Storytelling as therapy: implications for medicine.

Storytelling is an art developed during the beginning of human history, probably to teach the wisdom of generations past, including basic mental and physical health principles. This approach, based on sound behavioral medicine principles, is explored here for use as an integral part of medical practice. Also, practical considerations are addressed concerning the conduct of storytelling, with emphasis on relaxation, imagery, and lifestyle change implementations.

Effect of immune system imagery on secretory IgA.

This study was an investigation of the effects of physiologically-oriented mental imagery on immune functioning. College students with normal medical histories were randomly selected to one of three groups. Subjects in Group 1 participated in short educational training on the production of secretory immunoglobulin A. They were then tested on salivary IgA, skin temperature, and the Profile of Mood States (POMS) before and after listening to a 17-minute tape of imagery instructions with specially composed background "entrainment" music designed to enhance imagery. Subjects in Group 2 (placebo controls) listened to the same music but received nor formal training on the immune system. Group 3 acted as a control and subjects were tested before and after 17 minutes of no activity. Treatment groups listened to their tapes at home on a bi-daily basis for six weeks. All groups were again tested at Weeks 3 and 6. Secretory IgA was analyzed using standard radial immunodiffusion techniques. Repeated measures analyses of variance with planned orthogonal contrasts were used to evaluate the data. Significant overall increases (p less than 0.05) were found between pre- and posttests for all three trials. Groups 1 and 2 combined (treatment groups) yielded significantly greater increases in sIgA over Group 3 (control) for all three trials. Group 1 (imagery) was significantly higher than Group 2 (music) in antibody production for Trials 2 and 3. Symptomatology, recorded by subjects at Weeks 3 and 6, was significantly lower for three symptoms (rapid heartbeat, breathing difficulty, and jaw clenching), favoring both treatment groups over the control group.

The development of the Dallas Pain Questionnaire. An assessment of the impact of spinal pain on behavior.

The Dallas Pain Questionnaire (DPQ) was developed to assess the amount of chronic spinal pain that affects four aspects (daily and work-leisure activities, anxiety-depression, and social interest) of the patients' lives. Results of the DPQ's statistical properties suggest that the DPQ is an externally reliable instrument as well as internally consistent. Two factors emerged from factor structure analysis. Factor 1 represents functional activities and Factor 2 represents emotional capacities. A correlation analysis suggests the concurrent validity of the psychological functional factors of the DPQ. A t test demonstrated that chronic pain patients have significantly higher DPQ scores than normals. Because these findings support its statistical properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.

Reduction of postoperative pain parameters by presurgical relaxation instructions for spinal pain patients.

This study investigated the effects of a relaxation instruction session conducted presurgically with postsurgical pain parameters for patients undergoing spinal surgery. Results indicated that the relaxation group (n = 50) as compared with an equivalent group (n = 50) matched to type of surgery and sex type, workers compensation status had significant reduction of days of hospitalization, complaints noted by nurses, and medications (primarily demerol and phenaphen). Sex type, age, and workers compensation status were not significant factors regarding these outcome measures. The results were considered in light of the anxiety/pain explanation of pain sensitivities with implications for health care with spinal pain surgical candidates.

Biofeedback-assisted relaxation: effects on phagocytic capacity.

The purpose of this study was to investigate whether subjects who self-report high levels of stress have lower immunity, and whether "low"-immunity subjects under "high" stress could enhance phagocytic activity through biofeedback-assisted relaxation (BAR). During Phase 1, the level of stress and the level of phagocytic immune functioning (nitroblue tetrazolium test) were assessed as "high" or "low." Significant chi-square analysis (chi 2 = 3.8624, df = 1, p less than .05) showed that subjects with "high" stress had "low" immunity. Sixteen "high"-stress, "low"-immunity subjects were randomly assigned to BAR and control groups during Phase 2. Following treatment, NBT changes showed significant increases (F = 11.11, p less than .003) for experimental group as compared to control group. White blood cell count and white blood cell differential were unchanged across blood samples for both groups. Experimental subjects reported significant decreases in tension-anxiety and increases in overall coping. BAR was concluded to have improved coping skills and phagocytic capacity. BAR affected the quality, rather than the quantity, of phagocytic neutrophils.

Ethnic and sex differences in response to clinical and induced pain in chronic spinal pain patients.

There is widely held clinical opinion and some tentative research justification for stereotypic or ethnic and sex differences in response to pain. To more adequately test this notion, 60 chronic spinal pain patients (black, Mexican American, and Caucasian, with ten men and ten women per group), all having persistent spinal pain for over 1 year, were studied. They were administered the ischemic pain test, a numerical estimate of spinal pain, and two independent raters scaled the amount of pain emphasis, based upon the patient's physical condition and pain behaviors. Results showed ethnic differences on the ischemic test (a psychophysiologic scaling technique used to approximate clinical pain and pain tolerance) with Mexican Americans describing the highest levels. Women of all ethnic groups tended to be judged as emphasizing their pain more than men, based upon judgment of their pain behaviors, and upon their own numerical estimates of pain. They also indicated that they more nearly approached their pain tolerance. It was concluded that while ethnic and sex differences were found, stereotypic responses were not uniform, and tended to be related to the manner in which that pain was assessed. These results are discussed in light of cultural differences.

