JOURNAL OF

PSYCHIATRIC NURSING
DOI: 10.14744/phd.2020.70707
J Psychiatric Nurs 2020;11(3):165-172

Original Article

Effect of guided imagery on the functionality

of individuals diagnosed with schizophrenia
in a community mental health center
Özge Elgit,1 Ayşegül Bilge,2 Adem Bayrakçı3
1
Department of Cardiovascular Surgery, Ege University Faculty of Medicine, İzmir, Turkey
2
Department of Psychiatric Nursing, Ege University Faculty of Medicine, İzmir, Turkey
3
Departmen of Psychiatry, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey

Abstract
Objectives: The aim of this study is to determine the effect that guided imagery has on the functionality of individuals
diagnosed with schizophrenia in a community mental health center.
Methods: This is a pretest-posttest-controlled group study including 631 individuals registered in the Communi-
ty Mental Health Center (CMHC) of Ege University Medical Faculty Hospital, of which 55 individuals were diagnosed
with schizophrenia, as well as 300 individuals registered in the CMHC of Katip Çelebi University Atatürk Training and
Research Hospital, of which 30 individuals were diagnosed with schizophrenia, and who were receiving continuous
daytime service. The study sample included 48 individuals that fit the inclusion criteria among the 85 individuals who
benefitted from daytime CMHC. The study was completed with 24 individuals in the experimental group and 24 in-
dividuals in control group. The value of power analysis is 98.8%. As data collection tools, an Introductory Information
Form, Functional Remission of General Schizophrenia Scale (FROGS), and Subjective Recovery Assessment Scale (Sub-
RAS) were used. For the numerical measurements, Mann-Whitney U test, Wilcoxon t test, one-way ANOVA test, and
Chi-squared test were used.
Results: As a result of guided imagery applied to the study group 10 minutes daily for two weeks, a statistically signif-
icant difference was detected between the mean score of daily living skills subscale of FROGS (z=-2.69, p≤0.01); mean
score of treatment subscale (z=-2.37, p=0.01); overall mean score of FROGS (z=-2.41, p=0.01); mean score of SubRAS
(z=-3.70, p≤0.01). However, no significant difference could be found between the mean scores of social functioning
subscale of FROGS (z=-1.80, p=0.07) and the mean scores of professional functioning in FROGS (z=-0.46, p=0.64).
Conclusion: According to the results of the study, it can be said that the guided imagery application for two weeks has
created a significant difference in functional remission of the cases diagnosed with schizophrenia.
Keywords: Community mental health nursing; functional recovery; guided imagery; schizophrenia.

A lthough it has been more than a half-century since the

performance of medical treatment practices for severe
mental disorders in the 1950s, there are still fields that need
schizophrenia do not explicitly recover. Such patients com-
prise a vast majority of the patients in large hospitals, which
can have many patients for a long time.[2] Patients with schizo-
to be developed in the treatment of the diseases.[1] Despite phrenia have serious problems in skills such as daily life skills,
the recent developments in the psychopharmacological and social relationships, communicating with parents and people
psychosocial treatments, almost 25–30% of the patients with around.[3] Schizophrenia comes into prominence with posi-

Address for correspondence: Özge Elgit, Ege Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalı, İzmir, Turkey
Phone: +90 232 390 49 08 E-mail: [email protected] ORCID: 0000-0003-4749-9753
Submitted Date: August 02, 2019 Accepted Date: April 22, 2020 Available Online Date: October 05, 2020
©
Copyright 2020 by Journal of Psychiatric Nursing - Available online at www.phdergi.org
166 Psikiyatri Hemşireliği Dergisi - Journal of Psychiatric Nursing

What is known on this subject?

