Victoria Maizes: Hi, Andy. I am delighted that our next guest is Belleruth Naparstek. She is a pioneer in developing guided imagery and has reached millions of people with her guided imagery materials. Andrew Weil: She's also a longtime friend and colleague, Victoria Maizes: and she's taught at our center for some years and the Fellows just love her. At the end of this episode we have uploaded a four-minute guided imagery session for you to experience. Andrew Weil: Good this will be fun Intro Music Victoria Maizes: It's my pleasure today to introduce Belleruth Naparstek. She's a clinical social worker and guided imagery pioneer, and she's created 80 or more guided imagery audio programs, and also founded Health Journeys, which produces and distributes mind/body programs. Belleruth has written three books: Staying Well With Guided Imagery; Your Sixth Sense; and Invisible Heroes: Survivors of Trauma and How They Heal. The last focuses on imagery and post-traumatic stress. Prevention Magazine notes that Belleruth has been creating an underground revolution among mainstream health and mental health bureaucracies by persuading major institutions, such as the US Army, the VA, the American Red Cross, Aetna, and many more organizations to distribute her guided imagery recordings, in many case, free of charge to recipients. Welcome, Belleruth. Belleruth Naparstek: Thank you. I'm delighted to be here. Two of my favorite people. Victoria Maizes: So Belleruth, I think it would be great to begin with definitions. Tell us, what is guided imagery, and how is it different than meditation or mindfulness? Belleruth Naparstek: Well, I'm so glad you asked, because lately, everybody is totally confusing meditation with mindfulness and doesn't know the difference. That's probably because the success of, uh, Headspace. Anyway, that's a sidebar. Let me get back to your question. [laughs] Guided imagery is a form of guided meditation. Guided meditation is actually a huge umbrella category under which it can fall. Uh, it's also a form of hypnosis. The most potent guided imagery, in my opinion, is the kind that's done in an altered state, which becomes the power cell for driving all kinds of coherent response from a person. So what is it? It's a kind of deliberate, directed daydreaming where you're actually voting for something with your imagination. Unlike mindfulness, which has a neutral attitude towards outcome, guided imagery is actually aiming to use your imagination and all of your sensory memory to- to envision and encapsulate a successful experience of something you're seeking. Victoria Maizes: Belleruth, I've heard you say that guided imagery is the lazy man's meditation. How is it easier than meditation? Belleruth Naparstek: Yeah. Well, and it's also the lazy woman's- Victoria Maizes: [laughs] Belleruth Naparstek: ... just... [laughs] Victoria Maizes: Thank you for that correction. Belleruth Naparstek: Oh, you're welcome. [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: But, um, yeah, because, you know, and especially in these days, when people are so stressed, and under the gun, and feeling like they're at... they're- they're just using every ounce of bandwidth they've got to get through the day. You don't want them to have to acquire the discipline of mindfulness. This is not the time to learn an exquisite practice, but that takes effort and is not going to immediately reward you, necessarily. So it basically does the work for you. Especially with a recording, where bas- the instruction is, "Press play-" Victoria Maizes: [laughs] Belleruth Naparstek: ... "if you don't like it, press pause." You know, it- it's that simple. Andrew Weil: And, Belleruth, is it necessary to rely on visual imagination on that? Because some people say that they're not good visualizers. Belleruth Naparstek: Right. About 45% of the population will probably say that to you… Andrew Weil: Mm-hmm [affirmative]. Belleruth Naparstek: ... and no, in fact, uh, probably- probably kinesthetic, uh, sensation, and emotional sensation, and all of your other senses play into this. And people think they know they're visual or they're auditory, but actually, we don't know exactly what combinations will ping the best on us. So it's good to try them all- Andrew Weil: Mm-hmm [affirmative]. Belleruth Naparstek: ... but, yeah, no. And I- I never call it visualization for that reason. It's misleading. Victoria Maizes: And give us a sense of where guided imagery is particularly useful. I know it's been really broadly applied, but help our listeners understand this. Belleruth Naparstek: Okay. Well, I can tell you what the research says, but let me tell you what I think first- Victoria