ArticlePDF Available

Abstract and Figures

Insomnia is commonly associated with chronic health problems. Behavioural and cognitive factors often perpetuate a vicious cycle of anxiety and sleep disturbance, leading to long-term insomnia. National Institute for Health and Clinical Excellence currently recommends behavioural approaches before prescribing hypnotics. Behavioural approaches aim to treat underlying causes, but are not widely available. Research usually includes patients diagnosed with insomnia rather than secondary, co-morbid sleep- related problems. To examine the effectiveness of autogenic training (AT) as a non-drug approach to sleep-related problems associated with chronic ill health. Prospective pre- and post-treatment cohort study. AT centre, Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Foundation Trust. All patients referred for AT from April 2007 to April 2008 were invited to participate. Participants received standard 8-week training, with no specific focus on sleep. Sleep questionnaires were administered at four time points, 'Measure Your Medical Outcome Profile' (MYMOP) and Hospital Anxiety and Depression Scale, before and after treatment. Results before and after treatment were compared. Camden and Islington Community Local Research and Ethics Committee approved the study. The AT course was completed by 153 participants, of whom 73% were identified as having a sleep-related problem. Improvements in sleep patterns included: sleep onset latency (P = 0.049), falling asleep quicker after night waking (P < 0.001), feeling more refreshed (P < 0.001) and more energised on waking (P = 0.019). MYMOP symptom, well-being, anxiety and depression scores significantly improved (all P < 0.001). This study suggests that AT may improve sleep patterns for patients with various health conditions and reduce anxiety and depression, both of which may result from and cause insomnia. Improvements in sleep patterns occurred despite, or possibly due to, not focusing on sleep during training. AT may provide an approach to insomnia that could be incorporated into primary care.
Content may be subject to copyright.
Autogenic Training as a behavioural approach
to insomnia: a prospective cohort study
Ann Bowden
1
, Ava Lorenc
2
and Nicola Robinson
2
1
Royal London Hospital for Integrated Medicine, University College London Hospitals, London, UK
2
Department of Allied Health Sciences, London South Bank University, London, UK
Background: Insomnia is commonly associated with chronic health problems.
Behavioural and cognitive factors often perpetuate a vicious cycle of anxiety and sleep
disturbance, leading to long-term insomnia. National Institute for Health and Clinical
Excellence currently recommends behavioural approaches before prescribing hypnotics.
Behavioural approaches aim to treat underlying causes, but are not widely available.
Research usually includes patients diagnosed with insomnia rather than secondary,
co-morbid sleep- related problems. Aim: To examine the effectiveness of autogenic
training (AT) as a non-drug approach to sleep-related problems associated with chronic
ill health. Design: Prospective pre- and post-treatment cohort study. Setting: AT centre,
Royal London Hospital for Integrated Medicine, University College London Hospitals
NHS Foundation Trust. Methods: All patients referred for AT from April 2007 to April
2008 were invited to participate. Participants received standard 8-week training, with no
specific focus on sleep. Sleep questionnaires were administered at four time points,
‘Measure Your Medical Outcome Profile’ (MYMOP) and Hospital Anxiety and Depression
Scale, before and after treatment. Results before and after treatment were compared.
Camden and Islington Community Local Research and Ethics Committee approved the
study. Results: The AT course was completed by 153 participants, of whom 73% were
identified as having a sleep-related problem. Improvements in sleep patterns included:
sleep onset latency (P50.049), falling asleep quicker after night waking (P,0.001),
feeling more refreshed (P,0.001) and more energised on waking (P50.019). MYMOP
symptom, well-being, anxiety and depression scores significantly improved (all
P,0.001). Conclusion: This study suggests that AT may improve sleep patterns for
patients with various health conditions and reduce anxiety and depression, both of
which may result from and cause insomnia. Improvements in sleep patterns occurred
despite, or possibly due to, not focusing on sleep during training. AT may provide an
approach to insomnia that could be incorporated into primary care.
Key words: autogenic training; behavioural approach; insomnia; sleep
Received 17 February 2010; accepted 11 April 2011
Introduction
Insomnia is one of the most common problems
presented to health-care professionals, with an
estimated prevalence of 10–38% (National Institute
for Health and Clinical Excellence (NICE), 2005).
Correspondence to: Dr Ann Bowden, M.B., Ch.B, D.C.H.,
MFHom, Lead Clinician, Autogenic Therapy, Royal London
Hospital for Integrated Medicine, University College London
Hospitals, Great Ormond Street, London WC1N 3HR, UK.
Email: ann.bowden@uclh.nhs.uk
rCambridge University Press 2011
Primary Health Care Research & Development page 1 of 11
doi:10.1017/S1463423611000181 RESEARCH
Sleep disturbances are considered insomnia once
they become chronic. This may include diffi-
culty in falling asleep, waking up frequently and
waking up feeling un-refreshed (Morgan, 2008).
Insomnia is associated with impaired social
functioning, anxiety, delayed recovery from acute
illness, depression and many non-specific physical
symptoms (Luthe and Schultz, 1969; Morgan,
2008). Thus, it is costly both financially and in its
impact on physical and psychological well-being
(Chilcott and Shapiro, 1996; Szuba et al., 2003).
A number of factors are associated with the
increased risk of long-term sleep disturbance:
high levels of psychological and physical arousal;
a worrisome cognitive style (often familial);
being female or of older age; individuals with
long-term ill health; and those providing care
at home for a dependent relative or spouse
(Morgan, 2008).
The most common causes of acute insomnia are
loss through death, separation or divorce, physical
illness, mental or emotional trauma (Szuba et al.,
2003). The acute episode may need short-term
medication, but for most people with appropriate
support there will be resolution over time. For
others, although the precipitating event has
resolved, the sleep disturbance continues and it is
at this point that cognitive and behavioural fac-
tors perpetuate the problem (Spielman et al.,
1987). Maladaptive habits and unhelpful beliefs
establish a vicious cycle in which anxiety about
not sleeping becomes the focus of attention.
Patients report that their lack of sleep makes
them anxious and that their anxiety stops them
from sleeping (Bowden, 2010).
Prescribing a hypnotic has been a standard
solution to insomnia (Murtagh and Greenwood,
1995) and can be effective and welcomed by
patients desperate for a good night’s sleep. How-
ever, despite the introduction of newer, ‘better’,
‘safer’ and more expensive hypnotics over the past
50 years, they have not solved the problem of
inability to sleep. A meta-analysis of hypnotics for
older people with insomnia concluded that their use
could not be justified in this group because of the
risk of adverse effects (Glass et al., 2005). In addi-
tion, trials have shown that no drug is more effec-
tive than placebo for improving sleep, daytime
functioning, cognition, falls and dependency (Glass
et al., 2005). Ironically, the side effects of this group
of drugs – cognitive impairment, daytime sleepiness
and depression – are similar to the symptoms of
insomnia (Holbrook, 2004).
Patients with sleep-related problems tend to be
well informed about the pros and cons of the long-
term use of hypnotics and are likely to welcome
alternatives. Behavioural (non-pharmacological)
approaches attempt to address the underlying cause
of insomnia and include relaxation-based interven-
tions, such as stimulus control therapy, sleep
hygiene education, cognitive behavioural therapy
and mindfulness-based stress reduction, often in
combination (Morin et al., 1994; Szuba et al., 2003).
