The effects of distraction, relaxation, and guided imagery on procedural fear and pain in children

The fear and pain of medical procedures are a source of great distress to children. Techniques such as distraction, relaxation and guided imagery help children to cope, and in some cases, have a marked influence on the experience of fear and pain during painful medical procedures. However, the effects, embedded in the relationships between consciousness, imagery, fear and pain, are unclear, particularly with regard to the clinical (as opposed to the laboratory) reality of procedural pain. The aim of this thesis was to empirically account for the therapeutic effects of distraction, relaxation, and imagery on procedural fear and pain in children and to offer a model based on a constructive view of experience allied to recent advances in neurophysiology that could account for the effects. Two studies were undertaken to address this aim. The first study investigated the effects of cartoon distraction on fear and pain in children undergoing venepuncture. The second study investigated the independent and combined effects of relaxation and imagery on fear and pain in children also undergoing venepuncture. The studies indicated that relaxation, distraction and imagery reduced procedural fear. Procedural pain was not affected by relaxation but distraction showed positive effects as did imagery, particularly if procedural pain was defined in terms of its sensory and emotional components. These effects are explained using a model based on a top-down constructivist view of the psychology and neurophysiology of fear, pain, imagery and consciousness. The neurophysiological components of the model comprised the amygdala, anterior cingulate cortex and association areas within a working memory view of consciousness. The constructivist perspective held that during relaxation the child’s cognitive, emotional and sensorial quality were largely based on the ‘reality’ of the procedure room, but that during imagery and perhaps distraction, the qualia were located elsewhere. The thesis concludes with the relevance of the model for clinical practice and implications for further psychological and neurophysiological research.Doctor of Philosoph