Functional relaxation and guided imagery as complementary therapy in asthma: a randomized controlled clinical trial.

BACKGROUND: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. METHODS: 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV(1)) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. RESULTS: Participation in FR, GI and FR/GI led to increases in FEV(1) (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV(1) were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV(1) in all groups. CONCLUSIONS: Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option.

Lamotrigine treatment of aggression in female borderline patients, Part II: an 18-month follow-up.

Borderline patients often display pathological aggression. We previously tested lamotrigine, an anti-convulsant, in therapy for aggression in women with borderline personality disorder (BPD) (J Psychopharmacol 2005; 19: 287-291), and found significant changes on most scales of the State-Trait Anger Expression Inventory (STAXI) after eight weeks. To assess the longer-term efficacy of lamotrigine in therapy for aggression in women with BPD, this 18-month follow-up observation was carried out, in which patients (treated with lamotrigine: n = 18; former placebo group: n = 9) were tested every six months. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the lamotrigine-treated subjects. All subjects tolerated lamotrigine relatively well. Lamotrigine appears to be an effective and relatively safe agent in the longer-term treatment of aggression in women with BPD.

[Treatment results from inpatient psychosomatic rehabilitation of Turkish migrants: a prospective study]. / Behandlungsergebnisse stationärer psychosomatischer Rehabilitation bei türkischen Migranten: Eine prospektive Studie.

Psychosomatic rehabilitation and the concluding social-medical assessment constitute a particular challenge. The aim of this study was to examine whether inpatient psychosomatic rehabilitation in the context of an integrated treatment concept, conducted in Turkish and German, is effective in the rehabilitation of Turkish migrant laborers, and what concluding socio-medical assessment results from this treatment. 195 Turkish patients--44 male and 151 female--received inpatient psychosomatic treatment for approximately 40 days. Sociodemographic, psychiatric and social-medical data were recorded, as well as Symptom Checklist (SCL-90-R) testing upon admission and discharge. A predominant number of patients were laborers, with a low level of primary education, who were afflicted with psychosocial problems and dissatisfaction with their workplace and who first came into psychosomatic treatment many years following the onset of their illness. Many of them had a clearly defined desire to retire. At the end of their admission, a significant improvement in almost all the scales of the SCL-R-90 was ascertained on the one hand, but on the other, adequate socio-medical results were hardly observed. The symptoms' improvement would confirm that the combination of service offerings in Turkish and German proved themselves. A portion of the patients (approx. 40 %) were classified subsequent to treatment as capable of working for 6 hours or more. Nevertheless, approximately approx. 75 % still sought to retire. Timely psychosomatic treatment could counteract chronification of the illness and the establishment of a steadfast desire to enter retirement, and consequently represent an improvement in the prognosis. Likewise, consistent psychosomatic training of physicians, as well as systematic prophylactic measures with the migrant laborers, should be considered.

[Treatment motivation and results of inpatient psychotherapy for women with depressive disorders: a prospective study]. / Behandlungsmotivation und Ergebnisse der stationären Psychotherapie bei Frauen mit depressiven Erkrankungen: eine prospektive Studie.

Whether the treatment results in inpatient psychotherapy are significantly influenced by the patient's motivation is a subject of discussion. The goal of this study was to assess whether the primary motivation for therapy in depressive women influences the results of psychotherapeutic treatment. In a prospective study, the monitored results from 64 female inpatients (32 who were highly motivated to enter therapy, and 32 who were minimally motivated) were compared to each other. The period of observation was six weeks. As instruments of assessment, the Fragebogen zur Therapiemotivation (FMP) (Questonnaire on Motivation for Entering Therapy) and the Beck Depression Inventory (BDI) were aministered upon admission; after the fourth and sixth weeks of therapy, the Veränderungsfragebogen des Erlebens und Verhaltens (VEV) (Questionnaire of Changes in Experience and Behavior) was administered as well. All patients who had applied for a pension were found in the group of less motivated patients and consolidated into a subgroup. The analysis was carried out according to the intent-to-treat principle. The variance analysis for the repeat measurements showed significant differences on all the FMP scales and on the BDI (all P< 0.001). The measurements with VEV likewise resulted in a significant difference (P< 0.01). The subgroup of "pension patients" showed significantly less change in all three of the above measurements. Patients with depressive symptomology who essentially are relatively highly motivated for therapy could profit significantly more from inpatient psychosomatic treatment than those who are less motivated. Establishing and developing motivation prior to inpatient hospitalization could possibly contribute to more efficient and cost-effective clinical treatment. Where legal proceedings pertaining to a pension are pending, relatively less motivated patients fare significantly worse not only in their motivational development for therapy, but also in their final treatment results. It should be noted, however, that the relatively small random sample, the restricted blinding, which was only partially possible, could have led to possible distortions.

