International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426
A Study to Evaluate the Effectiveness of Guided
Imagery Technique on Stress among Hypertensive
Patients in Selected Rural Areas of Kodaikanal
Taluk, Tamilnadu
Dr. Senthil Kavitha R
Associate Professor, ESIC College of Nursing, Kalaburagi, India
Abstract: Stress has long been listed as a potential and important cause of hypertension among other potential risk factors such as low
potassium consumption, low physical activity and sleep abnormalities. Acute stress can induce transient elevation of blood pressure, but
it is still unclear whether this effect results in sustained elevation of blood pressure and hypertension. This study examined the effect of
guided imagery visualization on stress of individuals with hypertensive patients. A pre and post test group design was selected for this
study. The randomized control trial (RCT) in which subjects were randomly assigned to one of two groups thirty samples in each groups:
the study group received the intervention of guided imagery that is being tested, and the other group control received a usual treatment
care. The two groups were pre tested then followed up at 7 th week and 12th week to see if there are any differences between them in
outcome. Simple lottery method was used to select the primary health centers for randomization. Subjects underwent 20 to 25 minutes of
Guided imagery audio relaxation was given daily for 7 weeks. Experts validated the tool of DVD and CD of Guided imagery relaxation
and reliability of Standardized tool of perceived stress scale was .83.Descriptive and inferential statistics were used for analysis. Results:
Pre test mean and standard deviation of control group was 31.3 and 54.566 and in study group was 22.8 and 4.2215. In post test it’s
observed that mean and standard deviation of study group stress level was found to be reduced distinctly on 21 days itself, followed by
greater reduction in 3months mean and standard deviation of 7.133 and 3.5109. Whereas in control group stress level changes were not
noted it’s found to be same level. The t value of pretest in both the groups was noticed as non significant (t=0.8508) The effectiveness of
Guided imagery was manifestly noted in 21 days with the t value of 2.1216 which was significant at p<0.05 level. Similarly strikingly
noted in 3 months with t value of t 17.2047 which was significant at p<0.05. In pretest 68% of them were noted in very high level stress
in control group and the same level found to be continued in 21 days and 3months. While in study group pretest stress level instituted as
65% in high group. Subjects who underwent guided imagery relaxation found in greater reduction of stress level on 21 days, 92 %
recognized in low stress level. When comparing before and after measures in 3 months 40% of them attained very low level stress and
57 % reached to low level and none of them observed in high and very high level stress level. Conclusion: Randomized control trial was
given the major strength of this study & findings bring out the conclusion that there was a significant reduction in stress level after
guided imagery in study group among hypertensive patient after 3 months. Guided imagery is safe, practice sessions strength
optimistically influence mood and reduce cortisol level, hormonal regulation can have health implications for hypertensive patients
Keywords: Effectiveness, Guided imagery, Stress, RCT, Perceived Stress Scale, Rural Hypertensive Patients
1. Introduction Fourth District Level Household Survey reported
hypertension in 25.3% with greater prevalence in men
Hypertension is widely considered to be one of the most (27.4%) than women (20.0%). This translates into 207
important risk factors of cardiovascular diseases (angina, million persons (men 112 million, women 95 million) with
arrhythmia, etc.). It is the second leading disease that causes hypertension in India2
mortality in the world. Hypertension is the condition when
there is an increase in the force of blood on the walls of Stress is a normal part of life. Excessive stress in life may
vessels. It can be extremely serious and often referred to as face serious health problems. That’s because body’s “fight
the” silent killer “, because there are no symptoms in the or flight reaction” its natural alarm system is constantly on.
early stages of disease. One in three adults worldwide when we encounter perceived stress threats hypothalamus, a
tiny region at the base of brain, sets of the alarm system in
An estimated 1.13 billion people worldwide have our body. A positive attitude and self esteem are good
hypertension, most (two-thirds) living in low- and middle- defenses against stress, because they help to view stress as a
income countries. In 2015, 1 in 4 men and 1 in 5 women had challenge rather than a problem. But too much stress can
hypertension. Fewer than 1 in 5 people with hypertension lead to emotional, psychological and even physical problems
have the problem under control. Hypertension is a major including heart diseases, high BP, chest pain or irregular
cause of premature death worldwide. One of the global heartbeats. It could be because chronic stress hormones like
targets for noncommunicable diseases is to reduce the adrenaline and cortisol.
