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R ecen t D eve lo p m e n ts in P s y c h i a t r y a n d A l l i e d F ie l d s

AUTOGENIC TRAINING: METHOD, RESEARCH AND APPLICA­


TION IN MEDICINE
W. L ttthe, M.D.
Montreal, Canada

I n t r o d u c t io n

Autogenic Training is a psychophysiologic form of psychotherapy


which the patient carries out himself by using passive concentration
upon certain combinations of psychophysiologically adapted stimuli.
In contrast to the other methods of psychotherapy, autogenic training ap­
proaches and involves mental and bodily functions simultaneously.
Passive concentration on Autogenic Standard Formulas can be so tai­
lored that a normalizing influence upon various bodily and mental func­
tions will result. From a neurophysiologic point of view there is clinical
and experimental evidence indicating that certain changes of eortico-
diencephalic interrelations are the functional core around which auto­
genic training revolves (1).
About 40 years ago the founder of the method, J. H. Schultz, psychia­
trist and neurologist in Berlin, wrote the first publications about clinical
and experimental observations of what he called “ autogenic organ exer­
cises” (2, 3). In 1932, the first edition of Autogenic Training became
available (4). Since then, 10 German editions have appeared (5), trans­
lations into Spanish (6), Norwegian (7), and French (8), as well as a
recent American edition (1). During the last three decades autogenic
training has become widely known in Europe and today it is regarded as
a valuable standard therapy in various fields of medicine. It has also
been integrated into the training programs of many universities (1, 9-
1 2 ).
The steady increase of interest in autogenic training is reflected by the
progressively increasing number of publications of a clinical and experi­
mental nature (13). During each of the last three years more than 100
articles on the subject were published in medical journals and books. It
is interesting, however, that only about one per cent of a total of about
1,000 publications were written by English speaking authors (1).
BACKGROUND OF THE METHOD

The beginning of autogenic training stems from research on sleep and


hypnosis carried out in the Berlin Institute of the renowned brain physi­
ologist Oskar Vogt during the years 1890 to 1900. Vogt observed that
intelligent patients who had undergone a series of hypnotic sessions under
174
AUTOGENIC TRAINING 175

his guidance were able to put themselves for a self-determined period of


time into a state which appeared to be very similar to a hypnotic state.
His patients reported that these ‘ 4autohypnotic ’ ’ exercises had a remark­
able recuperative effect (1, 4, 5).
At the time he observed that these short-term mental exercises, when
practiced a few times during the day, reduced stressor effects like fatigue
and tension. Other disturbing manifestations, as for example headaches,
could be avoided and the impression was gained that one’s over-all effi­
ciency could be enhanced. On the basis of these observations Yogt con­
sidered such self-directed mental exercises to be of definite clinical value.
He called them “ prophylactic rest-autohypnoses’ ’ (PropJiylaktische
Ruhe-Autohypnosen) .
Stimulated by Vogt’s work (14) J. H. Schultz became interested in
exploring the potentialities of autosuggestions. His aim was to find a
psychotherapeutic approach which would reduce or eliminate the un­
favorable implications of contemporary hypnotherapy, such as the pas­
sivity of the patient and his dependency on the therapist.
During subsequent years, while investigating the question of halluci­
nations in normal persons, Schultz collected data which appeared to link
up with Vogt’s prophylactic mental exercises (4). Many of Schultz’s
hypnotized subjects reported to have experienced, almost invariably, two
types of sensations .*a feeling of heaviness in the extremities often involv­
ing the whole body and frequently associated with a feeling of agreeable
warmth. Schultz concluded that the psychophysiologic phenomena re­
lated to the experience of heaviness and warmth were essential factors in
bringing about the changes from the normal to a hypnotic state.
The next question was whether a person could induce a psychophysio­
logic state similar to a hypnotic state by merely thinking of heaviness and
warmth in the limbs. The systematic pursuit of this question was the
actual beginning of autogenic training. Under certain technical circum­
stances and by the use of passive concentration on verbal formulas imply­
ing heaviness and warmth in the extremities, Schultz’s subjects were able
to induce such a state, which appeared to be similar to a hypnotic state.
The self-directed nature of the approach had a number of clinical ad­
vantages over the conventional techniques of hypnosis, among them, the
active role and the responsibility of the patient in applying the treat­
ment and the elimination of dependence on the hypnotist.

