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The kinesthetic room
The Arts in Psychotherapy,
Vol. 18, pp. 69-72.
0 Pergamon
Press plc, 1991. Printed in the U.S.A.
0197-4556/91
$3.00
+ .OO
BRIEF REPORT THE KINESTHETIC
ROOM
Visual and Other Supportive Therapy for Confined Patients
WILLIAM
REGELSON,
MD and BRIAN WEST, PhD*
Confinement due to illness can lead to boredom, sensory deprivation, and depression. We need a working partnership between those in the arts and medicine to provide options for patients who require controlled stimulation for quality survival. In 1978, we proposed a combined program for evaluation and supportive treatment of advanced cancer patients that used not only psychoactive drugs, psychological counseling and support, but also environmental stimulation. It was apparent to us that we lacked specially trained therapists skilled in the applications of music and art techniques to deal with the needs of those bed confined patients. Our program (The “Kinesthetic Room”) was based on the fact that the existing stimulation provided to patients in most hospitals, nursing homes, or in home environments consists of a window, a framed picture, flowers, television, or radio. Although the video cassette (VCR) or laser disc provides increased opportunities for self-stimulation, the availability of appropriate programs to upgrade mood or to calm and reassure are frequently limited. What we must seek to create are kinesthetic rooms designed for application of psychosensory technology to meet the needs of individual patients. This technology of controlled environmental stimulation has been applied to crewmen in atomic submarines and has served to aid in minimizing their feelings of isolation.
The Kinesthetic Room was an outgrowth of analgesic research studies by our supportive drug team that have showed psychoactive drugs to be generally ineffective (or have significant side-effects) in alleviating anxiety and depression in an advanced cancer patient population, and our experience has showed that often such drugs did not affect reality-based anxiety and depression in chronic and other disabling diseases. Although a variety of pharmacological and psychological interventions are useful, we felt that the introduction of patients to the Kinesthetic Room was a good alternative. Our plan, developed in prototype form at the Medical College of Virginia, created a demonstration for what we felt should become a major factor in hospital or nursing home design. The Kinesthetic Room offered the following elements: 1. Living Window. This was the name given to the concept of creating, through visual imagery and accompanying sound, an alternate environment to that which an individual might otherwise be restricted. We utilized colored slide projection, film, and TV tapes with subject material selected by the patients and with images we determined to be pleasant reinforcement for them. We presented these images to patients and student volunteers and provided a
*William Regelson is Professor of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA. Brian West is in clinical practice of psychology, Charleston, SC. The authors acknowledge the ideation and help of Robert Spiegel of the Naval Ship Engineering Center, Washington, DC. 69
70
REGELSON combination of tests to evaluate the psychological effects of the Living Window experience.
Little emphasis on patient response had been placed on films conveying pleasant associations although a number of studies have suggested that positive imagery may clinically alter behaviors (including physiological and cognitive behaviors) in a desired direction (Simonton & Simonton, 1975; Singer, 1974). As emotional responses can be elicited by visual and/or auditory stimuli (Seligman, Maler & Solomon, 1971), we sought to do this in our study by developing film presentations that represented cognitive and/or imagery cues for the subject to recall pleasant experiences. Our goal was to develop an emotionally related change on viewing a film that represented a predetermined positive experience. The patients evaluated in this initial program were advanced cancer patients admitted for radiation and/or chemotherapy. Control subjects consisted of medical and psychology graduate students. Our program reached the pilot developmental stage with the production of five 6-20 minute films for standardized evaluation in different subjects. These films consisted of views of a mountain stream, a modem dance piece with contrasting electronic and classical music backgrounds, a European travelogue, and a 35mm retroscreen projected series of merging images made from colored slides of loving faces of children and adults, trees and flowers, ocean, sunrise and sunsets. One aspect of our experience deserves special attention: In the development of these visual programs, we found that the use of still or moving pictures of nonobjective patterns (i.e., two dimensional crystal formations, snowflake patterns) preceding film presentations by several minutes could enhance the initial intensity of the color, clarity, and excitement of the representational films or slides shown. This visual preconditioning may have real value as a lead into standard film fare. Nonobjective patterns, at least those developed by a natural phenomenon (i.e., crystal formation), enhance the quality of representational imagery. Although we are not familiar with other workers who have observed this, it does suggest that such techniques may be useful. Our goal was to develop archetypal imagery as a therapeutic tool to help patients cope with disease. Apart from films and TV, we found that still pictures had a tremendous aesthetic appeal in producing mood effects quite different from that created with ordinary
