Bridging the gap between mind and body: a biobehavioral model of the effects of guided imagery on pain, pain disability, and depression

Abstract

Chronic noncancer pain (CNCP) is a common and complex disorder associated with declines in physical health and functional status, emotional well-being, and quality of life. To best address the complexity of this condition, research and clinical practice for CNCP should be guided by a framework incorporating both biologic and psychologic factors. This article presents a biobehavioral model of chronic pain that hypothesizes mechanisms related to the effectiveness of a complementary therapy, guided imagery (GI), for this population. Using the research-to-model/theory strategy, we mapped findings from published reports of interdisciplinary research into physiologic and psychologic aspects of the nature and mechanisms of pain, as well as the use of GI for pain, to build the model of GI's effects on pain, pain disability, and depression. In the model, these outcomes of GI for persons experiencing CNCP are mediated by psychologic (pain self-efficacy and pain beliefs) and physiologic (immune-mediated analgesia and sickness response) variables. A biobehavioral approach to nursing phenomena will advance understanding of health and health-related issues and has the potential to improve outcomes through delineation of mechanisms underlying relationships between psychologic and biologic factors. Increased consumer use of complementary therapies to treat pain, the current cost-driven health care system, and the mandate for evidence-based practice support the need to validate the efficacy of such therapies. This empirically derived model provides a framework for practice and research for nurses and other health care providers to promote health, function, and well-being in persons with CNCP.