METHOD

From Schultz’s clinical work a number of useful verbal formulas gradually


evolved which, according to their more bodily or mental orientation, formed two
basic series of mental exercises: the Standard Exercises and the Meditative
Exercises.
176 AMERICAN JOURNAL OF PSYCHOTHERAPY

The six standard exercises are physiologically oriented. The verbal content
of the standard formulas is focused on the neuronmscular system (heaviness)
and the vasomotor system (warmth); on the heart, the respiratory mechanism,
warmth in the abdominal area, and cooling of the forehead.
The meditative exercises are composed of a series of seven exercises which
focus primarily on certain mental functions and are reserved for trainees who
master the standard exercises.
Later, as more clinical and experimental data became available, a number of
complementary exercises specifically designed for normalization of certain patho-
functional deviations evolved. These were called special exercises.
Psychophysiologically, autogenic training is based on three main principles:
(a) reduction of exteroceptive and proprioceptive afferent stimulation; (b)
mental repetition of psychophysiologically adapted verbal formulas; and (c)
mental activity conceived as “passive concentration.”
A reduction of afferent stimuli requires observation of the following points:
the exercise should take place in a quiet room with moderate temperature and
reduced illumination; restricting clothes should be loosened or removed; the body
must be relaxed, and the eyes closed, before the mental exercises are begun. Three
distinctive postures have been found adequate: (a) the horizontal posture; (b)
the reclined arm-chair posture; and (c) the simple sitting posture. All three
training postures require careful consideration of a number of points. When
certain details are not observed, disagreeable side-effects or after-effects and
ineffective performance of the exercises have been reported.
The first exercise of the autogenic standard series aims at muscular relaxation.
The functional theme of the verbal formula is heaviness. Right-handed persons
should start out with passive concentration on “My right arm is heavy.” Left-
handed persons should begin with focusing on the left arm.
During the very first exercises about 40 per cent of all trainees will experi­
ence a feeling of heaviness predominantly in the forearm. During subsquent
periods of regular training, the whole arm becomes heavy and the feeling of
heaviness will spread to other extremities. This spreading of a certain sensation
(the heaviness, tingling, warmth) to other parts of the body is called the “gen­
eralization phenomenon.” Along with the development of the generalization
phenomenon, passive concentration on heaviness will be extended to the other arm
or the homolateral leg. Usually the heaviness training continues until heaviness
can be experienced more or less regularly in all extremities. This may be achieved
within two to eight weeks. Clinical investigations of larger groups of trainees,
however, indicate that about 10 per cent of the patients do not experience a
sensation of heaviness. This fact is one of the reasons why patients should be
told that the Heaviness Formula (and others) functions merely as a technical key
to bring about many different functional changes in the brain and bodily system,
and that a sensation of heaviness may or may not occur.
Furthermore, it has been found helpful to tell a patient that many changes of
bodily functions occur (see section on experimental data) which one cannot feel.
It is also important for the patient to know that according to experimental ob­
AUTOGENIC TRAINING 177

servations, the exercises are effective as long as they are performed correctly,
even if one does not feel anything at all. Apart from this it is necessary that the
therapist is familiar with the therapeutic problems resulting from different forms
of autogenic discharges and processes of autogenic abreaction which may start
while the patient is in an autogenic state (15-18).
Subsequently, passive concentration on warmth is added, starting, for example
with “My right arm is warm.” This formula aims at peripheral vasodilation.
Depending on the generalization of the feeling of warmth in other limbs, the
training progresses until all extremities become regularly heavy and warm. This
training may take another period of from two to eight weeks.
After having learned to establish the feeling of heaviness and warmth, the
trainee continues with passive concentration on cardiac activity by using the
formula “Heartbeat calm and regular.” Then follows the respiratory mechanism
with “It breathes me,” and warmth in the abdominal region: “My solar plexus is
warm.” The final exercise of the physiologically oriented standard exercises
concerns the cranial region which should be cooler than the rest of the body.
Here, one applies the formula “My forehead is cool.”
The time usually needed to establish these exercises effectively varies between
four and ten months.
The trainee’s attitude, while repeating a formula in his mind, is conceived as
“passive concentration.” Passive concentration may best be explained in com­
parison with what is usually called “ active concentration.” Concentration in the
usual sense has been defined as “the fixation of attention,” or “high degree of
intensity of attention,” or “the centering of attention on certain parts of experi­
ence.” This type of mental activity involves the person’s concern, his interest,
attention, and goal-directed investment of mental energy and effort during the
performance of a task and in respect to the functional result.
In contrast, passive concentration implies a casual attitude during the per­
formance and with regard to the functional result. Any goal-directed effort,
active interest, or apprenhensiveness must be avoided. The trainee’s casual and
passive attitude toward the psychophysiologic effects of a given formula is re­
garded as one of the most important factors of the autogenic approach. Fur­
thermore, the effectiveness of passive concentration on a given formula depends
on two other factors namely (a) the mental contact with the part of the body indi­
cated by the formula (for example, the right arm ); and (b) keeping up a steady
flow of a filmlike (verbal, acoustic or visual) representation of the autogenic
formula in one’s mind. Passive concentration on a formula should not last more
than 30 to 60 seconds in the beginning. After several weeks the exercises may
be extended to three or five minutes; after a few months up to 30 minutes and
longer.
The state of passive concentration is terminated by applying a three-step
procedure, namerly (a) flexing the arms energetically, then (b) breathing deeply,
and (c) opening the eyes. Usually three exercises are performed in sequence,
with about a one minute interval between each of them.
After the standard exercises have been mastered satisfactorily, one may train
178 AMERICAN JOURNAL OF PSYCHOTHERAPY

