Effect of Guided Imagery on Stress, Physical Complaints,
and Occupational Well-Being in Pregnant Adolescents
Sean Sparrow, OTS and Mary Schneider PhD, OTR, and Lesa Reisdorf MA
Occupational Therapy Program, Dept. of Kinesiology, University of Wisconsin-Madison
INTRODUCTION
Background
• Experiencing stress during pregnancy is related to negative
infant outcomes such as preterm birth, difficult infant
temperament, and cognitive delay
RESULTS
Figure 1. Psychological Stress Measure-9 Pretest & Posttest Scores
35
• Stress is often self reported as perceived physical
complaints such as headache, abdominal pain,
musculosketel pain, and problems sleeping.
(Sunblad, Jansson, Saartok, Renstrom, & Engstrom, 2008)
Purpose – To determine whether guided imagery intervention
changes perceived stress levels, perceived physical complaints,
and occupational well-being in a population of pregnant
adolescents. A specific focus was placed on perceived physical
complaints.
HYPOTHESIS
• Decreased levels of occupational well-being may be a
result of the biological and psychological changes
occurring during the progression of pregnancy.
20
15
10
• Current research lacks intervention methods that reduce
levels of stress and increase occupational well being in
pregnant adolescents.
• Future research is needed to determine appropriate
frequency and duration of GI intervention. Long term
follow-up is also needed to track stress levels and
continued use of GI intervention.
5
0
Session 1 Session 2 Session 3 Session 4
High PSM-9 Scores suggest a trend for high levels of stress
• Data analysis revealed non-significant results for overall pretest and
posttest scores and scores across sessions. Mean differences
between pretest and posttest ratings indicated a decrease in stress
levels for all participants.
Guided Imagery Intervention will decrease perceived
stress levels, decrease physical complaints, and
increase occupational well-being.
Figure 2. Reported Levels of Physical Complaints
on Psychological Stress Measure-9
18
16
RESEARCH DESIGN &
METHODS
Mean Score
14
Three pregnant adolescents ages 15,16, & 17 from the School
Age Parent Program (SAPAR) participated in this study. A
quasi-experimental, one-way repeated measures design was
used during the 4 sessions of GI.
Guided Imagery (GI): Guided Imagery for pregnancy through
labor and delivery. Audio recording by Diane L. Tusek, RN
(Tusek, 2010). Adapted to 13 minutes. Audio recording
downloaded onto MP3 players.
Psychological Stress Measure-9 (PSM-9)
•The original form was published by Louise Lemyre and
Réjean Tessier in 1988 and the 9 item was published in 2002
(Lemyre & Tessier, 2003).
•Questionnaire measuring perceived stress levels.
•PSM-9 given before and after each GI session.
Perceived Physical Complaints
•Question on PSM-9 measuring complaints of physical aches
and pains, head ache, sore back, stiff neck, and stomach ache.
Occupational Well-Being Questionnaire (OWBQ)
•24 item questionnaire measuring meaning and satisfaction
of occupations in daily life developed by Susan Doble (Doble
& Santha, 2008).
•OWBQ given before and after 4 total sessions.
• Mean differences between session 1 and session 4
suggest that the use of GI decreases postintervention stress levels over a period of time.
• GI may decrease complaints of physical aches, sore
backs, headaches, stiff necks, and stomach aches.
25
Mean Scores
(Mollborn & Morningstar, 2009)
Pretest
Posttest
30
(Wadhwa et al. 2001; Huizink et al. 2002)
• Pregnant adolescentst are at additional risk for increased
stress levels due to maternal adjustment, psychological
issues, and unrealistic expectations of childhood
CONCLUSIONS
12
10
8
6
4
2
0
Pretest
Posttest
High PSM-9 scores suggest a trend for high level of stress
• Reported levels of perceived physical complaints resulted in non
significant findings. Participants reported a trend for a decrease in
physical complaints after using guided imagery intervention.
Table 1. Occupational Well-Being Questionnaire Pretest & Posttest Scores
Participant
Pretest
Posttest
Point Difference
1
2
3
92
74
70
82
73
57
-10
-1
-13
• Reported levels of satisfaction designated by occupational wellbeing scores showed a non-significant trend for decrease after GI
intervention.
IMPLICATIONS FOR
PRACTICE
• Occupational Therapists (OTs) can aid in the
integration of a GI intervention into daily habits
and routines for adolescents experiencing stress
during pregnancy.
• Scope of GI intervention can be expanded for use
with other clients experiencing stress and physical
complaints in addition to a disability, disease, or
condition.
Elements of Client Centered Treatment
• OT’s provide independence in clients’ ability to
manage their own stress levels
• OT intervention in development of stress-free
environment
• OT Client and Family education for stress reduction
strategies
• OT assessment of meaningful activities of daily
living
ACKNOWLEDGEMENTS
Thanks to the Gertrude E. Gaston Fund, Dr. Mary Schneider,
Dr. Wilbarger, and the students and staff of SAPAR for
making this research project possible.
REFERENCES
Doble, S. E., & Santha, J. C. (2008). Occupational well-being: rethinking occupational therapy outcomes. Canadian Journal of Occupational
Therapy.Revue Canadienne d'Ergotherapie, 75(3), 184-190.
Huizink AC., Robles de Medina PG., Mulder EJ. et al. (2002). Psychological measures of prenatal stress as predictors of infant temperament. J
Am Academic Child Adolescent Psychiatry;41:1078.
Lemyre, L., & Tessier, R. (2003). Measuring psychological stress. Concept, model, and measurement instrument in primary care research.
Canadian Family Physician Medecin De Famille Canadien, 49, 1159-60, 1166-8
Mollborn, S., & Morningstar, E. (2009). Investigating the relationship between teenage childbearing and psychological distress using longitudinal
evidence. Journal of Health and Social Behavior, 50(3), 310-326.
Sundblad, G. B., Jansson, A., Saartok, T., Renstrom, P., & Engstrom, L. M. (2008). Self-rated pain and perceived health in relation to stress and
physical activity among school-students: a 3-year follow-up. Pain, 136(3), 239-249. doi:10.1016/j.pain.2007.06.032.
Tusek, D. (2010). Guided imagery for pregnancy through labor and delivery. Guided Imagery Inc.
Wadhwa PD, Culhane JF, Rauh VR et al. (2001). Stress and preterm birth: neuroendocrine, immune/inflammatory, and vascular mechanisms.
Maternal Child Health J, 5:119–25.