Treatment Fidelity in Mind-Body Interventions.

PURPOSE: To contribute to the treatment fidelity literature by providing real-world examples and suggestion for future research and potential clinical application, this article reports on implementation, assessment, and evaluation of treatment fidelity in mind-body self-care approaches in at-risk women. METHOD: Aligning with best practices, treatment fidelity was integrated into three randomized clinical trials. The first examined the effects of a tai chi intervention designed to decrease cardiometabolic risk factors in women; the second examined the effects of a tailored guided imagery intervention on pregnancy outcomes in African American women; and the third explored effects of a mindful physical activity intervention (yoga) on psychological outcomes in women with moderate to severe depressive symptoms. FINDINGS: Each of the studies successfully designed, implemented, and evaluated strategies to address recommended treatment fidelity components. These strategies provided qualitative and quantitative data that informed intervention refinement, directions for future research, and application in clinical practice. CONCLUSIONS: The treatment fidelity framework used here is based on best practices and was a feasible and reliable approach for ensuring and reporting on treatment fidelity, which is contributing to future research to foster translation of potentially effective mind-body self-care approaches into practice.

A Stress Coping App for Hospitalized Pregnant Women at Risk for Preterm Birth.

BACKGROUND: Pregnant women hospitalized with preterm labor (PTL) complications experience increased stress. Prior researchers have attempted to provide stress management strategies with use of various media players to deliver stress coping interventions. PURPOSE: The purpose of this study was to examine the efficacy of a mobile device delivered stress coping app designed to reduce stress in a sample of high-risk pregnant women hospitalized with complications of PTL. METHODS: A descriptive study using a prospective mixed methods one-group pre/posttest design. Fifteen pregnant women used the mobile device app for 8 consecutive days. The app included study measures, educational overview of concepts, four guided imagery audio files to be listened to daily, and a stress self-assessment scale to be used before and after each use. Measures included: Perceived Stress Scale (PSS), Visual Analog Stress Scale (VASS), Coping Self-Efficacy Scale (CSES), and semistructured interviews. RESULTS: There was a significant drop in VASS scores when comparing scores before and after listening to the app (p < 0.0001). There were no significant differences between the baseline and Day 8 scores of PSS or CSES. All participants reported benefits from using the app and provided suggestions for improvement. CLINICAL IMPLICATIONS: The intervention reduced immediate stress and provided a respite from the stress response in this population. Maternal child nurses may consider incorporating stress coping interventions as standard care practice.

Feasibility of a Relaxation Guided Imagery Intervention to Reduce Maternal Stress in the NICU.

OBJECTIVE: To test the feasibility of a relaxation guided imagery (RGI) intervention for mothers of hospitalized preterm infants and to explore the biobehavioral effects of RGI on their distress, responsiveness, and physiological stress. DESIGN: Single sample, pretest-posttest design. SETTING: A large Level III NICU in Southern California. PARTICIPANTS: Twenty mothers of hospitalized preterm infants (24-32 weeks gestational age). METHODS: Correlational analyses of RGI use with self-reported measures of distress (perceived stress, state anxiety, and depression symptoms), awakening salivary cortisol level, and salivary cortisol awakening response collected from mothers at baseline and after 8 weeks of an RGI intervention. RESULTS: Nineteen mothers completed the study. Average use of RGI varied from 1.7 to 7.4 times per week (mean = 4.46, standard deviation = 2.7). Greater average use of RGI was correlated with lower awakening cortisol levels (r = -.38), greater cortisol awakening response (r = .36), and lower levels of distress (perceived stress [r = -.38], anxiety [r = -.43], and depression [r = -.41]). CONCLUSION: Relaxation guided imagery may be a feasible and acceptable intervention to reduce mental and physiologic stress and improve responsiveness in mothers of hospitalized preterm infants.

Physical Activity and Yoga-Based Approaches for Pregnancy-Related Low Back and Pelvic Pain.