to modify the pain threshold in certain parts of the body or train the time sense
for waking up at a specific time. The therapy may be continued by applying
autogenic principles for approaching specific functional disorders or even certain
organic diseases. A number of special formulas and procedures have been
worked out for meeting the therapeutic requirements of various functional and
organic disorders like bronchial asthma, writer’s cramp, hemorrhoids, brain
injuries, esophagospasm, pruritus and others.
The meditative exercises should not normally be started until after six to 12
months of standard training, and the trainee should be able to prolong the au­
togenic state up to 40 minutes without experiencing any disagreeable side-effects
or after-effects.
The meditative series begins with passive concentration on phenomena of
visual imagination, as for example the spontaneous experience of certain colors.
Later, the trainee may focus on seeing all colors at will. When that is achieved,
the meditative series continues with visual imagination of objects. This training
phase may take several weeks before results are obtained. It is followed by
imagining abstract concepts like “happiness” or “justice” in different sensual
modalities (musical, chromatic, plastic). Still later, one may meditate on one’s
own feelings and, in contrast, try to evoke the image of another person. Finally,
at the deepest level of meditation, an interogatory attitude may be assumed in
expectation of answers from the unconscious.
Autogenic training at the meditative level may be applied as what has been
called “Nirvana Therapy” (4, 5) in clinically hopeless cases (for example ad­
vanced cancer) or in monotonous and desperate situations as may occur under
exceptional circumstances. The meditative exercises have also been found to be
of particular value in depth-dimensional psychotherapy. In general, it has been
observed that the effects of the more physiologically oriented standard exercises
are reinforced by the meditative training. However, the meditative exercises are
not introduced to the average patient. The average clinical therapy centers on the
standard formulas in combination with special exercises and intentional formulas
specifically designed to meet the therapeutic requirements of relevant functional
or organic disorders.

e x p e r im e n t a l d a t a

From experimental data and clinical results we know that passive con­
centration on the standard formulas induces multidimensional changes
of a mental and organismic nature. In principle, two categories of
effects may be distinguished: immediate effects, occurring during passive
concentration on the different formulas, and effects resulting from prac­
tice of autogenic exercises over periods of weeks and months. Informa­
tion about the immediate effects during the exercises is still incomplete.
However, the experimental data available indicate clearly that each of
the standard formulas induces physiologic changes of certain autonomic
functions which are coordinated by diencephalic mechanisms.
AUTOGENIC TRAINING 179

During passive concentration on heaviness, Siebenthal (19, 20), Witt-


stock (21), and Eiff and Jorgens (22) recorded a significant decrease of
muscle potentials. Along the same lines Schultz found a significant re­
duction of the patellar response during passive concentration of heaviness
in both legs (4, 5). Determinations of motor chronaxie (muse, extensor
digit, comm, dexter) by Schultz, Lewy, and Gaszmann (4, 5) indicated
that the intensity of the stimulus has to be increased during the heaviness
exercise because the excitatory threshold rises from its resting value.

F igure 1

sKintemp.

Changes in peripheral circulation during passive concentration on


heaviness and warmth have been verified by a number of independent
authors (1, 3, 4, 23, 24). The most extensive study was carried out at the
University of Wurzburg by Polzien (25, 26, 27). Polzien found that
the rise of the skin temperature was more pronounced in distal parts of
the extremities than in the more proximal areas. Simultaneously variable
changes in the rectal temperature were recorded. Depending upon the
subject, and the duration of passive concentration, the increase of skin
temperature in the fingers varied between 0.2 and 3.5°C. These findings
are in accordance with other results reported by Siebenthal (19) and
Miiller-Hegemann (28). Using special devices, both authors independ­
ently recorded an increase of weight in both arms during passive con­
centration on heaviness. The measured increase of weight has been
ascribed partly to the relaxation of regional muscles and partly to an
increase of blood flow in the arm (1).
More recently, Marchand (29, 30) demonstrated that the standard
exercises and passive concentration on warmth in the liver area induce
certain changes in the trainee’s blood sugar level. During the first three
180 AMERICAN JOURNAL OF PSYCHOTHERAPY

