Storytelling reduces pain, stress in hospitalised children
A new research has shown for the first time that storytelling is capable of providing physiological and emotional benefits to children in Intensive Care Units (ICUs).
The study was published in the Proceedings of the National Academy
of Sciences, the official scientific journal of the National Academy of
Sciences of the US.
It was carried out by the D'Or Institute for Research and Education (IDOR) and the Federal University of ABC (UFABC). The study was led by Guilherme Brockington, PhD, from UFABC, and Jorge Moll, MD, PhD, from IDOR.
"During storytelling, something happens that we call 'narrative
transportation'. The child, through fantasy, can experience sensations
and thoughts that transport him or her to another world, a place that is
different from the hospital room and is, therefore, far from the
aversive conditions of hospitalization," affirmed Guilherme Brockington,
PhD, and lead author of the study.
Storytelling is an immemorial practice of humanity. Legends,
religions, and social values have spanned millennia through orality and
writing. The most current best-selling cinematographic scripts and
novels captivate the audiences through the same mechanism: listening to a
good story is moving from one reality to another.
This movement, driven by imagination, can create empathy for events
and characters that fluctuate according to the interpretation of each
individual.
"Until now, the positive evidence for storytelling was based on
'common sense' and taken at face value, in which interacting with the
child may distract, entertain and alleviate psychological suffering. But
there was a lack of a solid scientific basis, especially with regard to
underlying physiological mechanisms," explained Dr Moll.
Considering the psychological and biological processes that occur
during, and after listening to a story, the study investigators came up
with the idea of seeking scientific evidence for the effects of
storytelling on critically hospitalized children.
In total, 81 children were selected, aged between 2 and 7 years and
with similar clinical conditions, such as respiratory problems caused by
asthma, bronchitis, or pneumonia.
The children were admitted to the ICU at Rede D'Or Sao Luiz
Jabaquara Hospital, in Sao Paulo, Brazil, and were randomly divided into
two groups: 41 of them participated in a group in which storytellers
read children's stories for 25 to 30 minutes, while in a control group,
40 children were told riddles offered by the same professionals and
during the same length of time.
To compare the effects of the two interventions, saliva samples were
collected from each participant before and after each session to
analyze the oscillations of cortisol and oxytocin - hormones related to
stress and empathy, respectively.
In addition, the children took a subjective test to evaluate the
level of pain they were feeling before and after participating in the
activities. They also performed a free word association task by relating
their impressions about 7 cards illustrated with elements from the
hospital context (Nurse, Doctor, Hospital, Medicine, Patient, Pain, and
Book).
The outcomes were positive for all groups, as both interventions
reduced the level of cortisol and increased the production of oxytocin
in all the children analyzed, while the sensation of pain and discomfort
was also mitigated, according to the evaluation of the children
themselves.
However, a significant difference was that the positive results of
the children in the storytelling group were twice as good as those in
the riddles group. These findings led the researchers to conclude that
the narrative activity was substantially more effective.
"Another highlight of this study is that it was not performed in an
artificial environment, but rather within the routine of the pediatric
ICU. The storytelling was done individually; the child chose which story
would be told. Among the books offered, we chose titles available in
ordinary bookstores and without a pre-defined emotional bias, so that
the story would not influence the child's reaction so much after the
activity," highlighted Dr Brockington.
Even though storytelling was already being adopted in many
children's hospitals, this is the first time we are presented with
robust evidence of its physiological and psychological impacts. This
contributes to seeing the activity as an effective and low-cost
therapeutic method, which can make a great difference in the quality of
life for children in intensive care units.
"I consider this study to be one of the most important I have
participated in, due to its simplicity, rigor, and potential direct
impact on practices in the hospital environment, aiming at the relief of
human suffering. As it is a low-cost and highly safe intervention, it
can potentially be implemented in the entire public system, once
larger-scale studies verify its reproducibility and effectiveness. We
intend to extend and replicate it in other settings and patient groups
and to support volunteering dedicated to the noble activity of
storytelling, now with more solid scientific evidence," pointed out Dr
Moll.
The emotional impacts of storytelling were also revealed in the
results of the free word association test, done at the end of each
intervention. Children in the storytelling group reported more positive
emotions than in the control group, when exposed to the Hospital, Nurse,
and Doctor words.
For example, the children in the control group responded to the card
with the drawing of a Hospital saying, "This is the place that people
go when they are sick". Children in the storytelling group reported for
the same card as: "this is the place that people go to get better."
For the illustrations of a nurse and a doctor, the same pattern was
observed. Children in the control group remarked "This is the bad woman
who comes to give me an injection", while those who were told the
stories said phrases such as: "This is the woman who comes to heal me."
Although the research had the support
of trained volunteer storytellers from the Brazilian non-profit
association "Viva e Deixe Viver", the authors state that storytelling is
an activity that can be equally practiced by parents and educators,
thus providing space for children to participate in the choice of the
book and to interact with the story.
In addition to reducing anxiety and
stress, the activity enables the strengthening of bonds between the
child, the narrator, and the other people present in the environment.
The authors also remarked that the
findings of this research on storytelling point to additional potential
applications for children experiencing environmental stress, such as the
disruption caused by the pandemic.
Storytelling by parents, relatives and
friends may be a simple and effective way to improve the wellbeing of a
child and is accessible to all families.