Relaxation methods focus primarily on reducing
somatic arousal and the mental arousal of thoughts
and worries. These methods include autogenic
training (AT), progressive muscle relaxation and
biofeedback. However, behavioural treatments for
insomnia are not widely available at present. To
enable implementation of current NICE guidelines
for treating insomnia, there would need to be an
increase in the number of appropriately trained
staff within the NHS (Anonymous, 2004).
AT is one of of the many complementary
therapies provided at the NHS Royal London
Hospital for Integrated Medicine (RLHIM).
1
It is
a stress management technique particularly
recommended for conditions in which stress plays
a major role in producing or maintaining ill health
(Stetter and Kupper, 2002). AT was developed by
the German physician and psychiatrist J.H.
Schultz in the early twentieth century and is based
on his extensive work on hypnosis and sleep.
AT is a psychophysiologically based form of
autonomic self-regulation, a structured medita-
tive practice. Here, the patient learns a set of six
simple meditative exercises that focus the mind
on the body’s experience of relaxation, heaviness
and warmth in the limbs, a calm heart beat,
slower breathing, abdominal warmth and a cool
forehead. This leads to a reduction in excessive
sympathetic tone and a better balance between
sympathetic and parasympathetic activity (Luthe
and Schultz, 1969). Supporting this ‘autogenic
shift’ is a state of ‘passive awareness’, which is a
non-striving, non-judgmental attitude with the
ability to accept ‘what is’ making possible the
diminution of the effects of stressors both internal
and external (Luthe and Schultz, 1969). Home
1
Formerly the Royal London Homeopathic Hospital.
2Ann Bowden, Ava Lorenc and Nicola Robinson
practice is a key component and emphasises
the autogenic aspect (auto 5‘self’ and genic 5
‘arising from’); the patient then comes to realise
that it is their own process (Luthe and Schultz,
1969). Practice is an appointment with the self,
and it is the patient who decides when and where
to practise and how much time to devote to it
(Luthe and Schultz, 1969).
AT improves sleep latency, duration, efficiency,
and reduces medication, daytime dysfunction,
anxiety and depression (Nicassio and Bootzin, 1974;
Coursey et al., 1980; Stam and Bultz, 1986; Wright
et al., 2002; Hidderley and Holt, 2004). A rando-
mised study found that AT significantly improved
sleep latency compared with placebo (Nicassio
and Bootzin, 1974). Two other studies compared
AT with biofeedback and client-centred therapy
(Engel-Sittenfeld et al., 1980) and with biofeedback
and electrosleep (Coursey et al., 1980) and found
significant improvements in insomnia, but no dif-
ference between treatments.All three studies used
patients with a diagnosis of functional insomnia,
in contrast to this study, which uses a sample of
patients with a range of health conditions with
incidentally high levels of insomnia. The pragmatic
nature of this study’s NHS setting is also novel.
This study examines the effectiveness of AT as
a self-management, non-drug approach to sleep
disorders within NHS outpatient provision within
the context of chronic ill health.
Methods
Study design
This was a prospective, cohort study of AT for
insomnia. Ethical approval was obtained from
the Camden and Islington Community Local
Research and Ethics Committee (reference no.
06/Q0511/106).
The primary outcomes were related to sleep
and were measured at four time points: at initial
consultation, usually approximately 2.5 months
before treatment (T1); at the start of treatment
(T2); at the end of treatment (T3); and at follow-
up (T4). Secondary outcomes were symptoms
and well-being measured using ‘Measure Your
Medical Outcome Profile’ (MYMOP) and anxi-
ety and depression measured using the Hospital
Anxiety and Depression Scale (HADS) at T2 and
T3. Participants acted as their own controls by
comparing changes in scores during pre-treatment
period (T1–T2) with changes during treatment
(T2–T3). The pre-treatment period (T1–T2) was
approximately 2.5 months, which was considered
sufficient time to show significant changes in sleep
parameters for this period.
Setting and sample
The study took place in the AT department at
the RLHIM, University College London Hospi-
tals NHS Foundation Trust. Patients were refer-
red from primary care (35%), tertiary care (60%)
and self-referral (5%). Referrals covered a wide
range of health problems, in which stress is con-
sidered to play a major role.
All patients who chose to start an AT course
between April 2007 and April 2008 were invited to
participate. Inclusion criteria for the course were
based on a verbal agreement to attend the course,
workinagroupandengageinhomepractice.
Patients who would not be able to understand or
follow the instructions were excluded. For this
study, no further inclusion or exclusion criteria were
applied.
Intervention
All patients referred for AT, irrespective of
their presenting complaint, had an initial assess-
ment where health problems were discussed, the
principles of AT and the necessity of home prac-
tice explained and possible benefits outlined.
Training took place in a group setting with six to
eight participants per group, eight weekly sessions
of 2 h and follow-up at three months after train-
ing. AT courses were delivered as standard by
three experienced AT practitioners. There was no
particular emphasis, discussion or recommenda-
tion for dealing with sleep-related problems other
than expectation and encouragement of standard
AT practice. Consistency in the study was implicit
as the three practitioners used exactly the same
training model (British Autogenic Society, 2009).
Outcome measures
Three outcome measures were used: for primary
outcomes, a sleep questionnaire based on the Pitts-
burgh sleep index was used (Buysse et al., 1989),
which has been shown to be valid and reliable for
healthy volunteers and those with depression and
Autogenic Training for insomnia 3
sleep disorders (Buysse et al., 1989); for secondary
outcomes, MYMOP
2
– a patient-generated measure
– was used, which was shown to be valid and
responsive for patients in primary care and com-
plementary therapy clinics (Paterson, 1996) and
HADS
3
(Zigmond and Snaith, 1983), validated for
physically ill patients (Herrmann, 1997). The sleep
questionnaire included the following aspects: time
taken to fall asleep (sleep latency),
4
number of
night-time awakenings,
2
difficulties in getting back
to sleep,
2
total sleep time,
2
feeling refreshed on
waking,
2
dream recall
2
and previous day’s energy.
2
Questionnaires also contained open-ended ques-
tions about patients’ perceived reasons for sleep-
related problems, as well as on the effects of AT on
sleep. Participants completed the standard AT
medical history form and feedback forms.
Participants also received a study information
pack and signed a consent form at the start of
training.
Data analysis
Sleep data for the pre-treatment period (T1–T2)
were compared with data for the treatment period
(T2–T3). For MYMOP and HADS, scores at
T2andT3werecompared.Pairedt-tests were used
for normally distributed data (continuous variables
and interval data). Non-parametric tests were
used for non-normally distributed data: Wilcoxon
signed-ranks test for interval data; and McNemar’s
test for interval variables with inconsistent inter-
vals. In addition, an intention-to-treat analysis was
performed, imputing missing values with the last
available value carried forward. Analysis was per-
formed using SPSS version 15 (SPSS Inc.).
Results
A total of 289 patients were referred to the AT
service during the study period. Of these referrals,
84 did not start the course because of a variety of
reasons including personal choice, and being
unable to commit. Data are presented for the
total of 153 participants who completed the AT
course, that is, completed all eight sessions and
one or more questionnaires at T3 (52 started but did not complete). Attrition at follow-up was high
(only 32% of the 153 provided data at T4), and
therefore no follow-up data are presented. There
were 102 completed sets of sleep questionnaires,
that is, 119 for MYMOP and 138 for HADS.
