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A cognitive-behavioural approach to preventing anxiety and fear during magnetic resonance imaging examinations, and an investigation into attention biases in anxiety

Davan, Ian (1997) A cognitive-behavioural approach to preventing anxiety and fear during magnetic resonance imaging examinations, and an investigation into attention biases in anxiety. Professional Doctorate thesis, Murdoch University.

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Many patients report anxiety while undergoing magnetic resonance imaging (MRI). Apart from the immediate consequences of anxiety during the scan such as movement and withdrawal, there is also a risk that patients may develop more long term psychological reactions such as the development of fear. The aims of this research were to identify the best predictors of anxiety during MRI scans and the development of fears afterwards, to evaluate a cognitive behavioural intervention designed to prevent MRI anxiety and fear, and to assess the influence of the type of MRI machine on anxiety and fear. This study also aimed to investigate the development of biases in attention that have been associated with anxiety. Two studies were conducted to achieve these aims.

The first study involved 102 patients who participated in earlier research by Lukins (see Lukins, Davan, & Drummond, 1997). At least 7 months after their scan, these patients were re-assessed with selected items from the Fear Survey Schedule. It was found that MRI-related fears increased over time while other fears did not. Patients who were highly anxious during their scan were more likely to develop MRI-related fears than those who reported little anxiety. The relaxation intervention did not prevent the development of MRI­related fears.

The second study involved 95 patients scanned with one of two machines (the clinic's original machine and a newer model which replaced the first during the course of the study). Anxiety during the scan was best predicted by a claustrophobia questionnaire which assessed fears of suffocation and restriction. Anxiety during the scan also correlated significantly with trait anxiety, anxiety sensitivity, and anticipatory anxiety but not pain nor concern about the diagnosis. Claustrophobic fear was the best predictor of peak distress (the highest level of distress felt during the scan); however, concern about the diagnosis was also an important predictor of peak distress. Patients were re­assessed with the claustrophobia questionnaire approximately six weeks after their scan. There was no significant increase in claustrophobic fears after six weeks. None of the measures of anxiety, panic or fear taken before the scan or during the scan predicted a change in scores on the claustrophobia questionnaire.

When the two machines were compared, it was found that there was no appreciable change in anxiety in patients from the new machine whereas there was a substantial increase in anxiety in patients from the original machine. Features of the new machine, such as an elongated bore, improved airflow, colour of the internal surface of the bore, and external fitting of the head coil may have contributed to a less threatening environment for patients.

A cognitive-behavioural intervention was developed to prevent anxiety during the scan and the development of fears afterwards. Patients were· assigned to the control condition (no intervention), or an intervention which involved listening to an educational and instructional audio tape several times during the 3 weeks before their scan. The intervention was effective in limiting anxiety during the scan in the original machine but not in the new machine. The intervention did not influence the development of claustrophobic fears in either machine; neither was there any appreciable change in claustrophobic fears over time in the control group.

It was hypothesised that an intense anxiety experience may lead to threat-related biases in attention. This hypothesis was explored by comparing patients who became highly anxious during the scan to those who did not. Attention bias was assessed with a version of the Stroop task which was administered immediately before and after the scan. It was hypothesised that an increase in Stroop threat word interference would be observed in patients who became highly anxious during the scan. The hypothesis was not supported; indeed it appeared that patients who became highly anxious were more likely to process threat words faster after the scan than before when compared to those in the relaxation group who remained relatively calm. A further finding of interest was that an increase in claustrophobic fears at least six weeks after the scan was predicted by the degree of MRI threat word facilitation.

It was concluded that as machines become more patient friendly it may become more important to identify and target only the most vulnerable patients for psychological intervention. Also, it was suggested that the threat word facilitation observed in the Stroop data suggested that, unlike anxiety patients, the subjects tested here were able to override the tendency to be distracted by threatening information by increasing the effort directed to performing the primary task of colour-naming.

Item Type: Thesis (Professional Doctorate)
Murdoch Affiliation(s): Division of Social Sciences, Humanities and Education
Notes: Note to the author: If you would like to make your thesis openly available on Murdoch University Library's Research Repository, please contact: Thank you.
Supervisor(s): Drummond, Peter
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