Forty one studies (n=1,153) were included in the review (17 RCTs, 13 non-RCTs, seven case studies and four qualitative studies.)
Anxiety and depression were reduced after music therapy (three studies). Nausea and vomiting were reduced after distraction therapy using video games (one study), hypnosis (two studies), and self-hypnosis (four studies), relaxation and distraction therapy (one study). Acupuncture reduced the number of antiemetics administered, but not nausea scores (one study). Distress was reduced after distraction and hypnosis therapy (one study), but there was no significant reduction in distress using relaxation, distraction or hypnosis therapy (one study).
Procedural anxiety was reduced using breathing and distraction treatment (one study), CBT (two studies), distraction as age-appropriate techniques (three studies), video game interventions (three studies), age-appropriate humour (one study) and hypnosis (nine studies).
Procedural distress was reduced using art therapy (one study), distraction therapy (three studies) and general relaxation techniques (one study). Mixed results were reported for multimodal therapy using breathing, distraction, imagery and play (one study), CBT (six studies) and nonessential touch (one study). Music-assisted relaxation was not found to reduce procedural distress, fear or pain (one study).
No intervention reduced procedural fear (five studies).
Procedural pain was reduced using hypnosis (six out of seven studies), distraction and relaxation therapy (one study), CBT (one study), virtual reality distraction therapy (two studies), imagery combined with relaxation therapy (one study). One study of CBT and one of music-assisted relaxation showed no reduction in pain. Imagery treatment showed mixed effects (two studies).