Table 1 provides demographic characteristics of
Table 1 Demographic characteristics of participants
Completed
course
(n5153)
Did not
complete
course
(n552)
%(n)
a
%(n)
a
Gender
Female 75 (115) 83 (43)
Male 18 (28) 15 (8)
Missing (10) (1)
Marital status
Single 43 (61) 33 (17)
Married 26 (37) 27 (14)
Divorced (11) (4)
Widowed (9) (2)
Cohabiting (7) (2)
Missing 12 (35) 25 (13)
Education
Primary school (1) 0
Secondary school 16 (25) 12 (6)
Further education 66 (101) 79 (35)
Missing (26) 21 (11)
Age (years)
,18 (1) 0
19–29 8 (9) 8 (4)
30–39 16 (20) 25 (13)
40–49 30 (38) 12 (6)
50–59 26 (33) 25 (13)
60–69 14 (17) (2)
70–79 (7) (2)
Missing (28) 23 (12)
Medication
b
Homeopathic 29 (32) 30 (10)
Antidepressants 22 (23) 21 (7)
Cardiovascular 22 (23) 21 (7)
Vitamins/minerals 13 (14) (2)
Gastrointestinal 12 (12) 18 (6)
Hypnotics 10 (11) 18 (6)
Endocrine (thyroid, diabetes) 10 (11) 18 (6)
NSAIDs (10) 0
Anxiolytics (8) (1)
Respiratory (7) 0
Neurological (4) 0
Other 14 (15) 18 (6)
NSAIDs 5non-steroidal anti-inflammatory drugs.
a
Percentage was not calculated when n,10.
b
Percentage of cases, many were on more than one
type of medication.
2
Ordered categorical variable with consistent categories.
3
Continuous variable.
4
Ordinal variable categorised as deteriorated/stayed the same/
improved.
4Ann Bowden, Ava Lorenc and Nicola Robinson
participants who completed the course and those
who did not complete.
The average length of pre-treatment period was
2.6 (SD 2.08) months, the average treatment
period was 1.9 (SD 0.69) months and the average
follow-up period was 3.69 (SD 2.19) months.
Presenting health complaints
The most common presenting complaints of
those who completed the course (n5153) were
anxiety/depression (64% of cases), cardiovascular
disorders, mostly hypertension (15%), insomnia
(13%), gynaecological problems, including pre-
menstrual tension, polycystic ovaries, endometriosis
and infertility (10%); musculoskeletal disorders
including rheumatoid arthritis, osteoarthritis, fibro-
myalgia, pain tension syndrome (11%); and neu-
rological disorders including multiple sclerosis and
Parkinson’s disease (6%). Associated problems
included family and relationship dysfunction (40%),
family illness or death (39%) and employment
problems (12%).
Frequency of and reasons for sleep-related
problems
A total of 112 (73% of those who completed the
course) participants reported having a sleep-related
problem: 17 as their presenting complaint; 95 on the
pre-course questionnaire or sleep questionnaire.
The reasons participants gave for their sleep-
related problems (open-ended question) were:
worry/can’t switch off (21%), stress (16%) or anxi-
ety/depression (15%). Participants also reported
pain, tension, family troubles, noise disturbances,
snoring, menopausal flushes, work worries, medica-
tion, shift work, irritable bowel syndrome and
bladder symptoms, reflux and nightmares as reasons
for not sleeping.
Sleep changes
Comparing changes in the pre-treatment period
(T1–T2) with changes in the treatment period
(T2–T3), there were significant improvements
for the primary outcomes of: time taken to fall
asleep; difficulty getting back to sleep; energy
levels; dream recall and feeling refreshed upon
waking (Table 2). Analysis was repeated using
intention-to-treat analysis, imputing missing
values with the most recent data available, which
increased the total number of cases to 121 – time
taken to fall asleep was no longer significant;
difficulty getting back to sleep, feeling refreshed,
dream recall and energy all remained significant;
total hours asleep and number of night-time
awakenings remained non-significant.
Qualitative comments and feedback forms
The comments in Box 1 show how participants
appreciated AT as a self-management tool often
to help them get to sleep or to get back to sleep
when they wake up in the night. Qualitative data
have been presented in more detail elsewhere
(Robinson et al., 2010).
The feedback forms indicate that one of the
most important aspects of the training was group
support, as well as relaxation and increased con-
fidence.
Improvements in anxiety and depression
Anxiety/depression was reported by 64%
(n574) of participants as their most important
current health problem. Figure 1 compares
HADS scores from T2 to T3 (HADS was not
administered at T1). Significant improvements
were shown with a reduction of 11.55 to 8.94 for
anxiety (95% CI 51.950 to 3.262, P,0.001) and
7.35 to 5.28 (95% CI 51.467 to 2.664, P,0.001)
for depression.
Typical responses on the evaluation forms (in
response to questions on change of symptoms or
other changes following AT) illustrated the
impact of the effects of AT on anxiety and
depression (Box 2)
MYMOP improvements
All MYMOP scores (symptoms 1 and 2, activ-
ity and well-being) improved significantly (all
P,0.001) when comparing T2 with T3 (MYMOP
was not administered at T1) (Table 3). Profile
scores dropped by an average of 1.28 following
treatment.
Discussion
Summary of the main findings and
comparison with previous literature
This study showed significant improvements in
sleep following eight sessions of AT and personal
Autogenic Training for insomnia 5
Table 2 Changes in sleep variables comparing pre-treatment period (T1–T2) with treatment period (T2–T3)
Variable Pre-treatment control (T1–T2; completed
both questionnaires, n5125)
Treatment (T2–T3; completed both
questionnaires, n5111)
Intention-to-treat
analysis (n5121)
Deteriorated Stayed
the same
Improved Missing
data
Significance
test and
P-value
Deteriorated Stayed
the same
Improved Missing
data
Significance
test and
P-value
Significance test –
comparing changes
during treatment with
pre-treatment control –
and P-value (completed
all questionnaires,
n5102)
Missing
data
Significance
test and
P-value
Time taken to fall
asleep
a
23 79 23 0 x
2
512.89,
P50.23
956442x
2
529.897,
P,0.001*
x
2
57.84, P50.049* 0 x
2
56.84,
P50.77**
Number of night-
time awakenings
a
29 71 23 2 x
2
55.58,
P50.70
11 64 34 2 x
2
519.20,
P50.038*
x
2
56.80, P50.079 1 x
2
57.849,
P50.49***
Time taken to get
back to sleep
b
22 85 18 0 Z520.47,
P50.64
163407Z524.87,
P,0.001
Z524.47, P,0.001* 4 Z523.906,
P,0.001*
,
***
Total hours asleep
c
33 66 25 1 95%
CI 520.15
to 0.22,
P50.73
15 55 41 0 95%
CI 520.46 to
20.01,
P50.044*
95% CI 520.49 to 0.26,
P50.55
0 95%
CI 520.42 to
0.21,
P50.498***
Feeling refreshed
on waking up
d
42 32 50 1 Z521.39,
P50.17
18 15 68 10 Z525.93,
P,0.001*
Z53.92, P,0.001* 7 Z523.039,
P,0.002*
,
***
Dream recal
b
30 81 11 3 Z522.81,
P50.005*
12 69 21 9 Z521.39,
P,0.16
Z521.96, P50.050* 10 Z521.960,
P50.050*
,
***
Energy (previous
day)
c
38 27 50 10 95%
CI 50.41 to
20.41,
P50.97
21 23 56 11 95%
CI 521.48 to
20.56,
P,0.001*
95% CI 521.76 to 20.17,
P50.019*
2 95%
CI 521.38 to
20.03,
P50.041*
,
***
*Significant results; **lost significance; ***no change.
