The purpose of this paper is to demonstrate how science has uncovered the connection between imagery and the resilience and length of a person’s telomeres for increased, health, wellness, and longevity. The paper will explore the origins of guided imagery as the vehicle for increased health and wellness by mitigating the effects of chronic stress and its negative effects on the immune system. Current research will demonstrate the ability of guided imagery to lower cortisol levels, decrease blood pressure, increase and repair telomeres and provide evidence-based knowledge on its use within medical facilities throughout the United States. Finally, the paper will suggest the use of a psychobiological approach to scripting guided imagery for the skeptic with the goal of counteracting their skepticism using anatomy and physiology-based guided imagery.

The Ancient Roots of Imagery

The ancient roots of imagery are inveterated into civilizations ranging from the southern to the northern hemispheres and traversing throughout the east and west continents. Imagery created a web that connected the mind-body-spirit and soul of the individual to their tribe and community. Predating the scientific method, imagery bore the power of integrating medicine and religion. The religious leaders and spiritual healers often coalesced into a single entity that transcended traditional boundaries of healer and priest to provide healing and comfort to others (Achterberg, 1985). Centuries before the age of literacy, the verbal traditions of healing rituals and prayers were passed from shaman to shaman, medicine man to medicine man, priest to priest, and wise woman to wise woman. It wasn’t until the rise of the Age of Empiricism that purposeful disquisition took hold and began to dominate the once holistic world of the healing art of imagery. The Age of Empiricism grew from the belief that knowledge can only come out of an actual experience that stems from scientific experimentation. The ancient verbal traditions were slowly dismissed and superseded by microscopes and laboratories.

Guided Imagery in Modern Medicine

Despite the birth of the microscopic - reductionist approach to viewing the world through a magnifying lens in favor of the once holistic view of our ancestors, the language of science has slowly begun to return to its roots to explore the web that connects mind-body and perhaps the spirit and soul (Moss, 2011). Guided imagery has begun to find its place among various hospitals throughout the country, Beaumont Health System, Health Journeys, Healing Healthcare, University of Wisconsin Hospitals, Penny George Institute for Health and Healing, Dartmouth, Johns Hopkins, Brigham and Women’s Hospital, Harvard Medical, and Cleveland Clinic are just a few medical facilities that offer guided imagery to provide their patients a means of integrative and holistic healthcare (Cleveland Clinic, 2019).

A common theme among the hospitals offering GI is to support the patient during times of increased stress, anxiety, fear of pain, and a sense of a loss of control (Cleveland Clinic, 2019). The relaxation that can occur with the use of GI among patients has been shown to increase a feeling of calm that physiologically reduces cortisol, decreases blood pressure, reduces pain, improves patient outcomes, and has been shown to decrease the length of the hospital stay (Hadjibalassi et al. 2017).

Blending Imagery and Evidence-Based Medicine

Evidence-based medicine is a “systematic effort to bring science and research-based knowledge into the heart of clinical practice” (Moss, 2011, para. 17). Moss (2011) credits the clinical popularity of an integrative approach, mind-body medicine, among a new age of healthcare providers with scientific research, random control trials and numerous case studies that substantiate the positive healing effects of MBM.

The use of legitimizing GI using the systematic, random control trial (RCT) methods has its limitations due to the hierarchical requirements of RCTs. Yet the value of quantitative results demonstrated through physiological changes that occur during GI only helps to propel GI further into the medical model of standardized, evidence-based treatment.

The suggested mechanisms by which guided imagery affects patients involve a pathophysiological cascade of autonomic and endocrine functions within the limbic system (Dartmouth, 2019). The limbic system is a link of structures within the brain which include the amygdala (maintains and forms new memories), hippocampus (memory center of the brain), thalamus (transmits motor and sensory signals to the cerebral cortex), hypothalamus (production of important hormones and regulation of thirst, hunger, and mood), basal ganglia (reward processing, habit formation, movement and learning), and the cingulate gyrus (assists in the regulation of emotions and behavior as well as helps to regulate autonomic motor function). The combined interaction among the components of the limbic system and the signaling molecules called neuropeptides that help to communicate within the limbic system, create a response to emotional and behavioral stimuli predominantly in response to one's primal survival behaviors (Dartmouth, 2019). The synthesis of the independent structures during guided imagery has been shown to activate a physiological relaxation response increasing parasympathetic tone, which counteracts the increased activation of the sympathetic stress response (Yijing et al. 2015).

