Cancer Imagery Research and Reference

Dr. Alan Watkins states that every idea, thought and belief has a neurochemical consequence, which is what makes imagery such a significant mind-body bridge. He writes that the flow of neuropeptides from the CNS, which enhances or inhibits one’s immunology through two major neuro immuno modulatory pathways; neuroendocrine and autonomic, are critically important in maintaining health and fighting disease [Watkins A 1997 Mind-body medicine. Churchill Livingstone, NY].

D. L. Tusek and R. E. Cwynar of Ohio acknowledged that patients often describe the experience in a hospital as overwhelming, evoking fear, anger, helplessness, and isolation. Tusek and Cwynar view guided imagery as one of the most well-studied complementary therapies being used that can improve the patient experience and outcome by providing a significant source of strength, support, and courage as they prepare for a procedure or manage the stresses of a hospital stay [AACN Clin Issues 2000 Feb; 11(1): 68-76].

V. W. Donaldson in NC at the Center for Stress Management examined the effects of mental imagery on the immune system response, and specifically, on depressed white blood cell (WBC) counts. Results indicated significant increases in WBC count for all patients over a 90-day period, even when possessing disease and illnesses that would have predicted a decrease in WBC count [Appl Psychophysiol Biofeedback 2000 Jun; 25(2): 117-28].

L. M. Troesch et al. of the Arthur G. James Cancer Hospital and Research Institute at Ohio State University in Columbus found that those patients using a chemotherapy-specific guided-imagery audiotape expressed a significantly more positive experience with chemotherapy, finding guided imagery to be an effective intervention to promote patient involvement in self-care practices and to increase patient coping abilities during symptom occurrence [Oncol Nurs Forum 1993 Sep; 20(8): 1179-85].

D. S. Burns at the Group/Walther Cancer Institute found that individuals who participated in guided imagery sessions scored better on both mood scores and quality of life scores than those who did not. Interestingly, these scores continued to improve in the experimental group, even after sessions were complete, indicating that guided imagery is effective in improving mood and quality of life in cancer patients [J. Music Ther. 2001 spring; 38(1) :51-65].

Gaston-Johansson et al. of Johns Hopkins University School of Nursing in Baltimore, Maryland showed significant benefits from the use of information, cognitive restructuring, and relaxation with guided imagery in those patients with breast cancer who underwent autologous bone marrow/peripheral blood stem cell transplantation. This strategy was found to be effective in significantly reducing anxiety, nausea, and nausea combined with fatigue 7 days after surgery when the side effects of treatment are usually the most severe [Cancer Nurs 2000 Aug; 23(4):277-85].

Researchers at Ohio State University in Columbus, Ohio found that people with cancer who used imagery while receiving chemotherapy felt more relaxed, better prepared for their treatment and more positive about care than those who didn't use the technique. They also found it can help chemotherapy patients cope with one of the most severe side effects of their treatment.

Howard Hall, measuring the effects of healthy people imagining their White blood cells as strong as powerful sharks, found a number of subjects could demonstrate an increase in the number of lymphocytes as well as an increased responsiveness of the immune system after the session as compared to before [Hall H R 1983 Hypnosis and the immune system. American Journal of Clinical Hypnosis, 25:92-103].

C. H. McKinney et al. from the University of Miami found that 13 weeks of guided imagery and music showed significant decreases in cortisol level (the “stress hormone” strongly correlated with mood disturbances, as well as demonstrating a significant reduction in depression, fatigue, and total mood disturbance.) The study also [Health Psychol 1997 Jul; 16(4): 390-400].

FEAR

L. Baider, et al. examined the long-term effects of relaxation and guided imagery on patients recently diagnosed with cancer at Hadassah University Hospital. Results showed a decrease in psychological distress and an increase in the patient's sense of internal control [Gen Hosp Psychiatry 2001 Sep-Oct; 23(5): 272-7].

A study by J. A. Royle, et al. of Ontario, found that guided imagery was the intervention best used by nurses to decrease patient anxiety [Can Oncol Nurs J 1996 Feb; 6(1): 20-5].

DEPRESSION

Fawzy et al. found that information on the cancer and training in stress
management and coping skills, showed participants exhibiting less fatigue, depression, mood disturbances, as well as increased vigor [Fawzy F I, Kemeny M E, Fawzy N W et al. 1990 A structured psychiatric intervention for cancer patients: II. Changes over time in immunological measures. Archive of General Psychiatry 47:729-35].