standard exercises there is a slight increase of blood sugar. The fourth


standard exercise (It breathes me) coincides with a slight drop in blood
sugar, which is followed by another slight increase during passive con­
centration on “ My solar plexus is warm” (fifth standard exercise). Sub­
sequently passive concentration on warmth in the liver area is associated
with a significant rise. The control values obtained after termination of
the exercises indicate a sharp drop of blood sugar values, which, however,
are slightly higher than the control values determined before starting the
standard exercises. White cell counts during this investigation (24 sub­
jects) indicated that the first four standard exercises are associated with
a slight but progressive decrease in white cell values. This trend was
reversed during the fifth standard exercise and during passive concen­
tration on warmth in the liver area which was associated with a marked
increase. The highest white cell values were obtained three minutes after
termination of the exercises. Subsequent determinations corresponded
to values obtained before starting the exercises (29, 30).
Various electroencephalographic studies (1,15,18, 31-38) during pas­
sive concentration on the standard formulas revealed that the different
standard exercises and the autogenic state were associated with certain
changes which are similar to but not identical with, patterns occurring
during sleep or hypnosis (18, 38).
According to the observations reported by P. Geissmann and C. Noel
(36) no true psychogalvanic reactions appeared during the standard ex­
ercises in completely relaxed trainees; certain reactions which were
observed in a number of subjects seemed to be due to difficulties related
to the experimental arrangement.
A systematic study of the respiratory changes occurring during the
standard exercises revealed a significant decrease of the respiratory fre­
quency which was associated with a gradual and significant increase of
the thoracic and abdominal respiratory amplitude and a corresponding
significant augmentation of the inspiration/expiration ratio (1, 13, 38,
39). Furthermore, it was observed that passive concentration on heavi­
ness in the limbs is associated with a significant decrease of the respira­
tory volume and that the different standard formulas may produce a num­
ber of qualitative changes of the trainee’s respiratory pattern. In
asthmatic patients an almost instantaneous normalization of a disturbed
pattern of respiratory innervation has been observed frequently (1).
The close physiologic and topographic relations between respiratory
and circulatory mechanisms stimulated further studies of the effect of the
standard exercises on cardiac activity (1), blood pressure (1,13), the elec­
trocardiogram (1, 13, 40) and certain variables more closely related to
AUTOGENIC TRAINING 181

metabolic processes (1, 25-27, 29, 30, 41-43) In a group of normotensive


subjects it was found (1,13) that passive concentration on heaviness
produces a slight but significant decrease of the heart rate (5 to 10%)
and a tendency toward lowering of the blood pressure. In hypertensive
patients regular practice of the two first standard exercises usually
produces a significant drop of the systolic (10-25%) and the diastolic
(5-10% ) blood pressure (1, 13).

F igure 2

Electrocardiographic changes during autogenic standard therapy


were reported by various authors (1, 13, 35, 36, 40, 44). The relevant
observations may be summarized as follows: during passive concentra­
tion on heaviness (and warmth) the heart rate usually decreases. In
relatively few cases an increase of the heart rate has been observed. This
paradoxic reaction is regarded as resulting from autogenic discharges
(16, 17, 18).
During the Third World Congress of Psychiatry in Montreal (1961),
Polzien reported that 28 out of a group of 35 patients with confirmed
ST-depressions showed an elevation of the ST-curve and an increase of
the T-wave by .05 mV or more during the first standard exercise. In five
eases the ECG remained unchanged and two patients reacted with fur­
ther deterioration. In a control group of 20 patients with normal curves,
182 AMERICAN JOURNAL OF PSYCHOTHERAPY

an elevation of the ST-curve or the T-wave by .05 mV or more was


observed in 10 trainees. It is of particular interest that a correlation
between the heart rate and the ST and T-wave changes did not exist.
This finding is in contrast to the physiologic correlation which normally
exists between the heart rate and the elevation of the “ ST segment-T
wave phase. ’ ’ In other words, it is not possible to explain the elevation
of the “ ST segment-T wave phase” as observed during autogenic train­
ing, by the simultaneously occurring changes (decrease, increase) of the
trainee’s heart rate (40).
More recent investigations carried out at the University of Wurzburg
have verified the normalizing effect of the standard exercises on certain
hyperthyroid conditions (45). Other experimental studies dealing with
the effect of autogenic training on bodily work and subsequent recupera­
tion have been carried out at the University of Leipzig (42, 43).
Briefly, the experimental data indicate that passive concentration on
physiologically oriented formulas influences autonomic functions which
are coordinated by diencephalic mechanisms. Both clinical results and
experimental data indicate that autogenic training operates in a highly
differentiated field of bodily self-regulation and that with the help of
autogenic principles it is possible to use one’s brain to influence certain
bodily and mental functions effectively. It is evident that this type of
psychophysiologic manipulation requires proper training, adequate
medical background knowledge, critical application, and systematic con­
trol of the effects of the treatment (10). Furthermore, I hope it is quite
clear that autogenic training is neither a simple relaxation technique nor
a self-persuasive approach as applied by Coue (46).
The long-range effects resulting from regular practice of the standard
exercises are manifold and depend largely on the psychophysiologic con­
stellation of the individual and the nature of the patient’s condition.
Briefly, one could say that a gradual process of multidimensional opti-
malization develops. This process is reflected in psychodynamic changes
which can be verified by physiologic measurements and projective tests.
In line with reports on gradual changes in the patient’s behavior
(1, 13, 47, 48), I have observed a characteristic pattern of projective
changes, for example, in the Drawing-Completion test: Progressive dif­
ferentiation of the projective responsiveness, increase of output, more
shading, elaboration of details, stronger pressure of lines, increase of
dynamic features, better integration and composition of the drawings,
less rigidity, fewer inhibitions, faster performance, and better adaptation
to the different stimuli. Corresponding changes have been observed in
the Draw-A-Person test (47).
AUTOGENIC TRAINING 183