Maizes: [laughs] Belleruth Naparstek: ... [laughs] and then I'll tell you what the research says. I think it's particularly useful for any kind of, um, emotional challenge. Um, depression or anxiety. It was made to order for coping with anxiety. Uh, traumatic stress. It is a beautiful intervention for traumatic stress, and it has within it the ability to cushion an intervention in ways that lots of things don't or can't. It's very good for helping people recover from stroke or bodily injury. It's wonderful for pre-surgical, uh, use for better outcomes, quicker recovery, uh, less bleeding during surgery. It's... oh, gee. It- it's- it's terrific for all of those, uh, neuro-motor problems like Parkinson's, stroke, because you can envision movement in a way that athletes do. And that's another thing: it's really good for athletic performance or any kind of performance under pressure. Victoria Maizes: One of the places that people use guided imagery is pre-surgery, to prepare for a successful surgery. And I know you've done work in that field, and actually research in that field. Can you speak to that a bit? Belleruth Naparstek: Yeah, it's- it's surprisingly effective. Uh, Kaiser Permanente started using pre-surgical guided imagery, and then Blue Shield of California did a study of it. this was a... This was a single-blinded study, uh, with about, um, I think it was 335 patients. And what they found was, guided imagery alone reduced blood flow, uh, by some phenomenal amount. Belleruth Naparstek: But we also found that they al... they- they recovered faster, they... it cost less, it clo- it cost a health plan an average of something like $2,000 less per hysterectomy in 2001 dollars. So anyway, it ended up showing lots... less pain medication, less return visits, less complications. It was shocking, actually, what I... what I saw and heard. So there were sev-... and there have been several studies since then. So even with one-day surgeries, ambulatory surgeries, they're significantly reduced. That's another example of how this, meditation stuff can change hard values in so many places. Andrew Weil: Belleruth, one of the questions I get frequently is: can I do this on my own or do I have to do it with a practitioner? Belleruth Naparstek: And actually, there are two very different ways to use guided imagery. They're both terrific, it depends on what you like best. But no, you can get a- a really good audio recording and use that. Or you... or you can... if you're somebody who really does want to have a more interactive experience, where you do some... you're guided to do some imagining, um, you come up with something, and you keep getting these wonderful prompts from a practitioner. So that's interactive guided imagery, it's one on one. Um, you can... you can also use it very well in a group. So- Andrew Weil: Can you describe for our listeners what a typical interactive guided, uh, imagery session is like? What does it look like? Belleruth Naparstek: Yeah, sure. So- so we just did something like this with, uh, with... for the... for a VA training, where this- this terrific practitioner, David Gaffney, was- was working with a veteran who had a bunch of pesky symptoms, including neuropathy in his feet. So he basically asked him what his favorite place to go was for soothing and relaxation. Uh, Marty came up with this beach place where he goes before the sun comes up and meditates. Then, um, he had... he had him walking in the sand, asking him what the sensations were. He- he prompted him to start feeling the sand on his feet, between his toes. Then he- he basically asked Marty, um, "I- I think you might be getting a surprise. You- you... I want you to open your eyes, look around, and see, at the beach, a surprise. I think something's coming." And Marty goes... and... it was really funny, 'cause it's a big, tough, burly veteran, right? He gets this soft smile on his face, and he says, "It's my puppy!" Victoria Maizes: [laughs] Belleruth Naparstek: [laughs] And then... and David- Da- David goes, "Well, of course it's your puppy." [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: Anyway, it was a wonder... and he just kept feeding the experience to the point that, um, his- his feet really did feel a lot more sensation, were very different than when he started. And he- he ended up with an anchoring advi- uh, device, which was holding his puppy in his arms, and whenever he wanted to get that feeling back, more sensation in his feet, he would... he would apply this hug. Victoria Maizes: Wow. Belleruth Naparstek: Anyway, brilliant. It was fabulous, and it was about 40 minutes long. Victoria Maizes: When I was a fellow in integrative medicine, uh, I