Motor imagery training of goal-directed reaching in relation to imagery of reaching and grasping in healthy people.

The study aimed to determine whether four weeks of motor imagery training (MIT) of goal-directed reaching (reaching to grasp task) would affect the cortical activity during motor imagery of reaching (MIR) and grasping (MIG) in the same way. We examined cortical activity regarding event-related potentials (ERPs) in healthy young participants. Our study also evaluated the subjective vividness of the imagery. Furthermore, we aimed to determine the relationship between the subjective assessment of motor imagery (MI) ability to reach and grasp and the cortical activity during those tasks before and after training to understand the underlying neuroplasticity mechanisms. Twenty-seven volunteers participated in MIT of goal-directed reaching and two measurement sessions before and after MIT. During the sessions 128-channel electroencephalography (EEG) was recorded during MIR and MIG. Also, participants assessed the vividness of the MI tasks using a visual analog scale (VAS). The vividness of imagination improved significantly (P < .05) after MIT. A repeated measures ANOVA showed that the task (MIR/MIG) and the location of electrodes had a significant effect on the ERP's amplitude (P < .05). The interaction between the task, location, and session (before/after MIT) also had a significant effect on the ERP's amplitude (P < .05). Finally, the location of electrodes and the interaction between location and session had a significant effect on the ERP's latency (P < .05). We found that MIT influenced the EEG signal associated with reaching differently than grasping. The effect was more pronounced for MIR than for MIG. Correlation analysis showed that changes in the assessed parameters due to MIT reduced the relationship between the subjective evaluation of imagining and the EEG signal. This finding means that the subjective evaluation of imagining cannot be a simple, functional insight into the bioelectrical activity of the cerebral cortex expressed by the ERPs in mental training. The changes we noted in ERPs after MIT may benefit the use of non-invasive EEG in the brain-computer interface (BCI) context.Trial registration: NCT04048083.

Effects of training podiatrists to use imagery-based motivational interviewing when treating people with diabetes-related foot disease: a mixed-methods pilot study.

BACKGROUND: Self-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes. Motivational Interviewing (MI) can engage people in self-care and modifying it by integrating imagery may further improve its outcomes. No previous studies have trained podiatrists in using MI to address DFD self-care. This was the first study on training podiatrists to conduct imagery-based motivational interviewing (MI) when treating people with DFD, and to examine impacts on MI related skills, job satisfaction and subjective experiences in a mixed-methods pilot study. METHODS: Eleven recruited podiatrists (median age: 35 years, 9 female and 2 male) received two 4-h training sessions, and three received subsequent mentoring. MI and imagery skills were rated using validated tools during two clinical sessions per participant at baseline, and 2- and 12-weeks post-training. Job satisfaction was assessed at baseline and 12 weeks. Semi-structured interviews at 12 weeks were analysed using the framework approach. RESULTS: Significant improvements over time (p = .006-.044) with substantial effect sizes (η2 = .50-.67) were found in three of four global MI related communication skills and two of four MI behaviours. However, effects on these indices were not sustained to 12 weeks, and imagery was rarely used. Job satisfaction was high at baseline and unchanged at follow-up (p = 0.34, η2 = .100). In qualitative interviews, MI training and skills were valued, but significant challenges in using MI when treating people with DFD were reported. CONCLUSION: Training podiatrists in MI may have potential but more training, observation and mentoring appear needed to obtain sustained communication changes in practice.

Teaching Guided Imagery and Relaxation Techniques in Undergraduate Nursing Education.