OBJECTIVE: To conduct an integrative review to evaluate current literature about nonpharmacologic, easily accessible management strategies for pregnancy-related low back and pelvic pain (PR-LBPP). DATA SOURCES: PubMed, CINAHL, Cochrane Database of Systematic Reviews. STUDY SELECTION: Original research articles were considered for review if they were full-length publications written in English and published in peer-reviewed journals from 2005 through 2015, included measures of pain and symptoms related to PR-LBPP, and evaluated treatment modalities that used a physical exercise or yoga-based approach for the described conditions. DATA EXTRACTION: Electronic database searches yielded 1,435 articles. A total of 15 articles met eligibility criteria for further review. DATA SYNTHESIS: These modalities show preliminary promise for pain relief and other related symptoms, including stress and depression. However, our findings also indicate several gaps in knowledge about these therapies for PR-LBPP and methodologic issues with the current literature. CONCLUSION: Although additional research is required, the results of this integrative review suggest that clinicians may consider recommending nonpharmacologic treatment options, such as gentle physical activity and yoga-based interventions, for PR-LBPP and related symptoms.

Perceptions of guided imagery for stress management in pregnant African American women.

Maternal stress during pregnancy has been associated with numerous adverse pregnancy, birth, and health outcomes. Pregnant African American women have been reported to have higher levels of stress compared to other ethnic or racial groups underscoring the need for effective interventions to reduce stress in this population. The purpose of this study was to gain an in-depth understanding of the perceptions of guided imagery (GI) as a technique for stress management in a cohort of pregnant African American women who participated in a GI intervention as part of a larger mixed methods randomized controlled trial. The 12week intervention was a professionally recorded compact disc with four tracks developed and sequenced to reduce stress and associated symptoms. The findings from this descriptive phenomenologic study were derived from daily logs and interviews from 36 participants randomized to the GI group. Participants described the stressful nature of their lives. Results demonstrated pregnant African American women perceived the intervention as beneficial in reducing stress and the associated symptoms. The emergent themes suggested the intervention offered a respite from their stressful lives, reduced the negative emotional responses to stress and enhanced well-being, benefited other areas of their daily life, and provided an opportunity to connect with their baby. The study results support the perceived efficacy of GI as a stress coping intervention. GI is an economic as well as easy to implement, access and use technique that has potential stress coping benefits as perceived by pregnant African American women.

Guided imagery for stress and symptom management in pregnant african american women.

The purpose of this study was to evaluate the efficacy of a guided imagery (GI) intervention for stress reduction in pregnant African American women beginning early in the second trimester. This prospective longitudinal study of 72 women used a randomized controlled experimental design with two groups conducted over 12 weeks. The intervention was a CD with 4 professionally recorded tracts designed and sequenced to influence study variables. Participants in both GI and usual care (UC) completed measures and donated 5 cc of blood at baseline, 8 weeks and 12 weeks. Participants also completed a daily stress scale. A mixed-effects linear model tested for differences between groups for self-reported measures of stress, anxiety, and fatigue as well as corticotrophin releasing hormone (CRH), a biologic marker of stress. Significant differences in perceived stress daily scores and at week 8 but not week 12 were found in the GI group compared to UC group. The GI group reported significantly less fatigue and anxiety than the UC group at week 8 but not week 12. There were no significant differences in CRH levels between groups. Results suggest that GI intervention may be effective in reducing perceived stress, anxiety, and fatigue measures among pregnant African American women.

Guided imagery: an innovative approach to improving maternal sleep quality.

Mothers of preterm infants are at risk for poor sleep quality, which may adversely affect their health, maternal-infant attachment, and infant caretaking activities. This study examined the relationship of an 8-week relaxation guided imagery intervention on sleep quality and the association between sleep quality and maternal distress (perceived stress, depressive symptoms, and state anxiety) in 20 mothers of hospitalized preterm infants. Mothers received a CD (compact disc) with three 20-minutes recordings and were asked to listen to at least 1 recording daily for 8 weeks. This analysis used self-report data gathered at baseline and 8 weeks. Pearson correlations were used to examine the relationships between mean cumulative relaxation guided imagery use and measures of maternal distress and sleep quality scores at 8 weeks. Complete data on 19 mothers were available for analysis. At 8 weeks, higher mean relaxation guided imagery use was inversely correlated with sleep quality scores (r = -0.30); sleep quality scores were positively correlated with stress (r = 0.42), depressive symptoms (r = 0.34), and anxiety (r = 0.39) scores. In mothers of preterm infants, sleep quality was negatively affected by mental distress and may be improved by a guided imagery intervention.

Effects of a guided imagery intervention on stress in hospitalized pregnant women: a pilot study.

