control group in baseline measures (pre-surgery). The results show that after 4 weeks of guided imagery short-term relaxation and guided imagery had beneficial immunological effects on NK cell cytotoxicity and IL-2 activation of NK cells, or LAK activity1.
Lengacher et al.’s1 study supports the notion that presurgical mind-body intervention, focusing on relaxation can improve immune function (as measured by NK cell and LAK activity) in women undergoing surgical treatment for breast cancer.
Some Shortcomings of the Study:
This study does appear to blind participants, or any of the study personnel. However, I encourage readers to explore a report by the Institute of Medicine of the National Academies. The report titled “Need for innovative designs in research on CAM and conventional medicine”6 provides a comprehensive elaboration why double-blind randomized control trials, even though the gold standard in pharmaceutical research, are not always the best vehicle to research alternative medicine or mind-body medicine for that matter.
The study design did not account for an active control group, which could have included an activity that involved patient-clinician interaction for the same amount of time as the interaction between trained therapist and experimental group participants. Not all studies in this area seem to have similar effects.
The Bottom Line for Breast Cancer Patients and Survivors:
The women in the experimental mind-body group practiced guided imagery and relaxation an average of 4.9 times per week. This practice seems to have increased NK cell cytotoxicity, as well an increase in LAK activity, showing resilience to stress-induced immunosuppression.
In cancer patients circulating NK cells is a good thing, because NK cells have the ability to detect and destroy cancer cells. Stress seems to decrease NK cells, and they cytotoxic ability. Relaxation interventions, such as guided imagery, decrease stress. Decreasing stress can lead to improved NK cell activity, cytokines such as IL-2 could enhance NK cell cytotoxicity, supercharging NK cells into LAK cells, possibly leading to cancer prevention, regression and perhaps prevention of cancer recurrence in humans.
If you are thinking about giving guided imagery a try, please make sure you talk to your healthcare provider about the pros and cons of guided imagery in your healing journey.
If you already tried guided imagery, I would like to hear from you in the comments section. What is your experience with guided imagery? Mind-body modalities in general? In what context did you use guided imagery? Maybe you have some creative ways to use guided imagery? Has it helped you manage stress?
And finally, this is the part where I ask you to join our community of cancer patients, survivors, clinicians, loved ones and care providers of cancer patients and patient advocates who get free and hot off the press Alternative Medicine Blog content, so you never miss a beat.
1. Lengacher CA, Bennett MP, Gonzalez L, et al. Immune Responses to Guided Imagery During Breast Cancer Treatment. Biol. Res. Nurs. 2008;9(3):205–214. doi:10.1177/1099800407309374.
2. White D, Jones DB, Cooke T, Kirkham N. Natural killer (NK) activity in peripheral blood lymphocytes of patients with benign and malignant breast disease. Br J Cancer. 1982;46(4):611–16. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2011176/.
3. Bakke AC, Purtzer M., Newton P. The effect of hypnotic-guided imagery on psychological well-being and immune function in patients with prior breast cancer. J. Psychosom. Res. 2002;53(6):1131–1137. doi:10.1016/S0022-3999(02)00409-9.
4. Levy EM, Roberti MP, Mordoh J. Natural Killer Cells in Human Cancer: From Biological Functions to Clinical Applications. J. Biomed. Biotechnol. 2011;2011:1–11. doi:10.1155/2011/676198.
5. Whiteside T. Immune suppression in cancer: Effects on immune cells, mechanisms and future therapeutic intervention. Semin. Cancer Biol. 2006;16(1):3–15. doi:10.1016/j.semcancer.2005.07.008.
6. Committee on the Use of Complementary and Alternative Medicine by the American Public. Complementary and Alternative Medicine in the United States. The National Academies Press; 2005. Available at: http://www.nap.edu/openbook.php?record_id=11182.