Psychiatric nurses and community mental health nurses are
• This is the first study where guided imagery was performed on individu-
recommended to have the body of knowledge regarding the
als diagnosed with schizophrenia. methods in complementary treatments (relaxation, posture
What is the contribution of this paper? flexibility, correct respiration, colors, plants), provide the treat-
• Performance of guided imagery on individuals diagnosed with schizo- ment setting, make regulations in accordance with the study
phrenia positively affected the functionality. data, and participate in certified training programs in this
What is its contribution to the practice? field and train colleagues in other fields and practice on the
• Community mental health nurses can perform this method by receiving
guided imagery training at the centers they work in.
patients and patient relatives.[16] The guided imagery method
is such complementary treatment. Guided imagery method is
tive, negative, cognitive, and affective symptoms and requires significant for practice on individuals diagnosed with schizo-
practicing multiple treatment methods simultaneously due phrenia as a nursing intervention at community mental health
to its various features in etiology, clinical symptoms, process, centers (CMHCs).
and termination, causing serious problems in the quality of This study was conducted to determine the effect of guided
life and functions as it lasts an individual’s lifetime.[2,4,5] Com- imagery methods practiced on the people diagnosed with
munity mental health center teams need to be recovery-ori- schizophrenia at the CMHC on the functionality of the indi-
ented and focus on the patient instead of the disease.[6] The viduals.
common goal should be making the patient more functional.
In addition to the treatment approaches towards removing Materials and Method
the fundamental symptoms and mental deprivation during
Study Type
schizophrenia treatment, efforts to increase functionality
are expected to increase the subjective life, self-respect, and This is a pretest-posttest-controlled group study.
satisfaction with life.[1] The most important emotion for the
patients comes with reaching the condition of being able to Study Location and Time
do something for themselves that they previously relied on
This study was conducted between 2017 and 2018 in the
someone else to do. Arousing this emotion will ensure the
Community Mental Health Center (CMHC) of Ege University
continuity of the treatment.[7] The individual will reach the
Medical Faculty Hospital and the Community Mental Health
condition of one doing something for themselves with guided
Center (CMHC) of İzmir Katip Çelebi University Atatürk Train-
imagery practice.
ing and Research Hospital.
Guided imagery belongs to the mind-body field of comple-
mentary and alternative therapies. In guided imagery, the
thoughts and imagination of the person are focused on and Study Population and Sample
oriented to a specific goal by a guide. Images in the guided The study population includes n=55 individuals diagnosed
imagery include all the five senses and are based on an un- with schizophrenia who were receiving continuous daytime
derstanding that body and mind are connected, and the service, among n=631 individuals registered in the Communi-
mind may affect the body.[8] Stress and anxiety directly affect ty Mental Health Center of Ege University Medical Faculty Hos-
the brain and immune system.[9,10] In guided imagery, the pital, and n=30 individuals diagnosed with schizophrenia who
thoughts and imagination of the person are focused on and were receiving continuous daytime service among n=300 in-
oriented to a specific goal, mostly through a voice record of dividuals registered in the CMHC of İzmir Katip Çelebi Univer-
a guide.[8,10] Imaging may provide physical improvements in sity Atatürk Training and Research Hospital. The study sample
individuals in addition to psychological improvements, such included 48 individuals who met the inclusion criteria among
as in emotion control, concentration, and self-confidence.[11] the 85 individuals benefitting from daytime CMHC. Individu-
Guided imagery has been proved to help individuals cope als were distributed to the experimental and control groups
with many diseases, such as cancer, migraine, irritable bowel based on the lottery method. The study was completed with
syndrome, hypertension, anxiety, depression, immune system 24 individuals in the experimental group and 24 individuals in
diseases, posttraumatic stress disorder, and asthma.[12] A few the control group. The value of power analysis is 98.8%.
studies in international literature have used guided imagery in
psychiatry patients. The use of guided imagery in individuals
Hypotheses
diagnosed with schizophrenia is quite limited. This is the first
study where guided imagery was performed in individuals H0: The guided imagery method does not have any effect on
diagnosed with schizophrenia in Turkey. Patients diagnosed the functionality of individuals diagnosed with schizophrenia
with schizophrenia have difficulty in mentally forming consis- in the community mental health center.
tent scenes of future events[13] and dreaming about their pos- H1: The guided imagery method affects the functionality of
itive events in the future due to apathy,[14] which specifically individuals diagnosed with schizophrenia in the community
makes using guided imagery valuable in this group.[15] mental health center.
Özge Elgit, The effect of imagery on functionality / dx.doi.org/10.14744/phd.2020.70707 167

