Using Guided Meditation to Embody Lymphatic Anatomy and Improve Clinical Clarity.

For students of lymphatic therapies, mapping the drainage areas and vessel pathways can feel like navigating a shapeshifting landscape.

Initial lymph vessels populate almost every organ and tissue in the body, channelling fluid, immune cells and waste products from the tissues into lymph vessels that convey the unprocessed lymph to the lymph nodes.

These lymph pathways feature greater anatomical variability than other body systems, making the lymphatic system difficult to represent in standard textbook diagrams. Add to that the modern challenge of learning online at home, without the tactile cues and discussion of the classroom, and it's no wonder many students struggle to gain a working map of lymph vessels and nodes.

Yet within this challenge lies the opportunity to internalise and embody the lymph vessel system, teaching similar skills to your clients to improve clinical outcomes. 

Guided visualisation, or structured imagery, focuses on inner sensation and perception to assimilate two dimensional, text-based descriptions, and internalise the lymph vessels and pathways using you own body as a reference map.

Research shows these meditation-like exercises do more than aid learning, they can reduce study-related stress and lead to increased clinical confidence and observation skills. What's more they can be done at home alone, require no equipment and are easy to share with others.

Why a Guided Meditation?

Meditation and internal visualisation are skills that must be learned and practiced like any other. Carefully selected words can be used to; turn our attention inward to experience the inner body and shut out external distractions and noises (meditation), and direct our mind toward internal structures and processes to build our own 'sensory data' in great detail (guided self-awareness).

Wide-ranging benefits in daily meditation are well researched, and there is a growing body of evidence for using guided visualisation exercises in the educational setting.

Classroom observation and research demonstrate that guided imagery can enhance relaxation and receptivity to learning, access states of higher consciousness, and lead to greater subject mastery through embodied, sensory-rich learning (1).

A recent study with college students found that weekly guided imagery combined with progressive muscle relaxation decreased chronic stress and enhanced mental quality of life, even more so than traditional meditation alone (2).

A diverse range of health professionals were include in a large feasibility and impact study (RN 34%, MD 20%, Social Workers 14%, Trainees 14%, Dietitians 5%) which reported small but significant pre-to-post-module improvements in stress, anxiety, empathy, and self-efficacy in providing nondrug therapies for common symptoms (P < .001 for all) (3).

Participants had received online training (up to 3 hours) in how to use guided imagery in clinical practice which included example practices to allow for experiential learning. This study highlighted the cost-effectiveness and suitability of online delivery to train health professionals in the clinical use of guided imagery, and brings to light the personal benefits for health professionals when they undertake training of this nature.

Future studies are needed to examine the clinical impact of guided meditation training for health professionals to investigate the potential to improve self-efficacy and clinical outcomes.

Integration of studies on the use of guided meditation exercises across self-awareness and educational disciples may offer the evidence needed to support integration of meditation and self-awareness practices at all levels of health care; from undergraduate training of the health workforce, to self-care education for practitioners and clients alike.

Guided Visualisation in Lymphatic Education

Although there are undeniable cost- and convenience-savings in delivering theoretical content in online and remote learning formats, one of the downsides is the loss of the ability to view and learn from the bodies of physical classmates, or to explore and move body parts in anatomical models or cadavers.

Digital 3D models can meet many of these challenges, and are used routinely in areas such as surgical training. However for the average bodywork practitioner, even the best digital model won't replace the sensory input achieved by touching and palpating live body tissues and structures.

Guided imagery can go a long way to bridging this gap for online trainees, and may be particularly useful for students of the lymphatic system, as this is particularly difficult to visualise because:

• Although at least 80% of all vessels are located within a few millimetres of the surface of the skin, where they form an extensive network of microscopic initial lymph vessels, they are not visible or palpable.

• Lymphatic pathways can vary from person to person, and comparison between educational illustrations can be confusing.

• Lymph, and lymph vessels lack the rhythmic pulse of arteries, or the visible colour of veins.

• Distinct differences in the arrangement and location of lymphatic structures in the superficial and deep lymphatic systems, means that on the trunk the direction of lymph flow in the skin will be opposite to that in the deep system.