Our observation that a patient’s progressive improvement jumps


ahead after four to eight months of regular practice of the standard exer­
cises is reflected objectively by the patient’s performance in the control
tests which I administer at regular intervals during autogenic standard
therapy. With respect to these clinical observations it is of particular
interest that the EEG also reveals significant differences between trainees
who have practiced autogenic exercises for two to four months and others
who have practiced the standard exercises for much longer periods
(15, 18). Subjects practicing two to four months show an EEG pattern
similar to the EEG pattern seen in states of “ predrowsiness,” as for
example, bursts of anterior theta waves with a tendency to spatial gen­
eralization in anterioposterior direction in association with a preserved
alpha activity. In contrast, subjects with longer training periods (6 to
36 months) pass very rapidly from the pattern of a normal state to a
pattern characterized by (a) a flattening of the baseline pattern with
theta oscillations; (b) the alpha main frequency shows an increase of
rapidity (1 unit/sec.) ; and (c) brief paroxysmal bursts of theta waves
in temporal-posterior derivations (15, 18, 31-38, 44, 48).
These electroencephalographic differences between short-period and
long-period trainees seem to indicate that the regular practice of the
standard exercises over longer periods of time bring about certain func­
tional changes in the trainee’s brain.

CLINICAL APPLICATION

Autogenic training has been applied to patients suffering from a


variety of psychosomatic disturbances, a number of mental and behavior
disorders, certain organ diseases and the psychophysiologic effects result­
ing from mental and bodily stress in general.

Disorders of the Respiratory Tract


Autogenic therapy has yielded good results in the treatment of various
disorders of the respiratory tract. The following results (1) of a group
of 150 adult patients suffering from bronchial asthma and treated with
autogenic training were reported: 99 (66%) had no further complaints
during a control period varying between six to 50 months, 38 (25%)
patients had significantly improved and slight or no improvement was
observed in 13 (9% ) cases.
The application of autogenic training to asthmatic children and teen­
agers is limited by a number of factors. Children below the age of nine
usually have difficulty maintaining passive concentration effectively.
This is due partly to intruding thoughts and partly to the anxiety devel­
184 AMERICAN JOURNAL OF PSYCHOTHERAPY

oped by some children during the exercises. The best results have been
obtained with children aged ten to thirteen. Teenagers tend to regard
the exercises as somewhat ridiculous, and usually are unable to collaborate
seriously.
F igure 3

peace
Patients practicing autogenic training gradually become calmer and
appear to be more at ease and to feel more relaxed. Interpersonal relations
improve and the frequency and volume of emotional outbursts diminish
or cease completely. Sleep disturbances are reduced, and the patients
learn to deal more effectively with symptoms like insomnia, headaches,
and lack of appetite. The standard exercises have been applied success­
fully and without complications in patients with : pulmonary and bron­
chial tuberculosis, pneumothorax, temporary blocking of the phrenic
nerve, pneumoperitoneum, pneumolysis, pleurisy, and thoracoplasty.
Cavitation is not considered a contraindication.
Particularly sensitive patients who previously had developed anxiety
and tension before the refilling of their pneumothorax were much less
concerned, less tense, and more at ease before and during the refill-proce-
dure. A few detailed case studies (1) indicate that pulmonary hyperemia
as indicated by passive concentration on “ My lungs are warm” appears
to be responsible for improvements (for example disappearance of cavi­
ties) after conventional therapy had failed. However, so far no statisti­
cal data are available to demonstrate reliably that this organ-specific
AUTOGENIC TRAINING 185

approach has a particularly marked effect on the course of tuberculous


processes.
It has been frequently observed that patients undergoing autogenic
training become less susceptible to colds, to nervous coughing or to short­
ness of breath, or that chronic susceptibility to sore throats or sinusitis
disappears. The improvement of such disorders of the upper respiratory
tract is usually noted after relatively long periods of regular standard
training.
Disorders of the Gastrointestinal Tract
The clinical literature published during the last 30 years contains
more than 100 reports indicating that various chronic disorders of the
gastrointestinal tract were markedly improved or cured with the help of
autogenic exercises after other conventional approaches had failed
repeatedly. So far autogenic standard training has been found effective
in the treatment of patients suffering from chronic disorders like constipa­
tion, diarrhea, gastritis, peptic ulcer, ulcerative colitis, gastric hyperse­
cretion and hyposecretion, gastrointestinal neuroses, spasm of the colon,
and functional disorders of the gallbladder and bile ducts. Other con­
ditions associated with the gastrointestinal tract like cardiospasm, globus
hystericus, spasms of the esophagus, singultus, and hysterical dysphagia
are reported to respond favorably to autogenic therapy. Most patients
note considerable improvement or even spontaneous and permanent dis­
appearance of functional disturbances during advanced phases of auto­
genic standard therapy. In cases in which there is little or no satisfactory
improvement after the patient has practiced the standard exercises for
at least three months, the application of additional organ-specific for­
mulas in combination with patient adapted intentional formulas (for ex­
ample, “ My throat is wide, swallowing does not matter” ) is indicated
(1 ). ‘
The application of autogenic training in the clinical treatment of
different forms of chronic nonspecific gastritis (atrophic, superficial,
hypertrophic) has been found of particular value. There are no reliable
data which prove that autogenic therapy promotes recovery from gastric
ulcers. However, in patients suffering from duodenal ulcer, a significant
decrease in the number of relapses has been observed in those patients
who learned and continued to practice autogenic training after leaving
the hospital (49, 50).
Disorders of the Circulatory System
Autogenic therapy of certain functional and organic alterations of
the heart and vascular system usually requires certain modifications of
186 AMERICAN JOURNAL OF PSYCHOTHERAPY