Study Inclusion and Exclusion Criteria social functioning, daily life, treatment, and professional func-
Inclusion criteria included: tioning. The professional functioning subscale was bipolar-
ly performed, i.e., one of the items is the alternative for the
• Receiving daytime service from the Community Mental
other. Patients receiving a score below 58 from the Functional
Health Center (CMHC) of Ege University Medical Faculty
Remission of General Schizophrenia Scale (general total) are
Hospital or the Community Mental Health Center (CMHC)
those with a low level of functional recovery. Patients with a
of İzmir Katip Çelebi University Atatürk Training and Re-
score between 59 and 66 have a medium level of functional
search Hospital recovery, while patients with a score of 66 and above have a
• Followed up with schizophrenia diagnosis based on DSM- higher level of functional recovery. Patients with a score below
IV and V criteria for at least one year (no discrimination was 28 from the social functioning subscale have a lower social
found between subtypes of schizophrenia) functionality; those with a score between 29 and 33 have a
• Volunteered for participation in the study medium level of social functionality, and those with a score of
• With hearing ability to listen to voice recordings 33 and above have a good level of social functionality. Patients
with a score below 13 from the daily life scale have a lower dai-
• Listening to the guided imagery voice record at least once ly life skills; those with a score between 14 and 15 have a me-
daily for two weeks dium level of daily life skills, and those with a score of 15 and
above have a good level of daily life skills. Patients with a score
Exclusion criteria included: below 13 from the treatment scale have a lower functional-
ity on treatment level; those with a score between 14 and 15
• Patients in the acute exacerbation period
have a medium level of functionality, and those with a score of
• Inpatients or patients discharged two weeks ago at most 15 and above have a good level of functionality.
• Patients who actively use alcohol or psychoactive sub-
stance
Subjective Recovery Assessment Scale (SubRAS)
• Patients with a mental condition such as mental disability
Yıldız et al.[17] (2018) developed the 5-pointLikert-type scale
or dementia, which makes cooperation impossible
SubRAS (1 = does not suit me; 5 = fully suits me) including 17
Patients included in the study were monitored with ambula- items and evaluated through the total score. Its Cronbach Al-
tory controls by Community Mental Health Centers, and all pha value is 0.98. This study found the Cronbach Alpha value
patients continued to receive drug treatments including typ- to be 0.89. The scale does not have any subscales. A higher
ical and/or atypical antipsychotic medications. Patients’ drug total score means a positive contribution to the recovery level
treatments were not interfered with during the study. of the patient.

Data Collection Tools Data Collection Methods

Study data were collected through an Introductory Informa- The scales were performed on the individuals who regis-
tion Form, the Functional Remission of General Schizophrenia tered in the Community Mental Health Center of Ege Uni-
Scale (FROGS), and the Subjective Recovery Assessment Scale versity Medical Faculty Hospital and the Community Mental
(SubRAS). Health Center of İzmir Katip Çelebi University and agreed to
The introductory information form was prepared by the re- participate in the study. Individuals were distributed to the
searchers and included 11 questions about socio-demographic experimental and control groups through the lottery meth-
characteristics of the individuals (contact information, age, etc.). od. Individuals in the experimental and control groups were
separately interviewed and informed regarding the study,
and their written permissions were obtained. Guided imagery
Functional Remission of General Schizophrenia Scale method was performed on the experimental group after com-
(FROGS) pleting the introductory information form, Functional Remis-
Emiroğlu et al.[3] (2009) conducted the Turkish validity reliabili- sion of General Schizophrenia Scale, and Subjective Recovery
ty study of the Functional Remission of General Schizophrenia Assessment Scale.
Scale (FROGS), which was originally developed in French for Of the guided imagery methods, imagery with the script
use in clinical studies and patient evaluations. Cronbach Al- method was used in this study. Scenarios on which expert
pha value of the Functional Remission of General Schizophre- opinion was received were used for functional improvement.
nia Scale is 0.89. This study found the Cronbach Alpha value of Expert opinion for the scenario was received from one psy-
this scale 0.87. FROGS is a 5-point Likert-type scale (1 = Do not chologist, two psychiatrists, and one psychiatry nurse. The
do; 2 = Do partly; 3 = Do a significant part; 4 = Do almost all flow of the scenario started with breathing exercises and
the activity; 5 = Do perfectly) including 19 items and evaluat- continued with safe place practice; this is coming back to the
ing the functionality of the patients with schizophrenia inde- present, waking up by turning to the body after affirmations
pendently from symptoms. The scale includes four subscales: regarding functionality, while in a safe place in the mind. Voice
168 Psikiyatri Hemşireliği Dergisi - Journal of Psychiatric Nursing