AND WEST motion picture technology. The key features of still picture projection programming included: a. Use of pictures of loved ones, episodes of past and present (pictures of early life, marriage, birthdays, weddings, trips) that could be included in a pictorial representation from the patient’s own experience. We called this “The Time Machine.” Most people collect through their lives photographs of their experiences and of those they love. At the end of life, these are trashed or given to family survivors as disjointed mementos. What we did in our Time Machine effort was to take the still photograph mementos of our patients and convert them to super 8 film as a coherent historical record. This is now readily served by TV image recording where stills can be manipulated into a flowing narrative. Wherever we could, we strengthened the narrative supported by the patient’s own photographs with film of exterior scenes (i.e., a trip to Paris of subject “E”, providing a number of stills with photographs of the subject and his then young wife on tour at the usual Paris sitesEiffel Tower, in front of the Louvre, SacreCour, and other places). We thickened the narrative with stock photographs and film footage and supplied a musical upbeat background that served that person to reexperience the event and to lift his depression. b. Use of “retroscreen technology”, or its equivalent with which we utilized still films to provide moving imagery of striking emotional impact. For example, we can fixate on the pupil of the eye that can then be expanded to a view of the entire eye, the face, and then the full figure in a specific setting. One can look at the center of the flower, then the full flower, and, finally, the field in which it grows. c. The Living Window sequence was enhanced by music accompaniment to the changing imagery. The educational background and taste of the individual relevant to classical, country, jazz, or pop music were critical considerations. We called this the “Chinese menu” (i.e., select music from column A, column B, or column C-popular, western, classical. 2. The Kinesthetic Room Technologist: As valuable as we felt the experience was for the
THE KINESTHETIC patient, we found that the creation of these programs is time consuming and expensive. As a new therapeutic modality, they should eventually become recompensable from prepaid insurance programs directed to patient therapy. The programs require the training of a new visual arts technologist whose job description should include those engaged in art or music therapy. People in the creative arts, particularly those focused on their therapeutic application, are ideally suited for dealing with the interpersonal needs of patients and, in addition, are familiar with or can learn to adapt the technologies necessary for the program. The technician, based on experience and training, would develop Living Window programs for patients and for groups with particular needs or disease categories. The Kinesthetic Room Technologist would establish and administer the programs in conjunction with physicians, psychologists, and the family. 3. Olfactory Stimulation: We had a chemical engineer who was interested in providing up to 14 different odors (i.e., roasting coffee, pine scent, chocolate, flowers, etc.). A push button delivery system was to be developed to provide olfactory stimulation that could easily be changed to meet or modify moods. Olfaction provides a “Proustian option” that can strikingly affect memory, feelings, and attitudes of the individual confined to the Kinesthetic Room. Unfortunately, this aspect of the program never left the planning stage. 4. Sun Wall: We developed lighting techniques imitating the sun migrating across the sky to provide morning shadows, overhead light, or afternoon shadows that again change the character or mood of the patient. 5. Touch Stimulation: In addition, and important to this program, we sought to restore the back rub and massage as a therapeutic factor in the hospital. We felt that being touched by a physical therapist should be a critical feature of this program. Unfortunately, nurses no longer provide back rubs, but it was one of the advantages we had hoped to provide patients in the Kinesthetic Room setting.
