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15 Aug

Blue Shield of California: findings developed from data gathered in 2000–2001 based on 900 completed patient surveys.

CALIFORNIA BLUE SHIELD continues to report positive outcomes with its use of our Health Journeys guided imagery. Through the program, begun in 2000, individuals facing one of 90 elective surgeries are sent guided imagery tapes.Outcomes include: 45% of patients experienced high anxiety before listening to the tapes, but less than 5% experienced similar anxiety following use of the tapes pre-surgery, and “the more anxious patients felt, the more frequently they listened to the recordings and the greater improvement they documented. The findings were developed from data gathered in 2000–2001 based on 900 completed patient surveys.

Blue Shield’s research team also compared claims from 166 hysterectomy patients who reported using the guided imagery tapes and completed surveys against a control group of 183 hysterectomy patients who did not listen to the tapes. The result: 4.5% decrease in average total hospital charges billed for surgery among patients who used guided imagery prior to surgery, and an 8.4% decrease in the average hospital pharmacy charges.



15 Aug

In 1998, a research team led by Linda Halpin at the Inova Heart Center of Inova Fairfax Hospital compared cardiac surgical outcomes between two groups of heart patients - with and without guided imagery. A questionnaire was developed to assess the benefits of the guided imagery program to those who elected to participate in it, and, in addition, data from the hospital financial cost-accounting database were collected and matched to the two groups of patients.

Analysis of the data revealed that 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 used as a standard, complementary therapy to help reduce anxiety, pain, and length of stay among the cardiac surgery patients at Inova Fairfax.

Citation: Halpin LS, Speir AM, CapoBianco P, Barnett SD. Guided imagery in cardiac surgery. Outcomes in Management & Nursing Practice, 2002 Jul-Sep;6(3):132-7.

15 Aug

Twenty patients awaiting breast biopsy at a Kentucky Correctional Facility were randomly assigned to either 20 minutes of music therapy in the pre-op holding area or standard care. Their blood pressure, heart rate, respiration and anxiety levels were measured before and after the intervention. This pilot study showed that the anxiety and respiratory rates of the patients in the music condition were significantly lower than the controls.

Citation: Haun M, Mainous RO, Looney SW. Effect of Music on Anxiety of Women Awaiting Breast Biopsy. Behavioral Medicine, 2001. Fall; (3): pp. 127-132.

15 Aug

A research team in Hong Kong tested the effectiveness of music therapy on twenty ventilator-dependent patients, measuring blood pressure, respiratory rate and the Chinese version of the Spielberger State-Trait Anxiety instrument. Patients were randomly assigned to either 30 minutes of uninterrupted rest and then 30 minutes of music therapy, or the music therapy first, followed by the rest period. Patients had a choice of Chinese or Western music. Measures were taken at 5-minute intervals during the music intervention. The study showed that music therapy was more effective at decreasing anxiety than the rest interval (p < .01). Blood pressure and respiration did not show differences.

Citation: Wong HL, Lopez-Nahas V, Molassiotis A. Effects of Music Therapy on Anxiety in Ventilator-Dependent Patients. Heart Lung. 2001 Sept-Oct; 30 (5): pp. 376-87.

15 Aug

W J Hamel explored the effects of music therapy on the anxiety levels, heart rate and blood pressure of patients waiting for their scheduled cardiac catheterization. 101 (63 men and 38 women) patients were randomly assigned to listen to 20 minutes of pre-selected music or to a standard care control group. Measurements were taken during the waiting period and just prior to departure for the lab. The intervention group had a significant reduction in anxiety (p = 0.003) and when compared to the controls (p = 0.004). Where the heart rate and systolic blood pressure dropped in the music therapy group, it increased in the control group. This held up whether the patient was male or female, but the men as a group had higher diastolic scores than the women, and the women had higher anxiety scores than the men.

Citation: Hamel, WJ, The Effects of Music Intervention on Anxiety in the Patient Waiting for Cardiac Catheterization, Intensive Critical Care Nursing, 2001 Oct; 17 (5): pp. 279-85.

15 Aug

Here is a study that got past us when it first came out, from our own University Hospitals, Rainbow Babies and Children''s Hospital, and CWRU’s Frances Payne Bolton School of Nursing:

S. A. Lambert’s study examines the effect of hypnosis/guided imagery on the postoperative course of pediatric surgical patients. Fifty-two children (matched for sex, age, and diagnosis) were randomly assigned to an experimental or control group. The experimental group was taught guided imagery by the investigator. The imagery technique included suggestions for a favorable postoperative course. The controls were given standard care.

