For children, making small toys available, allowing access to a playroom, and coloring book distribution all served as distractors to reduce preprocedural anxiety.  (Image Source: Thinkstock)

For children, making small toys available, allowing access to a playroom, and coloring book distribution all served as distractors to reduce preprocedural anxiety. (Image Source: Thinkstock)

Doctors’ waiting rooms have different distractors: potted plants, televisions featuring shows such as Judge Judy or Pardon the Interruption (depending on the time of day you are sitting in the office), and toys or playrooms for children. There’s scientific evidence behind these practices: anxiety is reduced, perception of pain might be reduced, and perhaps you will be more likely to return to the dentist or doctor for more procedures. Pharmacologic therapies have limitations. Dr. Elaine Biddiss,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada, and coauthorsused ISI Web of Knowledge, PubMed, PsycINFO, EMBASE, CINAHL, and Medline to perform a systematic review of the literature related to nonpharmacological interventions for preprocedural anxiety management. Their findings are published in this month issue of Anesthesia & Analgesia in the article titled “The Effectiveness of Interventions Aimed at Reducing Anxiety in Health Care Waiting Spaces: A Systematic Review of Randomized and Nonrandomized Trials.”

41 articles met inclusion criteria. For children, making small toys available, allowing access to a playroom, and coloring book distribution all reduced preprocedural anxiety. The problem with many studies is that play opportunities are not standardized, thus making it difficult to compare different studies. In adults, listening to music significantly reduces self-reported anxiety. The physiologic indicators showing anxiety reduction are less consistent, however, so the effect of music on the need for sedation is mixed. Aromatherapy, particularly lavender and citrus, may reduce anxiety, but again, proof of its efficacy was inconclusive. Environment and design features such as plant exposure (real or images), or nouveau design also reduce anxiety, albeit in smaller amounts, and the clinical significance of the decrease could not be assessed.

Though televisions are probably the most common distractors used in waiting areas, little research has been undertaken to show whether they are useful and what type of programming is optimal. Toys may help reduce anxiety, though when passed from child to child, they may serve as a nidus of infection. The same goes for headphones that might be used to help reduce anxiety in adults. Some distractors involve a loss of self-control, such as music overhead vs. programming using an individual’s own headphones, or use of a child’s own toys compared to communal toys. Might nonpharmacologic interventions that provide patients with a greater sense of control over their environment and activities further reduce anxiety?  What about the use of these distractors before a procedure compared to during a procedure in terms of overall anxiety reduction? Though different distractors may reduce anxiety before a procedure, does that reduction have any effect on outcome, such as a reduction in the need for medications to reduce pain after the procedure? Clearly more study is needed in order to answer these questions.