RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
ANXIETY
July, 2006
Prevalence
and Costs
Anxiety
disorders are the most common psychiatric condition in the
United States, affecting 40 million people annually (NIHM,
2006). In the annual reporting period of 1997-1998, anxiety
was responsible for 12.3 million office visits, up from 9.5
million in 1985 (Harmon, Rollman, et al, 2002). 1996,
anxiety disorders cost the US economy over $46.6 billion in
direct and indirect costs (NCHS, 1997).
What
is Anxiety?
Anxiety
disorders is an umbrella term used to describe a wide
diversity of psychological conditions. The two major
anxiety disorders are Generalized Anxiety Disorders (GAD)
and Panic Disorders. Others include Post-Traumatic Stress
Disorders (PTSD), phobias, separation anxiety, performance
anxiety, and Obsessive-Compulsive Disorders (OCD).
All of these conditions are marked by feelings of
apprehension, tension, or uneasiness which can range from
mild to incapacitating. Physical symptoms can include
stress, palpitations, and sweating. The severity of these
symptoms can vary. No single cause seems to be responsible
for anxiety disorders. Both psychological and physical
causes are usually involved. Genetics can also play a role.
Medical Treatment of Anxiety
Treatment depends on the
precise anxiety disorder. Serotonin-reuptake inhibitors
(SSRIs) are the most frequent initial medications
prescribed. Other medications include benzodiazepines,
trycyclics (if depression is also involved), MAO inhibitors
(for OCD), beta-blockers (for phobias), and clonidine (for
PTSD).
Non-pharmacologic treatment including
imagery
The most effective approach is
cognitive-behavior therapy (CBT). It is usually combined
with medication.
Mind-body approaches have proven effective in cases of
situational anxiety, such as test-taking (Wachelka and
Katz, 1999), fear of flying (Aitken and Benson, 1984),
undergoing surgery (Saadat, Drummond-Lewis, et al, 2006;
Simmons, Chabal, et al, 2004; Tusek, Church, et al, 1997;
Tusek, Cwynar, 1999); and in dealing with illnesses or
conditions such as heart trouble (van Dixhoorn & White,
2005; Vila, Benedicto, et al, 2005), cancer (Deng &
Cassileth, 2005; Hidderley & Holt, 2004), infertility
(Chan, Ng, et al, 2006), pregnancy (Bastani, Hidarnia, et
al, 2005; Rees, 1995; Teixeira, Martin, et al, 2005), and
childbirth (Almeida, de Sousa, et al, 2005).
Many medical studies confirm the effectiveness of CBT for
anxiety disorders (Borkoved & Ruscio, 2001; Butler,
Fennell, et al, 1991; Lenz & Demal, 2000; Silverman,
Kurtines, et al, 1999; Toren, Wolmer, et al, 2000). CBT can
sometimes be so effective that it can replace medication in
treating the symptoms of OCD and PTSD (Basco, Glickman, et
al, 2000).
Studies also confirm the effectiveness of the mind-body
techniques of guided imagery (Rees, 1995; Tusek, Cwynar
& Cosgrove, 1999), relaxation (Aitken & Benson,
1984; Eppley, Abrams & Shear, 1989; Mathew, Ho, et al,
1981; Pender, 1985; Wachelka & Katz, 1999; Weber,
1996), hypnosis (Ashton, Whitworth, et al, 1997; Bryant,
Moulds, et al, 2005; Benson, Frankel, et al, 1978;
Davidson, Farnbach & Richardson, 1978; Stetter, Walter,
et al, 1994), meditation (Finucane & Mercer, 2006;
Kabat-Zinn, Massion, et al, 1992; Reibel, Greeson, et al,
2001), autogenic training (Hidderley and Holt, 2004; Jorm,
Christensen, et al, 2004) and biofeedback (Clark &
Hirschman, 1990; Rice, Blanchard & Purcell, 1993).
CBT and/or mind-body therapies have been effective in all
types of anxiety disorders and across all age ranges
(Barrett, 1998; Barrett, Duffy, et al, 2001; Barrowclough,
King, et al, 2001; Craske MG, Golinelli, et al, 2005;
Kendall & Southam-Gerow, 1996; Klinger, Bouchard, et
al., 2005; Otto & Smits, 2004; Rayburn
& Otto, 2003; Stanley, Beck, et al, 2003), and patients
reported feeling more in control of their lives (Pender,
1985; Weinman, Semuch, et al, 1983), even when delivery is
computer-assisted (Kenardy, Dow, et al, 2003).
These positive benefits have been sustained in follow-ups
as long as six years (Barrett; Barrowclough, King et al;
Kenardy, Robinson, et al, 2005; Kendall and
Southam-Gerrow). In a study of over 1000 patients,
behavioral medicine (relaxation response, cognitive
restructuring, exercise, and nutrition) was able to
significantly reduce anxiety as well as its medical
symptoms (Nakao, Fricchione, et al, 2001). A biofeedback
study of 45 people with GAD showed “significant reduction”
in one measure of anxiety and its physical and
psychological symptoms (Rice, Blanchard and Purcell, 1993).
Herbert Benson, a researcher famous for his studies on
relaxation, and his colleagues, reported the effectiveness
of meditation-based relaxation and self-hypnosis in the
treatment of anxiety (Benson, Frankel, et al, 1978). A
study of people with OCD showed that mental imagery could
be used successfully to “freeze” the anxiety trigger in
order to reduce fear and avoidance behavior in subjects
(Riskind, Wheeler & Picerno, 1997). Self-help
audiotapes and/or multimedia self-help programs have also
been effective (Davidson, Farnbach & Richardson, 1978;
Finch, Lambert & Brown, 2000).
Reviews of the literature confirm that all forms of CBT are
“likely to provide some benefit for adults” (Rodebaugh,
Holoway, and Heimberg, 2004), with relaxation techniques
having the strongest evidence for generalized anxiety,
panic disorders, dental phobia, and test anxiety, and
autogenic training and meditation having some evidence to
support their effectiness for generalized anxiety (Jorm,
Christensen, et al, 2004).
Studies confirm physiological changes occur after using
mind body techniques. After using relaxation training, one
small study showed that subjects’ anxiety and platelet MAO
levels were significantly lower (Mathew, Ho, et al, 1981),
while in another study, subjects’ salivary cortisol levels
were greatly reduced and salivary immunoglobulin A (sigA)
levels significantly increased (Pawlow and Jones, 2005).
Another 2005 study confirmed both physiological and
psychological changes (Tafet, Feder, et al, 2005).
Conclusion
A
program that includes imagery, relaxation, and behavioral
changes can be a low cost, effective way for patients to
actively participate in managing the symptoms of anxiety
disorders.
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