Patients with extreme obesity: change in mental symptoms three years after gastric banding.

OBJECTIVE: Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life. METHOD: We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36). RESULTS: In comparison with the control group, we observed significant changes in BMI (p < 0.01) and the existence of a partnership (p < 0.01), on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression:p < 0.01), and on all scales of the SF-36 Health Survey (p between < 0.05 and < 0.01 in every case). The most marked changes in all the qualities investigated occurred within the first 12 months of surgery. CONCLUSIONS: Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed. There was also a significant correlation between BMI reduction and reduction firstly on the depression scale (HADS-D) and secondly on the SF-36 scales for physical functioning (PHFU), role physical (ROPH), mental health (PSYC), and vitality (VITA).

[Effects of distress and coping on quality of life in HIV-positive patients: results of a longitudinal study]. / Wirkung von Belastung und Krankheitsbewältigung auf die Lebensqualität bei HIV-Positiven. Ergebnisse einer Längsschnittuntersuchung.

Preserving health-related quality of life (QOL) is an important approach with HIV-positive patients. In a longitudinal study over 3 years, with three measurements each 18 months, we examined 56 of these patients for the influence of distress and coping (assessed by interviews) on physical, cognitive-emotional, and social QOL (using the SEL questionnaire). The patients were 32.9 years old on average, with 28.3 months since diagnosis. Seventy percent were male, 82% asymptomatic, 14% with ARC, and 4% with AIDS. Forty-five percent had been infected by homosexual intercourse, 14% by heterosexual intercourse, and 41% by iv drug abuse. The patients reported significantly worse physical and cognitive-emotional QOL than healthy subjects. Those HIV-positive persons with great distress showed significantly lower QOL scores. Multiple analyses of regression showed evasive-regressive coping at the T1, T2, and T3 levels as negative predictors, vs active, problem-focused coping as a positive predictor for nearly all QOL parameters at T3. HIV-positive patients with ARC or AIDS reported more physical complaints and lower physical QOL than asymptomatic persons. Physicians should suggest psychosocial support to patients with poor QOL scores.

Psicoterapia Positiva: con documentación estructurada y sucesivos autocontroles. Primer estudio de efectividad y garantía de calidad / Positive psychotherapy with a structured documentation and successive self-control. First effectivity study and quality assurance

La psicoterapia positiva (PPT) ha sido aplicada a los procesos terapéuticos de pacientes tanto en hospitales como en la práctica privada durante los últimos treinta años desde un punto de vista transcultural.En este trabajo discutiremos los resultados de investigacion del estudio de la efectividad. Se presentará una evaluación de las alteraciones de los síntomas así como de los cambios en el modo en que los sujetos sienten y se comportan, que ocurrrieron en el período de tiempo entre el principio y luego del final de la terapia

Efficacy of 'functional relaxation' in comparison to terbutaline and a 'placebo relaxation' method in patients with acute asthma. A randomized, prospective, placebo-controlled, crossover experimental investigation.

BACKGROUND: 'Functional relaxation' (FR) according to Marianne Fuchs is a body-oriented psychotherapy that involves teaching the patient a type of relaxation techniques aimed at maintaining equilibrium of the nervous system. METHODS: In order to determine whether the practice of elementary parts of this therapy has an immediate beneficial effect on pulmonary function, a randomized, single-blind, prospective crossover study was done with 21 asthmatics with acute bronchoconstriction. On 3 consecutive days they were given either (1) a 5-min verbal standard instruction in elementary exercises of FR (eFR), which they were to practice during subsequent bodyplethysmographic measurement or (2) inhalative terbutaline (IT), a beta(2)-sympathomimetic drug, or (3) an unspecific 'placebo relaxation' technique (PRT), so that all subjects tried all 3 treatments in random order. Spirometric variables were assessed. RESULTS: There was a significant decrease in specific airway resistance with eFR, which, though not as pronounced as with IT, was significantly greater than with PRT. This study shows that clinically relevant effects can be achieved for patients with asthma through mind-body interaction, which can be triggered by reproducible procedures. CONCLUSION: Further development of the FR approach could lead to a nonpharmacological and effective supplementary treatment for asthma, which is in high demand by many patients.

Functional relaxation as a somatopsychotherapeutic intervention: a prospective controlled study.

