Seeking serenity: Associate dean creates guided imagery app for the COVID-19 era

Seeking serenity: Associate dean creates guided imagery app for the COVID-19 era

By Anna C. ChristensenHealth Sciences
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Staying at home is important to reduce the spread of the virus that causes COVID-19, but many people miss being outdoors. (Photo by Kris Hanning/UAHS BioCommunications)
Staying at home is important to reduce the spread of the virus that causes COVID-19, but many people miss being outdoors. (Photo by Kris Hanning/UAHS BioCommunications)
Judith Gordon, associate dean of research in the College of Nursing, is the co-principal investigator of the See Me Serene app. (Image courtesy of the College of Nursing)
Judith Gordon, associate dean of research in the College of Nursing, is the co-principal investigator of the See Me Serene app. (Image courtesy of the College of Nursing)
The app includes about 50 guided imagery scenes. (Courtesy of the College of Nursing)
The app includes about 50 guided imagery scenes. (Courtesy of the College of Nursing)
Tad Pace, pictured here with a vial of blood, runs a research lab at the College of Nursing. He will analyze saliva for cortisol to gauge stress levels in See Me Serene study participants. (Image courtesy of the College of Nursing)
Tad Pace, pictured here with a vial of blood, runs a research lab at the College of Nursing. He will analyze saliva for cortisol to gauge stress levels in See Me Serene study participants. (Image courtesy of the College of Nursing)

Judith Gordon, associate dean of research at the College of Nursing, has devoted her career to finding ways to help smokers give up tobacco.

She now hopes to apply her skill set to help people suffering from stress related to being cooped up inside all day, away from nature. That includes people staying home to reduce the spread of the coronavirus, as well as people with physical disabilities that keep them largely indoors.

Gordon's latest project is based on her previous work, which led to the creation of a smoking-cessation smartphone app using guided imagery, a self-help technique in which a patient invokes a mental image that re-creates a sensory perception. Gordon's previous studies hinted that it could be an effective tool for smokers looking to kick the habit. Now, Gordon hopes what she's learned from that work can be applied during the pandemic.

"Many studies are coming out showing dramatic increases in stress and effects on mental health from the COVID-19 pandemic," Gordon said. "We hope to help people cope."

Gordon is packing her guided imagery expertise into an app that may help alleviate isolation-induced stress. The app, called See Me Serene, offers vividly narrated stories, told in the second person, describing experiences in nature.

The app is available in the Apple and Google app stores.

"Our app is focused on using a person's imagination to create immersive experiences that make them feel as though they are outdoors and could potentially experience the benefits of being outdoors," Gordon said. "It focuses on all the senses and emotions – the sights around you, smells in the air, what you hear, what you might be tasting, things you feel on your skin. All of that will evoke an emotional response."

Gordon believes her team will be the first to investigate the potential connection between access to the outdoors and COVID-19-related stress. With See Me Serene now published, Gordon's team is seeking 100 participants to help measure the app's effectiveness.

Gordon said the app may be helpful to many University employees who find themselves isolated and working from home most days – especially now, when Tucson's summer heat makes being outside uncomfortable and even dangerous in some cases.

"That all affects our mental health," Gordon said. "This is very applicable to University of Arizona employees and we welcome University employees to use the app whether or not they want to participate in the study."

Using the app

After downloading the app and creating a username and password, users are asked a few basic questions about themselves, such as age and gender. The next page asks multiple-choice questions about stress and anxiety, including: "How often have you felt lonely today?" "How often have you felt upset (anxious, nervous, tense) today?"

Users will then find about 50 guided imagery recordings, each of a different scene. The recordings guide users through the sounds, feelings and sensations of being at a certain location, such as a beach, a farmers market or a waterfall. Others describe being with puppies, kittens or horses, or being in the rain.

Each recording begins with a calm voice against a backdrop of ambient music. The voice tells the listener to take a few deep breaths, focus on the rise and fall of their belly, release tension in their body and mind, and think to themselves "I am serene."

Then, the listener is immersed in the experience. In the rain scene, for example, the voice takes the listener through the process of donning a stiff raincoat and rubber rain boots for a walk through a gentle drizzle. The voice describes "dark, undulating clouds" and puddles glistening in the street. The voice also encourages rhythmic breathing, and helps the listener visualize puffs from their mouth as they exhale while walking through the rain.

The puppies scene takes the listener down a familiar street where neighbors are walking their dogs. Outside one house, neighbors are gathered in their yard next to a pile of sleeping puppies. The voice describes the listener petting and cuddling the puppies, "feeling their soft fur, which is warm from the sun."

Each guided imagery recording lasts about three minutes, and users are encouraged to listen to at least one each day, even on stressless days. The experience may not seem vivid at first, Gordon said, which is normal. With practice, users can increase the vividness of the experience and may even be able to recall the imagery on their own.

"What we want is for you to have a steady state of relaxation throughout the day so that if you do start to feel stressed, you can mentally recall that feeling of calm whenever and wherever you are," Gordon said.

Putting the app to the test

Those downloading the See Me Serene app will be invited to take part in a 100-person study investigating its potential role in reducing stress. Gordon says her team's main goal is to now recruit and retain participants and compare their stress levels before and after the intervention with the app. It will be a pilot study with no control group.

"It's a very promising line of research, but there hasn't been an enormous amount of large-scale trials on guided imagery," Gordon said.

In her small study, she'll put the app to the test by collecting several samples of participants' saliva before and after using the app's guided imagery program. In a College of Nursing laboratory, associate professor Thaddeus "Tad" Pace will analyze the samples for cortisol.

"Cortisol is a biomarker of stress," Gordon explained. "One of the important things cortisol does for our physiology is maintain an appropriate level of inflammation. If we have too much cortisol, it can have a negative impact on inflammation and the regulation of stress."

Stress hormones and inflammation can be beneficial when dealing with stress in the short term. Gordon says.

But "if that stress and anxiety hang around for longer periods of time, they keep that inflammation turned on." Gordon said. "When that inflammation is turned on for long periods of time, it ends up not being healthy for us. Chronic inflammation and chronic stress affect how our brains function, and we may experience anxiety, post-traumatic stress or depression as a result."

By looking at multiple snapshots of research participants' cortisol levels, Gordon's team hopes to uncover clues about how stress levels might fluctuate before and after completing the guided-imagery program. The hypothesis is that, after using See Me Serene daily for four weeks, participants' cortisol levels will decline. A successful pilot study may pave the way for larger and more sophisticated studies.

"If this app can help people feel calmer and more relaxed, and it can interrupt that stress and inflammation cycle, that would be wonderful," Gordon said.

Tapping into campus talent

To bring See Me Serene to life, Gordon reached out to Chris Gniady, associate professor of computer science in the College of Science, to enlist the talents of computer science undergraduate students.

"Dr. Gniady is always looking for projects his students could work on, and I'm always looking for people who can program the crazy ideas I come up with for solving health problems," Gordon said. "It's been a great learning experience for me, because I don't know how to develop an app. The students have been teaching me a lot of the language around app programming, and what things one can and cannot do via an app."

Gordon cites her team's diverse skills as a key ingredient to its approach.

"What's so exciting about this particular project is it's so interdisciplinary. We have computer science, nursing, psychology, family medicine and public health – all of these folks coming together, contributing their expertise to solving a really important public health problem," Gordon said. "The most rewarding aspect of my work is being able to help people improve their physical and mental health."

In addition to Gordon, Gniady and Pace, the team behind See Me Serene includes:

A version of this article originally appeared on the Health Sciences Connect website.

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