While the paramedic hurried over and the ambulance crew shouted instructions to each other, I imagined a large manta ray gliding through the warm water, with strong calm flaps of his majestic fins, noiseless and beautiful, the embodiment of calm, the embodiment of calm, the embodiment of calm… a truly wonderful creature!

The story “Manta Ray” outlines an intervention for impending heart attacks and asthma attacks, and was inspired by a patient who had suffered a heart attack but who amused the ambulance crew, paramedic and himself with jokes and anecdotes to relax both them and himself and to keep his blood vessels open, based on the principle that anxiety narrows the blood vessels, whereas relaxing images and thoughts widen them and thus increase the chances of survival in a threatened or acute heart attack. Similarly, anxiety during an asthma attack makes it harder to breathe and results in exactly what the patient fears. The metaphor incorporates suggestions for relaxation of the emotions and muscles, regulation of the frequency and intensity of the heart rate and breath and widening of the vessels (warm water), since the simulation of these autonomic states by the imagination stimulates a matching state in the body. Prior mental training is necessary to ensure that these images are called to mind automatically during a heart attack or asthma attack. If necessary, the manta ray should start flapping his fins with “fast and irregular beats” which then gradually become slower. When the story was told to a patient suffering from palpitations (sinus tachycardia), a reduction in pulse rate and a significant improvement in the accompanying symptoms were observed afterwards. The story can be modified to feature an electric ray which generates electrical pulses while he moves, in the same rhythm as his heart beat. As ever, it is important to use these methods to complement traditional medical treatments rather than as an alternative to them. Further stroies that can be used on heart diseases are found in Hammel, 2011, 67, 162. Stories and narrative interventions for asthma patients are found in Hammel, 2011, 70ff., 171 and in Hammel, 2017,120.

(From: Stefan Hammel: Handbook of Therapeutic Storytelling. Sories and Metaphors in Psychotherapy, Child and Family Therapy, Medical Treatment, Coaching and Supervision, Routledge 2019)