recordings of the scenario were made in a professional stu- Community Mental Health Center of Ege University Medical
dio setting, and the recording lasted 10 minutes. The exper- Faculty Hospital and the Community Mental Health Center of
imental group performed guided imagery were told to listen İzmir Katip Çelebi University Atatürk Training and Research
to scenarios at least once every day for two weeks. Individuals Hospital, not taking into consideration the possible effects of
were warned about the noteworthy subjects in the first inter- the drugs used by the patients, not providing randomization,
view when the pre-tests were conducted. They were told to data being based on the notifications of the patients (the pos-
listen to the voice recorder in the most convenient time of the sibility to give positive answers to the questions due to social
day for themselves and in an environment where no one can pressures), conducting the study in a relatively smaller sam-
disturb them, and to listen to the voice recording with ear- ple, and being the first study to examine guided imagery in
phones after changing the mode of the phone to plane mode the individuals diagnosed with schizophrenia in Turkey.
and let the family members know so they do not distract. Af-
ter letting participants read the text version of the scenario Ethical Considerations
during the interview, they were asked if there was a word or
sentence that they did not understand. People were told that Written permission dated 20.03.2018 numbered 18-3.1/25
they would be reminded via phone call to listen to the record- was obtained from the Clinical Studies Ethics Committee of
ings, and their permissions were obtained. The participants Ege University. Institution permissions were obtained from
listening to the voice recordings were asked to note down the Community Mental Health Center (CMHC) of Ege Universi-
the date and hour after each listening and write an evaluation ty Medical Faculty Hospital and the Community Mental Health
Center (CMHC) of İzmir Katip Çelebi University Atatürk Train-
about how they feel and what they think. In the first interview,
ing and Research Hospital. Written permission was obtained
voice recordings were sent to the phones of the participants
from the individuals within the scope of the study. Individuals
through computers in the Community Mental Health Center.
were assured that their name would not be written anywhere.
The study was conducted with only voice recording. The par-
The researcher received guided imagery training.
ticipant and therapist did not perform face-to-face practice.
After completing the interventions made to the experimental
group, individuals in the experimental and control group were Results
re-administered the scales.
This section includes the mean scale scores of the experimen-
tal group (n=24) and the control group (n=24), and the inter-
Statistical Analysis group comparison of the mean scores.
Study data were evaluated using the Statistical Package for
the Social Sciences (SPSS) 20 software program. Mann-Whit-
Findings Regarding Experimental–Control Group Advisees
ney U test, two-dependent-group Wilcoxon t-test, one-way
ANOVA test, and Chi-squared were used for the numerical The mean age of the experimental group was found to be
measurements. 34.13±8.82. Of the experimental group, 66.7% were male,
45.8% were university graduates, 87.5% were single, 70.8%
lived with a relative or friend, 25% had been receiving treat-
Hypotheses, Limitations, Difficulties Encountered ment for 11 to 16 years, 45.8% came to CMHC between 2 and
Study limitations included daytime patients registered in the 4 years, and 79.2% did not have any physical disease.

Table 1. Comparison of Functional Remission of General Schizophrenia Scale Subscales and Total Mean Scores Before and After
Guided Imagery Practice of the Experimental-Control Group

Scales Experimental Group Control Group

Before After z p Before After z p

Mean±SD Mean±SD Mean±SD Mean±SD

Social Functionality Sub Scale 18.25±6.60 19.70±5.72 -1.80 0.07 16.25±4.51 15.41±4.82 -1.11 0.26
Daily Life Skills Sub Scale 17.33±4.71 19.25±4.66 -2.69 0.00 18.58±3.39 17.45±4.18 -2.08 0.03
Health and Treatment Sub Scale 11.62±3.07 12.87±3.83 -2.37 0.01 12.70±3.08 11.58±3.07 -1.74 0.08
Professional Functionality Sub Scale 5.00±2.43 4.87±2.13 -0.46 0.64 4.29±1.68 4.12±1.51 -0.73 0.46
Functional Remission of General 52.20±14.6 56.70±14.33 -2.41 0.01 51.83±9.41 48.58±11.05 -2.11 0.03
Schizophrenia Scale
General Total

SD: Standard deviation.

Özge Elgit, The effect of imagery on functionality / dx.doi.org/10.14744/phd.2020.70707 169

