Nurses often become motivated to change aspects within the larger health care system based on their real-world experience. As such, many nurses take on an advocacy role to influence a change in regulations, policies, and laws that govern the larger health care system.
For this assignment, identify a problem or concern in your state(ILLINOIS), community, or organization that has the capacity for advocacy through legislation. Research the issue and use the "Advocacy Through Legislation" template to complete this assignment.
You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide.
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Advocacy Through Legislation
Identify a problem or concern in your state, community, or organization that has the capacity to be advocated through legislation. Research the issue and complete the sections below. For each topic that requires the listing of criteria, a minimum of two criteria should be identified and discussed. Add more rows as is appropriate for the topic/proposal.
In no more than 250 words, describe the problem, who is affected, and the current ramifications. Explain the consequences if the issue continues.
Idea for Addressing Solution
In no more than 250 words, outline your idea for addressing the issue and explain why legislation is the best course for advocacy.
Research the Issue
Perform research and compile information for your idea. Present substantive evidence-based findings that support your idea for addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.
Discuss the stakeholders who would support the proposed idea and explain why they would be in support.
Stakeholder(s) Supporting 1
Stakeholder(s) Supporting 2
Discuss the stakeholders who would oppose the proposed idea. Explain why they would be in opposition and how you would prepare to debate or converse about these considerations.
Stakeholder(s) Opposed 1
Stakeholder(s) Opposed 2
In no more than 250 words, summarize the financial impact for the issue and the idea (added costs, cost savings, increased revenue, etc.). Provided support.
Legislature: Information Needed and Process for Proposal
Discuss the how to advocate for your proposal using legislation. Include the following:
Provide the name and complete contact information for the legislator.
Describe the steps for how you would present this to your legislator.
Outline the process if your legislator chooses to introduce your idea as a bill to congress.
Christian Principles and Nursing Advocacy
In no more than 250 words, discuss how principles of a Christian worldview lend support to legislative advocacy in health care without bias. Be specific as to how these principles help advocate for inclusiveness and positive health outcomes for all populations, including those more vulnerable, without regard to gender, sexual orientation, culture, race, religion/belief, etc.
© 2019. Grand Canyon University. All Rights Reserved.
Running head: GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
Hannah K. Greenbaum
Department of Psychology, The George Washington University
PSYC 3170: Clinical Psychology
Dr. Tia M. Benedetto
October 1, 2019
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
A majority of Americans experience stress in their daily lives (American Psychological Association, 2017). Thus, an important goal of psychological research is to evaluate techniques that promote stress reduction and relaxation. Two techniques that have been associated with reduced stress and increased relaxation in psychotherapy contexts are guided imagery and progressive muscle relaxation (McGuigan & Lehrer, 2007). Guided imagery aids individuals in connecting their internal and external experiences, allowing them, for example, to feel calmer externally because they practice thinking about calming imagery. Progressive muscle relaxation involves diaphragmatic breathing and the tensing and releasing of 16 major muscle groups; together these behaviors lead individuals to a more relaxed state (Jacobson, 1938; Trakhtenberg, 2008). Guided imagery and progressive muscle relaxation are both cognitive behavioral techniques (Yalom & Leszcz, 2005) in which individuals focus on the relationship among thoughts, emotions, and behaviors (White, 2000).
Group psychotherapy effectively promotes positive treatment outcomes in patients in a cost-effective way. Its efficacy is in part attributable to variables unique to the group experience of therapy as compared with individual psychotherapy (Bottomley, 1996; Yalom & Leszcz, 2005). That is, the group format helps participants feel accepted and better understand their common struggles; at the same time, interactions with group members provide social support and models of positive behavior (Yalom & Leszcz, 2005). Thus, it is useful to examine how stress reduction and relaxation can be enhanced in a group context.
The purpose of this literature review is to examine the research base on guided imagery and progressive muscle relaxation in group psychotherapy contexts. I provide overviews of both guided imagery and progressive muscle relaxation, including theoretical foundations and historical context. Then I examine guided imagery and progressive muscle relaxation as used on their own as well as in combination as part of group psychotherapy (see Baider et al., 1994, for more). Throughout the review, I highlight themes in the research. Finally, I end by pointing out limitations in the existing literature and exploring potential directions for future research.