By using guided visualisation to enhance their understanding of lymphatic structures and processes, lymphatic practitioners can:

1. Map structures from the inside out:

Beginning with skin sensations, attention can be guided inward to explore the microscopic openings in the initial lymph vessels, tracking the flow of the lymph through ever larger vessels as they converge and traverse the fascial planes toward the lymph node basins.

2. Reinforce spatial understanding:

By visualising the pathway of the lymph in relation to familiar landmarks such as skeletal muscles and internal organs, students of lymphatic anatomy can simultaneously follow the pathway of the lymph while noting important checkpoints like the inguinal ligament and the clavicle. Practitioners can ask their client to identify key body parts and processes and then use their own terminology to make the guided imagery as relatable as possible to their personal needs.

3. Develop tactile empathy and enhance self-care education:

Nothing can replace the hands, nose and eyes of an experienced therapist to feel and assess swollen and congested skin. However when this is not available, internal exploration of the structures and processes may convey a better understand to the client of their condition and the purpose of the treatment on offer, and can assist in overcoming resistance to participating in their own self-care.

Words Matter; Composing Effective Guided Imagery

Structural design

Like every good story, the internalised experience needs a beginning, a middle, and an end. Almost all self-awareness exercises begin with the breath, either deliberately slowing or controlling the breath cycle, or by taking a passive observer view of mechanical actions such as the natural rise and fall of the chest and abdomen.

Sensory building aspects of the exercise (the middle) should focus on the main topic of learning, or a realistic resolution or improvement in a symptom, leading to a new state of being or understanding.

The ending should integrate the new state or knowledge; firstly into the whole body and the close environment, in a stepped approach that maintains the connection between the internal experience and the external world.

Language

Statistically, 70% of us prefer to process new information visually, and this is reflected in our vocabulary, where most of us will have no difficult in describing items using visual cues such as imagine, notice, observe, or view.

But what about the rest of us who are kinesthetic learners? Which in my observation has a higher than usual incidence among among those who choose a career in bodywork! We need words to help us feel our way though the system, such as being carried along the lymph channel, feeling tugging or pulling sensations, or sensing a spreading warmth.

While we will all have a preferred learning style, we can also process new information with all our available senses. Including hearing, olfactory and gustatory cues in every guided meditation will enhance sensory-data and integration aspects of the exercise. Pitch any technical jargon for the audience, but avoid abstract processes that may required thinking with the head, rather than experiencing with the body.

The use of metaphor with everyday items and activities can significantly aid in understanding complex processes occurring at a molecular level.

In lymphatic education and therapy, presenting the loose connective tissue as a warm watery bath for all body cells can be easily understood by almost everyone.

The bath-tub analogy is a useful, core concept that can be retuned to and built upon to include more complex processes over a course of internalisation exercises.

Enhancing autonomic engagement

Understanding the importance of autonomic balance and how to influence it can be the difference between a pleasant, meaningful and informative session, and feeling irritated or uncomfortable and hoping it will end soon because your nose is itchy...

The ideal environment will exclude loud or sudden noises which may make it difficult to stay focussed inside, however with practice these distractions can be successfully ignored, and guided imagery can be practiced anywhere, for example on public transport during a crowded daily commute.

For self-awareness beginners, creating the ideal learning environment is crucial. A pleasant experience in warm comfortable surroundings without harsh lighting or digital interruptions will enhance early outcomes and encourage repetition. Self-awareness skills can be practiced and improved to deliver more impactful results over time, and it is easier to keep doing and practicing what we feel is working.

Lying prone with bolsters elevating any congested areas is an ideal position when we are visualising the lymph system, as lymph flows more freely without gravity holding it down. But for some people sitting comfortably may prevent them from falling asleep too easily, and is also good for training yourself to 'go-inside' anywhere, such as at your desk in a busy office.

Use a calm, low-pitched voice tone of voice, with an unhurried pace. If background music is used this should not have a strong or fast beat which could entrain the heart rate, rather use a 'sound scape' style audio track, there are many excellent ones available on YouTube etc.

