Asthma and anxiety disorders: Relaxation and guided imagery as a school-based treatment

Asthma is the single most common chronic childhood illness in the U.S, accounting for 14.6 million lost school days. Concomitant with increased absenteeism, asthma is also linked to a restriction of activities such as physical education, and poor relationships with peers. Research has demonstrated that the symptoms of asthma can be exacerbated by stress and anxiety. Statistics indicate that about one third of all children diagnosed with asthma may also have an anxiety disorder. Patients with asthma and anxiety disorders reported a poorer quality of life and more frequent primary care visits than patients with asthma alone. The connection between stress and anxiety and asthma has led to psychological interventions targeted at ameliorating the asthma and anxiety. The majority of these interventions either do not lend themselves to applications within the school setting or have not demonstrated a consistent improvement in lung function. Relaxation and Guided Imagery (RGI) has been successfully used to improve lung functioning and quality of life in children with asthma. RGI is based on the theoretical premise that the mind and body both play a role in determining health outcomes, and has been shown to be effective in a variety of medical conditions. However, its impact on children with a dual diagnosis of asthma and an anxiety disorder has not been adequately studied. This study analyzed the impact of RGI on lung function (forced expiratory volume in 1 second [FEV1] and forced expiratory flow 25-75 [FEF25-75]) and anxiety by employing a multiple baseline design across 3 high school students with asthma and a clinically diagnosed anxiety disorder. The RGI intervention took place for a 20-minute period, an average of three times per week, over a 4-week period. At the onset of the intervention, it was found that lung function, particularly FEV1 increased in all three participants with effect sizes ranging from -.32 to -2.48. FEF25-75 improved in one of the participants. Additionally, a positive impact was also seen in the lowering of anxiety scores across all three participants, with effect sizes ranging from .12 to 1.69.