Features of Guided Imagery
Guided imagery involves a person visualizing a mental image and engaging each sense (e.g., sight, smell, touch) in the process. Guided imagery was first examined in a psychological context in the 1960s, when the behavior theorist Joseph Wolpe helped pioneer the use of relaxation techniques such as aversive imagery, exposure, and imaginal flooding in behavior therapy (Achterberg, 1985; Utay & Miller, 2006). Patients learn to relax their bodies in the presence of stimuli that previously distressed them, to the point where further exposure to the stimuli no longer provokes a negative response (Achterberg, 1985).
Contemporary research supports the efficacy of guided imagery interventions for treating medical, psychiatric, and psychological disorders (Utay & Miller, 2006). Guided imagery is typically used to pursue treatment goals such as improved relaxation, sports achievement, and pain reduction. Guided imagery techniques are often paired with breathing techniques and other forms of relaxation, such as mindfulness (see Freebird Meditations, 2012). The evidence is sufficient to call guided imagery an effective, evidence-based treatment for a variety of stress-related psychological concerns (Utay & Miller, 2006).
Guided Imagery in Group Psychotherapy
Guided imagery exercises improve treatment outcomes and prognosis in group psychotherapy contexts (Skovholt & Thoen, 1987). Lange (1982) underscored two such benefits by showing (a) the role of the group psychotherapy leader in facilitating reflection on the guided imagery experience, including difficulties and stuck points, and (b) the benefits achieved by social comparison of guided imagery experiences between group members. Teaching techniques and reflecting on the group process are unique components of guided imagery received in a group context (Yalom & Leszcz, 2005).
Empirical research focused on guided imagery interventions supports the efficacy of the technique with a variety of populations within hospital settings, with positive outcomes for individuals diagnosed with depression, anxiety, and eating disorders (Utay & Miller, 2006). Guided imagery and relaxation techniques have even been found to “reduce distress and allow the immune system to function more effectively” (Trakhtenberg, 2008, p. 850). For example, Holden-Lund (1988) examined effects of a guided imagery intervention on surgical stress and wound healing in a group of 24 patients. Patients listened to guided imagery recordings and reported reduced state anxiety, lower cortisol levels following surgery, and less irritation in wound healing compared with a control group. Holden-Lund concluded that the guided imagery recordings contributed to improved surgical recovery. It would be interesting to see how the results might differ if guided imagery was practiced continually in a group context.
Guided imagery has also been shown to reduce stress, length of hospital stay, and symptoms related to medical and psychological conditions (Scherwitz et al., 2005). For example, Ball et al. (2003) conducted guided imagery in a group psychotherapy format with 11 children (ages 5–18) experiencing recurrent abdominal pain. Children in the treatment group (n = 5) participated in four weekly group psychotherapy sessions where guided imagery techniques were implemented. Data collected via pain diaries and parent and child psychological surveys showed that patients reported a 67% decrease in pain. Despite a small sample size, which contributed to low statistical power, the researchers concluded that guided imagery in a group psychotherapy format was effective in reducing pediatric recurrent abdominal pain.
However, in the majority of guided imagery studies, researchers have not evaluated the technique in the context of traditional group psychotherapy. Rather, in these studies participants usually met once in a group to learn guided imagery and then practiced guided imagery individually on their own (see Menzies et al., 2014, for more). Thus, it is unknown whether guided imagery would have different effects if implemented on an ongoing basis in group psychotherapy.