Practice Makes Perfect: Common Barriers (and Workarounds)

Introducing guided self-awareness exercises to someone who has never experienced mediation or guided imagery before can raise a few barriers. We are naturally suspicious and fearful of what we don't know and this can manifest as commenting on external noises or distractions, or asking questions to delay the start of the exercise.

Statements such as 'I can never see anything', or 'this never works for me can be managed by starting with 1 or 2 minute micro-visualisations, and using physical touch to guide attention to internal movements such as placing a hand on the chest during breathing. Keep it short to begin with and focus one target structure or pathway at a time.

An Inner Map for Outer Clarity

In manual lymphatic therapy, our hands follow invisible paths. But when those paths are deeply etched in our minds, and old friends within our own bodies, we practice with more confidence, empathy, and precision.

Guided meditation is more than a study aid. It's a way to transform abstract anatomy into embodied knowing, and presents as an essentially free resource that can be used in almost any health care or training setting. Guided meditation and self-awareness practices hold the potential to unlock our inner resources, deepening our understanding of this fascinating system and taking our clinical practice to a new level.

Listen to a guided exercise on the lymphatic pathway from the skin of the ankle.

References:

1. Galyean, B.-C. and J. Krishnamurti (1981). "Guided Imagery in Education." Journal of Humanistic Psychology 21(4): 57-68.

   Guided imagery, a technique involving introspection, awareness of inner imagery and symbolic expression, focusing and subsequent heightened self-understanding, has recently come to the attention of educators as a valuable tool for learning on many levels. Classroom observations, articles and research reports, workshops and conferences on humanistic/holistic/ transpersonal education show that educators tend to use imagery processes for one or more of the following purposes: ( a) higher consciousness; (b) relaxation and receptivity to learning; (c) increased mastery of information. Although much research needs to be done in the field of imagery in education and transpersonal approaches to learning, successes from various projects lead us to conclude that education models of the future will include imagery activities as a core aspect of the standard curriculum.

   
   

2. Stefanelli, K. J. "Meditation and guided imagery show reduction in chronic stress and increase in mental health-related quality of life for college students." Journal of American College Health: 1-11.

   Objective: To explore the effects of guided imagery with progressive deep muscle relaxation (PDMR) and meditation programs on chronic stress perception and health related quality of life in college students. Participants: College students were recruited from a local private university in Northeast Pennsylvania. Participants were not concurrently enrolled in another weekly meditation class. Students were randomly assigned to a meditation group (n?=?16) or guided imagery with PDMR (n?=?17). Method: The study design was an experimental, repeated measures design with two groups and two independent variables: the Perceived Stress Scale and Health-Related Quality of Life (SF-36v2). Results: Students in both the meditation and guided imagery groups demonstrated a decrease in chronic stress and increase in their mental-health related quality of life midway through the 8-week program and maintained throughout. Conclusion: This research lends support for weekly participation in a mind-body class as a viable method to decrease stress for college students.

   
   

3. Rao, N. and K. J. Kemper (2017). "The Feasibility and Effectiveness of Online Guided Imagery Training for Health Professionals." Journal of Evidence-Based Complementary & Alternative Medicine 22(1): 54-58.

   This study evaluated the feasibility and impact of brief online guided imagery training (up to 3 hours) for health professionals. Paired t tests were used to measure pre-to-post-training changes in stress (Perceived Stress Scale,), anxiety (Patient Reported Outcomes Measurement Information System–Anxiety Scale), empathy (Empathic Concern Scale, and Perspective-taking Scale), and self-efficacy (Self-Efficacy in providing Non-Drug Therapies Scale). Online guided imagery training attracted diverse health professionals and trainees (n = 273; 14% trainees; 34% registered nurses, 20% physicians, 14% social workers, 5% registered dietitians, and 27% others). Participants reported small but significant pre-to-post-module improvements in stress (17.8 to 13.5), anxiety (T-scores 56.4 to 54.3), empathy (both empathic concern, 29.8 to 30.7, and perspective taking, 28.0 to 29.4), and self-efficacy in providing nondrug therapies for common symptoms (58.5 to 77.0) (P < .001 for all). Future studies will need to examine the clinical impact of online guided imagery training for health professionals.