Benson's Relaxation Technique, Music Therapy for Children With Thalassemia
Condition: Thalassemia in Children
MeSH terms: Thalassemia
Study type: Interventional

Summary: 
      The aim of the present study is to determine the effect of Benson's relaxation technique
      versus music therapy on physiological parameters and stress of children with thalassemia
      during blood transfusion.
    

Detailed description: 
      Thalassemia is the most common hematological disease in Egypt and the world that is
      transmitted by parents to their children and has no definitive cure. It means a group of
      hereditary blood diseases caused by defects haemoglobin (Hb) synthesis that results from an
      alteration in the gene responsible for producing globin chains leading to alteration in the
      rate of its production .

      Generally in worldwide, There are about 300 million thalassemia patients, 55 million of whom
      live in Southeast Asia . In Egypt, beta-Thalassemia represents a major public health problem.
      It is reported that the carrier rate is between 9 to 10% of the population. It has been
      estimated that one thousand children out of 1.5 million live births are born each year
      suffering from thalassemia. In spite of optimal treatment being available, only a few
      children can afford it. Unfortunately, most children suffer from complications of blood
      transfusions, mainly transfusion transmitted viral infections and iron overload. Prevention
      by carrier detection and prenatal diagnosis is needed in populations with high incidence of
      the disease, such as Egypt.

      The most severe form is the β-thalassemia major, which is characterized by a severe
      microcytic, hypochromic anemia (Cooley's anemia), whose symptoms appear usually within the
      first 2 years of life due to iron overload. Chronic iron overload can occur in children with
      beta-thalassemia as may need blood transfusions throughout their life. Iron overload can lead
      to growth retardation, pallor, poor appetite, and often jaundice; as well as hinder sexual
      development during the adolescent period and dysfunction of organs, such as heart, pancreas,
      and endocrine glands.

      When the storage capacity of the body is exceeded, iron remains in free form. The formation
      of hydroxyl free radicals can be catalyzed by this free iron, leading to damage of cell
      membranes and protein denaturation. Ultimately, tissue damage occurs which can lead to
      significant levels of morbidity and mortality. Iron chelation helps prevent complications of
      iron overload due to repeated blood transfusion. Indeed, the most common complication of
      beta-thalassemia that leads to death is organ failure, in children taking regular blood
      transfusions and no appropriate iron chelation. Elevated liver iron concentrations (LICs) and
      serum ferritin levels can manifest within 1-2 years of starting regular blood transfusions.
      Children with thalassemia whose serum ferritin level is more than 2500 ng/mL or LIC value is
      more than 15 mg Fe/kg dry weight are at high risk of development of cardiac diseases such as
      cardiomyopathy.

      Significant advances in treatment modalities and improved clinical management have led to a
      substantially higher life expectancy of these children. Children with thalassemia major have
      good survival but little is known about their psychological status. children are less able to
      voice their concerns and are more vulnerable than adults.

      Today, with the help of existing therapies and the use of new drugs to improve iron overload
      control and timely initiation of treatment, the disease has become a chronic disease and life
      expectancy in these children has increased. However, repeated blood transfusions and
      long-term use of iron-chelating drugs affect other aspects of these children' lives and
      significantly affect their general health, mental health, and quality of life, and their
      families.

      Thalassemia can cause different physiological, emotional, social, financial and behavioral
      problems that affect the life of both patients and their families, its effects are stronger
      particularly during school age and adolescence. It can greatly affect the sense of autonomy
      and mental health. Children with thalassemia major experience a lot of stress throughout
      their lives which constituted 18.8 %. Successive blood tests for fatigue, fatigue from
      successive blood transfusions, and subcutaneous injections of iron chelators, in addition to
      the body, irritate the souls of these patients. So much so that most of these patients also
      have mental disorders. It was described the fear and anxiety caused by injections in these
      children as the most difficult aspect of their illness.

      Physiological changes occur when a person is threatened with illness, trauma, or stress. The
      physiological response to the stressor in the cardiovascular system increases blood pressure,
      changes the number of pulses and respiration, increases oxygen saturation, and increases the
      risk of arrhythmias. Therefore, it is very important to find an effective solution that is
      also cost-effective for clinical use.