15 Aug

Clinical hypnosis versus cognitive behavioral training for pain management with pediatric cancer patients undergoing bone marrow aspirations.
15 Aug

A recent study by principal investigator, Carol Ginandes PhD, of McLean Hospital/Harvard Medical School, explored differences in speed and extent of surgical wound healing in 18 breast reduction surgery patients, among 2 experimental conditions and one control condition.

The women were randomly assigned to receive either 8 supportive attention sessions, 8 hypnosis sessions targeting accelerated wound healing, or usual care. Differences in healing were observed at weeks one and seven, through clinical exams by staff who were blind to the intervention received, as well as scored, digitized photographs, patients’ subjectively rated pain, self-percieved healing and general health status.

15 Aug

In a randomized, controlled clinical trial, researchers from Rome, Italy assessed the effects of guided imagery on the postoperative course in proctological patients. Patients undergoing surgery for anorectal diseases were randomized into group 1 (n = 43) with standard care and group 2 (n = 43) with relaxation techniques, where they listened to a guided imagery tape with music and relaxing text before, during, and after surgery. Patients evaluated their own (a) postoperative pain measured by visual analogue score, (b) their quality of sleep measured by a similar score, and (c) the nature of first micturition (ed. note: fancy word for peeing, I believe), evaluated as normal or difficult. Groups were similar in age and sex distribution, type of disease, and operation performed. The pain score was 3.2 +/- 1.4 in GI patients and 4.1 +/- 2.1 in controls (P = 0.07). The quality of sleep score was 4.8 +/- 2.9 in GI patients and 6.4 +/- 2.7 in controls (P = 0.01). The first micturition was painful in 10.3% of GI patients and in 27.3% of controls (P = 0.09). Perioperative relaxation techniques thus showed a trend to reducing pain following anorectal surgery and significantly improving the quality of sleep; a decrease in anxiety and a consequent muscle relaxation may be involved. The study concludes that guided imagery is a low cost and noninvasive procedure, can be recommended as an helpful tool in this type of surgery.

Citation: Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. International Journal of Colorectal Disease 2000 Nov;15 (5-6): pp. 313-316.

15 Aug

Researchers from Universite Laval in Quebec studied the relative effects of self-regulation therapies and pharmaceuticals on 78 adults with chronic and primary insomnia. Subjects were assigned to either Cognitive-Behavior Therapy (stimulus control, sleep restriction, sleep hygiene and cognitive therapy, N=18), pharmacotherapy (temazepam, N=20) or both (N=20), compared to a placebo group (N=20). The 3 active treatments were more effective than the placebo, and there was a trend for the combined approach to improve sleep more than either of its two single components. In fact, there was 63.5% greater reduction of time spent awake after sleep onset for the combined condition; 55% greater for the cognitive-behavior therapy condition; 46.5% greater for the pharmacotherapy condition; and 16.9% greater for the placebo condition. In addition, subjects trained in behavior therapy were more likely to sustain their clinical gains at follow-up, and reported greater satisfaction with treatment. The study concludes that behavioral and pharmacological approaches are both effective for the short term management of late life insomnia, but that sleep improvements are better sustained over time with behavioral therapies, and a combination might be best of all.

Citation: Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA 1999 March 17; 281 (11): 991-999.

15 Aug

The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction.

Forty-one people with insomnia were assigned to one of three possible groups. One group received instructions on how to use imagery to distract themselves from the unwanted thoughts, worries and concerns that were keeping them awake. Another group got general instructions general instructions to distract themselves, and the third group got no instructions. The imagery group fell asleep faster and had less distressing pre-sleep thinking and worrying than the other two groups. The study investigators attribute the success of the "imagery distraction" intervention to its occupying sufficient "cognitive space" to keep the individual from re-engaging with thoughts, worries, and concerns during the pre-sleep period.

Citation: Harvey AG, Payne S., The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction. Behavioral Research and Therapy 2002 Mar;40(3):267-77

15 Aug

A Norwegian research team from the University of Bergen randomly assigned 55 older insomniacs to 2 interventions (either sleep hygiene advice plus behavioral control training or sleep hygiene advice plus a relaxation tape.) in this controlled clinical trial. The subjects underwent no significant changes while on the wait list. But during the treatment periods, they improved on several sleep parameters and these gains were maintained at the 6-month follow-up. People did best on nocturnal treatment measures sleep onset and total sleep time and less well with daytime measures life satisfaction and daytime alertness. No differences were discovered between the two interventions.

Citation: Pallesen S, Nordhus IH, Kvale G, Nielsen GH, Havik OE, Johnsen BH, Skjotskift S. Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions. Behavioral Research & Therapy 2003 Jan; 41 (1): pp. 31-48.