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Audio-Recorded Guided Imagery Treatment Reduces Functional Abdominal Pain in Children: A Pilot Study
Abstract and Figures
This study was designed to develop and to test a home-based, guided imagery treatment protocol, using audio and video recordings, that is easy for health care professionals and patients to use, is inexpensive, and is applicable to a wide range of health care settings.
Thirty-four children, 6 to 15 years of age, with a physician diagnosis of functional abdominal pain were assigned randomly to receive 2 months of standard medical care with or without home-based, guided imagery treatment. Children who received only standard medical care initially received guided imagery treatment after 2 months. Children were monitored for 6 months after completion of guided imagery treatment.
All treatment materials were reported to be self-explanatory, enjoyable, and easy to understand and to use. The compliance rate was 98.5%. In an intention-to-treat analysis, 63.1% of children in the guided imagery treatment group were treatment responders, compared with 26.7% in the standard medical care-only group (P = .03; number needed to treat: 3). Per-protocol analysis showed similar results (73.3% vs 28.6% responders). When the children in the standard medical care group also received guided imagery treatment, 61.5% became treatment responders. Treatment effects were maintained for 6 months (62.5% responders).
Guided imagery treatment plus medical care was superior to standard medical care only for the treatment of abdominal pain, and treatment effects were sustained over a long period.
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... Furthermore, the need for repeated therapy sessions and inadequate mental health insurance coverage often impede optimal care [9,10]. As an alternative delivery modality, one research group reported that prerecorded guided imagery treatment-a form of self-hypnosis-delivered remotely through CDs was efficacious for children with FAPDs [11]. In another study, audio-delivered hypnosis was not inferior to therapist-delivered hypnosis [12,13], indicating that this type of treatment is likely effective. ...
... A research team member observed the caregiver or child completing the task list while sitting next to them and was available to answer questions and provide assistance. After opening the sample therapy session, the caregiver and child listened to a sample 8-minute-and-30-second session that previously demonstrated efficacy in a pediatric clinical trial (provided by the author MALvT) [11]. The sample included an induction phase, and all therapeutic suggestions for improvement were removed. ...
... Furthermore, adequate time is required during a session to become fully engaged in GIT. In a previous study that used audio recorded guided imagery to treat pediatric FAPDs, exit interviews revealed that the sessions (which lasted for approximately 10 to 25 minutes) were enjoyable, children did not need to be prompted by their parents to listen to the sessions, and most children listened to the sessions more often than instructed [11]. This feedback suggests that children and their caregivers may underestimate the importance of engagement during GIT when listening to a brief audio sample rather than an entire session. ...
Background:
Functional abdominal pain disorders (FAPDs) are highly prevalent and associated with substantial morbidity. Guided imagery therapy (GIT) is efficacious; however, barriers often impede patient access. Therefore, we developed a GIT mobile app as a novel delivery platform.
Objective:
Guided by user-centered design, this study captured the critiques of our GIT app from children with FAPDs and their caregivers.
Methods:
Children aged 7 to 12 years with Rome IV-defined FAPDs and their caregivers were enrolled. The participants completed a software evaluation, which assessed how well they executed specific app tasks: opening the app, logging in, initiating a session, setting the reminder notification time, and exiting the app. Difficulties in completing these tasks were tallied. After this evaluation, the participants independently completed a System Usability Scale survey. Finally, the children and caregivers were separately interviewed to capture their thoughts about the app. Using a hybrid thematic analysis approach, 2 independent coders coded the interview transcripts using a shared codebook. Data integration occurred after the qualitative and quantitative data were analyzed, and the collective results were summarized.
Results:
We enrolled 16 child-caregiver dyads. The average age of the children was 9.0 (SD 1.6) years, and 69% (11/16) were female. The System Usability Scale average scores were above average at 78.2 (SD 12.6) and 78.0 (SD 13.5) for the children and caregivers, respectively. The software evaluation revealed favorable usability for most tasks, but 75% (12/16) of children and 69% (11/16) of caregivers had difficulty setting the reminder notification. The children's interviews confirmed the app's usability as favorable but noted difficulty in locating the reminder notification. The children recommended adding exciting scenery and animations to the session screen. Their preferred topics were animals, beaches, swimming, and forests. They also recommended adding soft sounds related to the session topic. Finally, they suggested that adding app gamification enhancements using tangible and intangible rewards for listening to the sessions would promote regular use. The caregivers also assessed the app's usability as favorable but verified the difficulty in locating the reminder notification. They preferred a beach setting, and theme-related music and nature sounds were recommended to augment the session narration. App interface suggestions included increasing the font and image sizes. They also thought that the app's ability to relieve gastrointestinal symptoms and gamification enhancements using tangible and intangible incentives would positively influence the children's motivation to use the app regularly. Data integration revealed that the GIT app had above-average usability. Usability challenges included locating the reminder notification feature and esthetics affecting navigation.
