Tuesday, 30 November, 2021
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Storytelling may significantly alleviate physical and psychological pain of hospitalised children

Simple story telling to hospitalised children may help significantly to alleviate their physical and psychological pain, finds a Brazilian study reported in Scientific American.

“We know that narrative has the power to transport us to another world,” says Guilherme Brockington, who studies emotions and learning at Brazil’s Federal University of ABC in São Paulo and was lead author on the paper, published in the Proceedings of the National Academy of Sciences USA. Earlier research suggested that stories help children process and regulate their emotions—but this was mostly conducted in a laboratory, with subjects answering questions while lying inside functional MRI machines, according to the report in Scientific American.

“There are few studies on physiological and psychological effects of storytelling in a more commonplace hospital setting,” Brockington says.

So investigators working in several Brazilian hospitals split a total of 81 patients aged four to 11 into two groups, matching them with storytellers who had a decade of hospital experience. In one group, the storyteller led each child in playing a riddle game. In the other, youngsters chose books and listened as the storyteller read them aloud. Before and after these sessions, the researchers took saliva samples from each child, then asked them to report their pain levels and conducted a free-association word quiz.

Children in both groups benefited measurably from the interactions; they showed lower levels of the stress-related hormone cortisol and higher levels of oxytocin, which is often described as a feel-good hormone and is associated with empathy. Yet kids in the storytelling group benefited significantly more: their cortisol levels were a quarter of those in the riddle group, and their oxytocin levels were nearly twice as high. Those who heard stories also reported pain levels dropping almost twice as much as those in the riddle group, and they used more positive words to describe their hospital stay.

The study demonstrates that playing games or simply interacting with someone can relax kids and improve their outlook—but that hearing stories has an especially dramatic effect. The researchers “really tried to control the social interaction component of the storyteller, which I think was key”, says Raymond Mar, a psychologist at York University in Canada who studies the effects of storytelling but was not involved in the new research.

Next, the investigators plan to study how long these effects last, along with storytelling's potential benefits to kids with particular illnesses such as cancer.

For now Brockington says the results indicate storytelling is a low-cost and extremely efficient way to help improve health outcomes in a variety of settings.

Mar agrees. “It's very promising and scalable,” he says, “and possibly generalisable.”

Study details

Storytelling increases oxytocin and positive emotions and decreases cortisol and pain in hospitalized children

Guilherme Brockington, Ana Paula Gomes Moreira, Maria Stephani Buso, Sérgio Gomes da Silva, Edgar Altszyler, Ronald Fischer, and Jorge Moll

Published in in the Proceedings of the National Academy of Sciences USA (PNAS) in August 2021

Abstract

Storytelling is a distinctive human characteristic that may have played a fundamental role in humans’ ability to bond and navigate challenging social settings throughout our evolution. However, the potential impact of storytelling on regulating physiological and psychological functions has received little attention.

We investigated whether listening to narratives from a storyteller can provide beneficial effects for children admitted to intensive care units. Biomarkers (oxytocin and cortisol), pain scores, and psycholinguistic associations were collected immediately before and after storytelling and an active control intervention (solving riddles that also involved social interaction but lacked the immersive narrative aspect).

Compared with the control group, children in the storytelling group showed a marked increase in oxytocin combined with a decrease in cortisol in saliva after the 30-min intervention. They also reported less pain and used more positive lexical markers when describing their time in hospital.

Our findings provide a psychophysiological basis for the short-term benefits of storytelling and suggest that a simple and inexpensive intervention may help alleviate the physical and psychological pain of hospitalised children on the day of the intervention.

Background

We are all storytellers. From the bards and troubadours of the Middle Ages to the most recent Hollywood blockbuster, humans are exceptionally attracted to telling and listening to stories. Storytelling is culturally ubiquitous. In fact, our taste for narrative has probably played a critical adaptive role in human society. The act of telling stories has been shown to be a central element for establishing human connections and influencing subjective emotions in both the storyteller and the audience.

From a psychological standpoint, stories allow us to make meaning of our world. Furthermore, storytelling helps us navigate our social world by turning the continuum of lived events into a coherent and organized narrative, despite life’s emotional peaks and valleys), and helps to simulate possible social realities.

Recent research into the universal human interest in narratives and storytelling provides insight into possible mechanisms. One main hypothesis is derived from a process known as “narrative transportation,” a dynamic and complex interaction between language, text, and imagination which creates a state of cognitive and emotional immersion that deeply engages listeners in the world of the narrative. Stories invite readers or listeners to immerse themselves in the portrayed action and thus lose themselves for the duration of the narrative.

During this process, the world of origin becomes partially inaccessible to the listener, marking a separation in terms of the “here” and the “there,” the “now” and the “before,” the narrative world of the story and the world of origin. Current psychological and neuroscientific evidence supports the basic premises of this transportation process and its plausible origins based on evolutionarily relevant preadaptations involving mirror neuron systems, conversational language structures, metaphor processing, and imagination. Cognitive theories suggest that stories facilitate and enable mental simulations, thereby facilitating mental models that people use to simulate social realities. These narrative transportations and mental simulations can help reframe personal experiences, broaden perspectives, deepen emotional processing abilities, increase empathy, and regulate self-models and emotional experiences.

These various lines of inquiry provide some rationale for using storytelling as a form of behavioral intervention. Indeed, it is not uncommon to find storytelling programmes at hospitals all over the world. However, the effect of storytelling is mainly anecdotal, and its impact on children’s well-being and physiology is still insufficiently understood. Here, we present evidence that storytelling can positively influence both psychological and physiological variables in hospitalized children, even within highly challenging settings such as intensive care units (ICUs).

It is important to note that even though we used experienced storytellers for our research purposes, we believe parents should be encouraged to tell their children stories. As we have shown, it is not necessary to use special stories or books or even specific techniques to achieve a successful outcome. Storytelling can be an effective means of creating important emotional bonds. It is also important to highlight that in allowing children to choose a book that was more meaningful or interesting to them, we allowed them to exert control and maintain their agency, which can be highly valuable in a frightening and disempowering ICU environment.

Our results illustrate that storytelling and narrative fiction go well beyond simple entertainment value. To date, relatively little scientific research has examined possible psychological mechanisms behind storytelling. There is still much to understand about the role of stories and how story features and structures produce various psychological and physiological effects.

We focused on one possible mechanism, namely the transportation function of narratives. This unfolding of stories [e.g., the narrative arc] provides a context that allows individuals to identify with the main characters, become emotionally invested, simulate different mental worlds, and allow a temporal dislocation from the here and now—all of which contribute to the development of adaptive psychological and behavioural reactions when dealing with challenging real-life situations.

 

Scientific American article – Listening to a Story Helps Hospitalized Kids Heal (Open access)

 

PNAS article – Storytelling increases oxytocin and positive emotions and decreases cortisol and pain in hospitalized children (Open access)

 

See more from MedicalBrief archives:

 

Recording of mother’s voice may help neonates sleep in ICU

 

Bedtime routine ‘makes a difference’

 

The simple but profound values of dying children in their final days

 

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