ROOM
grams for catastrophic disease, they are largely inadequate because they do not utilize approaches that stimulate perception and mood. What is available to room and bed restricted patients, notwithstanding a growing technology that can help, is limited to room decor and standard TV fare. This is true despite the explosion of VCR and cable television availability. The stimulation of the confined is still left to the vagaries of the patient’s initiative, nursing personnel, and family choice, with little therapeutic thought as to how visual and auditory input can improve the life of those restricted by disease. Based on our experience, the Living Window concept can provide a visual Muzak (i.e., an escape from boring periods or repetitive action). However, to be successful, Living Windows must depart from the usual television, music box office fare by using archetypical imagery provided by nature and that are relevant to the specific person. Our work suggested that it has general utility and we could develop this as an option during five minute breaks at the end of an hour on an assembly line, in an office, or at any boring repetitive job. During their breaks, workers can gain in productivity by stimulation from the imagery and music presented in booths or special viewing sites. To raise sagging spirits, the Kinesthetic Room/Living Window concept can provide a visual Muzak therapy for the home or workplace. This option has specific value in physicians’ waiting rooms or offices prior to or during unpleasant procedures. The application of these techniques can be extended to the chronically ill through broader commercial application of the Kinesthetic Room to a healthy, ambulatory population. With application to the workplace, as well as the home and hospital, economic support can be found to expand the programs to bring in numbers of artists, photographers, interior designers, and psychologists who will develop the dynamic environmental effects and programs needed for patients in institutional or domiciliary settings. Our program sought to provide alternatives to boredom, hopelessness, and anxiety in the chronically ill. Although we do not expect these programs to have a major effect on survival (Cassileth, Walsh & Lusk, 1988), they are technically feasible and will improve the quality of life for those trapped by physical disability, medical procedures, and boredom.
Discussion Although in recent years there has been improvement in state and federal psychosocial support pro-
References Cassileth,
B.,
Walsh,
W.,
& Lusk,
E. (1988).
Psychosocial
72
REGELSON
correlates of cancer survival: A subsequent report 3 to 8 years after cancer diagnosis. Journal of Clinical Oncology, 6, 17531759. Seligman, M.E.P., Maler, S .F., & Solomon, R.L. (197 1). Unpredictable and uncontrollable aversive events. In F.R. Brush (Ed.), Aversive conditioning and learning. New York: Academic Press.
AND WEST Simonton, O.C., & Simonton, S.S. (1975). Belief systems and management of emotional aspects of malignancy. Journal of Transpersonal Psychology, 7, 2949. Singer, J. (1974). Imagery and daydreams: Methods in psychotherapy and behavior modi$cation. New York: Academic Press.
Vol. 18, pp. 69-72.
0 Pergamon
Press plc, 1991. Printed in the U.S.A.
0197-4556/91
$3.00
+ .OO
BRIEF REPORT THE KINESTHETIC
ROOM
Visual and Other Supportive Therapy for Confined Patients
WILLIAM
REGELSON,
MD and BRIAN WEST, PhD*
Confinement due to illness can lead to boredom, sensory deprivation, and depression. We need a working partnership between those in the arts and medicine to provide options for patients who require controlled stimulation for quality survival. In 1978, we proposed a combined program for evaluation and supportive treatment of advanced cancer patients that used not only psychoactive drugs, psychological counseling and support, but also environmental stimulation. It was apparent to us that we lacked specially trained therapists skilled in the applications of music and art techniques to deal with the needs of those bed confined patients. Our program (The “Kinesthetic Room”) was based on the fact that the existing stimulation provided to patients in most hospitals, nursing homes, or in home environments consists of a window, a framed picture, flowers, television, or radio. Although the video cassette (VCR) or laser disc provides increased opportunities for self-stimulation, the availability of appropriate programs to upgrade mood or to calm and reassure are frequently limited. What we must seek to create are kinesthetic rooms designed for application of psychosensory technology to meet the needs of individual patients. This technology of controlled environmental stimulation has been applied to crewmen in atomic submarines and has served to aid in minimizing their feelings of isolation.
The Kinesthetic Room was an outgrowth of analgesic research studies by our supportive drug team that have showed psychoactive drugs to be generally ineffective (or have significant side-effects) in alleviating anxiety and depression in an advanced cancer patient population, and our experience has showed that often such drugs did not affect reality-based anxiety and depression in chronic and other disabling diseases. Although a variety of pharmacological and psychological interventions are useful, we felt that the introduction of patients to the Kinesthetic Room was a good alternative. Our plan, developed in prototype form at the Medical College of Virginia, created a demonstration for what we felt should become a major factor in hospital or nursing home design. The Kinesthetic Room offered the following elements: 1. Living Window. This was the name given to the concept of creating, through visual imagery and accompanying sound, an alternate environment to that which an individual might otherwise be restricted. We utilized colored slide projection, film, and TV tapes with subject material selected by the patients and with images we determined to be pleasant reinforcement for them. We presented these images to patients and student volunteers and provided a
*William Regelson is Professor of Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA. Brian West is in clinical practice of psychology, Charleston, SC. The authors acknowledge the ideation and help of Robert Spiegel of the Naval Ship Engineering Center, Washington, DC. 69
70
REGELSON combination of tests to evaluate the psychological effects of the Living Window experience.