the standard approach. As a rule, passive concentration on the heart


(third standard exercise) should be placed at the end of the standard
series. This modified sequence was adopted after frequent observations
that passive concentration on the heart, when practiced too early (for
example, after heaviness and warmth training), may intensify the
patient’s ailments or lead to unpleasant effects during or after the exer­
cises. The onset of palpitation, extrasystoles, feelings of uneasiness, and
anxiety have been reported. A number of patients react with increased
awareness of their cardiac disturbance and consequently tend to develop
resistance to the therapy.

F igure 4

Autogenic therapy of patients suffering from anginal attacks due to


different precipitating causes has yielded very rewarding results.
Marked relief and a reduction in attacks have been also reported in cases
with considerable coronary insufficiency on a sclerotic basis (1). The
best results have been obtained when functional factors were predomi­
nant. It has been reported that patients with severe coronary spasms had
no further complaints after a few months of autogenic training.
Clinically, the prophylactic value of the autogenic approach appears
to be of particular importance. In 31 patients practicing autogenic train­
ing, Laberke (50) did not observe any myocardial infarctions during a
control period of one to four years. In a control group of 30 nontrained
patients there were four infarctions.
Sinus arrhythmia, premature contractions (extrasystoles), and dis­
orders resulting from fast discharges of stimuli (tachycardia, racing
heart) have been reported to respond favorably to autogenic therapy
(1, 13). Palpitations and even accelerated activity of the heart resulting
AUTOGENIC TRAINING 187

from hyperthyroid conditions have been normalized within a few weeks


(1, 13, 45). A variety of functional disorders of the heart (for example,
neurocirculatory asthenia, irritable heart, effort syndrome, emotional
tachycardia) tend to respond very well to autogenic training (1, 44).
After three to five weeks of standard training (heaviness and warmth)
most patients note some significant improvement. They report that they
feel more relaxed, calmer, and that their sleep is better. Hypochondriac
attitudes (for example, frequent observation of heart rate) subside. Pal­
pitations, “ jumps” or “ skips,” attacks of tachycardia, pains in the pre­
cordial region, and feelings of oppression in the chest were less frequent
and less disturbing. A number of concomitant symptoms characteristic
of a neurotic pattern, such as respiratory disorders, meteorism, constipa­
tion, nausea, dizziness, headache, ringing in the ears, faintness, and irri­
tability gradually tend to fade away.
There is clinical evidence that the autogenic standard exercises have
a normalizing effect on certain hypotensive conditions and on essential or
labile hypertension. In many cases of hypertension marked improvement
has been noted after six to eight weeks of regular standard training. Of
79 cases with primarily “ essential” or “ labile” hypertension, 37 showed
no improvement, 19 responded well, and in 29 others some definite im­
provement was observed (1).
Autogenic training has been found particularly helpful for patients
who manifest disagreeable side effects (sudden fall of blood pressure,
dizziness, impotence, flushes) and depressive symptoms while taking anti­
hypertensive drugs. Occasionally, however, patients are encountered
whose diastolic and systolic blood pressure increase during passive con­
centration on heaviness and warmth. This paradoxic reaction is consid­
ered to be due to the release of autogenic discharges affecting relevant
mechanisms of the vasomotor system. For this reason it is advisable to
control the blood pressure of persons undergoing autogenic therapy.
Patients who regularly respond with an increase of blood pressure during
the standard exercises should discontinue autogenic training.
The normalizing influence of autogenic exercises on autonomic self­
regulation, and the possibility of increasing at will the circulation in the
extremities, make autogenic training a valuable therapeutic tool in the
treatment of various disorders of the peripheral circulation (for example,
intermittent claudication, Buerger’s disease, ischemic neuritis, Kaynaud’s
phenomenon, scleroderma, frostbite, cold hands and feet). Clinical and
experimental observations indicate that different forms of passive concen­
tration enhance peripheral circulation to a variable degree. From a
physiologic point of view, experimental evidence supports the assumption
188 AMERICAN JOURNAL OF PSYCHOTHERAPY