Progressive Muscle Relaxation
Features of Progressive Muscle Relaxation
Progressive muscle relaxation involves diaphragmatic or deep breathing and the tensing and releasing of muscles in the body (Jacobson, 1938). Edmund Jacobson developed progressive muscle relaxation in 1929 (as cited in Peterson et al., 2011) and directed participants to practice progressive muscle relaxation several times a week for a year. After examining progressive muscle relaxation as an intervention for stress or anxiety, Joseph Wolpe (1960; as cited in Peterson et al., 2011) theorized that relaxation was a promising treatment. In 1973, Bernstein and Borkovec created a manual for helping professionals to teach their clients progressive muscle relaxation, thereby bringing progressive muscle relaxation into the fold of interventions used in cognitive behavior therapy. In its current state, progressive muscle relaxation is often paired with relaxation training and described within a relaxation framework (see Freebird Meditations, 2012, for more).
Research on the use of progressive muscle relaxation for stress reduction has demonstrated the efficacy of the method (McGuigan & Lehrer, 2007). As clients learn how to tense and release different muscle groups, the physical relaxation achieved then influences psychological processes (McCallie et al., 2006). For example, progressive muscle relaxation can help alleviate tension headaches, insomnia, pain, and irritable bowel syndrome. This research demonstrates that relaxing the body can also help relax the mind and lead to physical benefits.
Progressive Muscle Relaxation in Group Psychotherapy
Limited, but compelling, research has examined progressive muscle relaxation within group psychotherapy. Progressive muscle relaxation has been used in outpatient and inpatient hospital settings to reduce stress and physical symptoms (Peterson et al., 2011). For example, the U.S. Department of Veterans Affairs integrates progressive muscle relaxation into therapy skills groups (Hardy, 2017). The goal is for group members to practice progressive muscle relaxation throughout their inpatient stay and then continue the practice at home to promote ongoing relief of symptoms (Yalom & Leszcz, 2005).
Yu (2004) examined the effects of multimodal progressive muscle relaxation on psychological distress in 121 elderly patients with heart failure. Participants were randomized into experimental and control groups. The experimental group received biweekly group sessions on progressive muscle relaxation, as well as tape-directed self-practice and a revision workshop. The control group received follow-up phone calls as a placebo. Results indicated that the experimental group exhibited significant improvement in reports of psychological distress compared with the control group. Although this study incorporated a multimodal form of progressive muscle relaxation, the experimental group met biweekly in a group format; thus, the results may be applicable to group psychotherapy.
Progressive muscle relaxation has also been examined as a stress-reduction intervention with large groups, albeit not therapy groups. Rausch et al. (2006) exposed a group of 387 college students to 20 min of either meditation, progressive muscle relaxation, or waiting as a control condition. Students exposed to meditation and progressive muscle relaxation recovered more quickly from subsequent stressors than did students in the control condition. Rausch et al. (2006) concluded the following:
A mere 20 min of these group interventions was effective in reducing anxiety to normal levels
. . . merely 10 min of the interventions allowed [the high-anxiety group] to recover from the stressor. Thus, brief interventions of meditation and progressive muscle relaxation may be effective for those with clinical levels of anxiety and for stress recovery when exposed to brief, transitory stressors. (p. 287)
Thus, even small amounts of progressive muscle relaxation can be beneficial for people experiencing anxiety.
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
Combinations of relaxation training techniques, including guided imagery and progressive muscle relaxation, have been shown to improve psychiatric and medical symptoms when delivered in a group psychotherapy context (Bottomley, 1996; Cunningham & Tocco, 1989). The research supports the existence of immediate and long-term positive effects of guided imagery and progressive muscle relaxation delivered in group psychotherapy (Baider et al., 1994). For example, Cohen and Fried (2007) examined the effect of group psychotherapy on 114 women diagnosed with breast cancer. The researchers randomly assigned participants to three groups: (a) a control group, (b) a relaxation psychotherapy group that received guided imagery and progressive muscle relaxation interventions, or (c) a cognitive behavioral therapy group. Participants reported less psychological distress in both intervention groups compared with the control group, and participants in the relaxation psychotherapy group reported reduced symptoms related to sleep and fatigue. The researchers concluded that relaxation training using guided imagery and progressive muscle relaxation in group psychotherapy is effective for relieving distress in women diagnosed with breast cancer. These results further support the utility of guided imagery and progressive muscle relaxation within the group psychotherapy modality.