T1 5before treatment; T2 5at the start of treatment; T3 5at the end of treatment.
a
McNemars test.
b
Significance test.
c
Paired t-test.
d
Wilcoxon signed-rank test.
6Ann Bowden, Ava Lorenc and Nicola Robinson
daily home AT practice. These included: falling
asleep quicker; getting back to sleep quicker after
waking up in the night; feeling refreshed on waking
up (most frequent improvement) and having more
energy on waking up. When missing data were
included in the intention-to-treat analysis, only
results for time taken to fall asleep were affected.
MYMOP scores also showed significant improve-
ment in symptoms and well-being.
Recruitment for the study was not restricted to
patients presenting with insomnia; however, 73%
of the patients did in fact have a sleep-related
Box 1 Quotes from the sleep questionnaire and evaluation form
‘I worry less about sleeping’
‘It has definitely helped me to get better quality of sleep’
‘It has given me a coping mechanism for handling insomnia, knowledge that I possess this power is a
great reassurance and calming in itself. It prevents a vicious cycle of insomnia and panic about
having insomnia’
‘I have noticed I wake feeling more refreshed. Knowing I can use AT to get back to sleep if I need
to’
‘Very good – go off to sleep almost straight away after AT exercise – very relaxing’
‘I am sleeping undisturbed!! AMAZING’
‘Outstanding! I was astounded but very pleased with the almost immediate effect AT had on my
ability to fall asleep, its made a huge difference’
An excellent effect. It has been such a long time since I have had the pleasure and benefits of a
‘good’ restful sleep. Long may it last’
‘I am more able to put the day’s activities aside and relaxed. I feel calmer when I go to bed’
Score for
depression after
course
Score for
anxiety after
course
Score for
depression
before course
Score for
anxiety before
course
25
20
15
10
5
0
138
198
153
101
107
59
88
Borderline
presence of
condition
Likely
presence of
condition
Figure 1 Boxplot showing median scores and interquartile ranges for HADS scores
Autogenic Training for insomnia 7
problem, and over half had co-morbid insomnia
(a sleep-related problem secondary to their pre-
senting complaint). Chronic symptoms can pro-
duce physiological and cognitive changes that are
similar to those experienced as a result of pro-
longed stress (Sadigh, 2001). It is, therefore, not
surprising that our findings confirm that people
with chronic health problems often do not sleep,
which then becomes an additional burden (Katon
et al., 2007).
Research generally focuses on individuals with
primary insomnia, who are otherwise healthy and
not on medication (Murtagh and Greenwood,
1995). In this study, participants were suffering from
a wide range of chronic conditions, which included a
high incidence of insomnia. Improvements in sleep
occurred despite not specifically focusing on the
problem. Any discussion about sleep was instigated
by the participants; for example, reporting their first
good night’s sleep for a long time, or starting an AT
exercise on going to bed and sleeping through until
morning. In a group setting, these comments
encourage and enhance the effects of AT practice
and its possibilities.
Our findings support observations by AT thera-
pists that AT improves the sleep pattern. Some
trainees who have not mentioned a sleep-related
problem recognise the fact that they have a sleep
deficit. Others find that AT exercise results in
feeling refreshed with renewed energy. It has been
observed in trainees with or without sleep disorders
that after a few weeks of AT practice changes in
sleeping patterns occur, primarily falling asleep
more quickly, feeling more refreshed in the morn-
ing, improved mood and increased recall of dreams
(Luthe and Schultz, 1969).
Trainees report that they find their own way of
practising at home, but the most significant
changes are noticed when they practise regularly
during the day (Luthe and Schultz, 1969). Each
session acts as a ‘power’ rest and breaks up the
vicious cycle of increasing mental and physical
tension, restlessness and anxiety, which can build
up during the day and prevent sleep (Luthe and
Schultz, 1969).
The value placed on the group support element
of AT by participants highlights that the essence of
the AT group process is acceptance, respect and
trust between the therapist and the individual and
between the group members themselves (Bowden,
2010). Many participants who embarked on this AT
course were experiencing great stresses in their lives
and felt isolated with their symptoms. Feedback and
Box 2 Quotes on changes following AT
‘Feel a lot calmer and more centred/grounded’
‘Feel much happier’
‘I’m not so anxiousyThe repetitive thought
are almost nil’
‘I attract more positive responses from others.
Calmness and lack of panic are frequently
remarked upon by family and close friends’
‘I can control my panic attacks’
‘I am coping better as I have a more positive
outlook’
‘more control over my surroundings and a
feeling of assertiveness with confidence’
‘able to handle stressful situations better,
generally feel calmer’
Table 3 MYMOP scores
a
before versus after treatment
MYMOP Before treatment After treatment P-value
(before and after)
c
Mean (SD) Mean (SD)
Symptom 1 3.97 (1.310) 3.00 (1.408) ,0.001
Symptom 2 3.90 (1.133) 2.73 (1.256) ,0.001
Activity 4.09 (1.301) 2.71 (1.376) ,0.001
Well-being 3.43 (1.187) 2.54 (1.231) ,0.001
Profile score
b
3.90 (0.932) 2.62 (0.945) ,0.001
MYMOP 5Measure Your Medical Outcome Profile.
a
Scale from 0 to 6, 0 is good as it can be, 6 is as bad as it can be.
b
Mean of all other scores.
c
Wilcoxon signed-rank test.
8Ann Bowden, Ava Lorenc and Nicola Robinson
modelling from other group members provide
opportunities for social and cognitive reframing,
and from this can ensue the development of greater
self-esteem and self-confidence.
Strengths and limitations of the study
Unlike most studies on treatments for insom-
nia, participants for this study were not chosen for
their sleep-related problems, yet there was a high
prevalence of co-morbid insomnia. This recruit-
ment strategy allowed us to show that AT can
improve sleep despite sleep not being the focus of
training.
The study is subject to a number of limitations.
Participants acted as their own controls, which can-
not reliably confirm causal effects and may be sub-
ject to contamination by historical events. However,
we felt that it would be unethical to randomise
patients to ‘treatment’ or ‘no treatment’ groups as
the study was pragmatic, taking place within a nor-
mal NHS clinic, in which the act of volunteering for
the study was inherent in the expectation of doing
the training. Another possible option would have
been to use patients who declined the training as
controls; however, this would have inevitably intro-
duced confounding variables. We, therefore, chose
to use the pre-treatment period as the control, which
is an accepted methodology, and we believe that this
is a legitimate and valid design for psychological and
sociological research within service evaluation.
It is possible that those who did not benefit
from AT left the course or the study. However,
intention-to-treat analysis (although this only
added 19 cases) shows that the significance of
results for six out of seven variables did not
change. Dropout was usually due to patients’ ill
health, problems involved in travelling to the
hospital, unforeseen personal or work demands
or patients failing to engage with the process.
There were a number of missing and incom-
plete questionnaires that limited the findings. This
was due to the pragmatic nature of the study,
which took place in a time-limited NHS clinic.
