Coping with a stressful sigmoidoscopy: Evaluation of cognitive and relaxation preparations

Sigmoidoscopy involves the insertion of a small scope into the anal cavity to inspect for abnormalities in the colon. Although the procedure is not believed to be painful, it is often noxious for patients because it produces embarassment and discomfort. We examined the effectiveness of two brief interventions designed to enhance coping: self-instructional training and relaxation. In the self-instructional conditions patients were given brief training to focus their attention on either their own (internal) or the doctor's (external) ability to regulate the situation. A third (control) group received attention but did not experience self-instructional training. Half of each of these three groups also received relaxation training, while the other half did not. Planned comparisons demonstrated that subjects in the self-instructional strategies rated themselves as less anxious, had fewer body movements during the exam, and emitted fewer verbalizations than those in an attention control group. Patients in the external condition estimated that the exam took less time but tended to have elevated heart rates during the procedure. Those experiencing relaxation training tended to overestimate the duration of the exam, but made fewer requests to stop the exam and rated themselves as less anxious than patients who did not receive relaxation training.This research was supported by Grant R03MH30949 from the National Institutes of Mental Health to the first author.Thanks are due to Gregg Pascoe and Gail Metzger for their assistance in various phases of this research project. The cooperation of the medical staff in the Division of Gastroenterology at Scripps Clinic and Research Foundation (La Jolla, California) is also gratefully acknowledged.