Conclusions:
Children and caregivers rated our GIT app's usability favorably, offered suggestions to improve its appearance and session content, and recommended rewards to promote its regular use. Their feedback will inform future app refinements.
... Psychological interventions are considered a strong treatment option. Specifically, pediatric psychologists often use cognitive behavioral therapy (CBT) [63,64], relaxation strategies [66], and guided imagery [67] to help patients to cope more effectively with chronic pain. Physical therapy/rehabilitation strategies might include exposure to movement in the presence of pain as well as aiding the patient in setting and achieving functional restoration [66]. ...
The aim of this review is to heighten awareness of the association between chronic functional abdominal pain (CFAP) and restrictive eating disorders (ED) in adolescents. We describe current diagnostic practices and propose future research efforts to improve the assessment and treatment of comorbid CFAP and restrictive EDs. A narrative review of the literature on CFAP and EDs was performed using PubMed, JSTOR, ScienceDirect, and PsycINFO and the following search terms: ‘restrictive eating disorders’, ‘chronic functional abdominal pain’, ‘chronic pain’ ‘treatment’ ‘diagnosis’ and ‘adolescents’. Published studies on restrictive EDs and CFAP from May 2008 to March 2023 were included. Ascribable to the overlap in etiology and symptom presentation, adolescents with chronic pain are significantly less likely to have their ED pathology promptly identified by providers compared to adolescents without comorbid chronic pain. This highlights the importance of the time sensitive and accurate identification of EDs in adolescents with CFAP. Overall, assessment methods are limited and EDs take longer to be identified in adolescents with comorbid CFAP. Future efforts should address diagnostic practices in pediatric settings and improve the communication among medical and mental health providers in order to promote the rapid and effective diagnosis and treatment of comorbid CFAP and EDs.
... Both versions are of equal intensity (eg, exercise duration) and are feasible for all relevant age groups. 31 32 We include the instructions and exercises for both versions in a newly designed, responsive, login-protected website. Instructions are directly visible on the home page and vary each week. ...
Introduction
Children often present to primary care with functional abdominal pain (FAP) or irritable bowel syndrome (IBS), and around half still have abdominal complaints 1 year later. Hypnotherapy is an evidence-based treatment that is used in specialist care, but it lacks evidence in primary care. This study will investigate the (cost) effectiveness of home-based guided hypnotherapy for children with FAP or IBS in primary care.
Methods and analysis
We report the design of a pragmatic randomised controlled trial among children aged 7–17 years, diagnosed with FAP or IBS by their general practitioner (GP), with assessments over 12 months. The control group will receive care as usual (CAU) by their GP (eg, communication, education and reassurance), while the intervention group will receive CAU plus 3 months of home-based guided hypnotherapy via a website. The primary outcome will be the proportion of children with adequate relief from abdominal pain/discomfort at 12 months, analysed on an intention-to-treat basis. Secondary outcomes will include the adequacy of pain relief at 3 and 6 months, pain/discomfort severity, pain frequency and intensity, daily functioning and impact on function, anxiety and depression, pain beliefs, sleep disturbances, school absence, somatisation, and healthcare use and costs. We must include 200 children to determine a 20% difference in those with adequate relief (55% control vs 75% intervention).
Ethics and dissemination
The Medical Ethics Review Committee of the University Medical Center Groningen, the Netherlands, approved this study (METc2020/237). The results will be disseminated to patients, GPs and other stakeholders via email, a dedicated website, peer-reviewed publications and presentations at national and international conferences. We plan to collaborate with the Dutch Society of GPs to implement the results in clinical practice.
Trial registration number
NCT05636358 .
... Studies have shown that psychological interventions are of value in treating children with FAPDs. Guided imagery and hypnotherapy are effective in treating children with FAPDs [21,22]. These interventions are promising but challenging to apply in a clinical setting, especially in resource-poor clinics overburdened with patients and lack psychotherapists. ...