There were additional missing data for time taken
to get back to sleep and dream recall, probably
because of questionnaire layout and the inevit-
ability of participants not answering all the
questions on all questionnaires. A number of
questions on the sleep questionnaire were cate-
gorical, and thus may not have been sensitive
enough to identify smaller improvements, parti-
cularly dream recall.
A further limitation was the variation in the
length of the pre-treatment and follow-up periods
(SD 52.08 and 2.19 months, respectively). Future
research may need to improve participant moti-
vation regarding return of questionnaires and
monitoring of individual’s questionnaire comple-
tion, a common difficulty when using multiple
questionnaires in a clinical setting.
Attrition at follow-up (T4) was high, and there-
fore results could not be calculated, although
intention-to-treat analysis suggests that the effect
of dropout was minimal. The study took place at an
NHS specialist hospital in Central London, and
thus the study population was exclusive to those
patients who could be referred and could travel
(often long distances) to attend the sessions.
Although previous research has shown that out-
comes are not related to age or gender (Morin
et al., 1994), it is likely that providing AT locally
would result in its uptake by a wider patient
population and in better follow-up.
The group element of the training was valued
by participants; however, there is a chance that
interaction between participants within groups
biased the results by increasing the chance of a
type I error, although participants did complete
questionnaires by themselves, mostly at home
(Baldwin et al., 2005).
Clinical implications
The current NICE guidelines for treating
insomnia in primary care recommend that beha-
vioural approaches be considered before pre-
scribing a hypnotic (NICE, 2005). The results of
this study show improvements in sleep, anxiety
and depression and general well-being in patients
who completed an AT course in an NHS setting.
Participants recognised improvements and
described AT as a therapeutic tool, which is parti-
cularly helpful for inducing sleep and for getting
back to sleep after waking up in the night. Fitting
AT practice into busy lives can highlight beha-
vioural and cognitive patterns that are maintaining
ill health. With self-observed improvements in
symptoms, patients are encouraged to see AT
practice as a personal, internal, therapeutic resource
that they can use as required. Continued practice is
essential if health benefits are to be maintained.
Autogenic Training for insomnia 9
Dr Ann Bowden, previously a general practi-
tioner, has considerable experience of the positive
results of offering the training in General Practice
and of introducing AT into primary care (Author,
2010). A two-year pilot project, commissioned by a
Primary Care Group from the RLHIM, for anxiety,
panic attacks and insomnia, showed similar results to
the current study (Author, 2006).
Future research
This study shows very promising results for
using AT to treat co-morbid insomnia. Studies
using randomisation, separate control groups and
comparison with other behavioural interventions
and hypnotics are now needed. Studies focusing
on specific disease populations could provide
more insight into the treatment of insomnia as a
secondary component.
Conclusion
This study suggests that AT can improve sleep
patterns in participants with a wide range of health
conditions and may reduce depression and anxiety,
which can both result from and cause insomnia. The
improvements in sleep were despite, and possibly
due to, not focusing on sleep problems during
training. This highlights how observation of non-
specific effects of an intervention can measure the
holistic effect rather than simply the evaluation of
effects on the presenting complaint.
It also suggests that, as a drug-free treatment,
AT may provide a more acceptable option for
patients with chronic insomnia than taking hyp-
notics (Morin et al., 1994). As a structured eight-
session group-based course, it also has the
potential to be cost effective in the long term
(Anonymous, 2004).
Acknowledgements
This study received £1000 from the RLHIM
League of Friends. The authors have no conflict
of interest to declare. The authors thank Tamara
Callea and Chris Perrin, two of the AT therapists,
who were generous with their time and provided
invaluable help and support. They also thank Tom
Kirby, Clinical Governance Manager, for support
in setting up the project, and the RLHIM League
of Friends for their donation to the study.
The authors are very grateful to the patients who
took part.
References
Anonymous. 2004: What’s wrong with prescribing hypnotics?
Drug and Therapeutics Bulletin 42, 89–93.
Bowden, A. 2006: ATas a non-drug approach to anxiety, panic
attacks and insomnia. Journal of Holistic Care 1.
Baldwin, S.A., Murray, D.M. and Shadish, W.R. 2005: Empirically
supported treatments or type I errors? Problems with the
analysis of data from group-administered treatments. Journal
of Consulting and Clinical Psychology 73, 924–35.
British Autogenic Society. 2009: www.autogenic-therapy.
org.uk
Bowden, A. 2010: Clinical roundup: how do you treat insomnia
in your practice?: Autogenic Training. Alternative and
Complementary Therapies 16, 299–305.
Buysse, D.J., Reynolds, C.F. III, Monk, T.H., Berman, S.R. and
Kupfer, D.J. 1989: The Pittsburgh Sleep Quality Index: a
new instrument for psychiatric practice and research.
Psychiatry Research 28, 193–213.
Chilcott, L.A. and Shapiro, C.M. 1996: The socioeconomic
impact of insomnia: an overview. Pharmaeconomics 10,
1–14.
Coursey, R.D., Frankel, B.L., Gaarder, K.R. and Mott, D.E.
1980: A comparison of relaxation techniques with
electrosleep therapy for chronic, sleep-onset insomnia a
sleep-EEG study. Biofeedback and Self Regulation 5,
57–73.
Engel-Sittenfeld, P., Engel, R., Huber, H. and Zangl, K. 1980:
Wirkmechanismen psychologischer Therapieverfahren bei
der Behandlung chronischer Schlafstorungen [Effects
of psychological therapy in the treatment of insomnia].
Zietschrift fur Klinische Psychologie 9, 34–52.
Glass, J., Lanctot, K.L., Herrmann, N., Sproule, B.A. and
Busto, U.E. 2005: Sedative hypnotics in older people with
insomnia: meta-analysis of risks and benefits. British
Medical Journal 331, 1169.
Herrmann, C. 1997: International experiences with the
Hospital Anxiety and Depression Scale–a review of valida-
tion data and clinical results. Journal of Psychosomatic
Research 42, 17–41.
Hidderley, M. and Holt, M. 2004: A pilot randomized trial
assessing the effects of autogenic training in early stage
cancer patients in relation to psychological status and
immune system responses. European Journal of Oncology
Nursing 8, 61–65.
Holbrook, A.M. 2004: Editorial: treating insomnia. British
Medical Journal 39.
Katon, W., Lin, E.H. and Kroenke, K. 2007: The association of
depression and anxiety with medical symptom burden in
patients with chronic medical illness. General Hospital
Psychiatry 29, 147–55.
10 Ann Bowden, Ava Lorenc and Nicola Robinson
Luthe, W. and Schultz, J.H. 1969: Autogenic therapy:
applications in psychotherapy. New York: Gronne Statton.
Morgan, K. 2008: Patients with insomnia should recieve sleep
hygeine advice. Guidelines in Practice 11, 35–41.
Morin, C.M., Culbert, J.P. and Schwartz, S.M. 1994:
Nonpharmacological interventions for insomnia: a meta-
analysis of treatment efficacy. American Journal of
Psychiatry 151, 1172–80.
Murtagh, D.R. and Greenwood, K.M. 1995: Identifying
effective psychological treatments for insomnia: a meta-
analysis. Journal of Consulting and Clinical Psychology 63,
79–89.