FlGU&E 5
AUTOGENIC TRAINING 189

that the peripheral vasodilation induced by passive concentration on


heaviness and warmth is due to autonomic changes which reduce the over­
activity of the sympathetic nervous system and retard the reflex vasocon­
striction. The clinical value of this effect is enhanced by the fact that
the peripheral vasodilatory changes are not immediately reversed when
the trainee terminates the exercise. According to the data collected by
Polzien (25, 26, 27), the skin temperature gradually returns to normal
over periods of 10 to 20 minutes (see Fig. 1).
Successful attempts have been made in the application of autogenic
principles to the treatment of hemorrhoids. The clinical approach
involves a combination of standard exercises with special formulas. The
organ-specific part of passive concentration focuses mainly on three fac­
tors: (a) local relaxation of muscular elements, (b) activation of local
and regional circulation, and (c) reduction in itching and pain in the
anal region. The approach has been successful in less severe cases and in
uncomplicated conditions where no other organic disease has been
involved.
The clinical results of autogenic training in the treatment of migraine
and different forms of headache are variable. In relatively few cases, no
improvement is noted after several months of standard training. The
majority of patients, however, report that the frequency and intensity
of headaches or attacks of migraine are much lower than before therapy.
Many patients reported that their headaches disappeared after they
practiced autogenic standard training for several months. Patients
suffering from periodic attacks of migraine can learn to circumvent the
onset of an attack by starting autogenic training as soon as prodromal
symptoms (for example, visual scotoma, hemianopsia, paresthesias,
nausea) develop. Since migraine and different forms of headaches are
often associated with emotional factors (for example, conflict, anxiety,
worry, sexual incompatibility) and a variety of other functional disorders
(for example, constipation, indigestion, deviations in blood pressure,
dermographia, cold feet), emphasis should be placed on the first five
standard exercises. The application of the sixth standard formula ( “ My
forehead is co ol)” requires precaution. Since the functional disorder
may involve localized vasodilation or vasoconstriction, and since there
often exists a particular irritability of the patient’s cranial vasomotor
system, it is advisable to proceed carefully with the application of the
sixth standard formula.
The abnormal and specific vasomotor reaction which leads to blushing
in average situations is usually found in association with other symptoms
of increased vasomotor irritability (for example, dermographia, fainting).
The disorder has been conceived as a disturbance in the person’s psycho-
190 AMERICAN JOURNAL OF PSYCHOTHERAPY

physiologic adaptation to certain environmental situations. Both the


increased vasomotor irritability and the person’s fear that blushing may
occur subside under the influence of autogenic standard therapy. After
two to three months of regular standard training the patients tend to note
that they are less emotionally involved and remain, without effort, much
calmer in situations which previously induced blushing. In addition to
the standard exercises, two specific formulas have been used: “ My neck
and shoulders are warm,’ ’ and “ My feet are warm.99 These two formulas
are considered as physiologic extensions of the warmth training and are
designed to divert the abnormal circulatory changes to areas of the body
which are acceptable to the patient. Under everyday circumstances the
patient learns to control blushing by “ switching on” “ My feet are
warm” (or “ My neck and shoulders are warm” ) as soon as a situation
arises where blushing may occur. The physiologic effects of this formula
may be supported by adding “ My forehead is cool.”

Endocrine Disorders
The clinical value of autogenic training in the field of endocrine dys­
functions and associated metabolic deviations is associated with its nor­
malizing effect on self-regulatory mechanisms of the autonomic nervous
system. The reduction in tension and the gradual smoothing of neurotic
symptoms and unfavorable emotional reactive-affective patterns are addi­
tional advantages in cases of endocrine or certain other metabolic disor­
ders precipitated, and aggravated, by mental or emotional stress.
So far, the autogenic approach has been applied mainly to patients
with dysfunctions of the thyroid gland, diabetes mellitus, conditions re­
lated to latent tetany and gynecologic disorders associated with endocrine
derangements.
It has been reported repeatedly that the regular practice of autogenic
exercises has a normalizing influence on deviations in blood sugar and
glycosuria. In diabetic trainees significant decreases of blood sugar have
been observed and it was necessary to reduce the habitual dosage of in­
sulin by 10 to 20 units per day. It is for this reason that autogenic
training should not be applied to diabetic patients when regular control
is not possible.
In hyperthyroidism, autogenic standard therapy has been applied
alone or as an adjunct, together with other clinical approaches. The
warmth exercises usually require careful adaptation. In many cases a
reduced step-by-step approach is necessary because of the patient’s
increased vasomotor irritability. Too early introduction of the heart
exercise may easily cause an increase in palpitation or other cardiac com­
AUTOGENIC TRAINING 191

plaints. In difficult cases it is advisable to postpone the heart exercise


until the end of the standard series; instead, emphasis should be placed
on practicing the fourth standard exercise (“ it breathes me” ). Bene­
ficial effects are commonly noted by the time an advanced heaviness train­
ing is reached. As autogenic training progresses, a number of typical
manifestations like sweating, hyperkinesis, tremor, nausea, vomiting,
diarrhea, and irritability tend to subside gradually. After six to 12
weeks of regular training, a significant increase in body weight and a
progressive normalization of the hyperthyroid condition as reflected by
laboratory tests have been reported (1,44,45).