Guided imagery and relaxation techniques have many documented benefits yet are not traditionally taught in undergraduate nursing education. These techniques can also be used by clinicians and students to manage their own stress. The impact of teaching guided imagery in an experiential skills lab on undergraduate nursing students was examined in this mixed-methods research study. Goals were to evaluate whether students learning these skills would be more likely to use them in clinical practice, to examine whether learning these skills would provide personal benefits, and to compare personal instruction with video instruction. Students completed questionnaires evaluating the experience in terms of satisfaction, personal benefit, and intent to use. Students provided comments and answered open-ended questions regarding personal and professional benefits and ability to apply knowledge and skills. Results were positive, with students reporting satisfaction with the format, personal benefit from the course, and increased likelihood that they will use the techniques with clients in the future. The lowest scores were on confidence in using the technique with clients. A statistically significant finding is that students preferred personal instruction in the areas of satisfaction with the content, satisfaction with the format, and the value of experience in advance of using these skills with patients (p < .05).

Development and Validation of a Mental Practice Tool for Total Abdominal Hysterectomy.

OBJECTIVE: Total abdominal hysterectomy (TAH) is a common operation performed by obstetrician-gynecologists. Training opportunities for this procedure are declining. Mental practice (MP), the use of mental imagery to rehearse a task symbolically before performance, has been used successfully in sports and music to enhance skill. This strategy demonstrates benefit in existing surgical education literature. We aimed to develop and validate a MP tool (MPT) for resident training in TAH. DESIGN: A prospective survey study was performed in a large, urban, academic medical center in Philadelphia, Pennsylvania, USA. A MPT was developed by guiding expert surgeons through a cognitive walk-through of TAH to identify key procedural cues. For validation, a convenience sample of 22 residents and attendings (N = 11 per group) mentally rehearsed TAH. Motivation, confidence, quality of imagery, and utility of the activity were assessed with a previously validated Mental Imagery Questionnaire (MIQ) before and after exposure to the MPT. RESULTS: Residents, but not attendings, found MP to be useful in preparation for surgery (residents, p = 0.01; attendings, p = 0.34) and had increased confidence following this exercise (residents, p = 0.01; attendings, p = 0.08). Significant improvement in global imagery score after use of the tool was shown by residents (p = 0.01) but not by the attendings (p = 0.08), with residents having lower imagery skills than attendings both pre-MP and post-MP. Reliability testing of the MIQ indicated internal consistency (pre-MPT, 0.91; post-MPT, 0.90). CONCLUSIONS: MP may serve as a potentially effective, portable, and inexpensive resident surgical training tool in preparation for TAH. Attendings may benefit from certain aspects of MP. The MIQ may serve as a measure of imagery skills in future experiments of MP in preparation for surgery.

Developing a Compassionate Internal Supervisor: Compassion-Focused Therapy for Trainee Therapists.

The concept of an 'internal supervisor' has been used in psychotherapy to describe the way in which the supervisory relationship is internalized and utilized by the supervisee. This research explores the possibility, and potential benefit, of training therapists to develop a 'compassionate internal supervisor'. A training programme was developed for trainee cognitive-behavioural therapists using adapted versions of compassion-focused therapy interventions. The training focused on guided imagery exercises and reflective practices undertaken for a 4-week period. Seven trainee cognitive-behavioural therapists were interviewed, utilizing a semi-structured format, regarding their experience of the training programme. The resulting transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified six super-ordinate themes: (1) the varied nature of the supervisor image, (2) blocks and their overcoming, (3) increased compassion and regulation of emotion, (4) impact on cognitive processes, (5) internalization and integration, and (6) professional and personal benefit. The themes describe the varied ways in which participants created and experienced their compassionate supervisor imagery. Working with the personal blocks encountered in the process provided participants with a deeper understanding of the nature of compassion and its potential to support them in their training, practice and personal lives. The process and impact of 'internalizing' a compassionate supervisory relationship is described by participants and then discussed for potential implications for psychotherapy training and self-practice. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Compassion-focused therapy, and related compassionate-mind imagery exercises, can be adapted specifically to develop compassion in trainee psychotherapists. Creating, and engaging with, an 'ideal compassionate supervisor' in an imaginal form can support psychotherapy trainees in their clinical practice and development, their supervision and their personal lives. The cultivation of therapist self-compassion can reduce unhelpful cognitive processes such as worry, rumination and self-criticism whilst increasing self-reflection, attentional flexibility and approach behaviour. Identifying, and working with, blocks to compassion is important when cultivating clinician self-compassion Therapist self-practice of compassion-focused exercises can provide important insights into the nature of compassion and its cultivation in clients.