trained in interactive guided imagery. And we used to use it with our patients in the clinic. I remember doing this setup, which is a little bit long, 'cause first, you take someone through progressive muscle relaxation and you help them relax, and eventually, maybe after, like, three or four minutes, you say something like, uh, "Imagine yourself in a place that is safe and comfortable, a place that you've never been, uh, before, or one that you go to all the time, or one that you've always wanted to go to." And then you pause, and you say, "Tell me where you are." And I always expected that the patient would say, "Well, what are you talking about? I'm in the clinic with you, on the sixth floor of the University Medical Center-" Belleruth Naparstek: [laughs] Victoria Maizes: ... and that never happened. Belleruth Naparstek: Never! [laughs] Victoria Maizes: Every single time, the patient would tell me these spectacular places they had gone to in their imagination. Belleruth Naparstek: It's true. And there was a tremendous con- amount of conversation among the VA clinicians about that. Like, "Oh, are they gonna think I'm... what a jerk! What..." [laughs] you know, "How silly that is." Nobody thinks it's silly. They're there. Yeah. Victoria Maizes: Yeah, it's- it's incredible. I- I'd like for you to talk a little bit about your V- VA work. I know some years ago when you came and taught for us at the, uh, Center for Integrative Medicine at the University of Arizona, you actually had us listen to a guided imagery that had, like, a preface. And the preface was a Drill sergeant. Can you talk about that- Belleruth Naparstek: [laughs] Victoria Maizes: ... and maybe a little bit of how it... how you began to work at the VA? [laughs] Belleruth Naparstek: Yes, but before I do, can I make a point? Because I'll forget. Victoria Maizes: Yes. Belleruth Naparstek: When you were saying it takes so long, you gotta do this setup, and then you have to do this, and that, um, we all thought that back in the day, but the fact of the matter is, people have been asking more and more for five and ten-minute guided imagery interventions. And lo and behold, I was very resistant to the idea, you really can do a lot in five or 10 minutes- Victoria Maizes: Mm-hmm [affirmative]. Belleruth Naparstek: ... and it's- it's surprising, and shocking, and really nice. Victoria Maizes: Mm-hmm [affirmative]. Belleruth Naparstek: Okay. So I wanted to say that. But... okay. So- so yeah, this was another Dave- [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: ... he does not mind my using his name. This was a drill sergeant who had suffered some severe trauma. He had been, uh, in one of the early, uh, Iraq wars, came back, um, very trau- very traumatized, difficult, edgy, he's a intense power-packed little guy anyway. He suffered a terrible loss. His- his oldest son committed suicide with a shotgun in his bedroom. And, uh, he just had a terrible time recovering from that. He knew he needed help, and he went to the clinic to get some help, to behavioral health. He had got a very young, uh, psychologist, intern, probably, who was just flummoxed by his sheer intensity. Uh, and she basically made a terrible clinical error. She basically said, "You know what? You need to listen to this tape." It was like, you know, "Let's put you in the quiet room and get you to calm down so I can deal with you." Anyway, he ends up in this room. He gets a very luxurious, uh, lounge chair, he gets the things over his eyes, the special headset that delivers perfect guided imagery. Here he is, so pumped up, so agitated. And he gets this, um, this woman's voice, and it's... and it's like, "She's all calm, and cool, and soothing"- Victoria Maizes: [laughs] Belleruth Naparstek: ... "and I hated her." [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: So- so he basically ripped off the equipment, goes storming out of the room, and says, "I hate that woman! I am never coming back here! You guys suck!" And he left. Okay, so about a year later, when the- the Army is setting up different, um, patient home-center clinics, they... a guy shows up, the doc shows up, and he, too, is someone whose son committed suicide. And somebody said to him, "Look, you gotta... maybe you should even stay with Dave, 'cause you... he could really use your wisdom and experience." So he did. He- [laughs] he stays with Dave. And he's having dinner with the family, and they're talking about this loss in this kind of very cerebral, um, way. And- and the doc says to him, "You know, I want you to listen to something. I- I want you to just trust me and let me play you something. I think it could help you." So he puts on