Using repeated-measures pre-/posttest design, the effects of guided imagery on maternal stress in 19 hospitalized pregnant women were examined. Mean stress and systolic blood pressure measurements postintervention were significantly lower than mean levels before listening to the guided imagery CD. All participants identified benefits of this holistic intervention. The study provides preliminary evidence that a guided imagery intervention may be effective in reducing maternal stress in hospitalized pregnant women and supports the feasibility of conducting a randomized clinical trial to further support incorporating this intervention into care.

Guided imagery as a treatment option for fatigue: a literature review.

PURPOSE: Fatigue is one of the most common complaints experienced among the general population. Because fatigue is recognized as a biobehavioral occurrence, a biobehavioral intervention such as guided imagery may be effective in reducing self-reported fatigue. Therefore, the purpose of this study was to explore the research literature related to the use of guided imagery as a nonpharmacological mind-body intervention for the symptom of fatigue. METHOD: The electronic databases MEDLINE, CINAHL, PsychInfo, Psychology and Behavioral Sciences Collection and the Cochrane Library were searched from January 1980 to June 2010. FINDINGS: Of 24 articles retrieved, eight met the inclusion criteria and were included in this systematic literature review. FINDINGS were inconsistent regarding the effectiveness of guided imagery on fatigue. Studies varied in study length, duration of the applied guided imagery intervention, dosage, and whether the images were targeted to the purpose of the intervention. IMPLICATIONS: Guided imagery is a simple, economic intervention with the potential to effectively treat fatigue, thus further research is warranted using systematic, well-designed methodologies Standardizing guided imagery interventions according to total duration of exposure and targeted imagery in a variety of different populations adequately powered to detect changes will contribute to and strengthen nursing's symptom-management armamentarium.

A nurse-driven quality improvement program to improve perinatal outcomes.

Preterm birth (PTB) is one of the most acute problems in obstetrics today. It is recommended that quality measures related to the prevention and management of PTB be identified and implemented for systems of clinical care. With its professional commitment to women and families, nursing is positioned to play an important role in this professional issue of quality improvement. A nursing team joined forces with a managed care organization to develop and implement a quality program to improve perinatal outcomes for pregnant women enrolled in the managed care organization. The team integrated a holistic framework, the best evidence, their clinical expertise, and the pregnant member's values and concerns. Using a pre/postprogram implementation design, perinatal outcomes in terms of neonatal intensive care length of stay were improved, with resultant cost savings. The improvement of these proxy measures for the health of the infant is an initial step in the reduction of PTB.

The biobehavioral effects of relaxation guided imagery on maternal stress.

PURPOSE: The purpose of this pilot study was to investigate the effects of relaxation-guided imagery (R-GI) on perceived stress, anxiety, and corticotropin-releasing hormone (CRH) levels in pregnant African American women beginning in the second trimester. METHODS: This prospective, longitudinal study of 59 women used a controlled randomized experimental design with two groups conducted over 12 weeks. The intervention was a set of three R-GI CDs developed and sequenced to influence study outcomes. Study measures included the Perceived Stress Scale (PSS), State-Trait Anxiety Inventory, and plasma CRH levels collected at three time points. Participants completed a daily Numeric Rating Scale of Stress (NRSS) and daily practice logs, which provided information on intervention use in the R-GI group. FINDINGS: State anxiety significantly decreased over time in the R-GI group, and it increased over time in the usual-care (UC) group. Although a significant difference was not found for perceived stress, as measured by the PSS, the R-GI group had a greater decrease in weekly Numeric Rating Scale of Stress NRSS scores over time compared to the UC group. The R-GI group also had significant decreases in NRSS scores before and after using R-GI. There were no significant differences in CRH levels between groups over time. CONCLUSIONS: Findings support the feasibility and effectiveness of an R-GI intervention in reducing anxiety and daily stress levels in pregnant African American women beginning in the second trimester. The pilot study is an important first step in evaluating the effectiveness of R-GI as a primary prevention intervention to reduce preterm birth.

Stress management during pregnancy: designing and evaluating a mind-body intervention.

The objective of this 12-week study was to determine whether a relaxation-guided imagery (R-GI) intervention designed as a primary prevention strategy for stress management was perceived as beneficial to African American women during the second trimester of pregnancy. All participants documented perceived benefits of the R-GI intervention that included the following: (1) improved breathing; (2) ability to relax, clear one's mind, and become calm; (3) ability to channel and decrease stress; (4) release of anxiety; (5) use of R-GI throughout the day helped control anger and state of mind, leading to a smoother day; and (6) improved ability to fall and stay asleep.