How Effective Is the Use of Metaphor Therapy on Reducing Psychological Symptoms and Pain Discomfort in Patients with Non-Cardiac Chest Pain: A Randomized, Controlled Trial

Document Type : Original Article

Authors

1 Interventional Cardiologist, Assistant Professor of Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Master of Clinical Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract

Introduction: Psychological symptoms of non-cardiac chest pain (NCCP) including perceptual, emotional, and behavioral problems can effect patient perception of chest pain. This study was conducted to determine the effect of metaphor therapy on mitigating depression, anxiety, stress, and pain discomfort in patients with NCCP.
Materials and Methods: This randomized, controlled, trial was conducted on 28 participants, who had visited the emergency department of Kermanshah Imam Ali Heart Hospital because of experiencing NCCP during the June to September 2014. The patients were randomly assigned to metaphor therapy and control groups (n=14 for each group) during a four-week period. Our data collection questionnaires included Pain Discomfort Scale (PDS) and Depression, Anxiety and Stress Scale (DASS). Chi-square and MANCOVA tests were run, using SPSS version 20.
Results: Twenty patients (71.4%) completed the trial period until the final assessment. Our findings showed that metaphor therapy couldn’t lower depression, anxiety, stress, and pain discomfort; In fact, there was not a significant difference between the metaphor therapy and control groups regarding the aforementioned variables (P>0.05).
Conclusions: Although the study results did not support the effectiveness of metaphor therapy for NCCP, further studies on the potential role of metaphor therapy in attenuating NCCP symptoms seem to be necessary.

Keywords

References

  1. Robertson N. Unexplained chest pain: a review of psychological conceptualizations and treatment efficacy. Psychol Health Med. 2006; 11:255-63.
  2. Achem SR. Non-cardiac chest pain treatment approaches. Gastroenterol Clin North Am. 2008; 37:859-78.
  3. Schroeder S, Schmid S, Martin A. Illness representations in noncardiac chest pain- a Brief Behavioral Medical Intervention. Verhaltenstherapie. 2013; 23:234-42.
  4. Bahremand M, Saeidi M, Takallo F, Komasi S. Comparison of depression, anxiety, and stress between mild and severe non-cardiac chest pain. Thrita. 2016; 5:e32752.
  5. Eslick GD, Fass R. Noncardiac chest pain: evaluation and treatment. Gastroenterol Clin North Am. 2003; 32:531-52.
  6. Kahn SE. The challenge of evaluating the patient with chest pain. Arch Pathol Lab Med. 2000; 124:1418-9.
  7. Eslick GD, Coulshed DS, Talley NJ. Review article: the burden of illness of non-cardiac chest pain. Aliment Pharmacol Ther. 2002; 16:1217-23.
  8. Barsky AJ, Cleary PD, Coeytaux RR, Ruskin JN. The clinical course of palpitations in medical outpatients. Arch Intern Med. 1995; 155:1782-8.
  9. Bringager CB, Friis S, Arnesen H, Dammen T. Nine-year follow-up of panic disorder in chest pain patients: clinical course and predictors of outcome. Gen Hosp Psychiatry. 2008; 30:138-46.
  10. Fleet RP, Dupuis G, Marchand A, Burelle D, Arsenault A, Beitman BD. Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. Am J Med. 1996; 101:371-80.
  11. Dammen T, Arnesen H, Ekeberg O, Husebye T, Friis S. Panic disorder in chest pain patients referred for cardiological outpatient investigation. J Intern Med. 1999; 245:497-507.
  12.  Haug TT, Mykletun A, Dahl AA. The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med. 2004; 66:845-51.
  13.  Mourad G, Jaarsma T, Hallert C, Stromberg A. Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease. Heart Lung. 2012; 41:446-55.
  14.  Webster R, Norman P, Goodacre S, Thompson A. The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review. Emerg Med J. 2012; 29:267-73.
  15. Webster R. Psychological distress in non-cardiac chest pain patients: an application of the common sense model of illness representations. [Doctoral Dissertation]. Sheffield, UK: University of Sheffield; 2012.
  16.  DeGuire S, Gevirtz R, Hawkinson D, Dixon K. Breathing retraining: a three-year follow-up study of treatment for hyperventilation syndrome and associated functional cardiac symptoms. Biofeedback Self Regul. 1996; 21:191-8.
  17.  Ryan M, Gevirtz R. Biofeedback-based psychophy-siological treatment in a primary care setting: an initial feasibility study. Appl Psychophysiol Biofeedback. 2004; 29:79-93.
  18.  Esler JL, Bock BC. Psychological treatments for noncardiac chest pain: recommendations for a new approach. J Psychosom Res. 2004; 56:263-9.
  19.  Potts SG, Lewin R, Fox KA, Johnstone EC. Group psychological treatment for chest pain with normal coronary arteries. QJM. 1999; 92:81-6.
  20. Jensen MP, Karoly P, Harris P. Assessing the affective component of chronic pain: development of the Pain Discomfort Scale. J Psychosom Res. 1991; 35:149-54.
  21.  Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995; 33:335-43.
  22. Sahebi A. Reliability and validity of the Lovibond stress, anxiety and depression scale. Unpublished report, Iran: Faculty of Psychology and Educational Sciences of the University of Mashhad; 2001.
  23. . Bahremand M, Moradi G, Saeidi M, Mohammadi S, Komasi S. Reducing irrational beliefs and pain severity in patients suffering from Non-Cardiac Chest Pain (NCCP): a comparison of relaxation training and metaphor therapy. Korean J Pain. 2015; 28:88-95.
  24.  Klimes I, Mayou RA, Pearce MJ, Coles L, Fagg JR. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. 1990; 20:605-11.
  25.  Jones H, Cooper P, Miller V, Brooks N, Whorwell PJ. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut. 2006; 55:1403-8.
  26.  Kwekkeboom KL, Gretarsdottir E. Systematic review of relaxation interventions for pain. J Nurs Scholarsh. 2006; 38:269-77.
  27. Yu DS, Lee DT, Woo J. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosom Res. 2007; 62:427-37.
  28.  Legowski T, Brownlee K. Working with metaphor in narrative therapy. J Fam Psychothe. 2001; 12:19-28.
  29.  Bahremand M, Saeidi M, Komasi S. Non-coronary patients with severe chest pain show more irrational beliefs compared to patients with mild pain. Korean J Fam Med. 2015; 36:180-5.
Journal of Cardio-Thoracic Medicine
Volume 4, Issue 2
June 2016
Pages 444-449

Files

Share

How to cite

Statistics