this CD, and lo and behold, it's- it's me, again- Andrew Weil: [laughs] Belleruth Naparstek: ... saying, you know, calming words. And he basically just said, "I know that tape! I hate that woman!" [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: Anyway, so George, the doc, says, "Please, just s- sit with me here and listen to it." So he- he did. And he did, ultimately, benefit from it, to the point that he and his family listened to it every night- Victoria Maizes: Oh, wow. Belleruth N.: ... but he said to George before he left, "Somebody should tell that lady she can't start that way with people like me." [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: You know? And so George says, "Call her up! She'll listen to you." So he did. He called me up and he gave me great advice, so great that I asked him to make an introduction for people like him. Andrew Weil: Ah. Belleruth Naparstek: And that's my story. Andrew Weil: Belleruth, do you find that kids have a great aptitude for guided imagery? Belleruth Naparstek: Oh, yeah. They hardly need us at all. We, like, get in the way. Y- yeah. Um, they're- they're amazing, and, um, they're doing it all the time. Actually, you can just touch in to what they're doing and they'll tell you. But if you... if you also hand them a recording, they're wonderful at that, too. And the thing is, the best kid of all is a teenager- Andrew Weil: Huh. Belleruth Naparstek: ... they're already running around in this hormone soup, they're in a [00:14:00] built-in trance, and they respond to it so well. But clinicians can be fooled by their curling lip and rolling eyes, you know- Andrew Weil: [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: ... just have to ignore that. [laughs] Victoria Maizes: Well, is there anyone who you'd say avoid guided imagery with? Belleruth Naparstek: Yes. I think there are some trauma survivors, um, who can be triggered by the sound of a... of a hypnotic human voice. That's one thing. Um, I think some people just don't like being guided by anybody's voice. And, uh, they would do well with some other kind of an intervention. Um, that's pretty much it, really. I used to say super psychotic people in active cycles of psychosis shouldn't listen to it, but I don't even think that's true. Too many people have told me, "No, you know, actually, I used it on our ward with completely, um, actively delusional and psychotic patients, and it worked out. They listened. They're fine. They calmed down." Advertisement: “Body of Wonder is Brought to You by AWCIM + COVID-19” Andrew Weil: Do you get referrals from physicians? Uh, how many physicians do you think are aware of the existence of this therapy and its utility? Belleruth Naparstek: You know, it's a great question. It's changed a lot over the years, but I still would say that- that we get the most, um, referrals from nurses, nurses with hands-on experience. Second by social workers, maybe pastors. Andrew Weil: Mm-hmm [affirmative]. Belleruth Naparstek: But a lot of physicians, especially physicians trained by you guys at the University of Arizona, bless your hearts, they totally get it, and they promote it. And of course, coming from somebody who's, like, either a department chair, or somebody who's running a unit, it means all the world to the staff. They'll do it. They'll try it. And... yeah. Victoria Maizes: Andy, you've been a huge proponent of mind/body medicine. I'm gonna put that question back to you. H- how do you get doctors to appreciate the value of guided imagery and other mind/body therapies? Andrew Weil: Well, as you know, Victoria, the problem is that these run up against the- the, uh, r- the dogma, [laughs] uh, of the materialistic paradigm that dominates, uh, our form of medicine and science, and that paradigm says that, uh, changes in the physical system must have physical causes. So there cannot be non-physical causation of physical events, and using the mind to influence the body is non-physical causation of physical events. So that's just not allowed for in the way of thinking that medical doctors are trained in. So we are working to- to change that. You know, mind/body medicine's a major plank of integrative medicine, um, and I think it is very important to get people to understand how useful and also how time-effective and cost-effective these methods are. And they're even fun. Belleruth Naparstek: Yeah, and I would say, especially now that- that we have functional MRIs, for instance, that really show that this- this intervention, say, guided imagery, really does cause different muscles to fire, um, and- and different cells to- to activate, you can see that there really is physical causation. Same thing