      Stress can be defined as any uncomfortable or agonizing emotional experience associated with
      changes in behavior as well as biochemical and physiological changes or in simple words we
      can say it is a feeling of being worried or overwhelmed. It can affect anyone regardless of
      age or gender of person and result in both physical as well as psychological health issues.
      Stress among children with thalassemia can be attributed to number of reasons like frequent
      treatment procedures and hospital visits, decreased life expectancy, expected complications
      from disease or treatment procedures and the monetary burden on parents. Also, the long
      painful treatment sessions such as to remove iron as iron overload being a complication of
      frequent blood transfusions, and an eight hour long painful procedure when injecting
      chelators by chelation pump is carried out, adding to the stress factors.

      Unlike pharmacological treatments, complementary therapies in addition to cost effective,
      have no serious side effects or drug interactions, they are easy to perform, and well
      accepted by the patient. It is important to pay attention to additional therapies in the
      sense that can be performed by nurses without the need for a doctor's prescription, as well
      as to pave the way for nurses to gain professional independence.

      Relaxation is one of the best complementary treatment strategies to decrease stress and
      mental disorders of the patients in order to improve their physical, psychological, and
      social functions. Moreover, relaxation increases the secretion of endorphins or analgesic
      hormone, but reduces the secretion of adrenaline hormone. In the present study, relaxation
      refers to one of the methods of concentration which is introduced due to its ease of learning
      and teaching. It was carried out in 4 stages: providing a relaxed environment, being in an
      appropriate physical position, concentration and creation of an inactive state. Creation of a
      calm environment, reduce muscle tension and focus by focusing on one word, increasing a
      person's attention, reducing the number of breaths and lactate in the blood can be occurred
      in Benson muscle relaxation due to lack of muscle stiffness, number of breaths, pulse and
      blood pressure are not increased and cardiac output is not increased.

      So Benson relaxation therapy, as well as other relaxation techniques, that may cause a
      decrease in physical and psychological stress, which conceptually can decrease epinephrine,
      decrease cortisol, decrease glucagon and decrease thyroid hormone. All of these have a
      positive effect on reducing stress levels. Reduction in stress levels and the attainment of a
      relaxed condition in patients have positive effect on reducing stress levels. Therefore,
      various efforts were made to make patients comfortable and remain relaxed.

      In addition to the Benson relaxation techniques described above, music therapy is another
      non-pharmacological methods that is believed to provide a relaxing effect on the patient and
      it considered to help reduce and even overcome psychological disorders and discomforts such
      as anxiety, stress, depression, and so on. Music therapy can be defined as the prescribed and
      organized use of music or its activities to change the maladaptive state in order to help
      clients achieve therapeutic goals. Music reduces stress by distracting and reducing a
      person's focus on stressful stimuli. Physicians can use it to reduce stress in children
      undergoing treatment or those with the possibility of further treatment. Due to the fact that
      therapeutic music has no side effects, in addition to this, it is easy, cheap, and safe and
      can be accepted by the client. Numerous studies have examined the effect of music therapy on
      reducing stress levels and vital signs.
    

Intervention name(s): Benson's Relaxation technique; Music therapy
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Each child in the study group had an individual interview with researchers, who demonstrated the Benson relaxation technique while teaching them. The child was then asked to demonstrate it. sit quietly in a comfortable position in separate room., close eyes, deeply relax all muscles, beginning at the feet and progressing up to the face and breathe through nose. Become aware of breathing pattern. As breathes out, say the word one silently to child. For example, breathe in, and then out, say one, in and out, and repeat one. Breathe easily and naturally. It is Continue for 10 minutes and repeated two times.; The child lessen to a Mozart's music, which is played before and throughout the blood transfusion procedure. Ambient noise can be reduced by using headphones. As a result, it is easier to see how the intervention has succeeded.
This intervention was done using an MP3 player during the blood transfusion procedure and immediately following the completion of the intervention to prevent the transmission of infections headphones were cleaned with disinfectant after each -use.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Benson's Relaxation; Music Therapy; Stress; Thalassemia