Psychological preparation for gastrointestinal endoscopy

The literature on stress and medical procedures is reviewed. Included are the effects of stress on the individual, psychosocial modifiers of stress and a review of psychological interventions in medical settings. Methodological issues regarding research in the health care setting are discussed and psychological aspects of gastrointestinal endoscopy are explored, including the issue of sedation. All main studies used three types of measures: self-report, physiological and behavioural. The results of these studies and their implications are discussed. Preliminary study 1 is described where patients undergoing a colonoscopy examination were interviewed and information regarding their experiences of colonoscopy and their preferences for psychological intervention is reported. One of the factors identified as important to an individual's experience of stress is perceived control. Preliminary study 2 piloted patients' responses to two relaxation tapes, with or without coping instructions to enhance the experience of perceived control. Study 1 formally investigated repetitive use of a relaxation procedure on patients undergoing a colonoscopy examination in comparison with a non-intervention control group. Patients listened to the relaxation procedure in their own homes during the week leading up to the examination. Anxiety measures were also taken during this time and analysis revealed different trends between the groups. Dose of analgesia, age and group membership were related to patients' experiences of colonoscopy. Individual coping style is another important factor when looking at how patients differ in their perception of stress. A further study looked at the effectiveness of a single procedure of relaxation and examined the importance of coping style and locus of control in its effectiveness. Comparisons were made with two control groups: attention control as well as non-intervention control groups. Dose of analgesia, state anxiety and duration of the examination were associated with experience of colonoscopy in this sample of patients. A relaxation group by trait anxiety interaction was also identified as relating to the experience of colonoscopy. Two further preliminary studies were carried out and consisted of interviews with patients undergoing different gastrointestinal endoscopy procedures, a) to assess their experience and thoughts on psychological interventions, and b) an attempt to modify a questionnaire concerning patients experiences of colonoscopy so that patients' endoscopic retrograde cholangio-pancreatography (ERCP) experiences could also be reported. A final study compared an alternative psychological preparation for patients undergoing an ERCP. Patients were randomly allocated to one of four intervention groups: relaxation, provision of information, attention control or non-intervention control groups. Dose of sedation, pre-ERCP oxygen saturation levels and social desirability scores were associated with response to ERCP. No between-group differences were detected in these patients during ERCP. Specific measures used, particularly the measurement of anxiety and outcome measures, are also explored. Future research is suggested and findings are summarised.