The effectiveness of guided imagery on psychological outcomes and quality of life in cancer patients: A systematic review and meta-analysis

Abstract

Purpose: To evaluate the effectiveness of guided imagery (GI) in reducing anxiety and depression and improving quality of life in adult cancer patients. Methods: Potential studies published up to December 31, 2024, were identified through a comprehensive search of seven electronic databases and the reference lists of similar reviews. Eligibility was determined based on the PICOS criteria, including adults (≥ 18 years) with a cancer diagnosis, GI alone or combined with progressive muscle relaxation as the intervention, outcomes of anxiety, depression, and quality of life, and a randomized controlled trial (RCT) design. The risk of bias in the included studies was assessed by two independent researchers using the Cochrane Collaboration’s Risk of Bias Tool. When appropriate data were available, the meta-analysis was conducted using RevMan 5.4 software. This review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42025643563. Results: This systematic review and meta-analysis included nine RCTs. The sample sizes of the included RCTs ranged from 30 to 208, with a total of 837 participants evaluated. All nine RCTs included demonstrated that GI significantly reduced anxiety levels (standardized mean difference [SMD]: -1.30 [95% CI: -1.98, -0.63]; p <.001). Seven RCTs also reported a significant reduction in depression levels (SMD: -1.11 [95% CI: -1.71, -0.51]; p <.001). Furthermore, four RCTs showed that GI significantly improved quality of life (SMD: 1.11 [95% CI: 0.44, 1.78]; p <.001). Conclusions: Guided imagery can be considered a complementary and integrative intervention that can be implemented during the treatment and rehabilitation phases of cancer patients to reduce anxiety and depression and enhance quality of life. However, since there is currently no standardized approach regarding session duration and frequency of this intervention, it is recommended to implement GI in clinical practice using structured protocols more extensively. Additionally, further research is necessary to evaluate its long-term effects.