B. L. Rees reported that patients receiving 4 weeks of relaxation and guided imagery scored significantly lower on trait anxiety, state anxiety, and depression, while scoring significantly higher on measurements of self-esteem [J. of Holistic Nursing. 13(3): 255-267. Sept. 1995].

C.L. Norred at the University of Colorado Health Sciences Center Department of Anesthesiology in Denver found that guided imagery may be an integrative therapy that can minimize preoperative anxiety [AORN J 2000 Nov; 72(5): 838-40, 842-3].

S.A. Lambert found that guided imagery and relaxation therapy significantly lowered postoperative pain ratings and shortened the hospital stays, as well as decreased the postoperative anxiety [J Dev Behav Pediatr 1996 Oct; 17(5): 307-10].

ANXIETY-QUALITY OF LIFE

C. H. McKinney et al. from the University of Miami found that 13 weeks of guided imagery and music showed significant decreases in cortisol level (the “stress hormone” strongly correlated with mood disturbances, as well as demonstrating a significant reduction in depression, fatigue, and total mood disturbance. The study also [Health Psychol 1997 Jul; 16(4): 390-400].

B. L. Rees reported that patients receiving 4 weeks of relaxation and guided imagery scored significantly lower on trait anxiety, state anxiety, and depression, while scoring significantly higher on measurements of self-esteem [J. of Holistic Nursing. 13(3): 255-267. Sept. 1995].

L. G. Walker et al. of the University of Aberdeen Medical School found that cancer patients receiving standard care plus relaxation training and imagery were more relaxed and easy going during the study, experiencing a higher quality of life overall during primary chemotherapy [Br J Cancer 1999 Apr; 80(1-2): 262-8].

A study by J. A. Royle, et al. of Ontario, found that guided imagery was the best intervention used by nurses to decrease patient anxiety [Can Oncol Nurs J 1996 Feb; 6(1): 20-5].

SIDE EFFECTS-PAIN

K.L. Syrjala et al. of the Fred Hutchinson Cancer Research Center in Seattle, WA concluded in their study that stand-alone relaxation and imagery training reduces cancer treatment-related pain [Pain 1995 Nov; 63(2): 189-98].

R.Sloman from the University of Sydney in Australia observed that progressive muscle relaxation combined with guided imagery has the potential to promote relief of cancer pain. The techniques appear to produce a relaxation response that may break the pain-muscle-tension-anxiety cycle and facilitate pain relief through a calming effect. This technique seems to provide a self-care strategy that, to a limited extent, shifts the locus of control from clinician to patient [Nurs Clin North Am 1995 Dec; 30(4): 697-709].

R. J. Moore and D. Spiegel from the Anderson Cancer Center in Houston, TX observed a desire for and a benefit from patients being able to attach meaning to the disease and its treatment. They felt that this is why many are drawn to guided imagery as a tool in the management of cancer-related anxiety and pain by using it to reconnect to the self, to make sense of their experiences with breast cancer, and for managing cancer pain in a manner that increases one’s sense of control, thereby alleviating the suffering of the survivor [1096-2190 2000 Mar 21; 2(2): 115-126].

D.L. Tusek, R. Cwynar, and D.M. Cosgrove studied the effect of listening to taped guided imagery for patients undergoing cardiovascular surgeries and concluded that guided imagery can decrease length of stay, pain, and anxiety [J of Cardiovascular Management. 22-28. March-April 1999].

C Renzi et al. found that listening to guided imagery tapes before, during, and after surgery showed results in which there was a trend for reduction in pain following surgery and a significant improvement in the quality of sleep [Int J Colorectal Dis 2000 Nov; 15(5-6): 313-6].

Omlor et al. found that preoperative relaxation techniques significantly reduced the number of postoperative hematomas as well as the amount of pain medication being required after surgery [Zentralbl Chir 2000; 125(4): 380-5; discussion 385-6].

Journal of Consulting and Clinical Psychology: 1991 Aug; 59(4): 518-25 concluded that relaxation therapy is effective in reducing adverse consequences of chemotherapy, for a study involving 81 cancer patients showed relaxation therapy to decrease nausea and anxiety during chemotherapy.

K. L. Kaufman et al. at Ohio State University tried a self-hypnotic, cue-controlled relaxation, and guided imagery intervention that showed a marked and clinically significant reduction in nausea and vomiting as well as a concurrent increase in sleep duration [J Adolesc Health Care 1989 Jul; 10(4): 323-7].

