A new research, carried out by the D'Or Institute for Research and Education (IDOR) and the Federal University of ABC (UFABC), has shown for the first time that storytelling is capable of providing physiological and emotional benefits to children in Intensive Care Units (ICUs). The study was published in the Proceedings of the National Academy of Sciences, the official scientific journal of the National Academy of Sciences of the U.S. The study was led by Guilherme Brockington, PhD, from UFABC, and Jorge Moll, MD, PhD, from IDOR.
"During storytelling, something happens that we call 'narrative transportation'. The child, through fantasy, can experience sensations and thoughts that transport him or her to another world, a place that is different from the hospital room and is, therefore, far from the aversive conditions of hospitalization", affirms Guilherme Brockington, PhD, and lead author of the study.
Storytelling is an immemorial practice of humanity. Legends, religions, and social values have spanned millennia through orality and writing. The most current best-selling cinematographic scripts and novels captivate the audiences through the same mechanism: listening to a good story is moving from one reality to another. This movement, driven by imagination, can create empathy for events and characters that fluctuate according to the interpretation of each individual.
"Until now, the positive evidence for storytelling was based on 'common sense' and taken at face value, in which interacting with the child may distract, entertain and alleviate psychological suffering. But there was a lack of a solid scientific basis, especially with regard to underlying physiological mechanisms", explains Dr. Moll.
Considering the psychological and biological processes that occur during, and after listening to a story, the study investigators came up with the idea of seeking scientific evidence for the effects of storytelling on critically hospitalized children.
In total, 81 children were selected, aged between 2 and 7 years and with similar clinical conditions, such as respiratory problems caused by asthma, bronchitis, or pneumonia. The children were admitted to the ICU at Rede D'Or São Luiz Jabaquara Hospital, in São Paulo, Brazil, and were randomly divided into two groups: 41 of them participated in a group in which storytellers read children's stories for 25 to 30 minutes, while in a control group, 40 children were told riddles offered by the same professionals and during the same length of time.
To compare the effects of the two interventions, saliva samples were collected from each participant before and after each session to analyze the oscillations of cortisol and oxytocin - hormones related to stress and empathy, respectively. In addition, the children took a subjective test to evaluate the level of pain they were feeling before and after participating in the activities. They also performed a free word association task by relating their impressions about 7 cards illustrated with elements from the hospital context (Nurse, Doctor, Hospital, Medicine, Patient, Pain, and Book).
The outcomes were positive for all groups, as both interventions reduced the level of cortisol and increased the production of oxytocin in all the children analyzed, while the sensation of pain and discomfort was also mitigated, according to the evaluation of the children themselves. However, a significant difference was that the positive results of the children in the storytelling group were twice as good as those in the riddles group. These findings led the researchers to conclude that the narrative activity was substantially more effective.
"Another highlight of this study is that it was not performed in an artificial environment, but rather within the routine of the pediatric ICU. The storytelling was done individually; the child chose which story would be told. Among the books offered, we chose titles available in ordinary bookstores and without a pre-defined emotional bias, so that the story would not influence the child's reaction so much after the activity", highlights Dr. Brockington.
Even though storytelling was already being adopted in many children's hospitals, this is the first time we are presented with robust evidence of its physiological and psychological impacts. This contributes to seeing the activity as an effective and low-cost therapeutic method, which can make a great difference in the quality of life for children in intensive care units.
"I consider this study to be one of the most important I have participated in, due to its simplicity, rigor, and potential direct impact on practices in the hospital environment, aiming at the relief of human suffering. As it is a low-cost and highly safe intervention, it can potentially be implemented in the entire public system, once larger-scale studies verify its reproducibility and effectiveness. We intend to extend and replicate it in other settings and patient groups and to support volunteering dedicated to the noble activity of storytelling, now with more solid scientific evidence ", points out Dr. Moll.
The emotional impacts of storytelling were also revealed in the results of the free word association test, done at the end of each intervention. Children in the storytelling group reported more positive emotions than in the control group, when exposed to the Hospital, Nurse, and Doctor words. For example, the children in the control group responded to the card with the drawing of a Hospital saying: "this is the place that people go when they are sick". Children in the storytelling group reported for the same card as: "this is the place that people go to get better".
For the illustrations of a nurse and a doctor, the same pattern was observed. Children in the control group remarked "This is the bad woman who comes to give me an injection", while those who were told the stories said phrases such as: "This is the woman who comes to heal me".
Although the research had the support of trained volunteer storytellers from the Brazilian non-profit association "Viva e Deixe Viver", the authors state that storytelling is an activity that can be equally practiced by parents and educators, thus providing space for children to participate in the choice of the book and to interact with the story. In addition to reducing anxiety and stress, the activity enables the strengthening of bonds between the child, the narrator, and the other people present in the environment.
The authors also remarked that the findings of this research on storytelling point to additional potential applications for children experiencing environmental stress, such as the disruption caused by the pandemic. Storytelling by parents, relatives and friends may be a simple and effective way to improve the wellbeing of a child and is accessible to all families.
About the D'Or Institute for Research and Education
Founded in 2010, the D'Or Institute for Research and Education (IDOR) is a non-profit organization that aims to promote scientific advancement, qualification, dissemination of knowledge, and innovation in Healthcare. IDOR develops studies aimed at both applied science, that is, with direct clinical impact in the short term, as well as fundamental science, which seeks deeper knowledge about biological, physiological, and pathological mechanisms. The importance of bringing basic and clinic science closer together was evidenced in research involving the Zika virus, in which IDOR researchers played a key role in proving the relationship between the virus and microcephaly. The results had a wide international reach and were published in Science, one of the most prestigious scientific journals worldwide.
About Viva e Deixe Viver
It is a private non-profit entity, created in August 1997, and is formed by volunteers - mostly storytellers - who provide their service free of charge. Through the art of storytelling, the Association forms citizens aware of the importance of welcoming and acceptance, producing well-being based on human values such as empathy, ethics, and affection. Viva e Deixe Viver gathers more than a thousand active volunteers and is present in hospitals in São Paulo and other states and cities in Brazil.
Proceedings of the National Academy of Sciences