Self-hypnosis reduces anxiety following coronary
artery bypass surgery. A prospective, randomized trial.
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
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
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,
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
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,
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
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;
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
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. email@example.com
Source Outcomes Management for Nursing Practice. 6(3):132-7,
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. firstname.lastname@example.org 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
The effects of guided imagery on comfort of women
with early stage breast cancer undergoing radiation
Authors Kolcaba K. Fox C.
Institution College of Nursing, University of Akron,
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
Source AJR. American Journal of Roentgenology. 162(5):1221-6,
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
Source Psychosomatic Medicine. Vol 57(2) Mar-Apr 1995,
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
Authors Tusek D. Church JM. Fazio VW.
Institution Guided Imagery Program, Cleveland Clinic
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