Objectives:
Functional abdominal pain disorders (FAPDs) are common gastrointestinal problems in children, and the pathophysiology is thought to be multifactorial. Adverse early life events (ELE) induce alterations in the central nervous system, perhaps predisposing individuals to develop FAPDs. We aimed to study the potential adverse ELE that are associated with FAPDs.
Methods:
We steered a school-based survey involving 1000 children from 4 randomly selected schools. FAPDs were assessed using the translated Rome III questionnaire, and ELE were identified using a pre-tested, parental questionnaire. FAPDs were diagnosed using the Rome III criteria.
Results:
Hundred and eighty-two (182) children had FAPDs (62.1% girls, mean age 8.5, SD 2.1). ELE of them were compared with 571 children without FAPDs (51.1% girls, mean age 8.8, SD 1.9). According to the binary logistic regression analysis, family members with abdominal pain, family member with chronic pain other than abdominal pain, prenatal maternal complications and interventional deliveries, were recognized as potential risk factors for the development of FAPDs. Breast feeding over two years has shown to reduce the prevalence of FAPDs.a.
Conclusions:
Prenatal maternal medical problems are associated a with higher prevalence of FAPDs later in life. Prolonged breastfeeding and normal vaginal delivery could be considered as factors that reduce the vulnerability of developing FAPDs in children. Therefore, minimizing pregnancy-related complications, encouraging vaginal deliveries, and encouraging breastfeeding are potentially valuable measures to prevent FAPDs during childhood.
... Berbagai masalah kesehatan dapat dibantu oleh terapi Guided Imagery and Music, termasuk: a) Menurunkan depresi dan kecemasan b) Menghilangkan fobia c) Mengurangi trauma d) Mengurangi rokok atau makan e) Penyembuhan penyakit fisik dan gejalanya (sakit kepala, tekanan darah, insomnia, nyeri kronis, dsb) van Tilburg et al. (2009) Guided Imagery and Music tidak dapat dilakukan oleh semua orang. Menurut (Geraldina, 2017) untuk suatu alasan tertentu, mereka yang memiliki emosi yang tidak stabil, kecerdasan yang terbatas, atau penolakan untuk menerima kenyataan bahwa mereka harus menerima dan mengetahui hal-hal yang tidak menyenangkan. ...
ABSTRAK Hipertensi merupakan tekanan darah di atas atau sama 140 mmHg bagian systole dan di atas atau sama 90 mmHg bagian diastole. Beberapa terapi yang dapat dilakukan dalam hipertensi yaitu penanganan non farmakologis seperti, pijat kaki atau refleksi, hipnoterapi, teknik relaksasi napas dalam, relaksasi otot progresif (Progressive Muscle Relaxation) dan imajinasi terbimbing sambil menikmati music (Guided Imagery and Music). Adapun salah satu keistimewaan dari Guided Imagery and Music ini yaitu membuat tubuh lebih rileks, menurunkan ketegangan otot, membuat tubuh beristirahat lebih berkualitas, tekanan darah sistolik dan diastolic dapat menurun. Tujuan pengabdian kepada masyarakat ini, untuk mendapatkan kompetensi dan pengalaman dalam memberian asuhan keperawatan komprehensif yaitu dengan pemberian terapi Guided Imagery and Music (GIM) terhadap penurunan tekanan darah. Adapun kegiatan yang dilakukan adalah membimbing klien agar rileks dan beristirahat sambil melakukan imajinasi terbimbing disertai dengan mendengarkan musik. Terdapat penurunan tekanan darah setelah dilakukan terapi Guided Imagery and Music (GIM) pada penderita hipertensi lansia. Dengan demikian, terapi Guided Imagery and Music (GIM) efektif dalam menurunkan tekanan darah. Kata Kunci: Guided Imagery and Music (GIM), Tekanan Darah, Hipertensi ABSTRACT Hypertension is blood pressure above or equal to 140 mmHg in systole and above or equal to 90 mmHg in diastole. Some therapies that can be done in hypertension are non-pharmacological treatments such as foot massage or reflexology, hypnotherapy, deep breathing relaxation techniques, progressive muscle relaxation (Progressive Muscle Relaxation) and guided imagination while enjoying music (Guided Imagery and Music). As for one of the features of Guided Imagery and Music, it makes the body more relaxed, reduces muscle tension, makes the body rest better, systolic and diastolic blood pressure can decrease. The purpose of this community service is to gain competence and experience in providing comprehensive nursing care, namely by providing Guided Imagery and Music (GIM) therapy to reduce blood pressure. The activities carried out are guiding clients to relax and rest while doing guided imagination accompanied by listening to music. There is a decrease in blood pressure after Guided Imagery and Music (GIM) therapy in elderly hypertensive patients. Thus, Guided Imagery and Music (GIM) therapy is effective in lowering blood pressure. Keywords: Guided Imagery and Music (GIM), Blood Pressure, Hypertension
Behaviour management is not just the application of individual technique formulated to deal with individuals but is a comprehensive metho dology meant to build a relationship between patient and dental professional & at same time in still positive dental attitude. The study aims to evaluate the efficacy of virtual reality & audio guided imagery in reduction of state anxiety and pain perception during inferior alveolar nerve block among 5-8 years old children.