Limitations of Existing Research
Research on the use of guided imagery and progressive muscle relaxation to achieve stress reduction and relaxation is compelling but has significant limitations. Psychotherapy groups that implement guided imagery and progressive muscle relaxation are typically homogeneous, time limited, and brief (Yalom & Leszcz, 2005). Relaxation training in group psychotherapy typically includes only one or two group meetings focused on these techniques (Yalom & Leszcz, 2005); thereafter, participants are usually expected to practice the techniques by themselves (see Menzies et al., 2014). Future research should address how these relaxation techniques can assist people in diverse groups and how the impact of relaxation techniques may be amplified if treatments are delivered in the group setting over time.
Future research should also examine differences in inpatient versus outpatient psychotherapy groups as well as structured versus unstructured groups. The majority of research on the use of guided imagery and progressive muscle relaxation with psychotherapy groups has used unstructured inpatient groups (e.g., groups in a hospital setting). However, inpatient and outpatient groups are distinct, as are structured versus unstructured groups, and each format offers potential advantages and limitations (Yalom & Leszcz, 2005). For example, an advantage of an unstructured group is that the group leader can reflect the group process and focus on the “here and now,” which may improve the efficacy of the relaxation techniques (Yalom & Leszcz, 2005). However, research also has supported the efficacy of structured psychotherapy groups for patients with a variety of medical, psychiatric, and psychological disorders (Hashim & Zainol, 2015; see also Baider et al., 1994; Cohen & Fried, 2007). Empirical research assessing these interventions is limited, and further research is recommended.
Directions for Future Research
There are additional considerations when interpreting the results of previous studies and planning for future studies of these techniques. For example, a lack of control groups and small sample sizes have contributed to low statistical power and limited the generalizability of findings. Although the current data support the efficacy of psychotherapy groups that integrate guided imagery and progressive muscle relaxation, further research with control groups and larger samples would bolster confidence in the efficacy of these interventions. In order to recruit larger samples and to study participants over time, researchers will need to overcome challenges of participant selection and attrition. These factors are especially relevant within hospital settings because high patient turnover rates and changes in medical status may contribute to changes in treatment plans that affect group participation (L. Plum, personal communication, March 17, 2019). Despite these challenges, continued research examining guided imagery and progressive muscle relaxation interventions within group psychotherapy is warranted (Scherwitz et al., 2005). The results thus far are promising, and further investigation has the potential to make relaxation techniques that can improve people’s lives more effective and widely available.
Achterberg, J. (1985). Imagery in healing. Shambhala Publications.
American Psychological Association. (2017). Stress in America: The state of our nation. https://www.apa.org/news/press/releases/stress/2017/state-nation.pdf
Baider, L., Uziely, B., & Kaplan De-Nour, A. (1994). Progressive muscle relaxation and guided imagery in cancer patients. General Hospital Psychiatry, 16(5), 340–347. https://doi.org/10.1016/0163-8343(94)90021-3
Ball, T. M., Shapiro, D. E., Monheim, C. J., & Weydert, J. A. (2003). A pilot study of the use of guided imagery for the treatment of recurrent abdominal pain in children. Clinical Pediatrics, 42(6), 527–532. https://doi.org/10.1177/000992280304200607
Bernstein, D. A., & Borkovec, T. D. (1973). Progressive relaxation training: A manual for the helping professions. Research Press.