Role of the primary motor cortex in the early boost in performance following mental imagery training.

Recently, it has been suggested that the primary motor cortex (M1) plays a critical role in implementing the fast and transient post-training phase of motor skill consolidation, known to yield an early boost in performance. Whether a comparable early boost in performance occurs following motor imagery (MIM) training is still unknown. To address this issue, two groups of subjects learned a finger tapping sequence either by MIM or physical practice (PP). In both groups, performance increased significantly in the post-training phase when compared with the pre-training phase and further increased after a 30 min resting period, indicating that both MIM and PP trainings were equally efficient and induced an early boost in motor performance. This conclusion was corroborated by the results of an additional control group. In a second experiment, we then investigated the causal role of M1 in implementing the early boost process resulting from MIM training. To do so, we inhibited M1 by applying a continuous theta-burst stimulation (cTBS) in healthy volunteers just after they learnt, by MIM, the same finger-tapping task as in Experiment #1. As a control, cTBS was applied over the vertex of subjects who underwent the same experiment. We found that cTBS applied over M1 selectively abolished the early boost process subsequent to MIM training. Altogether, the present study provides evidence that MIM practice induces an early boost in performance and demonstrates that M1 is causally involved in this process. These findings further divulge some degree of behavioral and neuronal similitude between MIM and PP.

Piloting tailored teaching on nonpharmacologic enhancements for postoperative pain management in older adults.

Despite many advances in the pharmacologic treatment of pain, the issue of unresolved postoperative pain continues to plague patients and health care professionals. Little seems to be known about the reasons why nonpharmacologic methods are not more widely used, particularly as they are commonly low in cost, easy to use, and largely free of adverse side effects. A central question has to do with what patients are taught about nonpharmacologic methods and how a novel mode of teaching can be embedded in practice. A seven-step pre-posttest teaching intervention pilot study was deployed with older joint replacement patients within the context of a translational research model. Results of the teaching pilot showed significant post-teaching changes in subjects' knowledge and attitudes about nonpharmacologic methods for pain management, high satisfaction with the nonpharmacologic methods they chose, and incrementally greater use of the nonpharmacologic methods over the course of the hospital stay. A randomized controlled trial of the study is now in the early planning stages in an effort to obtain generalizable results that will help solidify evidence of the impact of music, imagery, and slow-stroke massage on pain management and confirm the value of patient teaching as an important means of offering patients more options for managing their own pain.

Relaxation and imagery for chronic, nonmalignant pain: effects on pain symptoms, quality of life, and mental health.

Nonpharmacologic treatments are being increasingly adopted as alternative or primary approaches to chronic pain management. We present results of a pilot study examining the effect of a 6-week combined abbreviated progressive relaxation technique (APRT) and guided imagery (GI) intervention for the management of chronic pain (N=19) and, using power analysis, explore recommended sample sizes for future clinical trials. Results indicated consistent and clinically significant trends of improvement on pain (McGill Pain Questionnaire, visual analog scale), mental health (Depression Anxiety and Stress Scale), all domains of quality of life (RAND-36 Health Survey), and sleep for the treatment group only. Owing to inadequate power in this study, these results were not statistically significant. Methodologic concerns, along with suggestions for an improved intervention protocol, are discussed. It is concluded that there is strong preliminary evidence for the efficacy of APRT and GI as an adjunct to conventional treatment options for chronic pain.

Guided imagery and music: using the Bonny method to evoke emotion and access the unconscious.

