Exploring Alternatives to Drugs for Anxiety in Healthcare Procedures

In this 11-minute video Carole Weisfeld, Ph.D. and two doctoral candidates who were part of Detroit Mercy’s doctoral program in clinical psychology discuss how this research project began and what they learned from the experience.

Read the project's full synopsis below:

Is it possible to reduce patient anxiety in healthcare settings without using pharmaceutical interventions? Three graduate students in Detroit Mercy’s Clinical Psychology Ph.D. Program joined an interdisciplinary team of professionals trying to answer that very question in an ambitious literature review that took five years to complete, resulting in two articles being published in the highly regarded Journal of Alternative and Complementary Medicine. Instead of focusing on music or hypnosis as an intervention, the team searched existing literature; finding every study ever done on reducing patient anxiety for healthcare procedures, including dental procedures, without medicating patients. The question is important, because a calm patient will experience less pain and faster healing; but medicating a patient to induce calmness can cause other complications, such as constipation and nausea.

The project began when Carol Weisfeld, recently retired from psychology, was teaching a course on Health Psychology with the assistance of Jill Turner, a Librarian in the Detroit Mercy School of Dentistry. Based on articles in journals for Health Psychology (a relatively new field that addresses patients’ physical and psychological needs in a holistic way), the two were struck by how effectively patient anxiety could be reduced by means of massage or acupuncture. Turner pitched the literature review idea to her colleague Jen Bowen, and to Nursing faculty member Arthur Ko; both agreed to help. Weisfeld recruited two physical therapists from other universities, Kim Dunleavy and Kristen Robertson. Three of Detroit Mercy’s Clinical Psychology Ph.D. students, Brandi Roelk, Reem Eissa and Erica Benfield, learned of the project and volunteered to help as well.

Turner and Bowen organized a massive electronic literature search for relevant experimental work in medical and dental journals, finding 48,324 journal articles and 257 dissertations published from 1974 to 2018. The team then divided up the work, reviewing 718 experimental journal articles that merited complete evaluation, after screening abstracts to eliminate articles that weren't relevant (like pediatric articles, or articles that didn’t describe an experiment). After this phase of screening, they began reading, scoring articles on a quality measure and coding all the findings on an Excel spreadsheet. Of the initial 718 experimental journal articles, they chose to include 408 that met the criteria for the final Systematic Literature Review (SLR).

After organizing these final articles based on healthcare discipline and type of intervention, patterns emerged that helped the team make sense of all the data. In their first article published, the team described the SLR process and what the patterns of findings looked like in various healthcare specialties. Across studies, they found that the non-pharmaceutical approaches had a 71% success rate overall for significantly reducing patient anxiety— a percentage quite comparable to the success rate for prescription drugs, but without side effects. The first review article published by the team reported that surgery, for example, had often utilized music or patient education to reduce patient anxiety before a surgical procedure, with a success rate of 78-79%. Massage, acupuncture, and hypnosis were even better, being 100% effective, but there had been fewer experiments with them – this is where the review called for more research! Colonoscopy, however, was completely different. Music was only half as successful in reducing anxiety. Hypnosis and relaxation, it was found, were much more helpful during colonoscopy. In their second article, the team summarized why particular interventions seemed to work in particular healthcare domains and not in others. They found that, while patient education often helped, it would sometimes backfire and actually raise patient anxiety, a case that was especially true for colonoscopy. Patient education, they wrote, probably needs to be combined with some relaxation technique. Another method described was distraction; for example, playing a video game reduced anxiety in children but not in adults (except in dentistry, where dental personnel have used it successfully for 50 years)!

As for our Ph.D. students, they have put this experience into practice. Dr. Brandi Roelk completed her postdoctoral fellowship at the VA’s Center for Integrated Health in Syracuse/Rochester NY, where she is currently employed as a project director, coordinating funded research. Dr. Erica Benfield defended her dissertation in June of 2022 and she is about to begin a postdoctoral fellowship at the Rehabilitation Institute of Michigan in the DMC. Reem Eissa starts her internship in the Fall of 2022 at the University of Texas Health at San Antonio, TX. Bravo, team!