Clinical Case #1
Mr. Roof is a 45-year-old, Caucasian, married man who presents for vasectomy. He was previously scheduled for the procedure two weeks ago, but he did not keep the appointment. He lives with his wife, who is wheelchair bound due to multiple sclerosis, and their four children, ages 14-20. He works full-time as a contractor/carpenter. He has smoked two packs of cigarettes a day for 25 years. He reports drinking four to five beers once a week (Saturdays). His medical history is otherwise unremarkable. He reports anxiety related to the vasectomy procedure. He reports anxiety to the degree that he felt he could not manage to keep the original appointment. He is apologetic for missing it, and reiterates his decision to have the vasectomy, stating that he knows it is what he wants, but that the thought of the procedure is anxiety-provoking. He has had difficulty sleeping and concentrating since making both the original appointment, as well as the reschedule. He reports to irritability and in recent days, a sense of dread and occasional sensation of shortness of breath. He appears anxious in clinic today.
What can you do to assist Mr. Roof with his anxiety related to the procedure, and to successfully complete the procedure?
Normalize and Educate
After normalizing his anxiety, you may suggest that often, people find it helpful to take just a few minutes to release the uncomfortable sensations of worrying.
Remember to choose your words carefully (click to review "Imagery-Evoking Language" section).
The classic induction for imagery is to focus on the breath and the act of breathing. Assess whether your patient would prefer to remain seated in a chair, or would be most comfortable lying on the table.
Introduce the concept of using the breath to release tension or worry. Show the patient where the diaphragm is located and encourage the patient to place a hand over the diaphragm so they can monitor their breathing. It helps when the clinician demonstrates.
Induction and Guided Imagery
Listen to a brief recording of a suggested breathing exercise that leads into a visualization exercise designed to stimulate the mind’s senses and provide a calming, relaxed focus.
Listed to an exercise in breath and procedure preparation.
Here is a PDF of the script.
Use of Guided Imagery Beyond This Visit
Additional careplanning for Mr. Roof may include smoking cessation and stress management. Guided imagery can be adjunctive to medications or a stand-alone intervention to accomplish behavioral changes such as smoking cessation. It also would be beneficial for management of psychosocial stressors identified in clinic today.
See the Resource Section for:
1) The PDF of "Tips for Effective Use of Guided Imagery for Health and Well Being" that you may print and give to Mr. Roof, and
2) A list of resources for patients who want to explore guided imagery as a tool for health and well being, including resources specifically for issues such as smoking cessation, stress management and wellness (also attached below). You may also print and provide this to Mr. Roof.