The mean age of the control group was found to be Mean pretest SubRAS scores were found to be 56.54±13.32
40.46±10.73. Of the control group, 83.3% were male, 29.2% before guided imagery practice of the individuals in the
were primary school graduates, 29.2% were high school grad- control group, while posttest mean scores were found to be
uates, 91.7% were single, 87.5% lived with a relative or friend, 52.41±14.01. A statistically significant difference was found
33.3% received treatment for 6 to 10 years, 33.3% received between mean SubRAS scores of the individuals in the control
treatment for 17 years and more, 45.8% came to CMHC be- group (z=-2.31 p=0.02) (Table2).
tween 2 to 4 years, and 83.3% had no physical disease. Table 3 presents the FROGS subscale and general total
A statistically significant difference was found between the posttest mean scores between the experimental and control
pretest-posttest FROGS daily life skills subscale, health and group and the SubRAS posttest mean scores. A statistically
treatment subscale, and total FROGS mean scores of the ex- significant difference was found between the social function-
perimental group individuals (Table 1). No statistically signif- ing subscale of FROGS posttest mean scores between groups
icant difference was found between pretest-posttest FROGS (p<0.05). No statistically significant difference was found be-
social functioning subscale and professional functioning tween mean scores of FROGS daily life skills subscale, FROGS
mean scores of the experimental group individuals (Table 1). treatment subscale, FROGS professional functioning subscale,
A statistically significant difference was found between pre- and mean FROGS scores (p>0.05). No statistically significant
test-posttest FROGS daily life skills subscale, treatment sub- difference was found in the SubRAS posttest mean scores be-
scale, and total FROGS mean scores of the control group (Table tween groups (p>0.05) (Table 3).
1). No statistically significant difference was found between
pretest-posttest FROGS social functioning subscale and pro- Discussion
fessional functioning mean scores of the experimental group
individuals (Table 1). This study aimed to determine the effect of the guided imag-
Mean SubRAS scores were found to be 52.83±14.00 before ery practiced on the individuals diagnosed with schizophre-
guided imagery practice of the individuals in the experimental nia.
group, while it was found to be 60.29±14.29 after the practice. The experimental group listened to the 10-minute guid-
A statistically significant difference was found between pre- ed imagery voice recording downloaded to their phones, at
posttest SubRAS mean scores of the individuals in the experi- least once every day for two weeks using earphones, which
mental group (z=-3.70; p<0.001) (Table 2). increased the individuals’ daily life skills, health and treatment

Table 2. Comparison of Subjective Recovery Assessment Scale Subscales and Total Mean Scores Before and After Guided Imagery
Practice of the Experimental-Control Group

Scale Experimental Group Control Group

Before After z p Before After z p

Mean±SD Mean±SD Mean±SD Mean±SD

Subjective Recovery Assessment 52.83±14.00 60.29±14.29 -3.70 0.00 56.54±13.32 52.41±14.01 -2.31 0.02
Scale Score

SD: Standard deviation.

Table 3. Comparison of Intergroup FROGS Subscales and Mean General Total Post-Test Score and Mean SubRAS Post-Test Scores

Groups Scales

FROGS (Mean±SD) SubRAS (Mean±SD)

Social Daily life Health and Professional General

functionality skills treatment functionality total

Deney grubu 19.70±5.72 19.25±4.66 12.87±3.83 4.87±2.13 56.70±14.33 60.29±14.29

Kontrol grubu 15.41±4.82 17.45±4.18 11.58±3.07 4.12±1.51 48.58±11.05 52.41±14.01
Test ve önemlilik U=156.5 U=237.7 U=215.5 U=232.0 U=195.5 U=199.0
p≤0.01 p=0.29 p=0.13 p=0.24 p=0.05 p=0.06

FROGS: Functional Remission of General Schizophrenia Scale; SubRAS: Subjective Recovery Assessment Scale; SD: Standard deviation.
170 Psikiyatri Hemşireliği Dergisi - Journal of Psychiatric Nursing

