The Effects of Guided Imagery on Comfort - Term Paper Example

The Effects of Guided Imagery on Comfort, Depression, Anxiety, and Stress of Psychiatric Inpatients with Depressive Disorders Nadiia Boiko Abstract The article is aimed to describe a method of supplementary medical treatment for psychiatric inpatients with mental depressive disorders. The method is called a guided imaginary (GI) and is meant to reduce patients’ depression, anxiety and stress, and improve their health. The authors included in their experiment 60 inpatients with mood disorders providing complementary guided imagery treatment for 10 days. Apostolo and Kolcaba used modified Psychiatric Inpatients Comfort Scale (PICS) and Depression, Anxiety, and Stress Scales (DASS-21) in order to evaluate the changes in inpatients’ mental state and access the effectiveness of guided imagery method implementation. After careful consideration of outcomes of the experiment conducted, the authors concluded that conducted imaginary interventions contributed significantly to the reduction of patients’ depression, anxiety, and stress, and improved their comfort. Introduction It seems that at recent time depression has become a serious problem for modern society, which affects negatively both social and economical spheres of human activities. To confirm the statement it is enough to consider the quantity of psychiatric inpatients all over the world: according to the report ‘Mental Health Policy and Practice across Europe: The future direction of mental health care’, approximately 450 million of population undergoes various types of mental disorders at any point of time (Knapp, McDaid, Mossialos, and Thornicroft, 2007). It is not a rare situation when people with mood disorders need to repeat their treatment for several times and although hospitalization provides them with some kind of refuge, it also implies certain limitations on patients’ freedom. Moreover, hospitalization could also cause extra discomfort in addition to that, which is invoked by the illness itself. Taking into account that GI interventions might ease patients’ depression, anxiety and stress factors and improve their health, the method influences essentially on the whole success of mental disorders treatment (Shapiro, 2003). Implementation of nursing should be grounded on relevant theories and is aimed to provide psychiatric inpatients with the highest possible level of comfort in order to help them to be full-fledged members of society. Regarding the fact that Comfort Theory application relieves patients reduce their depression, anxiety, and stress and increase their comfort, the method is an important element of nursing process. The main purpose of the paper is to examine the effects of GI interventions recorded on compact discs (CDs) on psychiatric patients’ mental health and test the Null hypothesis, which states that people with mood disorders, who receive GI interventions, would perceive higher comfort level and lower stress and nervousness. Background of Comfort Theory In order to define the conceptual framework of the study the authors used the mid range theory developed by Kolcaba (1991). Within the scope of the theory they determined comfort as a feeling of personal strengthening, which refers to satisfaction of such basic human needs as relief, transcendence and ease. Relief is defined as a state when certain person’s comfort requirements are met while it is assumed that previously people perceived a state of discomfort. Ease implies that people perceive a feeling of composure and abirritation, which is supposed to be an integral part of human successful performance. Transcendence is described as a state when people believe that they are able to control their destiny and feel inspired and motivated to plan their future. In the paper the authors accessed patients’ relief, transcendence and ease within physical, sociocultural, psychospiritual and environmental contexts, which they determined in the following way: physical dimension comprises various body sensations; sociocultural dimension includes persons’ relationships with their relatives, friends, colleagues, etc.; psychospiritual dimension comprises patients’ assessments of their life, their meaning and role in others’ lives and possible referral to higher beings; environmental dimension pertains such elements of patients’ surrounding as light, temperature, noise, color, etc. In order to analyze relief, transcendence and ease in physical, sociocultural, psychospiritual and environmental contexts, the authors formed a taxonomic structure of 12 cells, which was aimed to represent the general level of patients’ comfort level. According to this taxonomic structure, Apostolo and Kolcaba developed a questionnaire to use it for recording of GI implementation’s affects for a period of 10 days. The concept of GI According to Bresler and Rossman, GI is "a range of techniques from simple visualization and direct imagery-based suggestion through metaphor and storytelling" (Bresler & Rossman, 2003). In practice, guided imagery method comprises some visual, smell, sound, touch and taste positive images, which are supposed to