with the more sophisticated blood and saliva assays. They change biochemistry. So it's harder to argue with, and really, I've found I haven't really had to work very hard to make that case lately. Andrew Weil: That's great. I- I agree with you. I think that's changed, and also this has made placebo responses much more understandable- Belleruth Naparstek: Yeah. Andrew Weil: ... um, by sh- by showing people that there are real neurological correlates of these. So yes, that's all- all to the good. Belleruth N.: Yeah. Yeah, it's very exciting. I'm very happy I stayed alive this long. Andrew Weil: [laughs] Belleruth Naparstek: [laughs] Belleruth Naparstek: How do you see guided imagery's progress over all these years? Do you think it's- it's made advances or has changed in any way that you could describe? Victoria Maizes: One of the things I find incredible about guided imagery is how accessible it is. they're at everybody's fingertips for free at any time. And so I find myself recommending the use of guided imagery more than ever, because it is so accessible, it's free, and the wide range of voices, lengths, applications, whether it's sleep, or stress, or, uh, athletic performance, it- it's just an incredible depth and breadth that's available to patients. Andrew Weil: Well, what I see, Belleruth, In our Fellowship training over the years, is that the practitioners who are exposed to guided imagery and learn about it get very excited about it. You know, it's fun, as I said, and I think they then see the possibilities for using this in their practice, for either learning it themselves or- or knowing how to refer people to it. Belleruth Naparstek: Yeah. It is fun. And, uh, it- it's much easier if you can just give people a sample of it. Belleruth Naparstek: It sounds a little odd if you just [laughs] try to describe it cognitively. But the experience is- is pretty powerful and fun. I agree, fun. Gotta have fun. Victoria Maizes: [laughs] You said that guided imagery is made-to-order for anxiety. A- at this particular moment in time, we're recording this during the coronavirus pandemic, lots of people are struggling with anxiety and also with grief, and they're doing so, often, in relative isolation. Um, can you talk about how it is that guided imagery is so helpful in this emotionally-charged situation we're in right now? Belleruth Naparstek: It's particularly good during this- this COVID epidemic, because- because it can be used remotely with great ease, from a phone, from- from a device, from your computer. And so you can send a lot of weirdly personal feeling intervention into the ears, mind, body, spirit of somebody from a distance, and that's great. It's almost like, whoa, this is built for this situation. And we've been... we've been building streaming pages for nurses, and first responders, and doctors, and hospitals, who are just at their wit's end. And by the way, they don't want more than 10 minutes of anything, except when they're trying to fall asleep. Anyway, I think it's good for anxiety, which was another piece of your question, because truly, I think it's built into our developmental hardwiring that- that we, as babies, as toddlers, as three-year-olds, learn to deal with anxiety by literally incorporating images of comfort, pa- uh, images of our caretaker, our mother, our grandma, our favorite teacher, um, our favorite snack. But peo- [laughs] people have- have been doing this. It's- it's... so it's- it's in our bones, um, to- to use something like this, uh, internalized images that are sensory to soothe us. Belleruth Naparstek: I could go... I could go on and on, but I'm gonna stop. [laughs] And can I throw in another thing? Speaking of... speaking of, uh, what- what us humans can do, I also think that imagery affords the wonderful opportunity to include archetypal figures and universal themes and symbols into the imagery. And there's something about that that just pings on everybody. It's, uh, I think it- it... that, too, is built into our hardwiring, our response to a certain kind of story or thematic material, you know, the hero's journey, the dark knight of the soul, the, um, the- the rebirth, the resurrection, uh, from- from being really half-destroyed. Victoria Maizes: You also incorporate music into your guided imagery. Can you tell us what that's so important? Belleruth Naparstek: Oh, with lots of people. Actually, what people say, as hard as we work on all the wording, and phrasing, and these magnificent, you know, Jungian thematic material, the things people respond to most are the music and the tone of the voice, pacing, tone of the voice, and breathing. So- so, um, music is huge. And we even did a test with