Little emphasis on patient response had been placed on films conveying pleasant associations although a number of studies have suggested that positive imagery may clinically alter behaviors (including physiological and cognitive behaviors) in a desired direction (Simonton & Simonton, 1975; Singer, 1974). As emotional responses can be elicited by visual and/or auditory stimuli (Seligman, Maler & Solomon, 1971), we sought to do this in our study by developing film presentations that represented cognitive and/or imagery cues for the subject to recall pleasant experiences. Our goal was to develop an emotionally related change on viewing a film that represented a predetermined positive experience. The patients evaluated in this initial program were advanced cancer patients admitted for radiation and/or chemotherapy. Control subjects consisted of medical and psychology graduate students. Our program reached the pilot developmental stage with the production of five 6-20 minute films for standardized evaluation in different subjects. These films consisted of views of a mountain stream, a modem dance piece with contrasting electronic and classical music backgrounds, a European travelogue, and a 35mm retroscreen projected series of merging images made from colored slides of loving faces of children and adults, trees and flowers, ocean, sunrise and sunsets. One aspect of our experience deserves special attention: In the development of these visual programs, we found that the use of still or moving pictures of nonobjective patterns (i.e., two dimensional crystal formations, snowflake patterns) preceding film presentations by several minutes could enhance the initial intensity of the color, clarity, and excitement of the representational films or slides shown. This visual preconditioning may have real value as a lead into standard film fare. Nonobjective patterns, at least those developed by a natural phenomenon (i.e., crystal formation), enhance the quality of representational imagery. Although we are not familiar with other workers who have observed this, it does suggest that such techniques may be useful. Our goal was to develop archetypal imagery as a therapeutic tool to help patients cope with disease. Apart from films and TV, we found that still pictures had a tremendous aesthetic appeal in producing mood effects quite different from that created with ordinary
AND WEST motion picture technology. The key features of still picture projection programming included: a. Use of pictures of loved ones, episodes of past and present (pictures of early life, marriage, birthdays, weddings, trips) that could be included in a pictorial representation from the patient’s own experience. We called this “The Time Machine.” Most people collect through their lives photographs of their experiences and of those they love. At the end of life, these are trashed or given to family survivors as disjointed mementos. What we did in our Time Machine effort was to take the still photograph mementos of our patients and convert them to super 8 film as a coherent historical record. This is now readily served by TV image recording where stills can be manipulated into a flowing narrative. Wherever we could, we strengthened the narrative supported by the patient’s own photographs with film of exterior scenes (i.e., a trip to Paris of subject “E”, providing a number of stills with photographs of the subject and his then young wife on tour at the usual Paris sitesEiffel Tower, in front of the Louvre, SacreCour, and other places). We thickened the narrative with stock photographs and film footage and supplied a musical upbeat background that served that person to reexperience the event and to lift his depression. b. Use of “retroscreen technology”, or its equivalent with which we utilized still films to provide moving imagery of striking emotional impact. For example, we can fixate on the pupil of the eye that can then be expanded to a view of the entire eye, the face, and then the full figure in a specific setting. One can look at the center of the flower, then the full flower, and, finally, the field in which it grows. c. The Living Window sequence was enhanced by music accompaniment to the changing imagery. The educational background and taste of the individual relevant to classical, country, jazz, or pop music were critical considerations. We called this the “Chinese menu” (i.e., select music from column A, column B, or column C-popular, western, classical. 2. The Kinesthetic Room Technologist: As valuable as we felt the experience was for the