Nicassio, P. and Bootzin, R. 1974: A comparison of progressive
relaxation and autogenic training as treatments for
insomnia. Journal of Abnormal Psychology 83, 253–60.
National Institute for Health and Clinical Excellence (NICE).
2005: Insomnia – newer hypnotic drugs: Guidance TA77.
London: NICE website Guidance TA77.
Paterson, C. 1996: Measuring outcomes in primary care:
a patient generated measure, MYMOP, compared with the
SF-36 health survey. British Medical Journal 312, 1016–020.
Robinson, N., Bowden, A. and Lorenc, A. 2010: Can
improvements in sleep be used as an indicator of the
wider benefits of Autogenic Training and CAM research in
general? European Journal of Integrative Medicine 2,
57–62.
Sadigh, M.R. 2001: Autogenic Training: a mind body approach
to the treatment of fibromyalgia and chronic pain
syndromes. Philadelphia, PA: Haworth Medical Press.
Spielman, A.J., Carruso, L.S. and Glovinsky, P.B. 1987: A
behavioural perspective on insomnia treatment. The
Psychiatric Clinics of North America 10, 541–53.
Stam, H.J. and Bultz, B.D. 1986: The treatment of severe
insomnia in a cancer patient. Journal of Behaviour Therapy
and Experimental Psychiatry 17, 33–37.
Stetter, F. and Kupper, S. 2002: Autogenic training: a meta-
analysis of clinical outcome studies. Applied
Psychophysiology and Biofeedback 27, 45–98.
Szuba, M.P., Kloos, J.D. and Dinges, D.F. 2003: Insomnia:
principles and management. Cambridge: Cambridge
University Press.
Wright, S., Courtney, U. and Crowther, D. 2002: A quantitative
and qualitative pilot study of the perceived benefits of
autogenic training for a group of people with cancer 6.
European Journal of Cancer Care (England) 11, 122–30.
Zigmond, A.S. and Snaith, R.P. 1983: The hospital anxiety and
depression scale. Acta Psychiatrica Scandinavica 67,
361–70.
Autogenic Training for insomnia 11
... Although some studies have indicated an effectiveness of AT in subjects with insomnia [43], we did not observe any effects on sleep conditions assessed by PSQI in our study. However, sleep conditions were assessed by a self-report questionnaire (PSQI). ...
... However, subjects were not screened for sleep disorders through medical examinations but through a self-reported questionnaire. As nocturnal HRV and HRR are affected by sleep disorders such as insomnia [43] or SAS [24], which are prevalent among working-age Japanese obese men, the possibility that the results were confounded by a variety of sleep disorders among the subjects cannot be excluded. Finally, we did not assess ANS activity, especially sympathetic activity, using more reliable biochemical or electrophysiological indices of sympathetic activity. ...
Article
Objective: Obesity-induced autonomic nervous system (ANS) dysfunction is related to cardiac disease. The purpose of this study is to examine the effect of autogenic training (AT), a therapeutic relaxation technique, on cardiac ANS functions as evaluated by heart rate variability (HRV) and heart rate recovery (HRR) in Japanese obese/overweight subjects. Methods: Subjects were 40 obese/overweight male workers (42.7 ± 8.8 years old, BMI 28.8 ± 3.3 kg/m2). The subjects were randomly assigned to an AT intervention group and a control group. Subjects of the intervention group were required to perform the AT training procedures (first-third steps) for three months, while the control group participants were waiting. Before and after intervention, HRV was calculated using a 24 hr Holter ECG, and HRR was assessed by a treadmill test. In addition, Profile of Mood States (POMS), job stress and sleep conditions were assessed. Effects of AT intervention were statistically examined using analysis of covariance (ANCOVA). Results: For the HRV, the ratio of the Low Frequency to the High Frequency (LF/HF) during sleep was significantly reduced in the AT group (-39.2% and -0.6%, respectively, p=0.009). HRR was lengthened in the AT group (5.2% and 0.6%, respectively, p=0.042). In addition, the Confusion-Bewilderment score in POMS was improved in the AT group. However, mediation analysis indicated that the Confusion-Bewilderment score was not considered as a mediator between AT and ANS. Conclusions: A three month AT intervention improved cardiac ANS activities in Japanese obese/overweight men. These results suggest the beneficial effects of AT on obesity-related cardiovascular conditions.
... Os dados referentes a indivíduos idosos são contraditórios, oscilando entre impacto positivo, negativo ou ausente (Friedman, Bliwise, Yesavage, & Salom, 1991;Lichstein & Johnson, 1993;revisão de Morin et al., 2006;Örsal, Alparslan, Özkaraman, & Sönmez, 2014;Piercy & Lohr, 1989;Ziv, Rotem, Arnon, & Haimov, 2008). Quanto ao treino autogénico é uma técnica para lidar com o stresse, tendo sido desenvolvida por J. H. Schultz no início do século vinte com base no seu trabalho sobre sono e hipnose (Bowden, Lorenc, & Robinson, 2012). Esta técnica envolve a visualização de uma cena pacífica e repetição de frases autogénicas para aprofundamento da resposta de relaxamento (Payne & Payne, 2010), podendo ser uma alternativa a incorporar no tratamento da insónia com adultos, incluindo idosos (Bowden et al., 2012). ...
... Quanto ao treino autogénico é uma técnica para lidar com o stresse, tendo sido desenvolvida por J. H. Schultz no início do século vinte com base no seu trabalho sobre sono e hipnose (Bowden, Lorenc, & Robinson, 2012). Esta técnica envolve a visualização de uma cena pacífica e repetição de frases autogénicas para aprofundamento da resposta de relaxamento (Payne & Payne, 2010), podendo ser uma alternativa a incorporar no tratamento da insónia com adultos, incluindo idosos (Bowden et al., 2012). A meditação mindfulness é uma nova abordagem de gestão do stresse e de regulação emocional (Kabat-Zinn, 1982) que se tem mostrado benéfica no tratamento da insónia (e.g., revisão de Larouche, Côté, Bélisle, & Lorrain, 2014;Ong & Sholtes, 2010) e mais eficaz a longo prazo do que a farmacoterapia (Gross et al., 2011). ...
Chapter
O sono é uma parte essencial da vida e universal entre os seres humanos e outros vertebrados. Durante bastante tempo o sono foi considerado um estado passivo de inconsciência, mas hoje o sono humano é considerado um processo fisiológico complexo, organizado e ativo, que requer a participação de uma variedade de regiões encefálicas (Bear, Connors, & Paradiso, 2002; Paterson, 2012; Stanley, 2005; Olbrich, Acherman, & Wennekers, 2011). A quantidade de sono exigida é geneticamente determinada e varia entre as pessoas. O que é importante na duração do sono é que esta seja suficiente para que o indivíduo se sinta revigorado e capaz de desempenhar as suas tarefas diárias de uma maneira satisfatória. Em geral, a quantidade de sono considerada suficiente para os adultos situa-se entre as sete e as oito horas por noite (Paterson, 2012), diminuindo, de uma forma geral, com a idade (Edwards et al., 2010), passando para as seis e a seis horas e meia entre as pessoas de idade mais avançada (Rajput & Bromley, 1999). A quantidade de sono em adultos idosos não deixa de ser, contudo, semelhante ou maior quando comparada com o tempo total de sono em adultos mais novos (Byles, Mishra, Harris, & Nair, 2003).