Guided imagery has been shown to reduce stress levels and mitigate inflammatory conditions exhibited by immune system dysfunction. Research has shown that excess stress depresses the immune system (Trakhtenbery, 2008). Studies examining guided imagery and its effects on the immune system, specifically white blood cells (WBCs) altered the serum levels of WBCs. The research of Donaldson (2000) found alterations in specific cell lines after cell-specific imagery among medical patients. Donaldson (2000) hypothesized the mechanism of cellular alteration among the WBC differentials, neutrophils, and lymphocytes were based on the physiology of psychoneuroimmunology.

Psychoneuroimmunology

Psychoneuroimmunology described by Segerstrom (2010) “is the study of the interaction between psychological processes and the nervous and immune systems of the human body” (Segerstrom, 2010, p. xvii). Psychoneuroimmunology described by Ader, (2001) ”is the study of the relationships among behavioral, neural and endocrine, and immune processes (Ader, 2001, para 1). Both descriptions and definitions demonstrate the mechanisms by which the human body, psyche, behavior, and immune system interact and synergistically create a well-orchestrated response to exogenous and endogenous experiences such as stress. Communication between the immune system and the brain via the vagus nerve, a branch of the parasympathetic nervous system (PNS) has been shown to regulate and activate an innate immune response within the body (Pavlov & Tracey, 2012). Activation of the innate immune response due to acute stress increases inflammatory biomarkers (Pavlov & Tracey, 2012). Studies have shown that guided imagery via psychoneuroimmunological mechanisms can mitigate a physiological stress response via vagus nerve involvement (Pavlov & Tracey, 2012).

Psychoneuroimmunology and Telomeres

In 1984 scientists Elizabeth Blackburn and Jack Szostak discovered telomeres, “short nucleotide sequences found at the end of linear chromosomes which protect the genetic information” (Telomeres, 2018, p. 1) in eukaryotic cells. The role of telomeres is to protect the end of the chromosomes from unraveling similar to the plastic cap on the end of a shoelace, which protects the shoelace from unraveling due to constant use. Telomeres help to keep the chromosome ends from fraying, which prevents the host’s genetic information from degrading each time the cell divides (Univ. of Utah, 2016).

The extent of telomere loss is predictive of aging and the lifestyle behaviors that accelerate aging such as excessive stress, smoking, high blood pressure, cardiovascular disease, diabetes, chronic inflammation, lack of sleep, poor nutrition, and physical inactivity, speed the reduction of the telomere. Studies have found the practice of meditation and guided imagery to increase telomere lengths in leukocytes, (Alda, Puebla, Rodero & Demargo, 2016), a possible psychoneuroimmunological mechanism of action.

Telomere Biochemistry

Similar to the DNA strands (ACGT) encapsulated within the organizing structure of the chromosome, the telomere contains its own strands of DNA (TTAGGG), which can be lost each time a cell divides. If the telomere continues to consistently loose its own DNA eventually it will be unable to sustain and protect the chromosome and the cell will die, referred to as apoptosis. Cell division and replication occurs throughout the lifespan of humans, it is a part of the biological phase of aging. A typical human somatic cell divides about 50 to 70 times in its lifespan and each time it divides the telomeres protecting the chromosome, which is the organizing structure of the DNA becomes progressively shorter (Sahin & DePinho, 2010). The telomeres DNA base pairs (TTAGGG) act as a guard to the main chromosome’s base pairs of DNA (ACTG). At birth, the length of the telomeres’ DNA within an infant’s white blood cell is approximately 8,000 base pairs as compared to adults who have an average of 3,000 base pairs and the geriatric population who have a dwindling 1,500 remaining base pairs (Univ. of Utah, 2016). On average, every time a somatic cell divides it loses 30 to 200 DNA base pairs from the telomeres (Univ. of Utah, 2016).