Bottomley, A. (1996). Group cognitive behavioural therapy interventions with cancer patients: A review of the literature. European Journal of Cancer Cure, 5(3), 143–146. https://doi.org/10.1111/j.1365-2354.1996.tb00225.x
Cohen, M., & Fried, G. (2007). Comparing relaxation training and cognitive-behavioral group therapy for women with breast cancer. Research on Social Work Practice, 17(3), 313–323. https://doi.org/10.1177/1049731506293741
Cunningham, A. J., & Tocco, E. K. (1989). A randomized trial of group psychoeducational therapy for cancer patients. Patient Education and Counseling, 14(2), 101–114. https://doi.org/10.1016/0738-3991(89)90046-3
Freebird Meditations. (2012, June 17). Progressive muscle relaxation guided meditation [Video]. YouTube. https://www.youtube.com/watch?v=fDZI-4udE_o
Hardy, K. (2017, October 8). Mindfulness is plentiful in “The post-traumatic insomnia workbook.” Veterans Training Support Center. http://bit.ly/2D6ux8U
Hashim, H. A., & Zainol, N. A. (2015). Changes in emotional distress, short term memory, and sustained attention following 6 and 12 sessions of progressive muscle relaxation training in 10–11 years old primary school children. Psychology, Health & Medicine, 20(5), 623–628. https://doi.org/10.1080/13548506.2014.1002851
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|Course Code||Class Code||Assignment Title||Total Points|
|NRS-440VN||NRS-440VN-O502||Advocacy Through Legislation||155.0|
|Criteria||Percentage||Unsatisfactory (0.00%)||Less Than Satisfactory (75.00%)||Satisfactory (79.00%)||Good (89.00%)||Excellent (100.00%)||Comments||Points Earned|
|Problem, Those Affected, Current Ramifications, and Consequences if Problem Continues||15.0%||A description of the problem, those affected, current ramifications, and consequences if the issue continues is omitted.||A partial or vague discussion of the problem, those affected, current ramifications, and consequences if the issue continues is presented. Why the problem would be best addressed through legislation is unclear.||A summary of the problem, those affected, current ramifications, and consequences if the issue continues is presented. There are some omissions and inaccuracies. Rationale is needed.||A discussion of the problem, those affected, current ramifications, and consequences if the issue continues is presented. Some rationale is needed.||A well-develop discussion of the problem, those affected, current ramifications, and consequences if the issue continues is presented. Strong and compelling rationale is provided. Insight into the problem and consequences is demonstrated.|
|Idea for Addressing Solution||10.0%||Idea for addressing the issue and why legislation is the best course for advocacy is omitted.||Idea for addressing the issue is vague. Why legislation is the best course for advocacy is unclear. There are major omissions.||Idea for addressing the issue is generally outlined. Why legislation is the best course for advocacy is summarized. There are some minor omissions. Rationale is needed.||Idea for addressing the issue is outlined. Why legislation is the best course for advocacy is generally explained. Some rationale is needed.||A logical and well-developed idea for addressing the issue is outlined. Why legislation is the best course for advocacy is thoroughly explained. Strong and compelling rationale is provided.|
|Research Supporting Solution for Problem||15.0%||Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are omitted.||Some support for the idea and its effectiveness in addressing the problem is presented. Findings presented are not substantiated, or do not provide evidence-based support for the idea.||Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are generally presented. More information is needed. There are some inaccuracies.||Idea for addressing the issue is outlined. Why legislation is the best course for advocacy is generally explained. Some rationale is needed. Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are presented. There are minor inaccuracies. Some detail is needed.||Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are presented and demonstrate strong and compiling support for the idea.|
|Stakeholder Support||10.0%||Stakeholders in support the proposed idea are omitted.||At least one stakeholder in support of the proposed idea is presented. The assignment criteria are largely incomplete.||Substantive evidence-based findings that support the idea for addressing the problem, including similar legislation in other states, are generally presented. More information is needed. There are some inaccuracies.General stakeholders in support of the proposed idea are presented. It is unclear why they are in support of the idea. More information is needed.||Key stakeholders in support of the proposed idea are presented. It is generally clear why they are in support of the idea. Some detail or rationale is needed.||All significant stakeholders in support of the proposed idea are presented and a well-supported explanation of why they are in support of the idea are provided.|
|Stakeholder Opposition||10.0%||Stakeholders in opposition to the proposed idea are omitted.||At least one stakeholder in support of the proposed idea is presented. The assignment criteria are largely incomplete.At least one stakeholder in opposition to the proposed idea is presented. The assignment criteria are largely incomplete.||General stakeholders in opposition to the proposed idea are presented. Explanation for why they are opposed to the idea and strategies for debating or conversing with opposing stakeholders is vague.||Key stakeholders in opposition to the proposed idea are presented. A general exp
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