Bulimia has several symptoms; among them, an impairment in self-soothing. Bulimia patients seem lacking in the ability to regulate their tension through internalizing earlier soothing or comforting experiences. The current theory among researchers is that those with bulimia use binge eating and purging in attempts to numb tension and assuage emotional distress. This study tested the hypothesis that guided imagery, through hypnotherapy could facilitate self-soothing for subjects with bulimia.

The reasoning was that:
1) Guided imagery occurs within the context of a therapeutic relationship,
2) Guided imagery evokes the relaxation response,
3) Through guided imagery, a therapist can act as an "external" source of comfort,
4) The specific words of the guided imagery process can be tailored to the context of the illness,
5) Guided imagery can enhance self-awareness.

Hypnotherapists have long used guided imagery for mental rehearsal and eliciting insight. The authors note also that bulimia patients have been found to be significantly more hypnotizable than normal age-matched populations or those with anorexia. This study sought to establish the possibility that hypnotherapy could be beneficial as part of a multidimensional treatment program for bulimia.

The hypnotherapy process incorporated a soothing voice tone by the therapist, soft music, soothing imagery with suggestions about pleasant physical sensations and emotions, dialog about relaxation and imagery, and metaphor. During the early stages or treatment, the therapist made suggestions to create a sense of safety, to promote use of imagination, and encourage participation and creativity on the part of the listener.

The authors assembled six guided imagery exercises for the study. Two familiarized subjects with guided imagery, focusing on relaxation and inner awareness. The other four promoted self-exploration. The article includes a script for the first exercise, called "Creating an Inner Sanctuary."

Fifty participants, diagnosed with Bulimia Nervosa, participated in the study. The randomized controlled trial compared subjects who received six weeks of individual guided imagery with a control group of untreated subjects. Scores on measures of eating disorder symptoms, psychological functioning, and self-reports about the guided imagery were obtained as dependent measures. It was found that guided imagery had substantial effects on reducing bingeing and purging episodes. The imagery group had a mean reduction of 74% in bingeing and a 73% reduction in purging. The imagery group reported improvement in attitudes toward eating, dieting and body weight, as well as a reduction in sense of aloneness and increased ability to self-comfort.

The full study can be found at the internet web site: http://jppr.psychiatryonline.org.