... AT has been shown to have positive effects on pain, anxiety, symptoms of depression, sleep disorders, fatigue, and quality of life [20][21][22][23][24][25] in various populations living with chronic disease. However, according to a systematic scoping review, few studies have evaluated the effects of AT on people living with HIV [26]. ...
Article
Full-text available
Background Various mind-body practices are used by people living with HIV to promote their general well-being. Among these is autogenic training (AT), a self-guided relaxation technique requiring regular practice for observable benefits. However, little has been written about the process of learning this technique, which is obviously a prerequisite to regular practice. This study therefore aims to describe the process by which people living with HIV learn AT. Methods The study is a descriptive qualitative study using semi-structured interviews and a thematic analysis with a mixed approach. Fourteen participants living with HIV completed sessions to learn autogenic training over a period of 3 months. Results The process of learning AT was approached through three themes: initiating the learning process, taking ownership of the technique, and observing its benefits on wellness. To initiate learning, participants had to express a need to take action on an aspect of their well-being and their openness to complementary approaches to care. Taking ownership of the technique was facilitated by guidance from the nurse researcher, the participants’ personal adaptations to overcome barriers to their practice, regular practice, and rapid observation of its benefits. Finally, the participants reported the observation of benefits on their wellness, including personal development, mainly in terms of the creative self, the essential self, and the coping self. This perception of the technique’s benefits was part of the learning process, as it contributed both to the participants’ ownership of the technique and to reinforcing their AT practice. Conclusions People living with HIV see learning AT as a progressive process, in which wellness is a major outcome and a contributing factor in developing a regular practice.
... They were also led in an autogenic relaxation practice, a behavioral method that has been shown to reduce anxiety and facilitate sleep. 26 An autogenic relaxation script was provided for home practice. ...
Article
Full-text available
Introduction The incidence of obstructive sleep apnea in military personnel has increased over 500% since the early 2000s. Adherence to continuous positive airway pressure (PAP), an efficacious treatment, has been suboptimal. This article presents a behavioral intervention model for enhancing PAP therapy adherence and describes how the model was received by military personnel. Materials and Methods The study population comprised 254 out of 280 military personnel (93% men, mean age 39 years) who attended a 90-minute behavioral intervention class within the first 8 weeks of PAP use. They were coached on the Knowledge, Skills, Attitudes (KSA) model of PAP therapy success: Knowledge about obstructive sleep apnea and PAP treatment; Skills to develop a habitual loop for nightly PAP use; and Attitudes that address readiness, barriers, and solutions for sustaining PAP use. Participants completed a voluntary, anonymous postclass survey that inquired of their perception of various elements of the class. Data were analyzed using descriptive statistics and a paired sample t-test. Results In participants’ self-rating of how much they know about PAP treatment before and after the class, their ratings indicated that they experienced a significant increase in knowledge (P < 0.0001). On the postclass survey, 77% of the participants (N = 195/254) “agree a lot” or “strongly agree” that the class gave them tools to have a successful treatment and 78% (N = 198/254) noted that it was a valuable educational experience. The Knowledge portion was rated by 79% (N = 201/254) of the participants as “quite a lot” or “extremely” beneficial. The Skills segment was rated as “quite a lot” or “extremely” beneficial by 72% (N = 183/254) of the participants. The Attitudes discussion was perceived as “quite a lot” or “extremely” beneficial by 70% (N = 178/254) of the participants. Participants’ free-text responses to “what was most helpful” were generally positive. Conclusions A KSA model of behavioral intervention for enhancing PAP therapy adherence was well received by participants. Future research will assess the impact of this intervention on adherence as measured by objective indicators.
... The program consisted of 8-week training, with no specific focus on sleep. 30 Progressive muscle relaxation (PMR) is a deep muscle relaxation method developed by American physician Edmund Jacobson in 1938. 31 The goal of PMR is reducing somatic tension and cognitive arousal that negatively affect sleep quality. ...
Preprint
Introduction: Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a nonpharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the nonpharmacologic approach is often underestimated by both patients and physicians. Objective: To provide primary care physicians an up-to-date approach to the nonpharmacologic treatment of insomnia. Methods: PubMed, Web of Science, and Scopus databases were searched for relevant articles about the nonpharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. Main Message: Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and nonpharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a sleep medicine specialist for refractory cases. Conclusions: This paper provides an overview of current recommendations and up-to-date evidence for the nonpharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered.
... Two RCTs found that AT decreases anxiety for people living with heart disease [48] and improves QoL among people living with multiple sclerosis [49]. A pre-and post-treatment study examining the effectiveness of AT found improvements in sleep patterns, anxiety, depression, and well-being among people with various chronic health problems, 73% of whom had a sleep-related problem [50]. These results could be explained by the mindfulness-to-meaning theory, which suggests that, through the mechanism of decentering, mindbody practices such as relaxation transform how one attends to experience [51]. ...
Article
Full-text available
Background Progressive muscle relaxation (PMR) and autogenic training (AT) are effective relaxation techniques to reduce depressive symptoms. However, no studies on their effectiveness have been conducted among people living with HIV and depressive symptoms. The primary aim of this pilot study was to assess the feasibility and acceptability of PMR and AT interventions among people living with HIV who have depressive symptoms. A secondary aim was to assess the potential effectiveness of these interventions on depressive symptoms and quality of life. Methods This study was a three-arm pilot randomized control trial with mixed methods. Participants were randomized to PMR, AT, or a control group (CG), with four assessments (baseline, and at one, three, and six months). The PMR and AT interventions consisted of six 1 h sessions of individual training over 12 weeks, plus home practice. Recruitment, attrition, and completion rates were calculated. Depressive symptoms and quality of life were assessed at all times. Participants' perceptions of the interventions were collected in semi-structured interviews. Results Following the screening, 54/63 people met the inclusion criteria, and 42/54 were randomly allocated to the PMR group (n=14), AT group (n=14), and CG (n=14). Six participants (43%; 95% CI 18–71%) in the PMR group and 10 (71%; 95% CI 42–92%) in the AT group completed the intervention. Participants reported better emotion management and improvements in depressive symptoms and quality of life. Conclusions The pilot study suggests that a randomized trial to test the effectiveness of these interventions is feasible. Trial registration ClinicalTrials.gov NCT01901016
... Autonomic training combine with biofeedback in clinical practices produced better results than control group for headache population (Luthe, 1979). Empirical research found that autonomic training was applied efficiently in emotional and behavioural problems, and physical disorder (Klott, 2013), such as skin disorder (Klein & Peper, 2013), insomnia (Bowden, Lorenc, & Robinson, 2012), and Meniere's disease (Goto, Nakai, & Ogawa, 2011). ...
Article
Full-text available
This article presents the argument that mindfulness-based meditation (MM) techniques are beneficial and share many of the same outcomes as similar mind-centered practices such as transcendental meditation, prayer, imagery, and visualization and body-centered practices such as progressive muscle relaxation (PMR), autogenic training (AT), and yoga. For example, many standardized mind-body techniques such as mindfulness-based stress reduction and mindfulness-based cognitive therapy (a) are associated with a reduction in symptoms of anxiety and depression, (b) can be mastered in relatively brief time frames, and (c) are relatively cost-effective. Functional magnetic resonance imaging studies suggest that MM, along with other mind-body techniques, can influence brain centers that regulate stress reactions (e.g., eliciting increased activity in cerebral areas related to attention and emotion regulation). Furthermore, MM and other mind-body techniques may provide benefit by mediating breathing processes that in turn regulate gamma aminobutyric acid, a major inhibitory neurotransmitter, which can quiet the overactivation of the sympathetic nervous system. This article compares the efficacy of mindfulness-based techniques to that of other self-regulation techniques and identifies components shared between mindfulness-based techniques and several previous self-regulation techniques, including PMR, AT, and transcendental meditation. The authors conclude that most of the commonly used self-regulation strategies have comparable efficacy and share many elements. The authors propose that additional research is needed to explore shared mechanisms among the self-regulation techniques and to identify any factors that might favor using one technique over another.
