Alternative Therapies in Health and Medicine.
2004
Jul-Aug;10(4):66-71.
Epstein GN, Halper JP, Barrett EA, Birdsall C, McGee , Baron KP,
Lowenstein S.
The Mount Sinai Medical Center, New York, NY, USA.
CONTEXT:
Despite the growing
number of studies of imagery and the use of complementary and
alternative modalities as treatments for asthma, research on mental
imagery in adults with asthma is practically, nonexistent. The purpose
of this feasibility study was to lay groundwork for a larger follow-up
clinical trial.
OBJECTIVE:
To determine whether
pulmonary function, asthma symptoms, quality of life, depression,
anxiety, and power differ over time in adults with asthma who do and do
not practice mental imagery (MI). (Power is the ability to make aware
choices with the intention of freely involving oneself in creating
desired change.)
DESIGN:
Randomized controlled
study using univariate repeated measures analysis of variance (ANOVA)
and replacement through block design.
SETTING:
Lenox Hill Hospital, an
affiliate of New York University Medical School, New York, NY. SUBJECTS:
Sixty-eight adults with symptomatic asthma, after 4 weeks of baseline
data collection and analysis, met requirements for this randomized
controlled study. Thirty-three completed pulmonary function as well as
self-report tests at 4 time points over 17 weeks. The 16 experimental
participants also completed the 4-session imagery protocol.
INTERVENTION:
Individual imagery
instruction (week 1) and follow-up (weeks 4, 9, 15). Participants were
given 7 imagery exercises to select from and practice 3 times a day for
a total of 15 minutes.
MAIN OUTCOME MEASURES:
1) Spirometry (FEV1);
2) medication use; 3) Asthma Quality of Life Questionnaire; 4) Beck
Depression Inventory; 5) Spielberger Anxiety Scales (A-State and
A-Trait); 6) Barrett Power as Knowing Participation in Change Tool,
Version II; 7) Epstein Balloon Test of Ability to Image.
RESULTS:
There was little
evidence of statistical change in this feasibility study; yet, valuable
lessons were learned. Paired t-tests indicated there was a significant
difference in the total power scores in the imagery group, and in the
expected direction (two-tailed, t-statistic = -2.3, P = 0.035) and the
choices sub-scale (two-tailed, tstatistic = -2.93, P = 0.01) of the
power instrument from weeks one to 16 of the study. Eight of 17 (47%)
participants in the MI group reduced or discontinued their medications.
Three of 16 (19%) participants in the control group reduced their
medications; none discontinued. Chi-square indicated differences between
groups (X2 = 4.66, P = 0.05). Persons who reduced or discontinued their
medications showed neither an increase in pulmonary function prior to
medication discontinuation, nor a fall in these parameters following
discontinuation.
CONCLUSIONS:
Findings related to
major outcome measures must be viewed with caution due to the small
sample size resulting from attrition related to labor intensiveness and,
therefore, low statistical power. However, the study did provide
significant data to plan a larger scale study of the use of mental
imagery with adult asthmatics. The study also demonstrated that imagery
is inexpensive, safe and, with training, can be used as an adjunct
therapy by patients themselves. Its efficacy needs additional
exploration. Further research for adults with asthma who practice
imagery is important, as current treatments are not entirely
efficacious. Lessons learned in this study may facilitate improvement in
research designs.
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