prevalence of hypertension by 25% by 2025 1
So relaxation is an active process involving techniques that
Fourth National Family Health Survey evaluated calm our body and mind. There are number of methods used
hypertension in a large population based sample (n = 799, to relax, guided imagery relaxation is a proven form of
228) and reported hypertension in 13.8% men vs. 8.8% focused relaxation that helps create harmony between the
women (overall 11.3%) aged 15–49 and 15–54 respectively. mind and body. In healing repetitive use of positive
More representative data (age > 18 years, n = 1, 320, 555) in visualization allows access to the mind and body connection.
Volume 8 Issue 12, December 2019
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20203176 DOI: 10.21275/ART20203176 124
International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426
This lets the mind and body work together to foster the tool of perceived stress scale reliability was .89. Descriptive
healing process of the body on a physical level. and inferential statistics were used for analysis.
Guided imagery is a right brain function will access Ethical clearance: Ethical clearance was taken from
functions such as emotion, intuition, empathy, laughter, Institutional Ethical Committee Board of Jayaraj
sensitive to music and openness to spirituality. A low cost Annapackium Christian college of Nursing, Madurai and
guided imagery program can be a valuable complement to from Government officer of Pannaikadu government
medical treatment of hypertension by contributing to more hospital, Written consent of each subject was obtained
effective management of blood pressure, better adherence to before the study. Confidentiality was maintained throughout
therapy, decreased need of doctor’s visit and higher quality the study.
of life. Even ten minutes of imagery can reduce blood
pressure, lower cholesterol levels, glucose levels and 5. Results and Discussion
heighten short term immune cell activity and quality of life
and sense of discomfort may be improved guided imagery Table 1: Comparison of Mean and Standard deviation of
techniques through imagery training tapes. 3 stress in control group and study group
Pretest Post Test- 21 days Post test - 3 Months
2. Objectives Control Study Control Study Control Study
Group Group Group Group Group Group
To determine the effectiveness of guided imagery on stress Mean & Mean & Mean & Mean & Mean & Mean &
among hypertensive patients of selected rural areas in SD SD SD SD SD SD
31.3 22.8 31.3 10.166 22 7.133
experimental group.
54.556 4.2215 54.566 0.7915 3.1741 3.5109
3. Hypothesis Study findings of the stress mean and standard deviations in
between the group are summarized in table1. Pre test mean
There will be a significant difference in pre and post test and standard deviation of control group was 31.3 and 54.566
stress among hypertensive patients of selected rural areas in and in study group was 22.8 and 4.2215. In post test it’s
experimental and control group. observed that mean and standard deviation of study group
stress level was found to be reduced distinctly on 21 days
4. Materials and Methods itself, followed by greater reduction in 3months, mean and
standard deviation was 7.133 and 3.5109. Whereas in
The evaluative research approach was adopted for this study. control group stress level changes were not noted it’s found
A pre and post test group design was selected for this study. to be same level.
The randomized control trial (RCT) in which subjects was
randomly assigned to one of two groups thirty samples in Table 2: Comparison of T value in stress in control group
each groups: the study group received the intervention of and study group
guided imagery that is being tested, and the other group Post test – t value
Pre test – t value
control received a usual treatment care. The two groups were 21days 3 months Overall
pre tested then followed up at 7th week and 12th week to see t = 0.8508 t = 2.1216 t = 17.2047 t =15.6286
if there are any differences between them in outcome. p>0.05NS p<0.05* p< 0.05* p<0.05*
Simple lottery method was used from primary health centers *P value < 0.05 significant, P >0.05Ns Non Significant
for randomization. Subjects underwent guided imagery
visualizations preliminary training program of 1 week Study findings of the stress t value in between the group are
through DVD followed by GI audio relaxation. Individual summarized in table2. The t value of pretest in both the
attention had been given to subjects to clarify their doubts. groups was noticed as non significant (t=0.8508) The
Thereafter 20 to 25 minutes of Guided imagery audio effectiveness of Guided imagery was manifestly noted in 21
relaxation was given daily for 7 weeks. Study conducted at days with the t value of 2.1216 which was significant at
villages of pannaikadu and Mangalmgombu, Kodaikanal, p<0.05 level. Similarly strikingly noted in 3 months with t
Tamilnadu. Experts validated the tool of DVD and CD of value of t 17.2047 which was significant at p<0.05..