bring relief for inpatients with mood disorders and stable their psychiatric and physiological state. The success of GI implementation is reached due to the theoretical premises, which state that exchanging negative cognitive processes for more positive ones would provide psychiatric inpatients with ease and relaxation. According to the article in Science Transitional Medicine journal, positive thinking affects essentially on patients general psychological state removing the feeling of doom and depression (Morrison, 2011). Therefore, GI implementation seems reasonable and should be widely applied as supplementary treatment method for inpatients with mood disorders. GI practical implementation For the purpose of their research, the authors in collaboration with clinical psychologists wrote a GI interventions on CD, which was a 21 minute long and contained the following relaxing techniques: instructions for profound diaphragmatic respiration; practical guide for physical exercises to relax different groups of muscles; calm sea and landscape visual images accompanied by sound, taste, smell effects, etc; The duration of the guided imagery treatment comprised 10 days and the measures were taken at two key points: before the beginning of GI implementation (T1) and after the accomplishment of the treatment (T2). Methods of measurements The authors developed special questionnaire based on their taxonomic structure (described in the section Background of Comfort Theory), which allowed them to gather all the necessary data concerning changes in patients’ mood state. They also exploited slightly modified Depression, Anxiety, and Stress Scales (DASS-21) worked out by S. Lovibond and P. Lovibond (1995), due to which they were able to evaluate inpatients’ depression, anxiety and stress in four dimensions: physical, sociocultural, psychospiritual and environmental ones. In order to consolidate the data and evaluate three dimensions of comfort (relief, transcendence and ease) in four contexts, Apostolo and Kolcaba used the Psychiatric Inpatients Comfort Scale (PICS). The scale included Likert gradation of 5 points and ranked patients’ responses beginning with answers that implied strong agreement with certain statements and finishing with answers that denied them. To make sure that the method applied is trustworthy and consistent, the authors checked its general reliability, concurrent and construct validity. Sample The authors conducted the research with the participation of 60 inpatients in total, 30 of which were included in experimental group and were subjected to guided imagery interventions while the rest of the patients was integrated in comparison group and were supposed to undergo no GI treatment. The requirements of the selection were the following: all the participants should be adults and be able to understand Portuguese; participants in experimental and comparison groups should have identical characteristics in terms of mental disorder, gender, age, education, etc.; all the participants should express a wish to take part in the experiment. Results Thought the instrumentality of the Depression, Anxiety, and Stress Scales (DASS-21) combined with the Psychiatric Inpatients Comfort Scale (PICS) and after careful analysis of the data, the authors concluded that the patients, who were undergone GI treatment, demonstrated essentially lower depression, stress, and anxiety and higher comfort levels on expiry of 10 days as against the participants from comparison group. Conclusions The results of the research confirmed the Null hypothesis, which states that psychiatric patients, who receive GI interventions, perceive much lower stress, depression and anxiety while their level of comfort increases significantly. After careful consideration of results of the experiment conducted, the authors concluded that guided imaginary interventions contributed significantly to the reduction of patients’ depression, anxiety, and stress, and improved their comfort. In other words, the research by Apostolo and Kolcaba confirmed that GI interventions are able to relieve depressive syndromes and strengthen patients’ good psychological and physiological general state. Therefore, it is recommendable to apply GI interventions in a form of supplementary treatment for patients with mood disorders. References Bresler, D., Rossman, M. (2003). History of guided imagery. Retrieved January 1, 2005. Knapp M., McDaid D., Mossialos E. and Thornicroft E. (Eds.). (2007). Mental health policy and practice across Europe: The future direction of mental health care, World Health Organization 2007 on behalf of the European Observatory on Health Systems and Policies (p.427). New York, NY: Two Penn Plaza. Kolcaba K. (1991). A taxonomic structure for the concept comfort. Image 23, pp. 237-240. Lovibond S., Lovibond P. (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney: Psychology Foundation. Morrison E. (2011). Great expectations: Power of positive thinking on medical treatment, Medill Reports journal. Chicago: Northwestern University. Shapiro G. (MS Ed.). (2003). Guided imagery: The healing power of imagination, Meta Arts Magazine. Read More