Mind Body Medicine
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XVII Imagery

Self-hypnosis reduces anxiety following coronary artery bypass surgery. A prospective, randomized trial. [see comments.].
Authors Ashton C Jr. Whitworth GC. Seldomridge JA. Shapiro PA. Weinberg AD. Michler RE. Smith CR. Rose EA. Fisher S. Oz MC. Institution Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, NY, USA. Comments Comment in: J Cardiovasc Surg (Torino). 2000 Apr;41(2):335-6 ; 10901550 Source Journal of Cardiovascular Surgery. 38(1):69-75, 1997 Feb. Abstract OBJECTIVE: The role of complementary medicine techniques has generated increasing interest in today's society. The purpose of our study was to evaluate the effects of one technique, self-hypnosis, and its role in coronary artery bypass surgery. We hypotesize that self-hypnosis relaxation techniques will have a positive effect on the patient's mental and physical condition following coronary artery bypass surgery. EXPERIMENTAL DESIGN: A prospective, randomized trial was conducted. Patients were followed beginning one day prior to surgery until the time of discharge from the hospital. SETTING: The study was conducted at Columbia Presbyterian Medical Center, a large tertiary care teaching institution. PATIENTS: All patients undergoing first-time elective coronary artery bypass surgery were eligible. A total of 32 patients were randomized into two groups. INTERVENTIONS: The study group was taught self-hypnosis relaxation techniques preoperatively, with no therapy in the control group. MEASURES: Outcome variables studied included anesthetic requirements, operative parameters, postoperative pain medication requirements, quality of life, hospital stay, major morbidity and mortality. RESULTS: Patients who were taught self-hypnosis relaxation techniques were significantly more relaxed postoperatively compared to the control group (p=0.032). Pain medication requirements were also significantly less in patients practising the self-hypnosis relaxation techniques that those who were noncompliant (p=0.046). No differences were noted in intraoperative parameters, morbidity or mortality. CONCLUSION: This study demonstrates the beneficial effects self-hypnosis relaxation techniques on patients undergoing coronary artery bypass surgery. It also provides a framework to study complementary techniques and the limitations encountered.

Imagery practice: the development of imagery skills in competitive athletes.
Authors Cumming J. Hall C.
Institution University of Western Ontario, London, Canada.
Source Journal of Sports Sciences. 20(2):137-45, 2002 Feb.
Abstract The aim of this study was to examine mental imagery within the context of the deliberate practice framework. Altogether, 159 athletes from one of three different competitive standards (recreational, provincial and national) completed the Deliberate Imagery Practice Questionnaire, which was designed for the present study to assess the athletes' perceptions of the importance of imagery along the three deliberate practice dimensions of relevancy, concentration and enjoyment. The results indicated that national athletes perceived imagery to be more relevant to performing than recreational athletes. In addition, athletes of a higher standard (i.e. provincial and national) reported using more imagery in a recent typical week and they had accumulated significantly more hours of imagery practice across their athletic career than recreational athletes. Finally, the relationships among the dimensions of deliberate practice did not lend conclusive support to either the original conception of deliberate practice or a sports-specific framework of deliberate practice.

Guided imagery: replication study using coronary artery bypass graft patients. [Review] [21 refs]
Authors Deisch P. Soukup SM. Adams P. Wild MC.
Institution Critical Care Clinical Nurse Specialist, Center for Advanced Nursing Practice, BryanLGH Medical Center, Lincoln, NE 68506, USA.
Source Nursing Clinics of North America. 35(2):417-25, 2000 Jun.
Abstract Replication of a guided imagery study, based on the work of D. Tusek and colleagues, was initiated for coronary artery bypass graft patients, using the Center for Advanced Nursing Practice's Evidence-Based Practice Model. Through the leadership of clinical nurse specialists and the support of perioperative and postoperative bedside clinicians, this initiative offered benefits to patients and served as a template for program expansion to other patient populations. [References: 21]

