The Effects of Guided Imagery and Relaxation Technique on Psychological Functioning of Children with Cancer.

1. This is a behavioural intervention approach called guided imagery relaxation (GIR) technique for children with cancer to improve their emotional functioning. 2. Guided imagery is based on psychoneurological theory developed by Green and Green in Vines (1988) who suggest when a person creates and holds an image in their mind, cerebral cortex and limbic system are activated. Subsequently the hypothalamus is activated to create a positive change in the autonomic nervous system. The imagination is hypothesised to induce relaxation, emotional comfort and physiological reaction, indirectly by influencing children’s cognition towards positive, calming thoughts. 3. The GIR audio has 3 versions of pre-recorded scripts; each using different imagination stimuli i.e. “The Balloon”, “The Flower Garden” and “The Flying Carpet”. The runtime for each version is “5:35 minutes, 5:36 minutes and 5:26 minutes” respectively. Except for a unique imaginary stimuli and coping strategy introduced in every version, the general structure of the scripts are made uniform. The GIR script starts with breathing technique followed by a short progressive muscle relaxation sequence. Then the listeners are guided through an imaginary journey to induce relaxation in a gradual manner. For instance, they are suggested to imagine flying up high in the sky in a big balloon, getting higher and higher and feeling more and more relaxed. Or they are guided to imagine entering in a very peaceful, beautiful, fresh and healing place such a garden and experiencing all the calming and healing sensations. Incorporated in the script are different coping strategies including distraction, magical healing pond, special support person, and the power of the Creator that promote healing, hopefulness, feeling of reliant and subsequently inner perceived strength. The script ends with deep breathing and active muscles relaxation sequences that try to bring the listeners into inner source of strength and then go back into the reality slowly in descendant order. The pre-recorded scripts are uploaded in MP3 players and children are guided to listen to the scripts using the players. 4. Children and parents in oncology ward are invited to join the study and asked to sign consent form if they agreed to participate. They are explained about the study and requested to fill in some baseline measures. A simple random sampling procedure is used to assign the consented children into two groups i.e. intervention or control group. Single-blind study is used, whereby the child is not aware if they are in the intervention group or control group, but the researcher knows. After randomization, children in the intervention group are given individual MP3 player with earphone attached and GIR audio downloaded. The children need to listen to the GIR audio at least 3 times a week for 3 weeks period. They are free to choose whichever version they wanted to repeat listening but they should listen to each version at least once. Every single week, investigator will visit or contact the children to monitor the listening task. The children in control group receives standard medical care. 5. No trained provider is needed for this self-administered intervention. In this study, a student researcher introduces the study to the children and guide them to operate the MP3 player. The listening task is done by individual child and is monitored by the student researcher every week for 3 weeks. 6. Mode of delivery – self-listening to pre-recorded GIR audio via individually-kept MP3 player, at least 3 times a week for 3 weeks. 7. Location of intervention depends on where the child is at in particular period of intervention such as in the ward or at home. 8. The children in the intervention group are required to listen to at least 3 sessions of GIR audio in a week for 3 subsequent weeks. 9. No individual tailoring is made/ needed in this intervention. 10. No modification is made for intervention in particular. 11. We tried to maintain the fidelity of the intervention by monitoring the child’s task completion in a weekly basis – asking the child’s listening activities from themselves and their parents.