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Introduction for the Doctor with Practical Suggestions1. In German - speaking medicine autogenous training (AT) is, at present, the best understood and most widely used method of psychotherapy. The scientific researcher J. H. SCHULZ, who developed this ingenious system of con centrative self-relaxation, devoted decades of work to the testing of its broad spectrum of indications as relaxation therapy. It comprises all "nervous" or neuro-vegetative, therefore functional or conversion neurotic clinical pictures, psychosomatic diseases such as Asthma bronchiale, Colitis ulcerosa, essential hypertonia, etc. But, after thorough practice in this pragmatic method, the patient can also learn to control, more or less himself, psychoneurotic symptoms, such as states of anxiety, slight depressive neuroses and character maladjustments. Principally, therefore, those 30-40% of all patients who suffer from diseases with psychological or partially psychological causes can be treated by AT. But, as is well-known, this method can also help healthy people, by means of the "prophylactic pause", to reduce and prevent stress to which ever-increasing numbers of the population are exposed nowadays.1.1 The AT therapy requires that the doctor himself masters the method and personally instructs his patient in it. The patient must meet certain requirements of intelligence, emphaty and strength of character with regard to the regular exercise he has to perform himself. 1.2 The effect of AT depends, to a certain extent, on the feedback to the cerebral cortex of the state of muscular tension (sense of heaviness), of the vascular circulation (experience of warmth), of the respiratory process (respiratory control), and the blood circulation in the epigastrium ("solar plexus"); this is achieved by a gradually increasing awareness of the above-named vegetative body functions. It is only after months of continuous practice that the patient achieves the decisive control of these functions ("Practising method"). 2. During the last decade there has been a tendency in scientific research in the USA to use electronic instruments for such "Bio-Feedback" processes. The aim of these experiments, as far as they are concerned with therapeutic application in human beings, has been to create a state of modified consciousness and of relaxation, similar to that achieved by AT. Out of the various possibilities, however, only two bio-feedback systems have emerged which, on the strength of broad basic research, may claim to be of clinical interest. These are the feedback of muscular actions by means of the Electromyelograph (EMG-feedback) for the treatment of migraine and tension headache, and the control of the heart action in cases of cardiac disorders. The latter procedure is still on trial. Top 3. In Germany a group of researchers worked along different lines. They examined the feedback of the respiratory movement, referred to as "Respiration Feedback" (Rfb) under its scientific designation, or as "Breathing Feedback" in its practice-related name. Professor Hanscarl Leuner, neurologist and psychotherapist, Head of the Department of Psychotherapy and Psychosomatics of the teaching hospital of Göttingen University, who is well-known for his many years of research in the field of modified states of consciousness, observed that physical-psychological relaxation (Hypnoid) and respiratory type correlate in a certain way (e.g. in AT, sleep, coma, during Yoga and meditation exercises). Since 1970 he and his study group have been developing and testing an electronic apparatus which scans the respiratory movement by means of a sensor on the patient and converts it without delay by amplification into an optical and/or acoustic signal, that is, translates it into a light of increasing and decreasing intensity and/or a tone (headphone) of changing pitch. The patient is thus distinctly aware of his breathing rhythm and his respiratory rate, without requiring any prior training. Prof. Leuner's expectations were not only confirmed, but in part even exceeded during the physiological and clinical trials. The EEG distinctly shows a considerable reduction in cerebral activity and thus the state of wake-fulness. It exceeds the EEG-changes during hypnosis, AT (and Alpha-Feedback) in the sense of a marked reduction of violance. At the same time the muscular tone (sense of heaviness in AT and in EMG-feedback) is distinctly reduced. There is a strong subjective awareness of the psychological influence of the procedure, which runs parallel to this physical "conversion" ("Umschaltung", J. H. SCHULZ ). It was possible to establish this statistically with significant frequency by means of the semantic differential ("Polaritätenprofil", HOFSTÄTTER ) in the following adjectives of subjective experience: "relaxed, at ease, indifferent, composed, comfortable, sure, safe, free, light, serene". 