The relationship of Minnesota Multiphasic Personality Inventory (MMPI) profile clusters to pain behaviors.

Previous research involving cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI) profiles among persons with chronic low back pain has suggested the existence of four distinct profile clusters. The present study had two goals: (1) to replicate the previous finding independently and (2) to investigate the relationship of the profiles to the subjects' self-reported pain history and response to treatment. Subjects were 92 patients in a multimodal inpatient low back-pain treatment program. A cluster analysis of the MMPI profiles was performed and the resultant clusters were compared in terms of histories and treatment outcome. The four clusters were successfully replicated for the total sample and for males and females separately. The profiles were significantly related to subjects' pain histories, but only one outcome difference was found. It was inferred that the MMPI is of value in understanding patients' pain coping behaviors but that further research is needed to explore the utility of the MMPI in understanding their response to treatment.

Treatment of acne vulgaris by biofeedback relaxation and cognitive imagery.

A multielement intervention involving biofeedback-assisted relaxation and cognitive imagery treatment of acne vulgaris was investigated in this study with 30 patients receiving medical dermatological treatment. Patients were matched on age, sex, and pre-treatment acne severity and randomly assigned to groups. Treatment consisted of 12 sessions over six weeks and resulted in a significant reduction in acne severity as compared to the attention-comparison and medical control groups. Treatment group patients continuing home practice until follow-up maintained their gains, whereas those who discontinued failed to maintain gains.

A motivational scoring system for outcome prediction with spinal pain rehabilitation patients.

The aim of this study is to demonstrate an effective method of testing using the Sixteen Personality Factor Questionnaire (16 PF) along with the Minnesota Multiphasic Personality Inventory (MMPI) to predict outcome criteria in a spinal pain clinic. Using an objective system of criteria for patient achievement, including goals attained, pain estimates, psychological adjustment, medication reduction, and physical function, a quantitative method of scoring was employed to find success and failure. Using appropriately constructed testing methods, a very high level of predictability of outcome is now available. The combined use of the 16 PF and the MMPI can be relied upon to predict effective results in a spinal pain program with considerable confidence.

Current status of laryngectomee rehabilitation: I. Results of therapy.

Of 103 people with the clinical diagnosis of laryngeal cancer studied by the authors, 53 eventually were treated by total laryngectomy and, in some cases, radical neck dissection (43), preoperative radiation therapy (15), postoperative radiation therapy (29), and post-operative chemotherapy (7). All were entered into a comprehensive rehabilitation program. Six months following completion of their cancer therapy 47 were re-evaluated. Of these, 12 (26 per cent) used esophageal speech as the dominant mode of communication, 16 (34 per cent) the electrolarynx, and the remainder either wrote (16 [34 per cent]) or signed (3 [6 per cent]). Twenty-six (55 per cen) were considered to be successfully) rehabilitated overall and 21 (45 per cent) were not. These data indicate that the rehabilitative needs of today's laryngectomee are not being met successfully with traditional methods.

Rheumatoid arthritis: a study of relaxation and temperature biofeedback training as an adjunctive therapy.

Rheumatoid arthritis (RA) is a painful systemic disease and is believed to be exacerbated by stress. Relaxation and biofeedback strategies have demonstrated utility in alleviating both pain and stress-related symptomatology, and therefore were tested for efficacy with this disease in a two-phase study. First, 24 patients were taught a relaxation technique and then trained in either temperature elevation or reduction. Second, a group of 15 patients thus trained was compared with 8 others who received traditional physiotherapy modalities. Psychological tests, functional/physical evaluations, as well as measurements related to pain, sleep, and other activities were carried out. Results of the first study revealed significant and positive changes following treatment that were primarily related to pain, tension, and sleep patterns for both groups, but no differential effects were noted between temperature elevation or reduction conditions. This was attributed to both groups having maintained temperature above baseline during biofeedback training. The results of the second study consistently favored the relaxation and biofeedback over the physiotherapy group on the physical/functional indices. The psychological measures tended to remain constant throughout both studies, leading to the conclusion that the effectiveness of treatment was specific to physical functioning rather than to a psychological enhancement of well-being.

Empirical derivation of a partial personality typology of alcoholics.

Based on data from the 16 Personality Factor Questionnaire, personality profiles were derived allowing partial classification of 65 to 70% of a group of alcoholics into three categories.