SUMMARY AND CONCLUSIONS

The scope of this paper does not permit discussion of other clinical and
nonclinical fields of aplication of autogenic therapy. The experience of
almost 40 years of clinical application of autogenic training may be
summarized as follows:
1. The successful application of autogenic standard therapy in
medical and psychiatric disorders is influenced by the nature of the dis­
order and also varies with the clinical condition of each individual case.
2. Autogenic training can be used alone or as an adjunct to psycho­
therapy with about 80 to 90 per cent of adults of all ages. It is known
that the applicability of autogenic training is influenced by the age factor,
intelligence, and over-all development. The method has been successfully
used with some intelligent children at the age of six; very good results
have been observed in children from eight to twelve; many difficulties were
encountered in teenagers (thirteen to sixteen) and there is some evidence
that patients beyond the age of fifty have more difficulties than patients
between eighteen and forty-nine (1, 10, 11, 12).
3. In comparison with other psychotherapeutic approaches, relatively
little time is required for therapy. After each step of the standard exer­
cises has been introduced to a patient, only periodical control sessions are
required for guiding him. Apart from this the patient carries out his own
therapy by performing a number of mental exercises for about ten
minutes three times a day.
4. Group therapy is possible. Outpatients do best in groups of less
than ten, while patients who are under continuous medical supervision
may practice autogenic training in larger groups. The application of
autogenic exercises to more than 20 persons should be discouraged because
adequate medical control is not possible (10).
5. The effectiveness and progress of the therapy can be controlled by
physiologic and psychologic tests (1, 13, 44, 47, 48).
192 AMERICAN JOURNAL OF PSYCHOTHERAPY

6. Autogenic training has been most frequently applied in nonpsy­


chiatric disorders. Clinical results demonstrated that autogenic training
has been effective and helpful in the treatment of (a) disorders of the
respiratory tract; (b) disorders of the gastrointestinal tract; (c) dis­
orders of the cardiovascular system and vasomotor disturbances; (d)
disorders of the endocrine system ; (e) disorders of the urogenital system ;
(f) disorders of pregnancy; (g) skin disorders (for example, allergic
conditions, pruritus, verruca vulgaris; (h) ophthalmologic disorders and
blindness (glaucoma, scotoma, certain forms of squint; (i) neurologic dis­
orders (certain neuromuscular disorders, brain injury, and epilepsy). A
variable 60 to 90 per cent of patients suffering from lond-standing dis­
turbances like insomnia, headaches, bronchial asthma, chronic constipa­
tion, and the like were cured, or improved considerably, within periods
ranging from two to ten months of standard training ( 1 ).
7. It has been observed that autogenic training is very helpful in the
treatment of behavior disorders and motor disturbances as for example,
stuttering, writer’s cramp, enuresis, hysterical dysphagia, singultus,
globus hystericus, blushing, certain states of anxiety, and phobia.
Patients have reported over periods ranging from a few weeks to several
months that their anxiety, insecurity, and neurotic reactions are smooth­
ing out or had gradually lost their significance. Generally, an increase
of emotional and physiologic tolerance, with a considerable decrease of
the previous need for reactive affective discharges, has been reported.
Social contact becomes less inhibited and more natural. Interpersonal
relations have been reported to be warmer and more intimate with certain
persons and less emotionally involved with others (1).
8. It has been observed that with the help of autogenic standard
exercises unconscious material becomes more readily available. Forty-
eight per cent of trainees reported spontaneously that they dreamed more
frequently. The impression was gained that dream and memory mate­
rial are more readily produced by trainees than by other patients. Free
association seems to be facilitated (1, 16, 17).
9. Many trainees have reported that their intellectual efficiency had
increased. Furthermore, it has been noted that increase of bodily resist­
ance develops against all kinds of stress (1).
10. Until further information is available, autogenic training should
not be applied in acute psychoses, postpsychotic states, chronic involu­
tional psychoses, initial stages of schizophrenia, in oneiroid conditions,
certain forms of epilepsy, “ clouded” or “ twilight states” (psychische
Dämmerzustände) , constant and multiple paradox reactions, and certain
medical conditions (for example, bleeding peptic ulcer, acute myocardial
infarction, insufficiently controlled diabetes (10).
AUTOGENIC TRAINING 193

11. Autogenic training is not indicated as a treatment for recalcitrant


psychopaths, for patients with dementia or oligophrenia, and for patients
with a lack of motivation to get better (1, 10, 12).
Clinical and experimental observations gathered over the past 35 years
have indicated that the physiologic changes occurring during autogenic
exercises are of a highly complex and differentiated nature, involving
autonomic functions which are coordinated by diencephalic mechanisms.
The physiologic changes which occur during the standard exercises
coupled with the fact that the regular practice of autogenic training over
longer periods of time has a normalizing influence on a great variety of
bodily and mental disorders led to the conclusion that autogenic training
exerts a therapeutic action on certain mechanisms which are of patho-
functional relevance for many different types of bodily and mental dis­
orders. In summarizing my experimental and clinical findings I hypothe­
sized (1, 13, 18) that the therapeutic key factor lies in a self-induced
(autogenic) modification of cortico-diencephalic interrelations, which
enables natural forces to regain their otherwise restricted capacity for
self-regulatory normalization. The hypothesis implies that the function
of the entire neurohumoral axis (cortex, thalamus, reticular system,
hypothalamus, hypophysis, adrenals) is directly involved and that the
therapeutic mechanism is not unilateraly restricted to either bodily or
mental functions.
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