functionalities, and general functionalities. Individuals were meditation regarding anxiety in individuals diagnosed with
found to have no idea about guided imagery, while they were schizophrenia suggested that mindfulness meditation train-
familiar with the term meditation. A small number of partic- ing was acceptable for all participants, and no finding worsen-
ipants who stated that they were meditating said that they ing the psychotic or other symptoms was found during med-
were not frequently doing it; however, it was good for them. itation.[20] In this study, individuals in the experimental group
Russionava conducted a study conducted with 157 individu- fully participated in the practice, and no individual felt bad
als—of which 40 were diagnosed with schizophrenia—with with this practice.
heavy mental illness. Of the 40 patients with schizophrenia, 11 The guided imaginary scenarios used in the study included
individuals practiced meditation, and two practiced guided breathing exercises and relaxation techniques. Individuals’
imagery.[18] Of the 28 individuals using guided imagery with feedback included comments such as, “Especially breathing
bipolar disorder and heavy depressive disorder, 13 increased exercise helped me to relieve the tension. My functionality
their emotional calmness in the emotional functionality. In increased a bit. I met with my old friends” and “Voice record
the cognitive functionality field, six individuals increased their relieved me when I listened. I felt relaxed and calmed down
self-realization levels, four individuals increased their level of whenever I listened. I felt precious and significant as much as
self-respect, and six individuals increased their spirituality. In everyone,” indicating that individuals were aware of the relax-
the social functionality field, four individuals developed their ation, and feedback showed positive effects on the individ-
interpersonal relationships, and one indicated that their lev- uals. Relaxation makes the release of chemicals feeding the
el of social isolation decreased. This study found that high- growth of new synapses or neurons easier.[21,22] This growth
er-scale scores of the advisees in the intervention group in- nearly reprograms the unconscious mind, and new emotional
dicated that imagery was effective in psychological recovery. and cognitive reactions emerge in harmony.[22] Relaxation is
The elements causing this situation included breathing exer- the first step for individuals to focus and concentrate on the
cises, relaxation techniques, affirmations on self-respect and recovery period.[23] Studies indicate that relaxation methods
functionality, individuals’ having the opportunity to listen to encourage patients to focus on the recovery process and give
the voice record at any time and allowing individuals to ex-
them the feeling of more autonomy regarding the manage-
press themselves. Study results showed that individuals learn-
ment of the disease.[24]
ing the guided imagery gave feedback indicating they devel-
oped more emotional calmness and awareness. This feedback Presentation and easy availability of the guided imaginary sce-
included; nario written for an individual diagnosed with schizophrenia
is significant, since it would be long-term and repetitive. Long
• It was good for my stress,
term and repetitive training and reinforcements will increase
• I relaxed, calmed down, felt well due to breathing exercis- the functionality of the patient in the long term.[2] On the oth-
es, er hand, it is important to repeat the imagery to create new
• I could prepare breakfast; I took care of my hair and clothes, neural nets.[22] It is thought that individuals’ functionalities
• It refilled my energy; I did not feel sleepy anymore, would regularly increase if they think this a time reserved for
themselves, to integrate into their lives, and regularly practice.
• I met my old friends,
Some of the individuals gave feedback such as, “I will continu-
• I aim to be appointed as an officer after getting a good ously practice this.” Accordingly, performing guided imaginary
score from E-KPSS, I realized that there is no such thing as practice in community mental health centers will help com-
pleasing as a relaxed mind and a mind committed to a pos- munity mental health center nurses to take guided imaginary
itive thought, training, help individuals to gain the habit, and increase the
• I felt relaxed while breathing and exhaling, permanence of the functionality, which is why nurses are rec-
• I breathed and relaxed instead of beating the busboy/bus- ommended to regularly perform this on individuals. The mis-
girl younger than me. sion of community health center nurses includes taking steps
The subjective recovery level of the individuals in the exper- towards the social adaptation of the patient and cooperating
imental group increased after guided imagery practice. The with the rehabilitation team, supporting the individual and
scenario included some instructions to focus the individual’s family during the recovery and adaptation process.[25] Nurses’
mind on the present. A study conducted with eighteen indi- role in the imaginary is thought to be consistent with basic
viduals diagnosed with schizophrenia and included scenarios nursing roles that train patients and empower them.[24] Nurses
starting with mindfulness to make individuals focus on the in the CMHC where the practice was performed indicated that
present found that imagery study decreased negative symp- they want to make advisees collectively listen to the voice re-
toms and increased positive emotions and psychological heal- cord once a week.
ing.[19] Evaluation notes were written by the individuals after Schizophrenia may not always be chronic and result in de-
each practice, and an increase in their mean subjective recov- struction; progress may be halted in each stage of the disease,
ery assessment scale indicated an increase in psychological and it even may be reversed, and functional improvement
healing. A pilot study investigating the effect of mindfulness may be made.[3] Studies indicate that imagery may be effec-
Özge Elgit, The effect of imagery on functionality / dx.doi.org/10.14744/phd.2020.70707 171

