Storytelling increases oxytocin and positive emotions and decreases cortisol and pain in hospitalised children

Research Article: View ORCID ProfileGuilherme Brockington,  View ORCID ProfileAna Paula Gomes Moreira, Maria Stephani Buso,  View ORCID ProfileSérgio Gomes da Silva,  View ORCID ProfileEdgar Altszyler,  View ORCID ProfileRonald Fischer, and  View ORCID ProfileJorge Moll

Meaning

Storytelling is a unique human ability, but we know little about its physiological and psychological impact. This study provides evidence of changes in biomarkers and beneficial effects of storytelling in children admitted to an intensive care unit. We found that, compared to an active control condition, a storytelling session with hospitalised children leads to an increase in oxytocin, a reduction in cortisol and pain, as well as positive emotional changes during a free association activity. These results support evolutionary theories of storytelling and demonstrate its physiological and psychological effects under natural stress conditions. These important clinical implications confirm storytelling as a low-cost, human-friendly intervention that can improve the well-being of hospitalised children.

Abstract

Storytelling is a distinctive human trait that may have played a key role in humans’ ability to bond and cope with challenging social contexts during our evolution. However, the potential impact of storytelling on the regulation of physiological and psychological functions has received little attention. We investigated whether listening to storytelling by a storyteller can provide beneficial effects for children admitted to intensive care units. Biomarkers (oxytocin and cortisol), pain scores and psycholinguistic associations were collected immediately before and after storytelling and an active control intervention (puzzle solving that also involved social interaction but lacked the immersive narrative aspect). Compared to the control group, children in the storytelling group showed a marked increase in oxytocin combined with a decrease in saliva cortisol after the 30-minute intervention. They also reported less pain and used more positive lexical markers when describing their time in hospital. Our results provide a psychophysiological basis for the short-term benefits of storytelling and suggest that a simple and inexpensive intervention can help alleviate the physical and psychological pain of hospitalised children on the day of surgery.

We are all storytellers. From the bards and troubadours of the Middle Ages to the latest Hollywood blockbuster, human beings are exceptionally attracted to telling and listening to stories. The act of storytelling has been shown to be central to establishing human connections and influencing subjective emotions in both the storyteller and the audience.

From a psychological point of view, stories allow us to make sense of our world. Furthermore, storytelling helps us navigate our social world by transforming the continuum of experienced events into a coherent and organised narrative, and helps simulate possible social realities.

Stories invite readers or listeners to immerse themselves in the action depicted and thus to lose themselves throughout the narrative. During this process, the world of origin becomes partially inaccessible to the listener, marking a separation in terms of ‘here’ and ‘there’, ‘now’ and ‘before’, the narrative world of the story and the world of origin. Current psychological and neuroscientific evidence supports the basic premises of this transport process and its plausible origins based on evolutionarily relevant pre-adaptations involving mirror neuron systems, conversational language structures, metaphor processing and imagination. Furthermore, cognitive theories suggest that stories facilitate and enable mental simulations, thus facilitating the mental models that people use to simulate social realities, thus enabling vicarious learning of social realities through the experience of fictional characters. These narrative transports and mental simulations can help reframe personal experiences, broaden perspectives, deepen emotional processing skills, increase empathy, and adjust models of self and emotional experiences.

Here, we present evidence that storytelling can positively influence both psychological and physiological variables in hospitalised children, even within highly demanding settings such as intensive care units (ICUs).

Hospitalisation inflicts significant trauma on children. Hospitalisation abruptly removes children from their daily routine, both at home and at school. In addition to experiencing the difficulties and inconveniences associated with their illnesses, this sudden upheaval can cause disorders that dramatically affect children’s lives. These disorders can be so severe that children develop unhealthy or painful habits that negatively affect them after they are discharged from hospital. Removed from their main social networks of friends and families and placed in a highly unfamiliar environment, children are deprived of the social elements that bring them comfort and security during difficult and painful times. These factors create a stressful situation that can disrupt their development and often cause affective and cognitive impairment, even after the hospitalisation event.

Storytelling could help these children feel transported to another possible world, far away and different from the threatening, aversive and boring environment of intensive care. Consequently, the adverse physiological and psychological reactions experienced during the intensive care stay should be temporarily reduced.

To comprehensively capture both psychological and physiological effects of narration, we will focus on physiological biomarkers, standardised psychometric tests and psycholinguistic indicators. To identify biomarkers, we consider the central role of storytelling as an effective intervention to increase empathy, strengthen human connection and reduce stress. Two promising biomarkers that provide insight into these mechanisms are oxytocin and cortisol.

Oxytocin is involved in empathic processes in establishing and maintaining positive interpersonal behaviour, modulating trust in social interactions and reducing stress. Studies have shown that oxytocin influences the creation of social bonds.
Cortisol is a hormone secreted by the adrenal glands that plays a central role in the human stress response.

To test our hypotheses, 81 children admitted to intensive care were recruited and randomised into two intervention groups: 1) Storytelling (n = 41) and 2) Riddle (n = 40). These children presented fairly similar clinical conditions, with respiratory problems (e.g. asthma, bronchitis and pneumonia) being the most common. Children who were sedated and those who had neurological problems that would have prevented them from taking part in the interventions were not included in the study. We randomly assigned each child a condition (story or riddle).

In the storytelling condition, the children were given a choice of eight stories typically found in children’s literature. All of the selected stories were light-hearted or funny. At any time, a child could change the story or ask for a particular story to be told.

For the riddle group, the children had to guess the solution to some riddles (“What is it?” “Something you don’t eat that is good to eat? “What opens all doors without ever entering or leaving them?”). This active control condition was designed to closely monitor social interactions and attention, which were very similar to the storytelling condition but lacked the narrative immersion provided by stories.

Children in both groups were pre-washed saliva samples before starting the experimental phase. They also took a test in which they had to score a standardised pain scale to assess how much pain they had felt before and after the intervention. All children were also asked to complete a free association word quiz after the surgery. They were shown seven cards with illustrations of a nurse, a hospital, a doctor, a sick person, a book, pain and medicine. Their associations were audio-recorded and subsequently transcribed.

Discussion

Our results revealed that both interventions involving positive social interactions were associated with increased oxytocin levels in hospitalised children. However, those assigned to the Storytelling group showed a two-fold increase in oxytocin levels than children in the Riddle group, also reporting marked decreases in subjective pain scores.

Recent studies reveal that an increase in oxytocin resulted in an alleviation of the psychosocial stress response, causing a decrease in anxiety and an increased feeling of calm as well as an increase in trusting behaviour during social interaction.

In both groups, the children were enthusiastic about the interventions because they disrupted the otherwise austere routine of intensive care. However, when they heard that they would be listening to stories, the children in the Storytelling group were enthusiastic and excited, which may have caused an increase in their cortisol levels before the start of the intervention.

The temporary reduction in cortisol levels that children experience after interventions can be very beneficial as high cortisol levels can negatively affect the immune system and social cognition.

It is important to note that although we used expert storytellers for our research purposes, we believe that parents should be encouraged to tell stories to their children. As we have shown, it is not necessary to use special stories or books or even specific techniques to achieve a successful outcome. Storytelling can be an effective means of creating important emotional bonds. It is also important to emphasise that by allowing children to choose a book that was most meaningful or interesting to them, we enabled them to exercise control and keep them proactive, which can be very valuable in an intensive care setting.