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information and serves to encourage its readers sys- tematically to evaluate decline in the clinical condi- tion of patients with serious life threatening illnesses. With some practice, Emergencies in Palliative and Supportive Care can be used effectively as a pocket manual for palliative care practitioners and as a good reference. —Reviewed by: Tammie E. Quest, M.D. Department of Emergency Medicine Emory University School of Medicine 49 Jesse Hill Jr. Drive Atlanta, GA 30303 E-mail: [email protected] DOI: 10.1089/jpm.2008.9918 MEDIA REVIEWS Medical Procedure Relaxation for Adults. Cather- ine Sheen, Ph.D. www.reachinward.com Relaxed and Awake during Medical Procedures. Belleruth Naparstek www.healthjourneys.com Stress Management and Self Relaxation Skills. Jon Seskevich, R.N. www.managestressnow.com Guided imagery refers to an increasingly popular set of techniques patients can use to ease the distress of undergoing medical procedures or to help alleviate the stress and anxiety of their illness and its symptoms. Yet the plethora of imagery recordings available through the Internet may leave practitioners unsure of which to recommend to patients or their care teams. As with other self-directed aspects of care, such as par- ticipation in actual or online support groups, it is ap- propriate for patients themselves to choose what fits best for them, but it can be of benefit for their care team to have direct knowledge of available resources to help steer them in a particular direction given their likely preferences. Ideally, the optimal guided imagery recording would most likely be one tailor-made interactively by a member of a patient’s own care team working di- rectly with the patient. The familiarity of the known voice, the shared time spent preparing for the record- ing, and the tangible gift of the recording would strengthen the experience on subsequent listenings. And having individualized references to a patient’s own “safe place” and their own real supportive figures could evoke a stronger relaxation response than a ge- neric recording by helping to hone in on a particular treasured setting, a specific loved one, imagined guide, or cherished pet and the patient’s own set of sensory associations with them. In the absence of a care team member with the ex- pertise to perform guided imagery, or the time and technological resources to do so, one can still turn to prerecorded sessions, which draw on a range of tech- niques such as progressive muscle relaxation, visual- izations/affirmations, and self-hypnosis. Giving pa- tients a set of several options to choose from might allow them to feel some control over this aspect of their treatment, and to maximize success based on their personal or aesthetic preferences. Catherine Sheen, Ph.D., is a psychologist and breast cancer survivor. Her CD Medical Procedure Relax- ation for Adults is closer to a hypnosis session than most guided imagery. Produced with no accompany- ing music, and with a good sound quality that feels like an individual patient’s recorded session, Dr. Sheen’s voice has a competent, confident, somewhat directive and clinical feel. The session begins with breathing- and body-centered relaxation, and then moves into a descending staircase counted relaxation that proceeds just like a hypnotic induction. A com- forting companion is invoked, and then an unspecified procedure is rehearsed (although a general anesthetic is presumed.) A series of affirmations and suggestions are given, e.g., “everything goes just as planned . . . I am in good hands . . . I recover easily and well with- out complications . . . there is nothing to be afraid of,” etc. Finally, the staircase is ascended to end the ses- sion. Dr. Sheen’s CD would be most useful in prepara- tion for a surgery or major procedure requiring anes- thesia. Its unequivocal prediction of an uncomplicated, successful procedure might prove problematic for pa- tients with histories of previously difficult procedures, who might feel that their own experiences were not being taken into account as a valid source of their anx- iety. This reservation aside, the session gives patients a set of tools to enter into and recover from a proce- dure with a relaxed, positive frame of mind. Belleruth Naparstek’s Relaxed and Awake During Medical Procedures is one of many guided imagery recordings available on her large website. Belleruth, as she prefers to be known as, is a psychotherapist and leader in the field of guided imagery. Her recordings have a studio quality, with accompanying new age mu- sic that is also included as a separate track for further relaxation practice. Her voice tone is warm and friendly, and balances well with the music, which builds gradually to strengthen the imagery. Relaxed Medical Procedure opens with a breath-focused re- BOOK AND MEDIA REVIEWS 650

Medical Procedure Relaxation for Adults; Relaxed and Awake during Medical Procedures; Stress Management and Self Relaxation Skills

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Page 1: Medical Procedure Relaxation for Adults; Relaxed and Awake during Medical Procedures; Stress Management and Self Relaxation Skills

information and serves to encourage its readers sys-tematically to evaluate decline in the clinical condi-tion of patients with serious life threatening illnesses.With some practice, Emergencies in Palliative andSupportive Care can be used effectively as a pocketmanual for palliative care practitioners and as a goodreference.

—Reviewed by:Tammie E. Quest, M.D.