3.1 The clinical trial of Rfb was carried out on a random group of 200 outpatients. They came from a medical and a psychiatric policlinic of a teaching hospital as well as from a neurological practice (ages 18-50 years, average age 33 1/2 years, average duration of symptoms 4 years). Patients with psychoses and internal diseases were excluded. The complete course of treatment consisted of 15 half-hour sessions and was to be supported by a further 8 sessions. After about 5 sessions at the latest the above-mentioned state of deep relaxation was achieved. Just under 90% of the patients felt that the treatment was agreeable, about 50% were willing to continue with it, in over 70% an objectively adequate to very good improvement of their symptoms could be observed. A comprehensive paper is available on request. Top 3.2. What are the Advantages of Respiratory Feedback? a) The time required for the instruction in relaxation is cut down considerably; the tangible therapeutic effect manifests itself within 3-4 weeks. b) The training aim is achieved with a high degree of certainty. c) The state of relaxation is intensive, and thus especially efficacious. d) Rfb makes no demands on empathy, intelligence or will-power on the part of the patient, except for the ability to yield to the state of relaxation. e) The method is therefore suitable for patients of all social groups. f) The doctor need not himself have learned the procedure. The training of the patient can largely be left to trained auxiliary personnel (training courses on request). 3.3. Practical Suggestions 3.3.1 Indications: Generally speaking: almost all conditions for which neuro-vegetative or the well-known minor tranquillizers are prescribed, or where AT is indicated; vegetative-functional disorders of all kinds (after an organic background has been eliminated), so-called conversion neuroses or psychosomatic states, but also psycho-neurotic symptoms, such as states of anxiety, phobias, slight depressive neuroses, as well as the group of acute or chronic stress-related reactions. Stress prophylaxis in stress susceptible asthenic persons or persons exposed to great stress. A statistical survey of the groups of diseases, the change of the test profiles and some individual reports by patients are available. Only about 5% of an unselected group of patients proved totally unsuitable for the treatment. 3.3.2 Contra Indications: Severe psychiatric symptoms, such as psychoses or suspected psychoses, or borderline cases, an abnormally restricted level of intelligence, imaginary of the patient with regard to the method or its rejections for any other reasons (clarifying discussion before commencing treatment). 3.3.3 External Conditions: A quiet, darkened exercise room, positioning of the apparatus, comfortable couch (with BIOSWING-System are the best), auxiliary personnel trained in the procedure (with first-hand experience, i.e. introduction by means of a course organized by MFB. 3.3.4 Time Schedule: One exercise takes 30-40 minutes. Double sessions are also possible. Including contact conversation, fitting of the sensor and brief concluding discussion, 50 minutes have to be allowed per session. A course of treatment consists of 15 sessions. 3-4 sessions per week should be carried out, depending on the severity of the symptoms. If the patient refuses to continue with the treatment after 5 sessions (as is extremely rarely the case), or if he believes that he does not benefit from the treatment, Rfb is not indicated. 3.3.5 After-treatment: 8 sessions, once weekly, are recommended in order to maintain the effect. Occasionally patients avoid the after-treatment if they are feeling well. In the concluding discussion an offer of after-treatment should be made which the patient may take up if he should experience renewed difficulties at a later date. After the course of treatment is completed the doctor should conduct a brief concluding orientation discussion, in order to form an impression of the effect of Rfb and to determine further therapy accordingly. 3.3.6 Medication: During the treatment with Rfb an attempt should be made to discontinue any neuro-vegetative and/or sedative medication. In cases where medication is indispensable, the dosage should be reduced to a minimum and then kept at a constant level (Instruction of the patient). 3.3.7 Interference Factors: In the treatment with Rfb these may arise from circumstances connected with the patient's own psyche, such as imaginary fears. 1 Leuner, H.: Das Respiratorische Feedback (Rfb), intensive Entspannungstherapie und ihre klinischen Ergebnisse bei Neurosen und psychovegetativen Störungen. Top Biofeedback |