The Bonny Method of Guided Imagery and Music (BMGIM) with Cancer Survivors: A Psychosocial Study with Focus on the Influence of BMGIM on Mood and Quality of Life

SHORT SUMMARY MAIN RESEARCH QUESTION: What is the influence of ten individual BMGIM sessions on mood and quality of life in cancer survivors? - The investigation addresses the following sub-questions: 1) Can ten BMGIM sessions improve the mood of the participants? 2) Can ten BMGIM sessions improve the quality of life of the participants? 3) Can music and imagery help the participants in their rehabilitation process? 4) What is the experience of the participants of BMGIM and its effects on mood and quality of life in the rehabilitation process? 5) What is the specific nature of the imagery or image configuration of cancer survivors in GIM? 6) How does the imagery develop and/or is re-configured during GIM therapy? 7) What elements are there that describe the relationship between the music and the imagery transformations? Subquestions 1-3 are addressed in a quantitative investigation with 10 hypotheses. Subquestions 4-8 are addressed in a qualitative investigation in three parts: 1. with focus on the participants’ experience of the BMGIM therapy, 2. with focus on the imagery, 3. with focus on the interrelationship between music and imagery. METHOD The quantitative investigation: Clinical trial/Pre-Post-Follow-Up-design/Multiple case study design. Participants: 6 women 40-65 years old in cancer rehabilitation (1,5 to 18 months after remissal from hospital) received 10 biweekly, individual BMGIM session conducted by a GIM therapist. Setting: The standard BMGIM format, and the standard GIM music repertoire (programs and selections) was used. The music-listening periods of the sessions were recorded (mini-disc). The therapist made standard transcripts and summaries of the sessions. Mandalas made by participants were optional and therefore not included in the data material. Data sampling: The following questionnaires/self reports were used: (a) Hospital Anxiety and Depression Scale (HADS) + (a1) Four specific MT/GIM questions (b) European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), (c) Antonovsky's Sense of Coherence Scale (SOC) After every session questionnaires (a) + (a1) + (b) were filled in. After termination and 6 weeks later all questionnaires were filled in. 2-4 weeks after FU all participants were interviewed. The qualitative investigation: 1) Grounded theory analysis of interviews with the six participants, 2) Grounded theory analysis of images and metaphors in all sessions, 3) 2 case studies – a hermeneutic/mimetic analysis of the imagery and its development in two participants, 4) Event structure analyses of the interrelationship of music and imagery in 4 music selection, 5) Grounded theory inspired categorization of music used in the project. RESULTS : Quantitative data analysis Results (descriptive statistics) of the quantitative study + preliminary results of the interview study have been presented at conferences in Norway and Denmark (Preliminary report in Danish available in pdf – send mail to me).Inferential statistics (Wilcoxon Signed Ranks Test) and Effect Sizes were calculated on (selected) scores of the three questionnaires: HADS: Significant effect found Pre-FU Anx: ,045 (Effect size: 1.33). QLQ-C30: No significant effects found. SOC: Significant effect found Pre-Post: ,028 (Effect size: 0.62) and Pre-FU: ,027 (Effect size: 0.41) RESULTS: Qualitative data analysis In the analysis of the semi-structured interviews with the six participants the following core categories emerged: Enhanced coping (all 6 participants), Improved mood (6), New perspectives on past/present/future (6 participants), Enhanced Hope (6), Improved self understanding (5 of 6), Coming to terms with life and death (4 of 6), Opening towards spirituality (4 of 6). The imagery of the participants (as recorded on minidisc and transcribed by therapist and researcher) was analysed, based on the principles of (1) grounded theory (Strauss & Corbin); and (2) hermeneutic investigation (Ricoeur). The analyses show that core metaphors and self metaphors emerged with all six participants, and that configuration of metaphors in narrative episodes or longer, coherent narratives could be identified in 5 of the 6 participants. The interrelationship between music and imagery was analysed a) in a comparative analysis of the imagery of the 6 participants, and of the relationship between music and imagery, in two specific GIM music selections: Brahms’ Violin Concerto, 2nd movement, and Bach’s Concerto for two violins, 2nd movement (representing two different types of therapeutic agendas: a more challenging and a more supportive music selction). b) in a comparative content analysis of 4 participants’ imagery to two Bach Choral preludes Komm süsser Tod and Mein Jesu! These analyses include: • Transcription of minidisc recordings (inserting transcribed dialogue in scores) • Heuristic Music Analysis (Bruscia 1999, 2003) of the two (a) selections (including Phenomenological description, SMME analysis (Grocke 1999) and Intensity profiles • Event structure analysis, correlating the imagery of the clients with the findings of the music analysis (Tesch 1992, Grocke 1999, Marr 2000) • Grounded theory analysis of the imagery/narrative (types and configurations of the imagery) Results of this study music and imagery study: • identification of three categories of music: supportive, mixed and challenging music, each category with specific therapeutic potentials. • uncovering of a close interplay of music and imagery/metaphors: the configuration of the metaphors follows the narrative matrix of the music • proposition of a grounded theory on the therapeutic function of music in BMGIM.