... Die positive Wirkung von autogenem Training auf den Schlaf setzt nach etwa 8 Wochen ein, wobei es nicht notwendig ist, ein eigenes schlafspezifisches Trainingsprogramm zu entwickeln (vgl. Bowden et al. 2012). ...
Chapter
Stress ist eine der häufigsten Ursachen für nicht erholsamen Schlaf. Bedingt durch die ständige Erreichbarkeit mittels moderner Kommunikationstechniken, wird es immer schwieriger, sich von der Arbeitswelt und den Verpflichtungen der Freizeitaktivitäten abzugrenzen. Auch wenn die Person es schaffen sollte, allen Terminen nachzukommen, die ihr auferlegt wurden oder die sie sich selbst auferlegt hat, so wird sie abends, wenn es Zeit ist, zu Bett zu gehen, noch immer „unter Strom“ stehen. Die direkten Folgen sind oftmals zunächst Einschlaf- oder Durchschlafschwierigkeiten, belastende Träume bis hin zu Albträumen, Magen-Darm-Beschwerden oder Herz-Kreislauf-Störungen. Ein geregelter Tagesablauf und die Einhaltung von Schlafhygieneregeln können dem beginnenden Kreislauf von gestörtem Schlaf und dadurch noch mehr Stress entgegenwirken.
Article
Introduction Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a nonpharmacologic approach should be preferred in most cases. Although generally considered first‐line treatment, the nonpharmacologic approach is often underestimated by both patients and physicians. Objective To provide primary care physicians an up‐to‐date approach to the nonpharmacologic treatment of insomnia. Methods PubMed, Web of Science, and Scopus databases were searched for relevant articles about the nonpharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. Main message Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and nonpharmacologic approaches, while the latter should be generally considered first‐line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. Conclusions This paper provides an overview of current recommendations and up‐to‐date evidence for the nonpharmacologic treatment of insomnia. This article emphasizes the importance of cognitive‐behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, e.g., light therapy, aromatherapy, music therapy, and herbal medicine.
Chapter
Relaxation techniques are an increasingly important part of modern therapeutic paradigms for numerous biopsychosocial disorders. In essence, all relaxation techniques elicit a broad relaxation response associated with characteristic changes in physiological, muscular, and cognitive/affective processes. Core relaxation techniques of the therapeutic arsenal include breathing techniques, guided imagery, progressive muscle relaxation, biofeedback, autogenic training, hypnosis, and meditation. This chapter describes the theory, clinical implementation, and efficacy research associated with each of these approaches. Technique-specific and broad clinical indications and contraindications are discussed. While an abundance of research has focused on the question of whether relaxation works, minimal research has focused on answering the question of how relaxation works. In this chapter we argue that to demonstrate the true public health value of relaxation interventions, future research needs to verify not only that various relaxation techniques work, but that they work for the reasons specified by the associated theory.
Article
Full-text available
Evaluated 2 relaxation techniques, progressive relaxation and autogenic training, as treatments for insomnia. No-treatment, a baseline control group, and a self-relaxation group designed to control for nonspecific therapeutic elements were employed. Ss were 30 adult insomniacs who had chronic and severe difficulties in falling asleep. As indicated by global measures of improvement and by reduction in time to fall asleep, progressive relaxation and autogenic training were equally effective as treatments and superior to both control groups. At a 6-mo follow-up, treatment gains had been maintained in time to fall asleep but not in self-reported global improvement, while control Ss showed no spontaneous improvement on either of the measures. (15 ref)
Article
Introduction and study aims: Poor sleep exacerbates health problems which in turn can affect sleep. Behavioural approaches to insomnia management are preferred to prescribed hypnotics. This article examines whether resolving sleep problems as a result of Autogenic Training (AT) can be used as a potential indicator of effectiveness for people with chronic health problems. Methodology: In an observational study at the Royal London Homeopathic Hospital, patients acted as waiting list controls before receiving standard 8 week group AT training. Data was collected on sleeping patterns, symptoms and general health. Results: Of 153 participants with various health conditions completing the AT course, 11% presented with sleep problems as their main complaint, on further questioning 62% also had a sleep problem. Worry, stress, anxiety and depression were identified as the possible cause or trigger of sleep problems for 52% of patients. After an AT programme overall changes in sleep included: improvement in sleep onset latency (p = 0.049), ability to fall asleep faster after night waking (p < 0.001), waking more refreshed (p < 0.001), and more energy on waking (p = 0.019). Sleep improved irrespective of whether insomnia was their main presenting complaint. Discussion/conclusions: Sleep problems were only one of the primary reason for patients' referral to AT. However, AT improved sleep quality despite sleep not being the focus of the training or a common presenting complaint. These changes in wellbeing may not be captured in health research, but make a critical difference to patients and their health outcomes. Measuring sleep disturbances as a potential outcome indicator for health research should be considered.
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
Two methods of relaxation therapy, electromyograph biofeedback and autogenic training, were compared to a nonrelaxation treatment, electrosleep therapy, in reducing sleep latency among 22 chronic, sleep-onset insomniacs. While none of the electrosleep patients improved on all-night laboratory electroencephalographic sleep records or daily home sleep logs, approximately one-half of the relaxation-treated patients showed marked improvement, which was sustained over a 1-month follow-up period. Although some sleep and treatment variables differentiated relaxation therapy responders from nonresponders, external stress appeared to be the most salient factor. Successful and unsuccessful patients could not be differentiated on any of the psychological variables studied.
Article
A 27-year-old man with severe insomnia secondary to cancer and chemotherapy was treated with a combination of somatic focusing and imagery training for five sessions. This led to a decrease in the latency of sleep onset and an increase in the duration of sleep which was maintained up to a 12-month follow-up. The utility of this treatment package is discussed with special reference to cancer patients.
Article
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
Article
The major behavioral treatments of insomnia--progressive relaxation, biofeedback, cognitive approaches, stimulus control instructions, chronotherapy, and sleep restriction therapy--are described. The basis of these interventions are conceptualized as issuing from the interdependence of sleep and wakefulness, the temporal organization of sleep-wake processes, cognitive effects on arousal, the role of perpetuating factors in chronic insomnia, and conditioning. A pilot study of the conditioning of rapid sleep onset with the aid of a hypnotic provides a preliminary demonstration of the application of conditioning to the pharmacotherapy of sleep. It is predicted that the commonly accepted view of sleep latency as solely reflecting physiological sleep tendency, will require modification to include the effects of conditioning. The current pattern of hypnotic usage, an issue of widespread concern, is subjected to a behavioral analysis based on a new model of conditioned tolerance. The intermittent administration of placebo within a hypnotic regimen is predicted to be especially beneficial in sustaining hypnotic efficacy.