Title: Use of Guided Imagery to Reduce Stress Among Mothers of Hospitalized Preterm Infants

Background

♦      12.3% of all births in the US are preterm (<37) weeks gestation.

♦      Preterm birth represents varying levels of stress for the new mother.  Perceived stress activates the  hypothalamus-pituitary-adrenal (HPA) axis resulting in increased release of circulating cortisol. Increased and prolonged activation of the physiologic stress response results in higher cortisol production, and may affect a psychological and physical health (e.g. decreased sleep quality, increased risk for depression, lower levels of concentration, decreased ability to attend to infant’s behavioral cues).

♦      Salivary cortisol levels normally follow a diurnal pattern with highest levels in the morning peaking about 30 minutes after waking. The “cortisol awakening response” (CAR) (amount of rise of cortisol level within 30 minutes of waking) normally shows a steep upward trajectory.  Salivary cortisol levels are reliable biomarkers of the HPA response.  Negative mental states such as chronic stress, anxiety, and depression can result in heightened HPA activation producing higher awakening cortisol (AC) and lower CAR levels.

♦      Relaxation guided imagery (RGI) is a mind-body strategy that has been shown to lower the physiological stress response; however, this low-risk intervention has not been tested in mothers of hospitalized preterm infants who are likely to experience high and persistent levels of stress.

Aims

The aims of this study were to: (1) test the feasibility of a RGI intervention in mothers of hospitalized preterm infants, and (2) to examine the effects of the RGI intervention on maternal levels of AC and CAR after 8 weeks of RGI use.

Research Design

20 mothers of preterm (<37 weeks gestational age) infants currently hospitalized in a NICU enrolled in an 8-week single sample intervention study. At baseline and 8 weeks each mother provided two saliva samples (upon waking, and 30 minutes later), and completed of self-report measures. Saliva samples were cryopreserved and batch processed.18/20 participants provided complete data for analysis.  Pearson correlations examined the relationship between average weekly CD listening and outcome variables.  Examples of maternal comments about the intervention are given. 

Results/Conclusions

♦      Feasibility

♦      Able to enroll and retain (19/20) mothers over 8 weeks of follow-up; mothers found no difficulties using the  intervention

♦      Mothers felt intervention was moderately useful (3.6 on a scale of 1=not useful to 5=very useful)

♦      Less likely to use intervention if baby became sick (e.g.“I felt too stressed to listen”)

♦      More frequent RGI use was associated with  lower stress, depressive symptoms, and state anxiety; lower AC and higher CAR indicating healthier cortisol response ; higher self-compassion; and more favorable maternal perception of infant responsiveness. 

♦      Further research using a randomized control trial with a more diverse sample is needed to test the effectiveness of this novel intervention. However, this low-risk, easily deliverable intervention appears to be both feasible and potentially useful in improving both psychological and physiologic outcomes among mothers of babies currently hospitalized in the NICU. 

Session