tive in the treatment of various diseases.[23] For this reason, Authorship contributions: Concept – Ö.E., A.Bi.; Design – A.Bi.;
guided imagery within daily life activities will positively affect Supervision – A.Ba.; Fundings - Ö.E.; Materials – Ö.E., A.Ba.; Data
recovery when used in addition to medication. On the other collection &/or processing – Ö.E.; Analysis and/or interpretation
hand, guided imagery practice did not affect social functional- – Ö.E., A.Bi.; Literature search – Ö.E.; Writing – Ö.E., A.Bi.; Critical
ity and professional functionality. Patients with schizophrenia review – A.Bi., A.Ba.
are not able to start working and provide continuity due to
social stigmatization, cognitive disabilities, side effects of the References
drugs, affection, interpersonal relationships, and a decrease 1. Yıldız M. Şizofreni hastaları için ruhsal toplumsal beceri eğiti-
in self-respect.[26] Guided imagery practice did not have an ef- mi eğitici el kitabı. 2nd ed. Ankara: Türkiye Sosyal Psikiyatri
fect on professional functionality, which may result from the Derneği Yayınları; 2011.
employment problem of these patients. Providing business 2. Sönmez S. Şizofreni hastalarında psikoeğitim grup çalışmasının
opportunities to the individuals diagnosed with schizophre- pozitif ve negatif belirtiler, sosyal işlevsellik, yeti yitimi, içgörü
nia for professional functionality and practicing long-term ve yaşam kalitesi üzerine etkilerinin araştırılması. Unpublishes
alternative treatments in addition to the drug treatments to Phd Tezi, Bakırköy Prof. Dr. Mahzar Osman Ruh Sağlığı ve Sinir
individuals may enhance their effectiveness in their working Hastalıkları Eğitim ve Araştırma Hastanesi. 2009.
life. Schizophrenic disorders generally last a lifetime and cause 3. Emiroğlu B, Karadayı G, Aydemir Ö, Üçok A. Şizofreni hasta-
serious problems in the individual’s level of social function.[27] larında işlevsel iyileşme ölçeğinin türkçe versiyonunun geçer-
There are various rehabilitation studies conducted to increase lilik ve güvenilirlik çalışması. Nöropsikiyatri Arşivi 2009;46:15–
the social functionality and quality of life of patients with a 24.
psychiatric disorder such as schizophrenia.[28] These studies 4. Doğan S, Doğan O, Tel H, Çoker F, Polatöz Ö, Başeğmez FD.
need to be generalized in the community mental health cen- Şizofrenide psikososyal yaklaşımlar: ayaktan hastalar. Anadolu
ters. Psikiyatri Dergisi 2002;3:69–74.
No practice was performed on the control group for two 5. Klinberg S, Langle G, Buchkremer G. Neuroleptics-psychother-
weeks. A significant decrease was found in the daily life skills apy-psychiatric social work. In schizophrenia help is needed
subscale of FROGS, general FROGS mean scores, and general from many sides.MMW Fortschr MedMMW 2003;145:28–31.
SubRAS mean scores. Statistically significant decrease in the 6. Soygür H. Community Mental Health Services: Quo Vadis?
daily life skills, total FROGS score, and SubRAS score may not Noro Psikiyatr Ars 2016;53:1–3.
have resulted from the guided imaginary practiced on the 7. Dülgerler Ş. Şizofrenik bozukluklar. In: Çam O, Engin E, (edi-
control group; however, considering the similar characteristics tors). Ruh Sağlığı ve Hastalıkları Hemşireliği Bakım Sanatı Ki-
in the experimental and control group, higher mean scores tabı. İstanbul: İstanbul Medikal Yayıncılık; 2014. p. 413–46.
(except professional functionality in the experimental group) 8. Wood D, Patricolo GE. Using guided imagery in a hospital set-
indicate the efficiency of the practice. Liberman (2011) stated ting. Alternative and Complementary Therapies 2013;19:301–
the place where recovery would reach as removing or mini- 5.
mizing the annoying symptoms and being able to live among 9. Mahbub-E-Sobhani, Haque N, Salma U, Ahmed A. Immune
people with disabilities in society.[29] Even though guided im- modulation in response to stress and relaxation. Pak J Biol Sci
agery practice increased functional improvements of the pa- 2011;14:363–74.
tients in the short term, it led to positive changes in the gener- 10. Patricolo GE, LaVoie A, Slavin B, Richards NL, Jagow D, Arm-
al situations of individuals. strong K. Beneficial Effects of Guided Imagery or Clinical Mas-
In this direction, the study findings support hypothesis H1 sage on the Status of Patients in a Progressive Care Unit. Crit
that guided imagery method practiced on the individuals di- Care Nurse 2017;37:62–9.
agnosed with schizophrenia in the community mental health 11. Kolayiş H, Sarı İ, Köle Ö. Takım sporlarıyla uğraşan kadın spor-
center affect the functionality of the individuals. cuların imgeleme, güdülenme ve kaygı puanları arasındaki il-
There are a few studies where guided imagery is used with psy- işkinin incelenmesi. Ankara Üniversitesi Spor Bilimleri Fakülte-
chiatric patients, in particular, with individuals diagnosed with si 2015;13:129–36.
schizophrenia. In Turkey, however, no such study was found. 12. Santos A. Nurse's guide to guided imagery. Nursing
As a result, increasing this practice in centers by the commu- 2016;46:55–8.
nity mental health nurses who receive education and training 13. Raffard S, D'Argembeau A, Bayard S, Boulenger JP, Van der Lin-
on guided imagery practices in psychiatric disorders is recom- den M. Scene construction in schizophrenia. Neuropsycholo-
mended, as well as conducting studies on providing more job gy 2010;24:608–15.
opportunities for individuals diagnosed with schizophrenia 14. Raffard S, Esposito F, Boulenger JP, Van der Linden M. Impaired
and increasing social functionalities in these individuals. ability to imagine future pleasant events is associated with ap-
athy in schizophrenia. Psychiatry Res 2013;209:393–400.
Conflict of interest: There are no relevant conflicts of interest to 15. Cox C, Jolley S, Johns L. Understanding and treating amotiva-
disclose. tion in people with psychosis: An experimental study of the
Peer-review: Externally peer-reviewed. role of guided imagery. Psychiatry Res 2016;246:387–91.
172 Psikiyatri Hemşireliği Dergisi - Journal of Psychiatric Nursing

