Imagery Content during Nonpharmacologic Analgesia in the Procedure Suite: Where Your Patients Would Rather Be 1 Lauri J. Fick, BS, Elvira V. Lang, MD, Henrietta L. Logan, PhD Susan Lutgendorf, PhD, Eric G. Benotsch, PhD Rationale and Objectives. Imagery as a hypnotic tech- nique can produce analgesia and anxiolysis, but effective use may be restricted to select, highly hypnotizable indi- viduals. This study assessed (a) whether patients not se- lected for hypnotizability can produce imagery during interventional radiologic procedures and (b) the type of imagery produced. A secondary goal of the study was to familiarize health care providers with a simple, time-effi- cient technique for imagery. Materials and Methods. Fifty-six nonselected patients referred for interventional procedures were guided to a state of self-hypnotic relaxation by a health care provider according to a standardized protocol and script. Patient hypnotizability was assessed according to the Hypnotic Induction Profile test. Results. Patients as a group had average distribution of hypnotizabilty. The induction script was started in all pa- tients and completed in 53. All patients developed an im- agery scenario. Chosen imagery was highly individual, but common trends were nature and travel, family and home, and personal skills. Being with loved ones was an important element of imagery for 14 patients. Thirty-two patients chose passive contemplation, and 24 were action oriented. Conclusion. Average patients who present for interven- tional radiologic procedures and are not presetected for hypnotizabilty can engage in imagery. Topics chosen are highly individual, thus making prerecorded tapes or pro- vider-directed imagery unlikely to be equally successful. Key Words. Anesthesia; hypnosis; imagery; intervention- al procedures. Hypnosis can be an effective means of analgesia and anx- iolysis (1,2). Many techniques, including imagery, can in- duce a hypnotic state. Self-hypnotic relaxation and imag- ery can reduce patients' pain and anxiety and the use of in- travenous sedatives and narcotics during invasive medical procedures (3-7), and they can facilitate magnetic reso- nance imaging (8). Concern sometimes is raised that effective use of hyp- nosis is restricted to select, highly hypnotizable patients and is limited to providers in the field of mental health care. This may be true in the case of open surgery without use of anesthetics, but requirements for less painful proce- dures are largely unexplored. Some reports suggest that lay persons (eg, parents [6]) and radiology personnel can be trained in effectively facilitating self-hypnosis and that even poorly hypnotizable patients may benefit from such interventions (9). Lack of familiarity with use of imagery can pose barri- ers to introducing this technique in conventional health care settings. Fear may exist that without aid from a highly skilled clinician, patients may not respond to imagery or may have negative experiences. The addition of a highly skilled, mental health care clinician to a procedure depart- ment may not be possible because of budget constraints, however, or may add unreimbursable expense. Providers Acad Radio11999; 6:457-463 1From the Departments of Radiology (L.J.F., E.V.L., E.G.B.), Psychology (S.L.), and Community and Preventive Dentistry (H.L.L.), University of Iowa, Iowa City; and the Department of Radiology, Harvard School of Medicine, Beth Israel Deaconess Medical Center, West Campus, 1 Deaconess Rd, Boston, MA 02115 (E.V.L.). Received October 19, 1998; revision requested January 22, 1999; revision received February 18; accepted February 19. Supported by the National Institute of Mental Health and the Office of Alter- native Medicine (RO1-MH56274). Address reprint requests to E.V.L. ©AUR, 1999 457