IMMUNE RESPONSE

K. Glaser and R. Glaser, studying a group of elderly people, found that over a month of relaxation training three times per week significantly increased their natural killer lymphocytes and T cell activity [Cousins N 1989 Head first. Dutton, NY].
J. Pennebaker found that “confessional writing,” of the type that occurs when journaling, led to salubrious changes in the immune system and better health in general. He felt that there is structuring and resolving of the harmful effects of those “hidden” feelings and images going on through the process of writing. [Pennebaker J W 1990 Opening up: the healing power of confidence in others. Avon, NY].
Danish researchers found increased natural killer cell activity among ten college students who imagined that their immune systems were becoming very effective. Natural killer cells are an important part of the immune system because they can recognize and destroy virus-infected cells, tumor cells and other invaders.
A group of metastatic cancer patients using daily imagery for a year achieved significant improvements in NK cell activity and several other measures of immune functioning.
C. Holden-Lund found that the use of an audiotape series employing relaxation with guided imagery demonstrated significantly less state anxiety, lower cortisol levels one day following surgery, and less surgical wound erythema than the control group. Thus, the guided imagery tapes demonstrated stress-relieving outcomes closely associated with healing [Res Nurs Health 1988 Aug; 11(4):235-44].

GUIDED IMAGERY RESEARCH

D.A. Rapkin, M. Straubing, and J.C. Holroyd from the University of California, Los Angeles explored the value of imagery-hypnosis on recovery from head and neck cancer surgery and found there were fewer surgical complications and less blood loss during surgery [Int J Clin Exp Hypn 1991 Oct; 39(4): 215-26].

L. LeShan found that psychological conditions had an enormous influence not only on the production of cancer, but also on the disease’s evolution and even on the person’s response to a particular treatment (LeShan L, Worthington R 1956 Personality as a factor in the pathogenesis of cancer: a review of the literature. British Journal of Medical Psychology 29:49-56).

K. Kolcaba and C. Fox measured the effectiveness of customized guided imagery for increasing comfort in early stage cancer. They found that listening to a guided imagery audiotape once a day for the duration of the study indicated a significant overall increase in comfort over time, and was especially salient in the first three weeks of therapy. [Oncol Nurs Forum 1999 Jan-Feb; 26(1): 67-72].

M. Jasnoski of George Washington University, Washington, D.C., is examining the effects of imagery on the immune system, with potential implications for use in cancer and AIDS.

Blair Justice of the University of Texas Health Sciences Center in Houston was funded to conduct a controlled study examining the effects of a group imagery/ relaxation process on immune function and quality of life in breast cancer patients

ARTICLES ON GUIDED IMAGERY

Strategies For Implementing A Guided Imagery Program To Enhance Patient Experience
Reviews the use of and research about guided imagery in surgery, and describes how to implement a program.
2000 AACN Clin Issues 11; 1:68-76
Tusek, D. L. and Cwynar, R. E.

Imagine This! Infinite Uses Of Guided Imagery In Women's Health
Reviews use of guided imagery in outpatient, inpatient, chronic care and home care settings related to women's health.
1999 J Holist Nurs 17; 4:317-30
Bazzo, D. J. and Moeller, R. A.

The Value Of Imagery In Preoperative Nursing
Review of interactive imagery with an institutional implementation plan.
1998 Semin Perioper Nurs 7; 2:108-13
Miller, T.

Guided Imagery. A Psychoneuroimmunological Intervention In Holistic Nursing Practice. Use of guided imagery as an intervention in nursing practice, and its impact on psychoneuroimmunology.
1997 J Holist Nurs 15; 2:112-27
Giedt, J. F.

Coping, Life Attitudes, And Immune Responses To Imagery And Group Support After Breast Cancer Treatment / Richardson MA. Altern Ther Health Med 1997; 3(5): 62-70.

The Effects Of Guided Imagery On Comfort Of Women With Early Stage Breast Cancer Undergoing Radiation Therapy / Kolcaba K, Fox C. Oncol Nurs Forum 1999; 26(1): 67-72.

Imagery And Hypnosis In The Treatment Of Cancer Patients / Spiegel D. Oncology (Huntingt) 1997; 11(8): 1179-89; discussion 1189-95.
Psychological, Clinical And Pathological Effects Of Relaxation Training And Guided Imagery During Primary Chemotherapy / Walker LG, Walker MB, et al. Br J Cancer 1999; 80(1-2): 262-8.

Relaxation And Imagery For Symptom Management: Improving Patient Assessment And Individualizing Treatment / Van Fleet S. Oncol Nurs Forum 2000; 27(3): 501-10.

Use Of Relaxation For The Promotion Of Comfort And Pain Relief In Persons With Advanced Cancer / Solman R. Contemp Nurse 1994; 3(1): 6-12.