Surgical anticipatory stress manifests itself in immunocyte desensitization: evidence for autoimmunoregulatory involvement.
Authors Fricchione G. Bilfinger TV. Jandorf L. Smith EM. Stefano GB.
Institution Division of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Source International Journal of Cardiology. 53 Suppl:S65-73, 1996 Apr 26.
Abstract The immunocyte behavior (conformational changes and locomotion in response to signal molecule challenge) in patients about to undergo elective cardiac surgery was studied to elucidate the effect of psychological anticipatory stress on the immune system. Granulocytes and monocytes from 10 patients and 35 non-surgical controls were examined. Computer-assisted microscopic image analysis, capable of measuring cellular conformational and velocity changes, was used to measure the responsiveness of these immunocytes to peptidergic and cytokine stimulation. Immunocyte desensitization would appear to account for the reduction in their abilities to respond to chemotaxic challenge associated with the pre-cardiac surgery state. Their abilities to respond to D-Ala2-Met-enkephalinamide (DAMA) were observed only at much higher concentrations than previously reported (10-11 M vs. 10-9 M prior to surgery). This finding, together with the observed decrease in adrenocorticotropin levels compared to non-surgical controls, suggests that neutral endopeptidase activity was elevated just prior to surgery. Indeed, neutral endopeptidase activity is statistically elevated in the pre-cardiac surgery state. Furthermore, glucocorticoid levels remained constant, within normal resting limits, in both groups. Thus, surgical anticipatory stress may manifest itself, in part, as a desensitization of various immunocytes. Thus, a psychological anticipatory stress response may be a precipitant of the desensitization. Although this desensitization seemed not to involve the entire hypothalamic-pituitary-adrenal axis, the data suggest that psychological anticipatory stress may initially involve and influence autoimmunoregulation.

The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation.
Authors Gaston-Johansson F. Fall-Dickson JM. Nanda J. Ohly KV. Stillman S. Krumm S. Kennedy MJ.
Institution International and Extramural Programs, Johns Hopkins University School of Nursing, Baltimore, Maryland 21205-2110, USA.
Source Cancer Nursing. 23(4):277-85, 2000 Aug.
Abstract Patients with breast cancer who undergo autologous bone marrow/peripheral blood stem cell transplantation (ABMT) cope not only with a life-threatening medical treatment, but also with multiple, interrelated symptoms including pain, fatigue, psychological distress, and nausea. The purpose of this study was to determine, in a randomized controlled clinical trial, whether a comprehensive coping strategy program (CCSP) was effective in significantly reducing pain, fatigue, psychological distress, and nausea in patients with breast cancer who underwent ABMT. The CCSP was composed of preparatory information, cognitive restructuring, and relaxation with guided imagery. Randomization placed 52 patients in the CCSP treatment group and 58 patients in the control group. The CCSP was found to be effective in significantly reducing nausea as well as nausea combined with fatigue 7 days after the ABMT when the side effects of treatment were most severe. These results are important given the high incidence of nausea and fatigue in the ABMT population. The CCSP-treated group experienced mild anxiety as compared with the control group who reported moderate anxiety. The greatest effectiveness of CCSP may correspond to the time of the greatest morbidity for patients with breast cancer who have undergone ABM.

Self-hypnosis and exam stress: Comparing immune and relaxation-related imagery for influences on immunity, health, and mood.
Author Gruzelier, John; Levy, Jonathon; Williams, John; Henderson, Don.
Institution Imperial Coll School of Medicine, Dept of Cognitive Neuroscience & Behavior, London, England.
Source Contemporary Hypnosis. Vol 18(2) 2001, 73-86.
Whurr Publishers, England
Abstract Examined the effects of self-hypnosis training on immune function, mood, and health at examination time in medical schools. In a replication of the study of J. Gruzelier et al (1998), 22 medical students (mean age 19.1 yrs) underwent 3 hypnotherapy sessions using instructions of increased energy, alterness, concentration and happiness; additionally, Ss received instructions concerning either immune or relaxation imagery. Collected data included blood levels of CD3, CD4, CD8, CD19 lymphocytes, CD56 natural killer (NK) cells and blood cortisol. Results show that Ss receiving immune-related imagery reported fewer viral illnesses, such as colds and influenza, during the exam period. Immunerelated imagery was also more successful in buffering decline in total lymphocytes and subsets. Independent of instructions, hypnosis buffered the decline in CD8 cytotoxic T-cells observed in control Ss, an effect associated with hypnotic susceptibility. Evidence of a buffering effect on NK cells was not replicated. Dissociations between negative mood and raised cortisol followed hypnosis training. Findings demonstrate benefits for reported illness as a result of a psychological intervention.

Guided imagery in cardiac surgery.
Authors Halpin LS. Speir AM. CapoBianco P. Barnett SD.
Institution Inova Heart Center, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA. linda.halpin@inova.com Source Outcomes Management for Nursing Practice. 6(3):132-7, 2002 Jul-Sep.
Abstract Clinical research has demonstrated that guided imagery, a simple form of relaxation, can reduce preoperative anxiety and postoperative pain among patients undergoing surgical procedures. In 1998, the cardiac surgery team implemented a guided imagery program to compare cardiac surgical outcomes between two groups of patients: with and without guided imagery. Data from the hospital financial cost/accounting database and patient satisfaction data were collected and matched to the two groups of patients. A questionnaire was developed to assess the benefits of the guided imagery program to those who elected to participate in it. Patients who completed the guided imagery program had a shorter average length of stay, a decrease in average direct pharmacy costs, and a decrease in average direct pain medication costs while maintaining high overall patient satisfaction with the care and treatment provided. Guided imagery is now considered a complementary means to reduce anxiety, pain,and length of stay among our cardiac surgery patients.

