Lai, W., Chao, C., Chantal, Yang, W., & Chen, C. (2010). Efficacy of guided imagery with theta music for advanced cancer patients with dyspnea: A pilot study. Biological Research for Nursing, 12(2), 188-197.

The objective of the study was to investigate the effect of guided imagery with theta music on dyspnea in patients with advanced cancer.

The intervention consisted of four periods.

• Three minutes resting quietly with no stimulation
• Four minutes of “control” (non-theta) music listening
• Guided imagery segment, consisting of three minutes of theta music only, followed by four minutes of theta music plus imagery instruction, followed by three minutes of theta music only
• Three minutes resting quietly with no stimulation.

Theta music was provided by a recording designed to stimulate brain waves in the theta range of 4–8 Hz. Music was provided by a standard audio CD with headphones. Dyspnea rating was done in the first and last periods of the intervention, while resting quietly. Physiologic parameters of respiratory rate, heart rate, end tidal CO₂, and pulse oxygen saturation were collected at each of the four segments of the intervention. Physiologic parameters were continuously measured using a Tidal Wave 715 capnograph/pulse oximeter, using a finger probe. Patients were interviewed at the end of the session via open-ended questions to elicit how they felt.

• The study reported on a sample of 53 participants.
• The mean age was 58 years (SD = 16.2 years).
• Of the sample, 58.5% were males and 41.5% were females.    
• Of the sample, 37.7% had lung cancer and the rest had other types of cancers.
• All had Borg scale scores greater than or equal to 5. 
• Of the sample, 54.7% were on oxygen therapy and 32.1% were on medication for dyspnea.
• Medications used are not described.
• Of the sample, 58.5% had secondary or higher-level education.
   

The study was conducted in a multi-site, inpatient setting in Taiwan.

• Patients were undergoing end-of-life care.
• The study has clinical applicability for late effects and survivorship and end-of-life and palliative care.
   

Single group repeated measures

• Modified Borg scale    
• Physiologic parameters via continuous pulse capnograph/eximeter
   

• The mean modified Borg scale score improved significantly with the intervention, with a baseline mean score of 5.9 and post-intervention score of 3.2 (p = .000). 
• Ninety percent of subjects said they felt that the intervention had benefited them, indicating they felt “refreshed\" or “comfortable and peaceful,\" and 57% fell asleep during the intervention. 
• Statistically significant declines were seen in heart rate (pre: 96.3 bt/min, post: 94.9 bt/min, p = .005) and respiratory rate (pre: 20.4/min, post: 18.9/min, p = .000). 
• No significant difference was seen in oxygen saturation. 
• End tidal CO₂  increased significantly from 28.5 pre-intervention to 29.1 post-intervention.
• Post hoc testing showed that CO₂ increased most with the combined guided imagery and theta music. 
• Subjects showed decline in heart and respiratory rates throughout all parts of the session.

Findings support the hypothesis that subjects who receive the guided imagery and theta music intervention experience reduction in heart and respiratory rate and subjective intensity of dyspnea.

• The study had a small sample size of less than 100.
• Although no control group was used for comparison, the repeated measures design did allow for comparison of physiologic parameters at various time points. 
• No analysis was done of differences between those on oxygen and those not, in terms of physiologic response. 
• Although changes in heart and respiratory rates were statistically significant, the level of the change does not suggest clinical significance of these changes. 
• Of an initial sample of 69 patients, 16 said they could not concentrate to complete the guided imagery. Analysis showed that these patients had significantly less formal education than others, suggesting that such factors may influence results. 
• The measures were short-term, so any more lasting effects on symptoms are not known. 
• Because the intervention was combined, what effects imagery versus the theta music itself had is not clear.
   

• Findings suggest that guided imagery and listening to theta music can be beneficial for patients with dyspnea.
• This appears to be a practical intervention. 
• Further research in this area is warranted to determine most effective “dosing” and timing of such an intervention and to further explore the relevance of education level to ability to participate fully in guided imagery. 
• Because most patients fell asleep during this intervention, the effect of this type of intervention to manage sleep disturbance may be useful as well.