The healing power of music has been recognized since ancient times. The use of music has been documented in diverse cultures worldwide, for ailments ranging from pain and cancer to depression and posttraumati stress disorder. The various models of music therapy are based on different theoretical traditions, including behaviorist, humanist, and psychodynamic approache This article describes the music therapy approach known as the Bonny Method of Guided Imagery and Music (GIM) therapy, reviews its research base, and presents a first-person account of the experience of GIM treatment.

Pain management: evaluating the effectiveness of an educational programme for surgical nursing staff.

AIMS AND OBJECTIVES: The purpose of this study was to assess the effectiveness of a pain management education programme in improving the nurses' knowledge about, attitude towards and application of relaxation therapy. BACKGROUND: Pain of surgical patients has long been an existing problem of health care. Nursing staff need to be educated continuously to develop the professional ability of pain management. METHODS: A quasi-study design with pre- and posttest and post- and posttest was used. Subjects were chosen from a medical centre in Taipei by convenience sampling. The total sample size of 81 was segregated into a study group of 42 and control group of 39 participants. The study group attended a seven-session pain management programme totalling 15 hours. The control group received no pain management training. Scaled measurements were taken on pain management knowledge and attitude and relaxation therapy practice. RESULTS: (1) Scores for pain management knowledge differed significantly between the two groups (F = 40.636, p = 0.001). (2) Attitudes towards pain management differed between the two groups (F = 8.328, p = 0.005) and remained stable over time (F = 1.603, p = 0.205). (3) Relaxation therapy practice differed significantly between the two groups, with the study group better than the control group (F = 4.006, p = 0.049). (4) Relaxation therapy was applied to nearly all (97.5%) of the patients cared for by study group nurses. All of the instructed patients performed this technique one to three times per day postsurgery. CONCLUSIONS: Continuing education can improve nurses' knowledge about, attitude towards and behaviour of pain management. RELEVANCE TO CLINICAL PRACTICE: Results of this study could be used to guide the development and implementation of continuing education programmes for nursing staff to enhance patients' care knowledge and skills.

Training nursing students in evidence-based techniques for cognitive-behavioral pediatric pain management.

This study evaluates the effects of a didactic training program for nursing students involving developmentally appropriate strategies for cognitive-behavioral pain management in children. Junior-level nursing students were assigned to one of two groups: training or control. Pretraining and posttraining knowledge and attitudes toward pain management were assessed. Implementation of cognitive-behavioral strategies was assessed via clinical role-play. Training participants had significantly more knowledge of cognitive-behavioral strategies after the training program versus before it, and they had more knowledge after the training program than did control participants. The training had no effect on attitude. In the role-play, training participants used a higher ratio of cognitive-behavioral strategies and implemented them in a higher quality manner than did control participants. These results suggest that a brief training program in cognitive-behavioral pain management can improve nursing students' knowledge of cognitive-behavioral pain management strategies and ability to implement them.

A snapshot of children's postoperative tonsillectomy outcomes at home.

PURPOSE: To describe home outcomes of pain, medication use, fluid intake, and emesis 24 hr after tonsillectomy and adenoidectomy. The theory of unpleasant symptoms provided a conceptualizing framework. DESIGN AND METHODS: A secondary analysis was conducted. Outcomes for 76 children were recorded on a home diary that included: self-reported pain, analgesic use, fluids ingested, and emesis. Descriptive and inferential statistics were used. RESULTS: Children reported moderate pain. Children who received analgesics received less than recommended standards. Only 11% of the children drank the recommended fluids, and 31% of the children vomited at home. PRACTICE IMPLICATIONS: Parents need to become partners in pain management. Recommend multimodal discharge teaching and follow-up phone call at home to ensure adequate analgesic administration and fluid intake.

Guided health imagery for smoking cessation and long-term abstinence.

