Guided imagery as treatment for anxiety and depression in breast cancer patients: a pilot study

M.A.It is well known that high levels of anxiety and/or depression often accompany the diagnosis and treatment of breast cancer. Literature from various sources, but in particular from the fairly new field of research, Psychoneuroimmunology, also provides ample evidence that excessive anxiety and/or depression can be immunosuppressive. It makes sense, therefore, that any intervention restoring balance to the immuno-regulatory system, thereby allowing the body’s innate healing processes to focus on eliminating cancer, is highly desirable. In line with current thinking based on the mind-body connection as well as cognitive behavioural techniques utilised in many therapeutic settings, various psychological interventions have been found to help the patient gain a better sense of control over distressing symptoms and side-effects of cancer. Some of these include: basic cognitive restructuring, hypnotherapy, relaxation-meditation techniques, art and music therapy, and guided imagery. Substantial international research was found illustrating the beneficial affect that the psychological intervention, guided imagery, provided in such diverse settings including work, sport and health. In this regard, it was decided to run a pilot study to ascertain whether a specifically designed tape recording with relaxing music and dialogue aimed at helping patients manage and cope with negative symptoms of cancer, could significantly reduce anxiety and/or depression levels in women with breast cancer. To operationalise the above, 40 women, aged between 30 and 60, with Stages 1, 2 or 3 breast cancer, who are about to commence adjunctive chemotherapy, were randomly selected to a treatment and a control group. A quasi-experimental design was applied to this study whereby the treatment group was subjected to pre- and post chemotherapy Hospital Anxiety & Depression (HAD) Scale and blood pressure measurements on their 1st, 3rd and final cycle of treatments. The HAD Scale is a well-researched and respected, quick, self-diagnostic assessment utilised abroad and in this country. The measurement of a person’s blood pressure is provided as a physiological backup to the psychometric assessment of the individual’s anxiety levels. For the intervention, each participant was supplied with her own copy of Healing Imagery for Cancer CD or audiotape, produced by a South African medical doctor, specialising in the “wellness” field. The participant was requested to listen to this tape as often as possible, but particularly during her chemotherapy treatments. The control group was tested pre-1st cycle of chemotherapy and post-6th cycle of chemotherapy. The main hypothesis of this pilot study was that there would be statistically significant decreases in levels of anxiety and depression as a result of the intervention of guided imagery tape recording in women with breast cancer undergoing adjuvant chemotherapy. Statistical analysis of the data revealed that the guided imagery intervention correlated with a decrease in blood pressure (systolic and diastolic) measurements, as well as depression and anxiety over a six-cycle period of chemotherapy. The most significant decrease was correlated with the anxiety variable. This pilot study revealed some methodological weaknesses but at the same time results are sufficiently encouraging to warrant further in-depth research regarding the use of guided imagery as a cost-effective, relatively easy method for individuals with cancer to learn and utilise as part of their integrative treatment regimen