# Relaxation training and guided imagery

Source: https://onco.cc/technologies/relaxation-guided-imagery/  
OnCo record `relaxation-guided-imagery` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Progressive muscle relaxation, breathing exercises and guided imagery are simple techniques that reduce anxiety and treatment-related distress during chemotherapy and radiotherapy. Guidelines say they may be offered, and audio versions cost nothing.

## Summary

Relaxation techniques (progressive muscle relaxation, diaphragmatic breathing, autogenic training) and guided imagery have been tested in dozens of small randomised trials in people receiving chemotherapy and radiotherapy, with consistent reductions in anxiety, anticipatory nausea and treatment-related distress, and some improvement in sleep and pain. The 2023 SIO-ASCO anxiety and depression guideline says relaxation may be offered for anxiety during treatment, and the 2022 pain guideline lists guided imagery with progressive muscle relaxation as an option for general cancer pain. Effect sizes are small to moderate, trials are unblinded and many are decades old. The techniques are freely available as recordings and integrate easily into chemotherapy suites.

## Fields

- Kind: Technology
- Status: established
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:moderate
- Principle: Deliberate muscle release and slow breathing engage the parasympathetic system and interrupt anticipatory anxiety; imagery redirects attention away from threat.
- Strengths: Free, self-administered, safe; Included in SIO-ASCO 2022 and 2023 guidance; Useful for anticipatory nausea and claustrophobia in scanners
- Limitations: Small, older trials; Small effect sizes; No effect on disease outcomes

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Guided_imagery
- SIO-ASCO guideline: integrative oncology care of anxiety and depression (JCO 2023): https://doi.org/10.1200/JCO.23.00857
- SIO-ASCO guideline: integrative medicine for pain management in oncology (JCO 2022): https://doi.org/10.1200/JCO.22.01357

## Connected records

- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Anxiety after cancer, in survivors and in their partners](https://onco.cc/technologies/rejuv-mind-anxiety-after-cancer/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available](https://onco.cc/technologies/rejuv-mind-fear-of-recurrence-treatment/)
- terms: [Quality of life](https://onco.cc/terms/quality-of-life/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline](https://onco.cc/key-papers/paper-mao-j-clin-oncol/), [Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline](https://onco.cc/key-papers/paper-carlson-j-clin-oncol/)

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