Guided Imagery Council: Feasibility, Acceptability, and Preliminary Effects of a Novel Group-Based Lifestyle Intervention in Predominantly Latino Adolescents

Abstract

Background The combination of higher stress and higher obesity rates suggests that Latino youth in the United States may be a population at particular risk for obesity-related adverse health outcomes. The objective of this article is to describe the feasibility, acceptability, and quantitative stress-related outcomes of a 6-week pilot lifestyle intervention using guided imagery (GI) council in order to reduce risk factors for obesity-related disease. Methods Seventeen urban, adolescents (12 females/5 males, 16 Latino, age 17 ± 1 years, grades 9–12, body mass index 22 ± 4) participated in the 6-week, after-school pilot intervention. The intervention consisted of three, 75-minute after-school sessions delivered weekly for 6 weeks. The 3 weekly sessions included 1 session each of nutrition education, physical activity education and practice, and GI delivered in council, a facilitated group process based on indigenous practices. Feasibility and acceptability were assessed by attendance and qualitative exit interview. Stress outcomes included salivary cortisol and perceived stress. Results The pilot intervention was found to be feasible to deliver in an after-school setting. The GI and council group format were well liked. A 31% reduction in salivary cortisol was observed following the stress-reduction GI sessions. Diurnal cortisol patterns did not change across the intervention, but change in perceived stress was correlated with change in cortisol awakening response. Conclusions The intervention was feasible to deliver and highly acceptable. Acute reduction in salivary cortisol was seen following group GI, while no change was seen in daily cortisol patterns. These results support the development of a full 12-week intervention using GI council to reduce obesity-related disease risk.

Effects of Group-delivered Stress-reduction Guided Imagery on Salivary Cortisol, Salivary Amylase, and Stress Mood in Urban, Predominantly Latino Adolescents

“…If so, this would indicate an acceptability of the guided imagery modality to a level where the participants use it in aspects of their life not directly related to the study protocol. This is supported by our previous findings 21 and anecdotal experience in this study, that once adolescents are trained in GI, they spontaneously use it without instructions to do so in settings outside the formal intervention structure. The findings that GI reduced stress mood in all 5 of the individual mood states further supports the use of GI for stress management in this population.…”

“…The results of this study replicate our earlier, uncontrolled pilot findings that SRGI delivered in group format leads to acute reduction in salivary cortisol levels in adolescents, adding our understanding that this effect is present whether the imagery is delivered to individuals, 20 or in groups. 21 To our knowledge, this is the first report of a randomized controlled study showing significant reductions in salivary cortisol in adolescents in response to group GI. In the present study, the decrease in salivary cortisol in the GI group compared to the LS control was of moderate effect size.…”

“…30 Guided imagery sessions were delivered in a classroom setting during the same after-school hours in the context of the facilitated group process known as "council." 21,30 Interventionists were highly skilled professionals with certification training in Interactive Guided Imagery SM (https:// acadgi.com/certification/), including an academic social worker, an integrative physical therapist, an expressive arts therapist, and a personal coach practitioner with longstanding certification in interactive guided imagery. All were trained in the council process by the PI and an experienced council practitioner consultant from the Los Angeles public schools' "Council in Schools" program.…”

“…In addition, this work did not address the utility of guided imagery in reducing cortisol in non-obese youth. Recently we replicated the acute salivary cortisol reduction using stress-reduction guided imagery (SRGI) delivered in group format 21 in a small population of obese and non-obese youth, but without a concurrent control group, limiting the interpretability of these findings. These findings need to be replicated in a larger study population with an appropriate control group.…”