Interactive Guided Imagery therapy with medical patients: predictors of health outcomes.

OBJECTIVES: To assess whether Interactive Guided Imagery (IGI) is helpful to medical patients and to identify factors that contribute to positive outcomes. DESIGN: A prospective cohort study of 323 medical patients who received 6 IGI sessions on a weekly basis. Patients and practitioners completed questionnaires at the beginning, middle, and end of the 6 IGI sessions. The questionnaires assessed the patients' ability to do IGI, the quality of the practitioner-patient interaction, possible confounding variables, and enabling factors. The hypothesis was that measures of the process of doing IGI and the practitioner-patient relationship would predict outcomes. SUBJECTS/SETTING: The subjects were all patients seeking treatment at California Pacific Medical Center in San Francisco, and Marin General Hospital in Greenbrae, CA. INTERVENTION: Using IGI interactively is a cognitive-behavioral intervention designed to help patients relax by using mental images to discover and cultivate healing intentions, and to reflect on the meaning of these images. MEASURES: The individual measures to assess the patients' ability to do IGI and measures of the practitioner-patient relationship were factor-analyzed to use as predictor variables in a multiple regression. Similarly, the questionnaire items measuring cognitive, emotional, behavioral, and spiritual benefits of IGI were factor-analyzed into factors representing "insight" and "all other" benefits. RESULTS: The multiple regression shows that both process and practitioner-patient interaction factors significantly contributed to a combined 40% of the variance in patients' ratings of insight into the nature of their problem and to becoming aware of an aspect of self, F(4,56) = 9.4, p < 0.005. The same process and interaction factors were less strongly related to the other outcomes, r2 = 0.14, F(4,56) = 2.3, p = 0.06. None of the demographic, confounding, or enabling factors was related to the outcome measures. CONCLUSIONS: The process of doing IGI and the relationship with the practitioner were both independently associated with the patients' insight into their health problems.

A descriptive analysis of an integrative medicine clinic.

OBJECTIVE: To evaluate and describe an integrative medicine clinic including its patients; their presenting problems, medical objectives, treatment recommendations; whether recommendations were recalled and adhered to; and patients' self-reported health outcomes. DESIGN: A prospective cohort study of 160 new clinic patients were treated using a wide range of integrative medicine therapies. Patients were interviewed at intervals of 1, 3, and 6 months after their initial visit. SETTING: The study was conducted at the Institute for Health and Healing clinic, at California Pacific Medical Center located in San Francisco, CA. SUBJECTS: The subjects were new clinic patients seeking care for a variety of symptoms and diagnoses. INTERVENTION: Patients presented with an average of 4.0 symptoms and 2.9 diagnoses; physicians recommended 9.5 "treatments" per patient. RESULTS: At 6-month follow-up, symptom intensity decreased from 6.5 to 4.2 (on a 10-point scale; p < 0.005); and 57% of the patients had made "substantial" progress or had completely achieved their health objectives (p < 0.005). The Short Form 12 (SF-12) measure of mental and physical functioning improved significantly from baseline to one month (p = 0.05; p = 0.001, respectively) and maintained this improvement at 3 (p = 0.01; p = 0.01) and 6 months (p = 0.001; p = .001). At 1-month follow-up, patients recalled 57% of the actionable statements from the physician without a prompt and they followed 55% of all recommendations well (90% or above). Over the follow-up period, patients increasingly attributed the reductions in symptoms (p = 0.01) and achieving their health objectives (p = 0.01) to the treatment plan. Self-reported measures of days ill and days missed at work/school did not differ significantly from the year before coming to the clinic. CONCLUSION: The results indicate that patients can recall and follow a complex treatment regimen. Subjective and objective measures of patients' health status improved after one month and this effect was sustained or improved further at 6 months follow-up. Further study is needed to determine whether patients' improvement was the result of the treatment regimen.