Imagery studies have varied widely in the methods used to deliver guided imagery interventions. This variation has led to difficulties comparing studies and uncertainty as to what methods should be followed. A review is needed to evaluate the interventions to date to inform applied recommendations. The aim of this systematic review was to (1) assess the quality of intervention design, (2) investigate the extent to which interventions vary, (3) highlight the different methods that should be considered in the design and implementation of future interventions, and (4) investigate adherence to some of the current theories and models of imagery use. A total of 20 interventions administered between the years 2001 and 2011 were compared over 17 main areas, including imagery ability, duration, script development, delivery method, and adherence to the PETTLEP model and the bio-informational theory. The results of this review found evidence of many inconsistencies between interventions and demonstrate a need for more comprehensive practical guidelines. Recommend-ations are offered for the design of future interventions, including increasing imagery practice time and the use of personalised imagery scripts. Numerous questions are raised to strengthen and direct future research such as the need for continued modification of scripts throughout an intervention.