Guided imagery relaxation and reliability of standardized
Table 3: Comparison of Grading of Stress in Control Group and Study Group
Control group (n= 30) Study group (n= 30)
Post test
Aspect Grading Pre test Pretest
21 days 3months 21 days 3months
f % f % f % f % f % f %
Upto 7 Very low 0 0 0 0 0 0 0 0 0 0 16 40
8-11 Low 0 0 0 0 0 0 0 0 27 92 13 57
12-15 Average 0 0 0 0 0 0 0 0 3 8 1 3
16-20 High level 13 32 13 32 13 32 16 65 0 0 0 0
21 & > Very high 17 68 17 68 17 68 14 35 0 0 0 0
Table 3 concluded the grading of stress in control group with level stress in control group and the same level found to be
study group. In pretest 68% of them were noted in very high continued in 21 days and 3months. While in study group
Volume 8 Issue 12, December 2019
www.ijsr.net
Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20203176 DOI: 10.21275/ART20203176 125
International Journal of Science and Research (IJSR)
ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426
pretest stress level rated as 65% in high level stress. Subjects
who underwent guided imagery relaxation found in greater
reduction of stress level on 21 days, 92 % recognized in low
stress level. When comparing before and after measures in 3
months 40% of them attained very low level stress and 57 %
reached to low level and none of them observed in high and
very high level stress level.
None of the demographic variables such as sex, education,
family history, medications, life style, dietary pattern and
bad habits were associated with stress level in study except
age and duration of illness in both the groups.
Study findings correspond to a study on prospective,
longitudinal study of 69 women used a RCT design with
two groups conducted over 4 weeks for hypertensive
pregnancy women. Guided imagery relaxation CDs
influenced the study outcomes. 75% reported enjoyment and
ease of use indicated they would use it for future
hypertension in pregnancy and for stress4.
Randomized control trial was given the major strength of
this study & findings bring out the conclusion that there was
a significant reduction in stress level after guided imagery in
study group among hypertensive patient after 3 months.
6. Conclusion
The study clearly establishes a significant reduction of stress
level in study group. A spike in blood pressure is a direct
result of stress. Constant stress can cause hypertension by
releasing a surge of hormones in preparation for a fight or
flight response. Guided imagery relaxation audiotapes is a
safe and improve healing, So its proved to be a suitable
intervention for hypertensive patients in reducing stress
levels.
References
[1] Hypertension ; https://www.who.int/news-room/fact-
sheets/detail/hypertension
[2] Gupta R, Xavier D Hypertension: the most important
non-communicable disease risk factor in India. Indian
Heart J. 2018; 10.1016/j.ihj.2018.02.003.
[3] Stress and high blood pressure. Webmed medical
reference http://www.webmed.com/hypetension-
highbloodpressure/guide/hypertension-easing-
stress?page=3
[4] Mofatt FW, Hodnott E, Esplen MI, watt-Watson J
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[5] Stress and psycho neuroimmunology revisited: using
mindbody interventions to reduce stress .Alternative
Journal of nursing. July 2006;issue 11.Available from:
http;//www.altjn.com/perspectives/stress.pdf
[6] Elizabeth Scott, MS.Using guided imagery for stress
management about.comguide.updated October 10, 2007
Available from
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gery.htm
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Licensed Under Creative Commons Attribution CC BY
Paper ID: ART20203176 DOI: 10.21275/ART20203176 126