The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction.
Authors Harvey AG. Payne S.
Institution Department of Experimental Psychology, University of Oxford, UK. allison.harvey@psy.ox.ac.uk Source Behaviour Research & Therapy. 40(3):267-77, 2002 Mar.
Abstract Insomniacs commonly complain that they are unable to get to sleep at night due to unwanted thoughts, worries and concerns. The present study investigated whether brief training in identifying and elaborating an interesting and engaging imagery task for use during the pre-sleep period can reduce unwanted pre-sleep cognitive activity and sleep onset latency. Forty one people with insomnia were given one of three instructional sets to follow on the experimental night; instructions to distract using imagery, general instructions to distract, or no instructions. Based on previous findings reported by Salkovskis & Campbell (1994) 'Behaviour Research and Therapy 32 (1994) 1' and ironic control theory (Wegner, 1994) 'Psychological Review 101 (1994) 34', it was predicted that (1) "imagery distraction" would be associated with shorter sleep onset latency and less frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group and that (2) "general distraction" would be associated with longer sleep onset latency and more frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group. Support was found for the first but not the second prediction. The success of the "imagery distraction" task is attributed to it occupying sufficient "cognitive space" to keep the individual from re-engaging with thoughts, worries, and concerns during the pre-sleep period. In addition, "imagery distraction" involved a very specific alternative cognitive task hence the operating process was given a feature positive search, conditions where mental control is likely to be achieved.

The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy.
Authors Kolcaba K. Fox C.
Institution College of Nursing, University of Akron, Ohio, USA.
Source Oncology Nursing Forum. 26(1):67-72, 1999 Jan-Feb.
Abstract PURPOSE/OBJECTIVES: To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer. DESIGN: Experimental longitudinal, random assignment to groups. SETTING: Two urban radiation oncology departments. SAMPLE: 53 women (26 in the experimental group, 27 in the control group) aged 37-81; 80% European and 10% African American with stage I or II breast cancer about to begin radiation therapy. METHODS: The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study. The Radiation Therapy Comfort Questionnaire was self-administered at three time points: prior to the introduction of intervention and the beginning of radiation therapy (Time 1), three weeks later (Time 2), and three weeks after completing radiation therapy (Time 3). The State Anxiety Inventory was administered at Time 1 only. MAIN RESEARCH VARIABLES: The effect of use of guided imagery on comfort with anxiety as a control variable. FINDINGS: Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group, with the treatment group having higher comfort over time. The data also revealed a significant linear trend in differences between groups. No significant interaction of group and time existed. CONCLUSIONS: Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer. The intervention was especially salient in the first three weeks of therapy. IMPLICATIONS FOR NURSING PRACTICE: Guided imagery audiotapes specifically designed for this population were resource effective in terms of cost, personnel, and time.

Anodyne imagery: an alternative to i.v. sedation in interventional radiology. [see comments.].
Authors Lang EV. Hamilton D.
Institution Department of Radiology, Department of Veterans Affairs Medical Center, Palo Alto, CA 94304.
Comments Comment in: AJR Am J Roentgenol. 1995 Mar;164(3):772 ; 7863924, Comment in: AJR Am J Roentgenol. 1995 Mar;164(3):772-3 ; 7863925
Source AJR. American Journal of Roentgenology. 162(5):1221-6, 1994 May.
Abstract OBJECTIVE. Pain and anxiety are to be expected in patients undergoing interventional procedures, and they are usually treated by IV conscious sedation. Insufficient treatment of pain and anxiety can cause cardiovascular strain and restlessness, which may jeopardize the success of the procedure. On the other hand, pharmacologic oversedation can provoke respiratory and cardiovascular depression, thereby increasing the procedural risks and delaying the patient's recovery. We therefore evaluated a nonpharmacologic method, which we call anodyne imagery (anodyne: able to soothe or relieve pain; soothing the feelings; relaxing), as an alternative to the use of drugs in interventional radiology. SUBJECTS AND METHODS. Anodyne imagery technique consists of conditioned relaxation, induction of a trance state, and guided processing of the patient's internal imagery. An intrapatient comparison of drug use was made in five patients who had equivalent procedures with and without anodyne imagery and an intergroup comparison was made between a group of 16 other patients undergoing anodyne imagery and a group of 16 control patients matched for factors affecting use of drugs and recruited from 100 interventional cases analyzed for patterns of drug use. For statistical analysis, drug unit scores (weighting: 1 mg of midazolam = 1 unit and 50 micrograms of fentanyl = 1 unit) were compared within patients by paired t-test and between groups of patients by analysis of variance in two-sided tests, with p less than .05 considered to be significant. RESULTS. The 100 patients who did not have anodyne imagery received 0-6 mg of midazolam (median, 1.4 mg), 0-500 micrograms of fentanyl (median, 80 micrograms), and 0.5-9 drug units (median, 2.5). Drug administration was insignificantly affected by the physician conducting the procedure, the type of procedure, or the patient's age, but significantly increased with longer table times. Ten of the 21 patients undergoing anodyne imagery associated fear-provoking images with their interventional procedure that were generally intense, vivid, and dramatic. Intrapatient comparison showed significantly lower median drug use with anodyne imagery than without (0.1 vs 5.3 drug units, p = .01). Intergroup comparison also yielded significantly lower median drug use during procedures with anodyne imagery than without (0.2 vs 2.6 drug units, p = .0001). CONCLUSION. Patients having interventional radiologic procedures frequently experience intense and frightening imagery related to the procedure. Our initial experience with anodyne imagery suggests that this alternative method of analgesia can mitigate patients' anxiety and fears and reduce the amount of drugs used during interventional radiologic procedures, and thereby has the potential to improve procedural safety and increase the speed of recovery.

