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MRI Anxiety - A Psychotherapist's phenomenological experience

· anxiety,MRI Scan

I've had several clients over the years request help in relieving anxiety about an upcoming MRI scan.  I have never had an MRI scan myself until today.  I hope to share my experience and anxieties about this process, and delineate my historic treatment plan to how I've updated it as a result of my scan.

"If you're not claustrophobic you'll be fine with an MRI scan", said a friend to me beforehand.  I pondered this, and have come to a different personal perspective.  Claustrophobia is a specific derivative of generalised anxiety, and certainly in my experience is not the only type of anxiety a person usually reports (i.e. anxiety in traffic jams, when work deadlines approach, about a relationship etc).  Anyone who has suffered trauma, shock or injury has stimulated their amygdala creating an emotional memory that can trigger anxiety in many different types of situations.

Historically I've used Mindfulness and cognitive strengthening techniques with anxious clients preparing for an MRI scan.  I have created personalised mindfulness visualisations which they can practice and use during the scan.

I was the 1st appointment of the day and was waiting 1/2hr to be called into the mobile scanning suite.  I had brought suitably boring reading material to soothe and distract my brain.  The two technicians were efficient and professional and as they helped lay me down on the bed for the first 20 minute scan on my shoulder.  They gave me a buzzer to press if I wanted the process to stop at any point.  I kept my eyes open as the bed was raised and slid into the scanner headfirst.  I was shocked at how confined I was with only a few centimetres to spare between my nose and the scanner.  I immediately closed my eyes, hearing through my headphones that the scan was about to start and it would be noisy, I started my Body Scan (based loosely on this one from Jon Kabat-Zinn https://www.youtube.com/watch?v=D8oKWQiEWYs).  I noticed that within moments my musculature and breathing had significantly relaxed and so had I.  As I became distracted by the noise, I imagined instead that I was in a relaxing Jacuzzi or in a vibrating chair which felt soothing.  I was reminded of a washing machine completing it's cycle as the bumps and clanks of the scanner changed.  I also drifted into a fantasy of writing a blog post about my experience which may benefit current and future clients and colleagues.  When the MRI technician re-entered the room and pulled the bed from out of the scanner-tube, I was surprised 20 minutes had passed.  

I had already been told I would be having two scans today, the first on my shoulder, and the second on my neck.  The technician altered the bed, replacing the shoulder brace with a head brace, which I noticed caused me more anxiety as I realised my head would be securely clamped and covered with a cage-like contraption.  I decided I would close my eyes before the head brace was attached and secured, this would also ensure I wouldn't see the small confined space within the scanner again.  I was back on the bed, noise-reducing headphones put on again, the buzzer put again into my hand and the head brace securely fastened, squeezing my head somewhat and allowing not a millimetre of movement.  I again repeated my Body Scan, noting my anxiety was actually higher than the last scan (i.e. my heart-rate and breathing were faster) due to the anxiety caused by the head brace.  It took slightly longer to relax than the time before, but I followed my programme of body scan, visualisations of being in a Jacuzzi, and mentally writing this blog, until the bed moved beneath me again to extract me from the tunnel. 

So, did the treatment plan I have used consistently with my clients help me get through my MRI scans with minimal anxiety?  Yes.  Have I changed my plan as a result of the experience?  Yes,  I would recommend a conscious but 3rd person perspective of creating a narrative of one's experience (as I did in mentally writing this blog).  

Can anxiety be completely eradicated from this process?  I would propose that even Buddhist monks who have practised meditation (mindfulness) for years and have succeeded in their ability to modulate their amygdala, would experience some level of anxiety during an MRI scan.  I believe the ability to hold the anxiety and honour its' protective function is necessary and healthy for us.

In summary, writing this blog in my mind, using the Body Scan technique and creating impromptu visualisations was my personal solution to managing anxiety during the process. NOW the three things I'm worring about are: the fact I've forgotten my purse and can't get out of the hospital car park; the results of my shoulder and neck scan in 2 weeks time; whether they can see signs of my anxiety or any other mental illness through my scan!! http://blog.journals.cambridge.org/2013/06/07/neuroimaging-may-offer-a-new-way-for-diagnosing-mental-illness/

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