CONTEXT: Functional relaxation is based on concentration on body perception while moving the joints of the skeleton smoothly and simultaneously breathing out. Case reports have shown that patients with headaches can profit from functional relaxation. OBJECTIVE: To examine whether patients with chronic tension headaches (International Headache Society diagnosis) who use functional relaxation as a complementary treatment will report less pain than before they learned this technique. DESIGN: Randomized, prospective, single-blind, controlled trial. Standardized elements of functional relaxation were compared to a placebo-relaxation technique, a simple isotomic exercise of the hand. SETTING: Primary care, ambulatory private practice. PARTICIPANTS: Twelve matched pairs were chosen according to age, sex, and initial pain intensity. This poststratification was performed on patients, who kept a complete pain diary covering 60 days before and 60 days after the introduction to the therapy. After a 45-minute introduction in small groups, the patients were told to do the exercises as often as possible for the following 2 months. MAIN OUTCOME MEASURES: Pain diary. RESULTS: In the functional-relaxation group, a significant reduction was found in the sum of total pain hours and in high- and medium-intensive pain (Wilcoxon signed rank test). CONCLUSIONS: This study supports the concept that this psychosomatic therapy can bring relief from tension headaches. This procedure can be viewed as an easy-to-learn relaxation technique to be used either prophylactic or complementary to pharmaceutical treatment.

Rhythmical changes of the cutaneous blood flow in the forehead region under the condition of hypnoid relaxation.

BACKGROUND: A characteristic and stable blood flow rhythm can be detected for the skin of the forehead and ear lobes with frequencies of approx. 0.15 Hz (9/min), which were primarily not related to the respiratory rhythm. PATIENTS AND METHODS: The perfusion of the skin in the forehead region was investigated non-invasively with laser Doppler fluxmetry in ten healthy subjects before and during Hypnoid Relaxation (HyR). The HyR-state was induced by suggesting formulas regarding to the well known Autgeneous Training. RESULTS: In all test subjects rhythmical fluctuations of bloodflow with a frequency of approx. 0.15 Hz could be observed both, before and during HyR. We found that the amplitude of these fluctuations clearly (> 20% from individual baseline) increased in five of ten test subjects under the condition of HyR. Furthermore, in three of ten cases the spontaneous respiration under HyR adjusted to the frequency of the described bloodflow rhythm, which exists both, before and during HyR. CONCLUSIONS: These phenomena suggest an individually stabil and autonomous rhythm which is effected by alterations in the level of conciousness and which may be caused by the close linkage between the nerval structures for control of respiratory and circulatory systems. May be, this autonomic rhythm could be used as a trigger for breathing therapies or as a parameter for the impact of relaxation techniques on hemodynamics, e.g. in complementary therapy of vascular diseases like systemic sclerosis.

The SIMA-project: effects of 1 year cognitive and psychomotor training on cognitive abilities of the elderly.

In an interdisciplinary project on maintaining and supporting independent living in old age, (a) competence training, (b) memory training and (c) psychomotor training as well as (d) combined competence and psychomotor training and (e) combined memory and psychomotor training was performed with n = 309 elderly of 75 to 89 years of age for 9 months. Regardless of treatment conditions, an age-related decline of health and subjective well-being was found 1 year after the end of the training. The specific training measures each led to highly significant specific improvements of the trained functions. A favorable influence of competence training on everyday coping and hence on active strategies for staying independent as well as of memory training on all cognitive functions and especially on memory performance was found. While global psychomotor performance was not significantly improved, effects of psychomotor training on specific functions were detected. In addition, the combined psychomotor and memory training led to an improvement of psychomotor performance and to a reduction of symptoms of dementia, even though neither psychomotor training alone nor memory training alone resulted in such effects. Neurophysiological changes leading to a provision of reserve-capacity of CNS-performance are among other effects assumed as an explanation.

'Functional relaxation' reduces acute airway obstruction in asthmatics as effectively as inhaled terbutaline.

BACKGROUND: 'Functional relaxation' (German: 'Funktionelle Entspannung') has been developed since 1944 by the German physiotherapist M. Fuchs. It is based on concentrating on body perception while moving the joints of the skeleton smoothly and at the same time breathing out. This procedure induces a physical and emotional relaxation in many cases. The aim of the study was to compare the efficiency of standardized elements of a somatopsychotherapy (eFE) and a standardized bronchodilatative test using terbutaline (IT). METHODS: Seventeen asthmatic patients with acute airway obstruction had either IT or eFE on 2 consecutive days. Airway resistance (R(aw)) was measured before and after IT and eFE. It was used for statistical evaluation as it is independent of the patient's will. RESULTS: Although both therapies lead to a significant mean decrease in R(aw) (p < 0.01), the comparison revealed no superiority of one over the other (ANOVA on repeated measurements, p > 0.78). CONCLUSIONS: This study supports the benefit of psychosomatic therapy in the relief of asthma and the procedure can be used as an easy-to-learn relaxation technique to be used during acute asthmatic airway obstruction.