Hypnotherapy, a form of psychotherapy, has become an established and evidence-based treatment modality in pediatric gastroenterology. This chapter describes what gut-directed hypnotherapy is, gives an overview of the evidence for its use in pain-related gastrointestinal disorders, and the potential mode of action of hypnotherapy. Moreover, the use of hypnotherapy in functional nausea and other gastrointestinal diseases, either as a stand-alone therapy or in combination with other medical treatment, is discussed. Directions towards implementing hypnotherapy in clinical practice are provided and examples of how it is used may be discussed with patients.
Functional abdominal pain disorders (FAPDs) are common in the pediatric population and are associated with a significant reduction in quality of life. Bidirectional communication of the brain-gut axis plays an important role in pain generation and perception in FAPDs. There is a paucity of data on the best approach to treat this group of disorders, with no Food and Drug Administration (FDA)-approved drugs and scarce research to substantiate the use of most medications. Use of hypnosis in pediatric FAPDs is supported by evidence and has long-term benefits of up to at least 5 years beyond completion of treatment, highlighting the importance of incorporating this therapy into the care of these patients. The mechanisms by which clinical hypnosis is beneficial in the treatment of FAPDs is not completely understood, but there is growing evidence that it impacts functioning of the brain-gut axis, potentially through influence on central pain processing, visceral sensitivity, and motility. The lack of side effects or potential for significant harm and low cost makes it an attractive option compared to pharmacologic therapies. This review addresses current barriers to clinical hypnosis including misconceptions among patients and families, lack of trained clinicians, and questions around insurance reimbursement. The recent use of telemedicine and delivery of hypnosis via audio-visual modalities allow more patients to benefit from this treatment. As the evidence base for hypnosis grows, acceptance and training will likely increase as well. Further research is needed to understand how hypnosis works and to develop tools that predict who is most likely to respond to hypnosis. Studies on cost-effectiveness in comparing hypnosis to other therapies for FAPDs will increase evidence for appropriate healthcare utilization. Because hypnosis has applications beyond pain and is child-friendly with minimal to no risk, hypnosis could be an important therapeutic tool in the wider pediatric gastrointestinal population.
In several countries, gut-directed hypnotherapy is becoming an established and evidence-based treatment in pediatric gastroenterology. This article describes what hypnotherapy is, offers an overview of its effect in gut-brain disorders and explains its potential mode of action. Moreover, the use of hypnotherapy in other areas of pediatric gastroenterology, as a supportive tool to reduce pain, stress, depression, and anxiety and improve quality of life, will be also discussed. Guidance towards implementing hypnotherapy in clinical practice is provided, including examples of how you can explain hypnosis to patients with gastroenterological symptoms.
The Pain Response Inventory (PRI) was developed as a multidimensional instrument to assess children's coping responses to recurrent pain. The PRI assesses 3 broad coping factors—Active, Passive, and Accommodative—each with subscales representing specific strategies for coping with pain. Confirmatory factor analysis was used to derive and cross-validate the factor structure of the PRI in 3 different samples of children and adolescents: 688 9–16 yr olds in general population, 120 8–18 yr old abdominal pain patients who also completed followup interviews 2-wks and 6 mo after initial interview, and 224 11–23 yr old former abdominal pain and well patients. The subscales were found to be internally consistent and reasonably stable. Validity of the subscales was assessed by examining the relations of particular coping strategies to various outcome indicators, including functional disability, somatization symptoms, and depressive symptoms. Results indicated that different types of health outcome were predicted by different patterns of PRI coping strategies, thus supporting the utility of a multidimensional approach to the assessment of coping responses to pain. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Described the development and validation of the Functional Disability Inventory (FDI) for school-age children and adolescents. Results provide support for construct, concurrent, and predictive validity. FDI scores also demonstrated stability over a 3-month period in patients with a chronic condition, and the instrument was sensitive to changes in patient status subsequent to medical treatment. There was some evidence that gender played a role in disability, particularly in adolescence. The instrument may be used (a) in studying individual differences in pediatric disability, (b) in examining the relation of disability to psychosocial functioning in the child and other family members, or (c) as an outcome measure in assessing the impact of interventions on patient functioning.