Department of Emergency MedicineEmory University School of Medicine

49 Jesse Hill Jr. DriveAtlanta, GA 30303

E-mail: [email protected]

DOI: 10.1089/jpm.2008.9918

MEDIA REVIEWS

Medical Procedure Relaxation for Adults. Cather-ine Sheen, Ph.D. �www.reachinward.com�Relaxed and Awake during Medical Procedures.Belleruth Naparstek �www.healthjourneys.com�Stress Management and Self Relaxation Skills. JonSeskevich, R.N. �www.managestressnow.com�

Guided imagery refers to an increasingly popularset of techniques patients can use to ease the distressof undergoing medical procedures or to help alleviatethe stress and anxiety of their illness and its symptoms.Yet the plethora of imagery recordings availablethrough the Internet may leave practitioners unsure ofwhich to recommend to patients or their care teams.As with other self-directed aspects of care, such as par-ticipation in actual or online support groups, it is ap-propriate for patients themselves to choose what fitsbest for them, but it can be of benefit for their careteam to have direct knowledge of available resourcesto help steer them in a particular direction given theirlikely preferences.

Ideally, the optimal guided imagery recordingwould most likely be one tailor-made interactively bya member of a patient’s own care team working di-rectly with the patient. The familiarity of the knownvoice, the shared time spent preparing for the record-ing, and the tangible gift of the recording wouldstrengthen the experience on subsequent listenings.And having individualized references to a patient’sown “safe place” and their own real supportive figurescould evoke a stronger relaxation response than a ge-neric recording by helping to hone in on a particular

treasured setting, a specific loved one, imagined guide,or cherished pet and the patient’s own set of sensoryassociations with them.

In the absence of a care team member with the ex-pertise to perform guided imagery, or the time andtechnological resources to do so, one can still turn toprerecorded sessions, which draw on a range of tech-niques such as progressive muscle relaxation, visual-izations/affirmations, and self-hypnosis. Giving pa-tients a set of several options to choose from mightallow them to feel some control over this aspect oftheir treatment, and to maximize success based on theirpersonal or aesthetic preferences.

Catherine Sheen, Ph.D., is a psychologist and breastcancer survivor. Her CD Medical Procedure Relax-ation for Adults is closer to a hypnosis session thanmost guided imagery. Produced with no accompany-ing music, and with a good sound quality that feelslike an individual patient’s recorded session, Dr.Sheen’s voice has a competent, confident, somewhatdirective and clinical feel. The session begins withbreathing- and body-centered relaxation, and thenmoves into a descending staircase counted relaxationthat proceeds just like a hypnotic induction. A com-forting companion is invoked, and then an unspecifiedprocedure is rehearsed (although a general anestheticis presumed.) A series of affirmations and suggestionsare given, e.g., “everything goes just as planned . . . Iam in good hands . . . I recover easily and well with-out complications . . . there is nothing to be afraid of,”etc. Finally, the staircase is ascended to end the ses-sion.

Dr. Sheen’s CD would be most useful in prepara-tion for a surgery or major procedure requiring anes-thesia. Its unequivocal prediction of an uncomplicated,successful procedure might prove problematic for pa-tients with histories of previously difficult procedures,who might feel that their own experiences were notbeing taken into account as a valid source of their anx-iety. This reservation aside, the session gives patientsa set of tools to enter into and recover from a proce-dure with a relaxed, positive frame of mind.

Belleruth Naparstek’s Relaxed and Awake DuringMedical Procedures is one of many guided imageryrecordings available on her large website. Belleruth,as she prefers to be known as, is a psychotherapist andleader in the field of guided imagery. Her recordingshave a studio quality, with accompanying new age mu-sic that is also included as a separate track for furtherrelaxation practice. Her voice tone is warm andfriendly, and balances well with the music, whichbuilds gradually to strengthen the imagery. RelaxedMedical Procedure opens with a breath-focused re-

BOOK AND MEDIA REVIEWS650

Page 2: Medical Procedure Relaxation for Adults; Relaxed and Awake during Medical Procedures; Stress Management and Self Relaxation Skills

laxation, and then invokes a visualized safe place, a“protective, insulating cushion of safety,” and a lov-ing group of supportive figures to accompany the pa-tient through an unspecified procedure. One drawbackof her using several suggested examples of safe placeswhich she then fleshes out with a variety of particularsense-experiences, rather than leaving these unspeci-fied, is that the listener is repeatedly pulled back andforth—from the beach, to the woods, to the desert, etc.Additionally, some patients might be initially put offby the new age music. Overall, however, Belleruth’scalming visualization would be helpful for a widerange of medical procedures.

Patients desiring a more general guided relaxationsession in anticipation of a procedure would find JonSeskevich’s Stress Management and Self RelaxationSkills useful. Seskevich, a nurse specialist, has a gen-tle, soothing voice and leads patients through both aprogressive breathing and muscle relaxation and aguided visualization using a very open ended safe or“happy” place. One unusual positive feature is his pos-

sible suggestion of a more “fun, active” or stimulat-ing place than is usually the case, which might helppatients prone to a more restless anxiety feel less ham-pered than they might by instructions to visualize amore physically calm or static location. Seskevich’sguided visualizations, while not specifically targetedto a medical procedure, would help patient’s cope withtheir illness-related stress as well as the stress of ananticipated procedure.

These are three of a large selection of guided im-agery resources available on the internet, some in CDformat and some as MP3s to download. They wouldbe an excellent start for beginning to build a resourcelist for a palliative care team to provide to patients orto their primary caregivers.

—Reviewed by:Dr. Sarah Bryce

Durham, NC

E-mail: [email protected]

BOOK AND MEDIA REVIEWS 651