Effect of guided imagery on quality of life for patients with chronic tension-type headache.
Author Mannix, Lisa K. Chandurkar, Rohit S. Rybicki, Lisa A. Tusek, Diane L. Solomon, Glen D.
Institution Headache Wellness Ctr, Greensboro, NC, US.
Source Headache. Vol 39(5) May 1999, 326-334.
Blackwell Science, Inc., US
Abstract Examined the effect of adjuvant guided imagery on patients with chronic tension type headache. 129 patients (mean age 41 yrs) with chronic tension type headache completed the Headache Disability Inventory and the Medical Outcomes Study Short Form (SF-36) at their initial visit to a specialty headache center and again 1 mo after the visit. In addition to individualized headache therapy, Ss listened to a guided imagery audiocassette tape daily for the month. 131 control Ss (mean age 40 yrs) received individualized therapy without guided imagery. Controls and Ss who listened to the guided imagery tape improved in headache frequency, headache severity, patient global assessment, quality of life, and disability caused by headache. More guided imagery Ss than controls reported that their headaches were much better. The guided imagery Ss had significantly more improvement in 3 of the SF-36 domains: bodily pain, vitality, and mental health.

Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery.
Author Manyande, Anne; Berg, Simon; Gettins, Doreen; Stanford, S. Clare; et al.
Institution U London, University Coll London, Dept of Psychology, England.
Source Psychosomatic Medicine. Vol 57(2) Mar-Apr 1995, 177-182.
Williams & Wilkins Co., US Abstract Tested the effects of a preoperative preparation that used guided imagery, not to reduce anxiety, but to increase patients' feelings of being able to cope with surgical stress; 26 adult imagery patients were compared with 25 adult controls who received, instead, background information about the hospital. State-anxiety was similar in each group, but imagery patients experienced less postoperative pain than did the controls, were less distressed by it, felt that they coped with it better, and requested less analgesia. Hormone levels measured in peripheral venous blood did not differ on the afternoon of admission, before preparation. Cortisol levels were, however, lower and noradrenaline levels greater in imagery patients than in controls immediately before and after surgery. Heart rate during surgery was lower in the imagery group than in controls, but differences were nonsignificant.

Guided imagery as a coping strategy for perioperative patients.
Authors Tusek D. Church JM. Fazio VW.
Institution Guided Imagery Program, Cleveland Clinic Foundation, USA.
Source AORN Journal. 66(4):644-9, 1997 Oct.
Abstract Patients who undergo surgery usually experience fear and apprehension about their surgical procedures. Guided imagery is a simple, low-cost therapeutic tool that can help counteract surgical patients' fear and anxiety. The authors randomly assigned 130 patients undergoing elective colorectal surgical procedures into two groups. Members of one group received routine perioperative care. Members of the other group listened to guided imagery tapes for three days before their surgical procedures, during anesthesia induction, intraoperatively, in the postanesthesia care unit, and for six days after surgery. The authors measured patients' anxiety levels, pain perceptions, and narcotic medication requirements. The patients in the guided imagery group experienced considerably less preoperative and postoperative anxiety and pain, and they required almost 50% less narcotic medications after their surgical procedures than patients in the control group.