PREOPERATIVE REHEARSAL OF ACTIVE COPING IMAGERY INFLUENCES SUBJECTIVEAND HORMONAL RESPONSES TO ABDOMINAL-SURGERY

Existing evidence suggests that preoperative psychological preparation that is designed to reduce anxiety may sensitize cortisol and adrenal ine responses to surgery. In a controlled trial of abdominal surgery p atients, we therefore tested the effects of a preoperative preparation that used guided imagery, not to reduce anxiety, but to increase pati ents' feelings of being able to cope with surgical stress; 26 imagery patients were compared with 25 controls who received, instead, backgro und information about the hospital. State-anxiety was similar in each group, but imagery patients experienced less postoperative pain than d id the controls, were less distressed by it, felt that they coped with it better, and requested less analgesia, Hormone levels measured in p eripheral venous blood did not differ on the afternoon of admission, b efore preparation. Cortisol levels were, however, lower in imagery pat ients than in controls immediately before and after surgery. Noradrena line levels were greater on these occasions in imagery patients than c ontrols. The results are interpreted in relation to two theories. One states that preoperative ''worry'' reduces surgical stress. The other concerns the influence of active and passive coping on endocrine respo nses to stress.