Effects of imagery, critical thinking, and asthma education on symptoms and mood state in adult asthma patients: a pilot study.

OBJECTIVE

To compare biologically targeted imagery (BTI) and critical thinking asthma management (CTAM) outcomes.

DESIGN

Participants were randomized to BTI (group 1, G1) or CTAM (group 2, G2) in a 2 x 2 x 4 design (BTI/CTAM x pretest/post-test x weeks [3 week averaged intervals of symptoms and peak flows]). Interventions were asthma education plus treatment (BTI or CTAM for two 2-hour sessions per week for 6 weeks). For BTI, data collection (symptoms, lung function) occurred preintervention (3 week baseline), during the intervention (6 weeks), and postintervention (6 weeks). For CTAM, data collection occurred at wait-list control (WLC) (12 weeks extended baseline), preintervention (3 weeks), during the intervention (6 weeks), and postintervention (6 weeks).

SETTING

Alaska Regional Hospital, Anchorage.

SUBJECTS: Seventy (70) adults (53 women, 17 men) with asthma.

INTERVENTIONS: WLC record keeping, BTI, or CTAM.

OUTCOME MEASURES: Dependent variables included asthma symptoms (wheezing, coughing, sleep, activity, attacks, peak flow) and self-report assessments of Profiles of Mood States (POMS-BI) (anxiety, hostility, depression, uncertainty, fatigue, confusion); Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire (KASE-AQ); Health Attribution Test (HAT) for locus of control (LoC); and the Revised Asthma Problem Behavior Checklist (RAPBC).

RESULTS

Analyses of covariance with repeated measures contrasted BTI pre- to post-tests, time periods, and WLC; CTAM pre- to post-tests, time periods, and extended baseline WLC; and BTI to CTAM outcomes. WLC improved all POMS-BI scores except anxiety, increased internal LoC, and reduced problematic behaviors. Compared to WLC, BTI reduced wheezing, anxiety, and chance LoC, and increased asthma knowledge, attitude, and self-efficacy. Compared to CTAM, BTI reduced wheezing and chance LoC, increased internal LoC, and improved 6 POMS-BI scores. Compared to extended baseline WLC, CTAM increased asthma knowledge, attitude, self-efficacy, internal LoC, and peak flow.

CONCLUSIONS

Both interventions significantly improved symptoms and asthma management more than record keeping. Contrary to hypothesis, BTI produced better outcomes than CTAM.