A recording or the real thing?

I’m musing about an article I read while browsing the internet looking for information on hypnosis. It’s from the BBC – you can read it here – where it is announced that a recording of guided imagery is useful for kids with abdominal pain, saying ‘they can imagine themselves in scenarios like floating on a cloud’ and experience improvements in their pain.

I think this is a great piece of news with a sting in the tail. Like most news articles it fails to deliver the detail, and as you know, the devil is in the details! Let me say firstly that I haven’t read the original article which is found in the journal Pediatrics, and apparently follows on from similar studies showing that hypnosis for kids has some good effect – apparently because kids have ‘fertile imaginations’. We could add also that kids develop very strong expectancies when powerful and important people in their lives tell them that a treatment has a certain effect.

Back to the story – firstly, the study is a small study of only 30 children. The ages of the children ranged from 6 – 15, and the BBC article gives no details of the duration of the pain, the average of the kid, whether they’d had psychological input before, whether their parents supported the treatment etc etc – all quite important factors in determining the efficacy of treatment in the ‘real world’.

It seems that the kids were divided into two groups – one got normal management, the other received CD’s and were asked to use them daily for eight weeks. No mention in the BBC article about whether the CD group also got ‘other’ management!

The results – the CD group ‘73.3% reported that their abdominal pain was reduced by half or more by the end of the treatment course compared with 26.7% in the standard care group.’ … and apparently this was maintained to a certain extent in 2/3 of the kids six months later.

Why am I critical of this article? Well the first thing is that it is skimpy on details of the study. Not unexpected, this is a news article not a scientific paper! BUT it is inclined to lead parents who read this to jump to conclusions that simply by buying a CD they may be able to help little Johnny or Mary with their tummy pain. I suppose at least it won’t do harm – except if the parents delay getting their kids seen by a medical professional.

But I think it suggests rather unfairly a couple of things: firstly the article says ‘a lack of therapists led them to the idea of using a CD to deliver the sessions’ I can imagine some hospital managers rubbing their hands with glee thinking ‘ahah! we can reduce the number of occupational therapists, psychologists and social workers in paediatrics with a recording!’

Perhaps that’s a little unkind, but that’s the sort of simplistic thinking that I’ve seen before – therapist leaves, referrals for assessment have dipped a little so let’s not replace the therapist and we can save some money (haven’t you heard of natural referral fluctuations? and what is that waiting list for treatment?)

It also suggests that a simple intervention can solve what is a complex and challenging problem. In my experience, kids with abdominal pain are within family and school systems that need input. While helping a kid get off to sleep or reduce their abdominal pain is one part of the solution, there is almost always much more. And usually it involves helping parents understand their role, and the role of siblings, teachers, friends and even family doctors, in the maintenance of the child’s disability and illness role. A CD is not going to do this.

Some parents find it exceptionally difficult to accept that no clear medical ‘diagnosis’ (and therefore cure) can be found – one parent said to me ‘You can’t consign my child to a lifetime of pain’ even when my job was to help the child cope with the pain while the team worked to identify contributing factors. She’d had her pain for four years, had spent two years off school, and had seen many specialists before being referred to the chronic pain team. BTW no medical diagnosis was made for this girl apart from ‘chronic abdominal pain’, and her father removed her from our team and continued to seek further invasive diagnostic procedures. I understand she remains off school another 18 months later having had several procedures but still finding no evidence of diagnosable pathology. Maybe she really does have ‘chronic pain’ in the tummy. If a parent doesn’t support the approach, a recording isn’t going to cut it, even if it’s an effective recording for relaxation.

My final thoughts on this article: if you’ve ever tried using a relaxation or imagery recording, you’ll probably know that some ‘fit’ you and some don’t. I personally get irritated with strong accents, pan pipes, and water trickling. I also really don’t enjoy imagery of beaches.

One size of imagery does not fit all – which is one reason I prefer to do at least one session where I talk before I start an imagery relaxation or hypnosis. That way I can identify the specific triggers, words, images or sounds that work well for the individual. I can make a recording that is tailored to the needs of the individual.

I don’t know whether there is an evidence-base to suggest that this is more effective than a mass-produced recording, but I do remember when I was a kid having nightmares about fairy stories that were supposed to happy and nice. I’d rather not assume that what I give a person is right for them without having an opportunity to talk to them about it, and adjust the recording if necessary. Let’s hope the managers reading that particular article don’t assume that a recording is as good as the real thing.


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