The Effect of Guided Imagery on Anxiety and Sleep Quality in Hemodialysis Patients: A Randomized Clinical Trial

Background and Objectives: Sleep disturbance and anxiety are common problems in patients undergoing hemodialysis, which can be influenced by use of complementary medicine. Therefore, the objective of this study was to determine the effect of guided imagery on anxiety and quality of sleep in patients undergoing hemodialysis.   Methods: This clinical trial study was carried out on 70 hemodialysis patients, who were divided into two intervention (35 subjects) and control (35 subjects) groups using block randomization method. In addition to receiving usual care, the intervention group received a compact disc (CD) of guided Imagery through headphones for a consecutive period of 4 weeks, and the control group received just the usual care. At the beginning and the end of the study, the Spielberger Anxiety Inventory and Pittsburgh Sleep Quality Index, were completed. Data were analyzed using descriptive and analytical statistical tests (independent t-test, paired t-test, and covariance analysis) using SPSS Version 16 at a significant level less than 0.05.   Results: The results of the study revealed that the prevalence of state and trait anxiety and the sleep quality of patients in the intervention group, were 54.42 ± 3.58, 52.05 ± 3.15 and 8.45 ± 2.31, respectively, and in the control group, were 47.91 ± 7. 21, 49.37 ± 5.49, and 6.51 ± 2.82, respectively; so that the mean anxiety scores in the intervention group, was significantly higher than the control group (p < 0.001). After the intervention, the anxiety score in the intervention group, was 43.05 ± 2.15 and 42.48 ± 2.06 and in the control group, was 47.37 ± 6.38 and 49.40±5.79, respectively, and the mean of the anxiety scores in the group was 47.37 ± 6.38, so that the mean anxiety score in the intervention group was significantly lower compared to the control group (p < 0.001). Moreover, the sleep quality score before the intervention was 8.45 ± 2.31 in the intervention group, which became 6.54 ± 1.93 after the intervention. Sleep quality score in the control group before the intervention, was 6.51 ± 2.82, which became 6.02 ± 2.47 after the intervention.   Conclusion: Use of guided imagery reduced anxiety and improved sleep quality in the hemodialysis patients. Thus, use of this technique is recommended as a non-pharmacological approach to reduce anxiety and improve the quality of sleep in patients undergoing hemodialysis.