The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.
Children and adolescents with chronic abdominal pain pose unique challenges to their caregivers. Affected children and their families experience distress and anxiety that can interfere with their ability to perform regular daily activities. Although chronic abdominal pain in children is usually attributable to a functional disorder rather than to organic disease, numerous misconceptions, insufficient knowledge among health care professionals and inadequate application of knowledge may contribute to a lack of effective management. This clinical report accompanies a technical report on childhood chronic abdominal pain and provides guidance for the clinician in the evaluation and treatment of children with chronic abdominal pain. The conclusions are based on the evidence reviewed in the technical report and on consensus achieved among subcommittee members.
Pediatric patients' self-report of health-related quality of life (HRQOL) has emerged as an important patient-based health outcome. A practical, validated generic measure of HRQOL facilitates assessing risk, tracking health status, and measuring treatment outcomes in pediatric populations.
The PedsQL is a brief, standardized, generic assessment instrument that systematically assesses patients' and parents' perceptions of HRQOL in pediatric patients with chronic health conditions using pediatric cancer as an exemplary model. The PedsQL is based on a modular approach to measuring HRQOL and consists of a 15-item core measure of global HRQOL and eight supplemental modules assessing specific symptom or treatment domains. The PedsQL was empirically derived from data collected from 291 pediatric cancer patients and their parents at various stages of treatment.
Both reliability and validity were determined. Cronbach's alpha coefficients for the core measure (alpha = .83 for patient and alpha = .86 for parent) were acceptable for group comparisons. Alphas for the patient self-report modules generally ranged from .70 to .89. Discriminant or clinical validity, using the known-groups approach, was demonstrated for patients on- versus off-treatments. The 11 scales showed small-to-medium positive intercorrelations, supporting the multidimensional measurement model. Further construct validity was demonstrated via a multimethod-multitrait matrix using standardized psychosocial questionnaires.
The results support the PedsQL as a reliable and valid measure of HRQOL. The PedsQL core and modular design makes it flexible enough to be used in a variety of research and clinical applications for pediatric chronic health conditions.
Little is known about the epidemiology of pain in children. We studied the prevalence of pain in Dutch children aged from 0 to 18 years in the open population, and the relationship with age, gender and pain parameters. A random sample of 1300 children aged 0-3 years was taken from the register of population in Rotterdam, The Netherlands. In the Rotterdam area, 27 primary schools and 14 secondary schools were selected to obtain a representative sample of 5336 children aged 4-18 years. Depending on the age of the child, a questionnaire was either mailed to the parents (0-3 years) or distributed at school (4-18 years). Of 6636 children surveyed, 5424 (82%) responded; response rates ranged from 64 to 92%, depending on the subject age and who completed the questionnaire. Of the respondents, 54% had experienced pain within the previous 3 months. Overall, a quarter of the respondents reported chronic pain (recurrent or continuous pain for more than 3 months). The prevalence of chronic pain increased with age, and was significantly higher for girls (P<0.001). In girls, a marked increase occurred in reporting chronic pain between 12 and 14 years of age. The most common types of pain in children were limb pain, headache and abdominal pain. Half of the respondents who had experienced pain reported to have multiple pain, and one-third of the chronic pain sufferers experienced frequent and intense pain. These multiple pains and severe pains were more often reported by girls (P<0.001). The intensity of pain was higher in the case of chronic pain (P<0. 001) and multiple pains (P<0.001), and for chronic pain the intensity was higher for girls (P<0.001). These findings indicate that chronic pain is a common complaint in childhood and adolescence. In particular, the high prevalence of severe chronic pain and multiple pain in girls aged 12 years and over calls for follow-up investigations documenting the various bio-psycho-social factors related to this pain.