However, there are specific enzymes such as telomerase that help to rebuild and protect the telomere from degrading during cellular division and replication. Telomerase is able to add the TTAGGG sequencing into the telomere to help maintain its integrity and longevity (Genome, 2019). Telomeres are found abundantly in egg, sperm, and stem cells and to a much lesser extent in the somatic cells (internal organs, skin, bones, blood and connective tissues), which are all programmed for aging and apoptosis. It is also important to note that cancer cells contain large quantities of telomerase, which allows for rapid and continued replication of the cancer cells, a type of biological immortality. As the cancer cell divides it is able to replicate itself without the threat of senescence unlike the somatic cells’ programmed apoptosis (Genome, 2019).

Telomeres and Aging

Research has shown that there is a three times greater increase of earlier death from heart disease and eight times greater likelihood to die from infectious disease. The study demonstrated the group of subjects with the shorter telomeres lived on average five years less than the group with the longer telomeres (Univ. of Utah, 2016).

The effect of telomere shortening is a direct cause of cellular aging (Sahine & DePinho, 2010). As we age humans lose DNA base pairs (adenine, thymine, and cytosine, guanine). Eventually, the cells die or become senescent as demonstrated in the aging process or from modifiable lifestyle behaviors that exacerbate excessive stress. As a cell divides and replicates itself the telomeres protect the DNA within the chromosomes from fragmenting and losing DNA sequencing.

Telomeres and Mental Health

Conklin et al. (2018) identified changes in telomere length in groups of meditators during a retreat that suggested the individual participants’ personalities had the greatest impact on the changes in telomere length. Significant findings among meditators were found in the length of the meditator’s telomeres who self-reported symptoms of anxiety as compared to those who self-reported high levels of calm and relaxation. The participants who reported high levels of anxiety were found to have consistently shorter telomeres as compared to the longer telomeres of the participants who reported a lifestyle that developed relaxation.

Mental health symptoms affect the entire body (Vakonaki et al., 2018). Physiological symptoms of depression increase oxidative stress and systemic inflammation throughout the body that correlates with shortening of telomere length, which can potentiate worsening symptoms of depression (Vakonaki et al., 2018). The authors identified several studies that linked bipolar disorders, schizophrenia, drug abuse and Alzheimer's disease to accelerated aging related to telomere length.

Telomeres and Chronic Stress

Chronic stress is debilitating to every cell in the body, and chronic stress permeates to the very threads of the DNA and can modify a person’s DNA response to their environment causing long term health complications (Lu, 2014). Chronic stress also diminishes the availability of telomerase, which disables the innate repair mechanisms of chromosomes (Lu, 2014). Studies examined people with mental health disorders and compared them to a control group of people without dysregulated mental health responses and found that the control group of healthy individuals consistently had longer telomeres as compared to the group of patients with psychiatric disorders (Lu, 2014). Another significant study found that a stressful fetal intrauterine environment dictated the length of the infant’s telomeres, which appeared shorter than fetuses who were not exposed in utero to a stressful or highly anxious maternal environment. (Lu, 2014).

Telomeres and Guided Imagery

Data investigating the practice of GI (and meditation) has shown positive correlations between longer telomere length and an increase in telomerase activity in subjects using GI as a health intervention as compared to subjects not using GI (Alda et al. 2016). The authors’ hypothesized that guided imagery reduced stress by lowering cortisol and pro-inflammatory biomarkers as well as high levels of reactive oxygen species (ROS) a form of oxidative stress (Alda, 2016). Prolong physical, emotional, and mental sensations of stress increase prolonged neural and autoimmunological reactivity leading to shorter telomere length and greater susceptibility to a dysfunctional immune response and an acceleration toward rapid aging (Epel, 2009).

Guided imagery counteracts the physiological stress response and promotes a sense of relaxation. According to Epel et al., “Positive cognitions and emotions may promote greater vagal tone, androgens, and growth hormone (GH) axis activity, whereas stress cognitions and negative affect lead to high cortisol, insulin, and oxidative stress” (p. 35). As discussed earlier, subjects who practiced guided imagery exhibited lower cortisol levels, a decrease in pain, shorter hospital length of admission, and alterations in their WBCs. The exact mechanism of action of how GI is able to physiologically alter telomere length related to stress reduction is still uncertain.