PURPOSE: To examine the effectiveness of guided imagery for immediate smoking cessation and long-term abstinence in adult smokers. DESIGN: A repeated measures design was used with 71 smokers recruited from a hospital outpatient clinic, 38 in the intervention group, and 33 in the control group. METHODS: Both study groups received educational and counseling sessions in their homes. The intervention group was provided with additional instruction in the use of guided imagery and was encouraged to practice this imagery at least once per day with a 20-minute audio-taped exercise for reinforcement. The repeated measures included smoking rates (cigarettes per day) that were measured and confirmed through corroborating friends and family. FINDINGS: At 24-months after the intervention, smoking abstinence rates were significantly higher for the guided health imagery intervention group (26% abstinence rate versus 12% abstinence rate for the placebo-control group). CONCLUSIONS: Guided imagery was an effective intervention for long-term smoking cessation and abstinence in adult smokers.

Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty.

PURPOSE: The purpose of this study was to compare pain and anxiety in orthopaedic patients scheduled for elective total hip or knee arthroplasty who have received a kit of nonpharmacologic strategies for pain and anxiety in addition to their regularly prescribed analgesics to those who receive the usual pharmacologic management alone. DESIGN: Descriptive comparative and correlational design using surveys and chart audits. SAMPLE: Sixty-five patients randomized to receive usual care or usual care plus a kit of nonpharmacologic strategies. FINDINGS: Patients who received the kit used nonpharmacologic measures for pain and anxiety more often than patients who did not receive the kit. The kit group tended to use less opioid and have less anxiety on postoperative day 1 (not statistically significant) and use significantly less opioid on postoperative day 2 than the patients who did not receive the kit. There were no between-group differences in pain intensity. There were significant correlations among postoperative pain intensity, opioid use, and anxiety. The coping method of diverting attention was related to lower present (now) pain scores, and ignoring the pain was associated with higher worst pain. DISCUSSION: Providing a kit of nonpharmacologic strategies can increase the use of these methods for postoperative pain and anxiety and decrease the amount of opioid taken. The influence of coping strategies in acute postoperative pain needs to be examined further.

The relationship between the use of kinaesthetic imagery and different visual imagery perspectives.

In two studies, we examined the strength of relationship between internal and external visual imagery with kinaesthetic imagery. In Study 1, 56 participants completed the Vividness of Movement Imagery Questionnaire and the Movement Imagery Questionnaire. Pearson's product-moment correlations failed to reveal a significant correlation between external visual imagery and kinaesthetic imagery. However, the correlation between internal visual imagery and kinaesthetic imagery approached significance. In Study 2, the instructional set of the Vividness of Movement Imagery Questionnaire was changed to make the participant the 'agent' of the external visual perspective images rather than somebody else. Sixty-four participants completed the two questionnaires. The results indicated a significant correlation between external visual imagery and kinaesthetic imagery (r = 0.60, P < 0.01). However, the correlation between internal visual imagery and kinaesthetic imagery was non-significant (r = 0.23, P > 0.01). The results are discussed in relation to who is the agent of the image and the processes that may underlie kinaesthetic imagery. The implications for researchers trying to establish the functional, behavioural and neurological differences within, and across, imagery modalities are considered.

Healing the body and the soul through visualization: a technique used by the Community Healing Team of Cape Dorset, Nunavut.

As Alice Kimiksana indicated, the Healing Circle or Healing Teams evolved to help First Nations people who attended residential schools deal with the aftermath of the abuse many of them suffered there. They use a variety of interventions, some traditional and some more Western in origin, for an innovative approach to a very serious problem. One technique developed by Western psychology, but very useful and adaptable in other cultural settings, is guided imagery or visualization. Often used for performance enhancement in sports, it is also applicable to other situations from medical settings to mental health treatment. In this presentation, Novaliinga Kingwatsiaq of Kingnait (Cape Dorset) led the audience through a modified version of a visualization used by her Community Healing Team. (During visualization one assumes a relaxed state with one's eyes closed and imagines oneself in the context of a story told by the person guiding the imagery.) The imagery she chose is both symbolically and culturally appropriate. Most audience members were unfamiliar with the process of visualization, and several indicated that they were intrigued by the experience. Kumaarjuk Pii introduced Novaliinga Kingwatsiaq and translated for her.