The psychoneuroimmunological effects of guided imagery in patients on hemodialysis for end -stage renal disease

This study was a randomized, quasi-experimental design that investigated the psychoneuroimmunological (PNI) effects of guided imagery for 4 weeks on selected physiological and psychological behaviors of patients with end-stage renal disease. The theoretical frameworks that guided the study were psychoneuroimmunology and the Roy Adaptation Model of nursing practice.;The sample was 62 subjects randomly assigned to either a guided imagery group (n = 32) or a music control group (n = 30). There were 39 men and 23 women ranging in age from 28 to 96 years (M = 59.24, SD = 15.24, Mdn = 59.5). Months on hemodialysis ranged from 1 month to 113 months (M = 21.73, SD = 23.37, Mdn = 18.5). Subjects listened to audiocassettes of either guided imagery or music only at least 3 times a week while receiving hemodialysis or during a time of their choice at home. Pretests and posttests were done on six dependent variables. Psychological behaviors were measured using the Hemodialysis Stressor Scale and the Center for Epidemiological Studies-Depression Scale. Neuroendocrine behaviors were represented by the diastolic blood pressure and apical heart rate. Immunological behaviors were measured using the lymphocyte count and the size of induration from a delayed-type hypersensitivity skin test (DHST) using candida antigen.;MANOVA, alpha = .05, was used to test the main hypothesis of guided imagery having an effect on the six dependent variables. No significant main effect was detected. Post-hoc analysis was done with t tests and multiple regression. Paired t-tests, Bonferroni correction of alpha = .004, indicated a statistically significant increase in DHST induration in both the guided imagery and music groups. Results of multiple regression analysis indicated that four demographic predictors combined accounted for 20% of the variance in only one of the dependent variables, diastolic blood pressure.;The findings in this study fail to support the hypothesis that guided imagery has an effect in patients on hemodialysis. Analysis of the data and the study circumstances reveal several threats to the validity of the study. The study should be repeated with design improvements that decrease the validity threats.