THE KINESTHETIC patient, we found that the creation of these programs is time consuming and expensive. As a new therapeutic modality, they should eventually become recompensable from prepaid insurance programs directed to patient therapy. The programs require the training of a new visual arts technologist whose job description should include those engaged in art or music therapy. People in the creative arts, particularly those focused on their therapeutic application, are ideally suited for dealing with the interpersonal needs of patients and, in addition, are familiar with or can learn to adapt the technologies necessary for the program. The technician, based on experience and training, would develop Living Window programs for patients and for groups with particular needs or disease categories. The Kinesthetic Room Technologist would establish and administer the programs in conjunction with physicians, psychologists, and the family. 3. Olfactory Stimulation: We had a chemical engineer who was interested in providing up to 14 different odors (i.e., roasting coffee, pine scent, chocolate, flowers, etc.). A push button delivery system was to be developed to provide olfactory stimulation that could easily be changed to meet or modify moods. Olfaction provides a “Proustian option” that can strikingly affect memory, feelings, and attitudes of the individual confined to the Kinesthetic Room. Unfortunately, this aspect of the program never left the planning stage. 4. Sun Wall: We developed lighting techniques imitating the sun migrating across the sky to provide morning shadows, overhead light, or afternoon shadows that again change the character or mood of the patient. 5. Touch Stimulation: In addition, and important to this program, we sought to restore the back rub and massage as a therapeutic factor in the hospital. We felt that being touched by a physical therapist should be a critical feature of this program. Unfortunately, nurses no longer provide back rubs, but it was one of the advantages we had hoped to provide patients in the Kinesthetic Room setting.
ROOM
grams for catastrophic disease, they are largely inadequate because they do not utilize approaches that stimulate perception and mood. What is available to room and bed restricted patients, notwithstanding a growing technology that can help, is limited to room decor and standard TV fare. This is true despite the explosion of VCR and cable television availability. The stimulation of the confined is still left to the vagaries of the patient’s initiative, nursing personnel, and family choice, with little therapeutic thought as to how visual and auditory input can improve the life of those restricted by disease. Based on our experience, the Living Window concept can provide a visual Muzak (i.e., an escape from boring periods or repetitive action). However, to be successful, Living Windows must depart from the usual television, music box office fare by using archetypical imagery provided by nature and that are relevant to the specific person. Our work suggested that it has general utility and we could develop this as an option during five minute breaks at the end of an hour on an assembly line, in an office, or at any boring repetitive job. During their breaks, workers can gain in productivity by stimulation from the imagery and music presented in booths or special viewing sites. To raise sagging spirits, the Kinesthetic Room/Living Window concept can provide a visual Muzak therapy for the home or workplace. This option has specific value in physicians’ waiting rooms or offices prior to or during unpleasant procedures. The application of these techniques can be extended to the chronically ill through broader commercial application of the Kinesthetic Room to a healthy, ambulatory population. With application to the workplace, as well as the home and hospital, economic support can be found to expand the programs to bring in numbers of artists, photographers, interior designers, and psychologists who will develop the dynamic environmental effects and programs needed for patients in institutional or domiciliary settings. Our program sought to provide alternatives to boredom, hopelessness, and anxiety in the chronically ill. Although we do not expect these programs to have a major effect on survival (Cassileth, Walsh & Lusk, 1988), they are technically feasible and will improve the quality of life for those trapped by physical disability, medical procedures, and boredom.
Discussion Although in recent years there has been improvement in state and federal psychosocial support pro-
References Cassileth,
B.,
Walsh,
W.,
& Lusk,
E. (1988).
Psychosocial
72
REGELSON
correlates of cancer survival: A subsequent report 3 to 8 years after cancer diagnosis. Journal of Clinical Oncology, 6, 17531759. Seligman, M.E.P., Maler, S .F., & Solomon, R.L. (197 1). Unpredictable and uncontrollable aversive events. In F.R. Brush (Ed.), Aversive conditioning and learning. New York: Academic Press.
AND WEST Simonton, O.C., & Simonton, S.S. (1975). Belief systems and management of emotional aspects of malignancy. Journal of Transpersonal Psychology, 7, 2949. Singer, J. (1974). Imagery and daydreams: Methods in psychotherapy and behavior modi$cation. New York: Academic Press.