Responders and nonresponders to autogenic training and cognitive self-hypnosis: prediction of short- and long-term success in tension-type headache patients.

The present study was conducted to determine whether demographic variables, medical status variables, and psychological measures at pretreatment were related to pain reduction immediately following behavioral treatment for headache and at a 6-month follow-up. The study sample consisted of 156 subjects, who were selected for participation in a behavioral outcome study on the efficacy of autogenic training and cognitive self-hypnosis training. A Headache Index based on pain diaries constituted the main outcome measure. Psychological measures included the Symptom Checklist-90, Dutch Personality Questionnaire, Coping Strategy Questionnaire, Multidimensional Locus of Pain Control Questionnaire, and treatment expectations. Subjects who expected more pain reduction at pretreatment achieved a lower level of pain at posttreatment, independent of pretreatment pain levels. None of the other pretreatment variables were related with pain reduction at posttreatment or at the follow-up. Finally, at the 6-month follow-up, 43 subjects were classified as responders (more than 50% pain reduction) and 113 as nonresponders (less than 50% pain reduction and dropouts). At pretreatment, the responders perceived more pain control than the nonresponders. None of the other pretreatment differences between responders and nonresponders proved to be significant. The main conclusion that could be drawn from this study was that pain reduction, in the short- and long-term, cannot be predicted with any accuracy by demographic and medical status variables or scores for psychological distress, personality traits, coping strategy use, and pain appraisals.

Autogenic training and self-hypnosis in the control of tension headache.

This study compares autogenic training and training in multiple self-hypnosis strategies in a sample of 56 patients diagnosed as having chronic tension headache on the basis of medical evaluation by a neurologist. At posttreatment and follow-up, no differences between the two treatment regimens in the reduction of headache and psychological distress were observed. During treatment, patients reduced their headache activity and level of psychological distress significantly in contrast to the waiting-list period (p < 0.05). Follow-up measurements indicated that therapeutic improvement was maintained (p < 0.05). Short-term and long-term pain reduction was accompanied by an increase in perceived pain control (p < 0.003). Moreover, those patients who attributed the pain reduction obtained during therapy to their own efforts manifested long-term pain reduction (p < 0.003).

Hypnosis and autogenic training in the treatment of tension headaches: a two-phase constructive design study with follow-up.

Tension headaches can form a chronic (very long duration) condition. EMG biofeedback, relaxation training and analgesia by hypnotic suggestion can reduce the pain. So far, no differences have been demonstrated between the effects of various psychological treatments. In a constructively designed study, we firstly compared an abbreviated form of autogenic training to a form of hypnotherapy (future oriented hypnotic imagery) which was not presented as hypnosis and secondly we compared both treatments to the same future oriented hypnotic imagery, but this time explicitly presented as hypnosis. The three treatments were equally effective at post-treatment, but after a 6-month follow-up period, the future oriented hypnotic imagery which had been explicitly presented as hypnosis was superior to autogenic training. Contrary to common belief, it could be demonstrated that the therapists were as effective with the treatment modality they preferred as with the treatment modality they felt to be less remedial.

Autogenic training and future oriented hypnotic imagery in the treatment of tension headache: outcome and process.

The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in the autogenic therapy condition and 27 in the future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version [van der Velden & Spinhoven, 1984] of the Creative Imagination Scale [Barber & Wilson, 1978/79; Wilson & Barber, 1978]). After statistically controlling for relaxation and imagery, hypnotizability scores (as assessed with the Dutch version [Oyen & Spinhoven, 1983] of the Stanford Hypnotic Clinical Scale [Morgan & J.R. Hilgard, 1975, 1978/79]) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo-dissociation and social-cognitive model of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.

Education and self-hypnosis in the management of low back pain: a component analysis.

The aim of this study was to conduct a component analysis of a group programme for chronic low back pain patients. Forty-five patients participated in the pain control course, consisting of education about pain and a training in self-hypnosis. A pain diary was used as a measure of pain intensity, up-time and use of pain medication. Psychoneuroticism and depression were assessed using the Symptom Checklist-90 (SCL-90). No evidence was found for a differential efficacy of education or self-hypnosis on pain diary and SCL-90 scores. On completion of the total treatment package, patients manifested statistically significant changes on all measures except reported pain intensity. It is suggested that the pain control course is a non-invasive, inexpensive means of treatment which could be of some value in teaching even more severely disabled low back pain patients to cope more adequately with their pain problem. For this group of patients, a better adjustment to continuing pain may prove to be a more realistic therapy goal than pain reduction.