RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
ASTHMA
July, 2006
Prevalence and costs
Asthma is a large, growing, and
expensive health problem in all industrialized countries
(American Lung Assn.). As of 2003, 20.7 million American
adults and 9.1 million children were affected by asthma, a
condition that generates 12.9 million office visits
annually (CDC). In 2002, asthma was responsible for 4261
deaths and 1.7 emergency room visits in this country
(CDC).
According to the Labor Occupational Safety & Health
Administration, 15% of disabling asthma cases are work
related. Occupational asthma is the most common type of
occupational lung disease in the industrialized nations
(Rabatin, 2001).
Workers with asthma are twice
as likely to retire early; they have higher rates of
absenteeism, and they rate their ability to work and their
general health as poorer than non-asthmatic workers (Sauni,
Oksa et al, 2001). Baking, electronics, chemical and metal
manufacturing, paints and plastics, farming, and house
cleaning are the highest risk occupations (Rabatin; Sauni,
2001).
What
is asthma?
Asthma
is thought to result from genetic sensitivity,
environmental exposure to irritants and stress responses
that lead to a cycle of “hyper-responsiveness” and
inflammation in the bronchi. This inflammation,
along with excess
mucus production, can close airways and make breathing out
difficult. Once established, this cycle is difficult to
stop.
Medical
treatment of asthma
Standard medical treatment
includes daily use of an inhaled steroid medication,
as-needed use of a bronchodilator (or “rescue medication”),
and avoidance of environmental asthma “triggers.” (Oral
medications are sometimes needed as well.) The biggest
problem in asthma care is noncompliance, particularly with
the steroid inhalers. Seventy percent of patients in some
studies (Rand & Wise, 1994) either failed to take
prescribed daily inhalers, or never filled the
prescriptions (Piecoro, Potoski et al, 2001)
Non-pharmacologic
treatment including imagery
According to researchers
Bloomberg and Chen (2005) at St. Louis Children's Hospital,
"The mind-body paradigm that links psychologic stress to
disease is necessary when considering the global evaluation
of childhood asthma." The mind-body connection is important
in adult asthma, as well.
Behavioral and mind/body approaches are also used to
control inflammation and spasm. Guided imagery was able to
increase oxygenation in COPD patients (Louie, 2004). In two
British studies, hypnosis reduced hyper-responsiveness, and
increased forced expiratory volume through one year of
follow up in adult patients who were easily hypnotized
(Ewer & Stewart, 1986).
In a
group of 250 patients who had not been tested for
susceptibility, 59% of those receiving hypnotic suggestion
were rated as “much better,” compared with 40% of a group
who received relaxation training without hypnotic
suggestions (Maher-Loughna, Macdonald et al, 1962).
Guided imagery uses deep relaxation and positive suggestion
in ways nearly identical to hypnosis. The terms
“self-hypnosis” or “auto-hypnosis” are used almost
interchangeably with “guided imagery” in the literature
(Olness, 1981).
A meta-analysis by Hackman, Stern, and Gershwin showed
that, though larger, more randomized studies were needed,
hypnosis has shown definite, long-term effectiveness in
asthma, and that effectiveness is enhanced by the use of
self-hypnosis. In one study, 303 pediatric
asthmatics were offered hypnosis; some patient’s symptoms
resolved after one session, and there was measurable
improvement in 80% of those participating. No patients’
symptoms worsened (Anbar, 2002).
In another study of self-hypnosis with children, the
researcher followed participants for a mean of nine months
post-hypnosis. Positive results were recorded in 13
patients. Two of the children had no more symptoms and were
able to discontinue their medication (Anbar, 2001).
Hypnosis, combined with an education program, improved
pediatric cooperation and compliance with taking peak flow
measurements (Lehrer, Feldman et al, 2002).
In another study, adult asthmatics who listened to imagery
tapes were less depressed an anxious, and were able to use
less medication (Report, 1997). Asthma education programs that
instruct patients about asthma, medications, and avoiding
triggers, as this program does, help to reduce asthma
morbidity.
According to a 2005 Mayo Clinic review of the hypnosis
literature (Stewart, 2005), no fewer than five studies
showed positive results for asthma patients using hypnosis;
results included a large multicenter trial, with hypnosis
patients reporting a "significant decrease" in failed
treatments and an even larger number deemed "much improved"
(Hypnosis for asthma, 1968).
In another study, 54% of hypnosis patients had "excellent"
results, and 21% became asymptomatic and were able to
discontinue medication (Collison, 1975).
In
the Freeman and Welton 2005 study, the results were
contrary to the researchers' hypothesis when it was shown
that biologically targeted imagery was more efficacious
than critical thinking asthma management.
Biofeedback was also effective
in reducing some asthmatics’ dependence on steroid
medication (Lehrer, Vaschillo, et al, 2004).
Team
or combination approaches in asthma management can be
beneficial, as with Stanford University School of
Medicine's multicomponent program (Shames, Sharek et al,
2004).
Remarkable improvement occurred in the Anbar-Hummell (2005)
multicomponent approach which incorporates hypnosis; 82% of
their patients showed either improvement or resolution of
their primary symptoms.
Conclusion
A low-cost imagery intervention
may reduce asthmatic patients’ anxiety and use of medical
services, and improve their pulmonary function.
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