HIV patients, this was ages ago, with and without the music to see what- what was more effective. And, uh, it was no contest. It was no contest. Without- without the music, the imagery was so much flatter. On the other hand, if you have a person who's very sensitive to music, who either does it by training or just has a huge love for certain kinds of music, it can almost distract them. Andrew Weil: Can you tell us how you came to all this? How did you first get interested in the whole idea of guided imagery? Belleruth Naparstek: I- I just was born interested in this- Andrew Weil: [laughs] Victoria Maizes: [laughs] Belleruth Naparstek: ... I was a spacey kid who had my own little dreamy thoughts. I used to wander upstairs to get something and never return. I would... yeah, I just, uh. So I always had this love for this- this imaginal stuff. And one day, I was with my now 50-year-old son, who at the time was about 12, in a bookstore, and he saw a tape called Win At Sports. And, uh, it was by David Illig, an Ericksonian hypnotherapist. And, uh, he said, "Ma, I- I want that. Can you buy that for me?" I said, "Sure." And, uh, I listened to it... actually, I didn't listen to it. So he took... takes it home. My son was an amazing pitcher. He actually had a- a knuckleball that was killer. And, uh, but he couldn't run, 'cause he had flat feet, so that's not a good thing for a pitcher, to not be able to scoop up a grounder. So, uh, he listens to this tape for about three weeks, comes down the stairs one morning, and says, "Ma, I swear, I'm running better. I am much better at running. My feet are working better." Anyway, so I said... that's when I said, "Give me the tape. I wanna listen to what's on the tape." [laughs] And I noticed, as I listened to his tape, that... I had taken this course on Ericksonian hypnotherapy at Sheppard Pratt, and I'm thinking, "This is really good. Anyway, then I really got excited. I thought, "This is great. My flat-footed kid is running like Pegasus, and it's this tape here.” Then in order to get the- the- the medical community in Cleveland to help me, I had a psychotherapy practice, which I loved doing, but I decided to start making individual tapes for my clients. I just thought that would be fun. And, in fact, uh, we did. And luckily, I was living on a street that had a bazillion doctors that had to face me on the tree lawn every Monday morning when we tossed the trash. So they helped me. They gave me great advice. I had a, um, maybe five different people who were terrifically helpful. Victoria Maizes: One thing I like to ask our, uh, guests on the show is, given that we're talking about health, and prevention, and managing stresses, and, uh, all of the good things we recommend, I like to find out if our guest has a vice that they would like to share. Belleruth Naparstek: [laughs] Just one? Victoria Maizes: [laughs] Andrew Weil: [laughs] Belleruth Naparstek: Um, I- I've been pondering my... what's become my worst vice: impatience. Andrew Weil: Hmm. Belleruth Naparstek: I am so impatient. When I was a therapist, you know, doing psychotherapy, maybe, uh, sometimes 10 hours a day, sometimes five, I was really a nice person. Andrew Weil: [laughs] Belleruth Naparstek: so patient, and meditative, and appreciative of people, 'cause that's what I did all day. I just took people in and empathized with them. That was my job. And they paid me for it! It was great. Victoria Maizes: [laughs] Belleruth Naparstek: [laughs] But, um, I think now that I'm, you know, trying to juggle lots of things, and running a business for which I basically have no apitude- aptitude, but I've forced myself to learn, I'm cranky and impatient. So I- Victoria Maizes: Is there guided imagery for that? Belleruth Naparstek: All of it's for that. Victoria Maizes: [laughs] Andrew Weil: [laughs] Belleruth Naparstek: [laughs] All of it works for that. And in fact, if I think to just pay attention and listen to some myself, it's very effective. [laughs] I have to say. Victoria Maizes: Belleruth, it's wonderful to see your face! Victoria Maizes: And thank you so much for being our guest on the podcast. Belleruth Naparstek: It was a pleasure. And thank you both for doing all the things you do. You've changed medicine in this country. Andrew Weil: [laughs] Belleruth Naparstek: And lord knows, it- Andrew Weil: It needs changing. [laughs] Belleruth Naparstek: [laughs] Belleruth Naparstek: Thank you. Outro-Music Victoria Maizes: And now listeners. Here is a guided imagery that you can practice. Remember, please do not do this while you're driving instead find a calm, quiet place close your eyes and fully experience the imagery Advertisement: My Wellness Coach