Using Guided Visualisation to Prepare for a Return to School

By Denise Allen M Health Sc OT, AccOT, Australia

Visualisation uses our imagination and our senses to create an experience. For example if I ask you to visualise holding a lemon in your hand you may feel its weight and texture or smell its aroma or even salivate. In visualising that lemon you have engaged your imagination and your senses. Guided visualisation can be a powerful technique that can reduce anxiety and can help us prepare for an upcoming event and reach our goals. It enlists the imagination to problem solve. It can stop the chatter of the mind and can provide time out from everyday worries, concerns and negative thoughts. Visualisation can also be called imagery, mental rehearsal and mental time travel.

A case study will be used to illustrate the use of guided visualisations. Tom is a 14 year old boy, who is anxious about returning to school in 2 weeks time. He has had almost 3 months off school having treatment for bone cancer. Initially he kept up contact with his friends and did a fair amount of school work but as the side-effects of his treatment worsened the contact with friends dropped off and he fell behind academically. Understandably Tom is feeling anxious about how he will cope with his return to school physically, academically and emotionally.

During a therapy session Tom was asked to remember a good day he had at school before his diagnosis and cancer treatment. He then created a mind map that included having fun with his friends, a positive experience with a favourite teacher, the feeling of doing well in an assessment task, the loudness of the playground and the smells of canteen.

Tom then created a mind map of his anxieties about returning to school. This included not knowing how his friends would react, being out of the loop about current events, dealing with questions about where he has been, people teasing him about his bald head and weight loss and doubting whether he would cope academically, and concern that he may get sick or tired during the day.

Tom and the therapist them brainstormed possible solutions to each of the above anxieties. He decide in the next two weeks that he could Facebook friends- posting a current photo and a brief outline of his current health, invite one or two close friends for a pizza and X-box night and ask his dad to talk to the Principal, Year Advisor or Counsellor at his school about his return. He planned to go for a 30 minute walk each day to improve fitness, and to be driven past, or walk through, the school on the weekend. His mother also agreed to be on call if he did feel unwell.

Tom then participated in a relaxation session which used a guided visualisation created around the items from his 2 mind maps. In the relaxation Tom used breathing and muscle relaxation to relax his body before the visualisation was introduced.

Imagine waking up on your first day back at school, acknowledging that you feel a little anxious, but that these feelings are quite reasonable, and taking a few deep slow breaths to calm down..........

Now imagine walking in the school gate.......remind yourself that you had seen and spoken to some of your friends recently and that they expecting you at school today..... Now imagine seeing a friend who comes up and greets you warmly and takes you over to join the group you used to sit with. Imagine the things they might say to you and how you will respond....perhaps you are pleasantly surprised by how supportive they are....Now the bell rings …....first up is one of your favourite subjects..... imagine one of your friends inviting you to sit with them.......imagine what the teacher might say to you......imagine devising a plan on how you can catch up on missed work........becoming aware of your breathing again and taking some deep slow breaths and every time you breathe out letting yourself relax even more.... You now have one minute to imagine the rest of your first day back at school.......focusing on the good things that could happen and remembering that this is only limited by your own imagination...........

(NB time is dilated in a relaxation/ visualisation and one minute can seem much longer.)

Tom used the relaxation and visualisation approximately every second day in his lead up to returning to school. Being able to mentally rehearse possible situations and use his imagination to problem solve reduced his anxiety and improved his confidence about returning to school.

Tom's return to school went quite well due to his preparation and his family support. He had one incident where he was taunted for his appearance and his friends came to his aid. In some subjects he felt overwhelmed by the amount of work he had missed and found the breathing techniques a useful calming tool. Tom was exhausted by the Friday of the first week and only attended for a half day, though he reported that he was looking forward to the next week of school.

Denise Allen M Health Sc OT, AccOT
Denise is an Occupational Therapist with over 30 years experience over a variety of health settings. For the last 15 years she has worked privately treating mainly children and adolescents with anxiety disorders and depression. She has created and produced 2 relaxation CD's:

  • Cool Karma- relaxation imagery for adolescents
  • Butterfly Deaming-relaxation and visualisation for children


Garth, Maureen. Earthlight. New Meditations for Children. Sydney: Harper Collins Publishers. 1997.
Moen, Larry. Guided Imagery. Naples: United States Publishing. 1992.
Murdock, Maureen. Spinning Inwards. Boston: Shambala Publications. 1987.
Pearson, Mark. Emotional Healing and Self Esteem. Melbourne: Acer Press. 1998.
Quoidbach, J., Wood, A., & Hansenne, M. Back to the future: The effect of daily practice of mental time travel into the future on happiness and anxiety. The Journal of Positive Psychology. 2009.

Breathing Exercises

Exercise 1 - Breathing Awareness

Close your eyes, make yourself comfortable. Start to become aware of your natural breath – do not try to change your breathing pattern – whatever it is, just become aware of it – become totally aware of your natural incoming and outgoing breath.

We breathe day and night, and yet we are normally not aware of even one breath. Be aware now of each and every breath that you take. Do not interfere with the natural rhythm of you breathing. Simply be aware as a witness of each breath in and each breath out.

Now count your breath. Breathing in is one ...breathing out is 2....breathing in is 3 ...out is 4,.....continue up to 10,.... then start again. Let yourself relax into the smooth ebb and flow of your breathing. Continue for 5 minutes.

Exercise 2 – Sigh Breathing

Focus very closely on the physical sensations of breathing. The filling up....the emptying out of your lungs.......... the flow of air through your nose and through your throat.......the movement of your ribcage...... Observe for 10 breaths.

Take a big breath in through your nose and then a long slow breath out through your mouth making a sound like a sigh.... Again a big breath in then a long slow breath out..........continue this sigh breathing at your own pace........the emphasis is on the long slow breath out which should last longer than your breath in..........Every breath out is an opportunity to allow your body to soften...........Every breath out is an opportunity to allow your body grow more comfortable.......more relaxed....continue sigh breathing at your own pace, for another 10 breaths.

Now add a pause after the breath out....this pause is just as long as feels comfortable for ...the breathing pattern is... a big breath in.... a long slow breath out through your mouth like a soft sigh … and then a pause... breathing back in when you are ready............continue this pattern of breathing at your own pace, for another 10 breaths.....enjoying the pause as a point of stillness in the breathing cycle. Continue for 5 minutes.