16. Bilge A. Tamamlayıcı/alternatif ve somatik terapiler. In: Olcay DL, Forward by Martin L. Rossman, (editors). Transformative
Çam, Esra Engin, (editors). Ruh Sağlığı ve Hastalıkları Hemşire- Imagery: Cultivating the Imagination for Healing, Change,
liği Bakım Sanatı Kitabı. İstanbul: İstanbul Medikal Yayıncılık; and Growth. Jessica Kingsley Publishers; 2016. p. 46–59.
2014. p. 1075–85. 23. Rossman ML. Guided Imagery for Self-Healing: An Essential
17. Yıldız M, Erim R, Soygür H, Tural U, Kiras F, Gules E. Develop- Resource For Anyone Seeking Wellness. New World Library;
ment of the subjective recovery scale for the patients with 2000. p. 35–40.
schizophrenia. Psychiatry and Clinical Psychopharmacology 24. Kubes LF. Imagery for Self-Healing and Integrative Nursing
2018; 28:163–9. Practice. Am J Nurs 2015;115:36–43.
18. Russinova Z, Wewiorski NJ, Cash D. Use of alternative health 25. T.C. Sağlık Bakanlığı. Hemşirelik Yönetmeliğinde Değişiklik
care practices by persons with serious mental illness: per- Yapılmasına Dair Yönetmelik. Available at : https://www.re-
ceived benefits. Am J Public Health 2002;92:1600–3. smigazete.gov.tr/eskiler/2011/04/20110419-5.htm.
19. Johnson DP, Penn DL, Fredrickson BL, Kring AM, Meyer PS, 26. Doğan O. Psychosocial approaches in schizophrenic disor-
Catalino LI, et al. A pilot study of loving-kindness meditation ders. Anatolian Journal of Psychiatry 2002;3:240–8.
for the negative symptoms of schizophrenia. Schizophr Res 27. Yamashita C, Mizuno M, Nemoto T, Kashima H. Social cogni-
2011;129:137–40. tive problem-solving in schizophrenia: associations with flu-
20. Brown, LF, Davis LW, LaRocco VA, Strasburger A. Participant ency and verbal memory. Psychiatry Res 2005;134:123–9.
perspectives on mindfulness meditation training for anxiety 28. Akpınar Ş, Kelleci M. The effects of a problem solving skills de-
in schizophrenia. American Journal of Psychiatric Rehabilita- velopment program on the social functioning of schizophren-
tion 2010;13:224–42. ic patients. RCHP 2008;2:47–56.
21. Siegel DJ. The Mindful Brain: Reflection and Attunement in 29. Liberman RP. From disability to recovery: Psychiatric Recovery
the Cultivation of Well-Being. New York, NY: Norton&Compa- Handbook. (Yıldız M, Translation Editor). Ankara: Turkey Social
ny; 2007. Psychiatric Association; 2011. (Original study, publication date
22. Miller E. The cultural evolution of guided imagery. In: Leslie 2008).