A pilot study of mind-body changes in adults with asthma who practice mental imagery.
BACKGROUND
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.)


METHODS
Randomized controlled study using univariate repeated measures analysis of variance (ANOVA) and replacement through block design.


METHODS
Lenox Hill Hospital, an affiliate of New York University Medical School, New York, NY.


METHODS
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.


METHODS
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.


METHODS
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.
The Mount Sinai Medical Center, New York, NY, USA.
Gerald N
GN
Epstein
James P
JP
Halper
Elizabeth Ann Manhart
EA
Barrett
Carole
C
Birdsall
Monnie
M
McGee
Kim P
KP
Baron
Stephen
S
Lowenstein
D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety; D001249:Asthma / Q000503:physiopathology* / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D016009:Chi-Square Distribution; D003863:Depression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D010865:Pilot Projects; D011603:Psychophysiology; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome