[The effectiveness of autogenic training in the psycho-corrective treatment of the patients presenting with chronic somatic diseases]. / Autogennaia trenirovka v psikhokorrektsii patsientov s khronicheskimi somaticheskimi zabolevaniiami: éffektivnost' i ee prediktory.

BACKGROUND: The autogenic training (AT) is one of the most widely used methods for psychotherapy of patients suffering from chronic somatic diseases (CSD). A number of studies have demonstrated the improvement of the psychological status in the patients under the influence of autogenic training. However, up to the present time, both the mechanisms underlying the therapeutic effectiveness and the predictors of the AT effectiveness have remained to be poorly studied which hampers the development of differentiated indications for the application of this technique. AIM: The objective of the present study was to estimate the effectiveness of AT and to identify the predictors of the outcomes of the treatment of patients presenting with chronic somatic diseases. MATERIAL AND METHODS: The study included 325 patients with CSD who were examined with the use of the shortened multifactorial personality inventory (SMPI), the Spielberger State-Trait Anxiety Inventory (STAI), and the Beck depression inventory (BDI) scales. The patients were randomized into two groups. Group 1 (main) was comprised of 163 patients who underwent AT-based psychotherapy, group 2 (control) consisted of 162 patients who did not receive the psychotherapy. In order to identify the predictors of AT effectiveness, the patients of the main group were subdivided into two subgroups at the end of the study period: (a) including 128 patients whose psychologic status was normalized under psychotherapy and (b) containing 35 patients showing the improvement of their health status. The comparative analysis of the baseline characteristics of the patients belonging to each group was performed. RESULTS: The study has demonstrated that by the end of the observation period the patients of the main group showed a significantly more pronounced (compared with controls) decrease of scales 1, 2, and 7 indicators, an increase of the SMPI scale 9 indicators, and a decrease of STAI and BDI indicators. The positive impact of autogenic training on the psychological status of the patients was mostly attributable to the reduction of anxiety, tension, fixation on negative sensations, and sensitivity to the stress factors as well as to the increased activity and the improved mood. The study of AT predictors revealed that the increase of scales 4 and 6 of SMPI and BDI indicators fairly well predicts the lack of the effectiveness of the method under consideration. CONCLUSIONS: The beneficial influence of the autogenic training on the psychological status of the patients presenting with chronic somatic diseases is mainly mediated through the decrease of anxiety, tension, fixation on negative feelings, sensitivity to stressful influences, increased activity, and improved mood of the patients. A study of AT effectiveness predictors revealed that an increased level of rigidity reduces the effectiveness of this method because of the tendency of the patients toward making excessive efforts to achieve the state of relaxation. The predictors of the high effectiveness of AT the development of which requires regular training proved to be a moderate decrease of the psychological adaptation level together with such characteristics as the ability of the patients to control their behavior, purposefulness, and perseverance in achieving the goal.

[The application of the biological feedback technique for the treatment of the patients presenting with chronic somatic diseases]. / Primenenie metoda biologicheskoi obratnoi svyazi pri lechenii patsientov s khronicheskimi somaticheskimi zabolevaniyami.

The objective of the present work was to study the influence of the application of the biological feedback (BFB) technique on the dynamics of the psychological and clinical status of the patients presenting with various chronic somatic diseases (CSD) and to identify the predictors of the effectiveness of the treatment by this method. PATIENTS AND METHODS: The study included 337 patients suffering from CSD who were interviewed with the use of the concise standardized multifactorial personality inventory (SMPI), the Spielberger State-Trait Anxiety Inventory (STAI), and the Beck depression inventory (BDI) scales. The patients were randomly distributed into two groups. Group 1 (main) was comprised of 168 patients who underwent psychotherapeutic treatment based on the BFB method, group 2 (control) consisted of 169 patients who did not receive the psychotherapeutic treatment. In order to identify the predictors of the effectiveness of the treatment by the biological feedback technique, the patients of the main group were subdivided into two subgroups at the end of the study period. Subgroup A contained 112 (67%) patients whose health status was normalized under the influence of psychotherapy, subgroup B included 56 (33%) patients who experienced the improvement of the somatic conditions. We undertook the comparative analysis of the background characteristics of the patients belonging to each group. RESULTS AND DISCUSSION: The study has demonstrated that by the end of the observation period the patients of the main group showed a significantly more pronounced (compared with controls) decrease of the parameters estimated based on the scales 1, 2, and 7 and an increase of those evaluated based on the (SMPI) scale 9. Simultaneously, the levels of state and trait anxiety estimated based on the Spielberger и Beck inventory scales decreased. These findings give evidence of the improvement of psychological adaptation of the patients, decrease of the anxiety level and emotional stress under the influence of the treatment with the use of the biological feedback technique; these changes were concomitant with the enhancement of the general activity of the patients, the improvement of their working capacity, mood, and feelings of optimism. The study of the predictors of the effectiveness of the BFB method revealed the significantly higher background values estimated based on the SMPI scales 1, 4, and 6 in the patients with the improvement of the health status compared with those exhibiting normalized conditions (p<0,01). In 12% of the patients in the former subgroup (but in none of the patients of the latter subgroup), the values obtained based on the Beck scale were higher than 20 scores which suggested either the moderate or high level of depression. These data give reason to conclude that the patients that exhibited a relatively weak response to the treatment with the application of the biological feedback technique were initially predisposed to the un-necessary excessive fixation of attention on their sensations in the combination with enhanced impulsivity, rigidity of attitudes, and the presence of depressive disorders.

Autogenic training in the treatment and secondary prevention of essential hypertension: five-year follow-up.

Ninety patients with essential hypertension were followed for 5 years. Initially the patients were randomized into two groups: (a) an experimental group consisting of 44 patients who received autogenic training and (b) a control group of 46 patients who did not receive any behavioral intervention. By the end of the follow-up period, the experimental group was significantly different from the control group, with reduced blood pressure (by 5.8 mm Hg systolic and 3.2 mm Hg diastolic vs. 4.3 mm Hg systolic and 2.0 mm Hg diastolic), a smaller increase in left-ventricular myocardial mass (14.6 g vs. 38.2 g), improved psychological indices, and a decrease in the number of sick days of leave. Autogenic training appeared to be more effective in patients with mild hypertension than in those with moderate hypertension and the results were comparable with those obtained with regular medication.

Psychophysiological interrelations and reactivity characteristics in hypertensives.

Two hundred three patients with essential hypertension (20- to 55-year-old men) were examined initially and at the end of a 1-year follow-up. Clinical, psychological, and psychophysiological methods were used. In the psychophysiological assessment, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, and respiratory rate were recorded at rest and during various emotional stressors. Patients who exhibited a greater increase in blood pressure during psychological stress, in addition to an inherited predisposition to essential hypertension, had higher levels of assertiveness and interpersonal conflict. The differences in cardiovascular response to various emotional stressors depended on the psychological features of the hypertensive patients. An SBP increase during the performance of mental arithmetic correlated with anxiety level, whereas a DBP increase was associated with assertiveness. Changes in SBP and DBP during a stressful computer game correlated with the level of competitiveness and conflict. Hypertensive patients who exhibited an increase in blood pressure during the follow-up were characterized initially by a greater DBP increase during emotional stress and a longer recovery period.

The USA-USSR collaborative cross-cultural comparison of autogenic training and thermal biofeedback in the treatment of mild hypertension.

We have conducted a cross-cultural (USA and USSR) comparison of thermal biofeedback (TBF) and autogenic training (AT) to a self-relaxation control condition in 59 unmedicated males with mild hypertension. Identical assessment and treatment protocols were carried out in both settings (Albany, New York, and Moscow). Treatments were delivered in small groups on an outpatient basis twice per week for 10 weeks. Results showed comparable, significant (p less than .05), short-term decreases (M = 8.5 mm Hg) in diastolic blood pressure (DBP) for both treatments at both sites. However, the Soviet patients, starting with significantly (p less than .01) higher systolic blood pressures (SBPs), showed significant decreases (M = 12.8 mm Hg) in SBP, whereas the American patients did not change appreciably (M = 4.6 mm Hg). During follow-up, the treated Soviet patients showed significantly (p less than .05) better maintenance of treatment effects, from 3 months to 1 year, than did the American patients. At 1 year, 75% of the treated Soviet patients had DBPs less than 90 mm Hg, whereas only 24% of the American patients had comparable DBPs.

Efficacy of relaxation techniques in hypertensive patients.

We examined 117 outpatients (20- to 45-year-old men) with mild essential hypertension before treatment, after the main treatment course (6 weeks), and at 12-month follow-up. The patients were randomized into two major groups: (a) a treatment group that received autogenic training (23 patients), biofeedback (24 patients), or breathing-relaxation training (23 patients) and (b) a control group that consisted of 24 patients who did not receive any intervention and 23 patients who were treated with a "psychological placebo." Clinical, psychological, and psychophysiological data from all patients who were offered relaxation therapy were analyzed. By the end of follow-up, and compared to the control group, the treatment group demonstrated a significant reduction in systolic and diastolic blood pressures, peripheral vascular resistance, and hypertensive response to emotional stress, and an improvement in psychological adaptation, quality of life, and capacity for work. Comparative analysis of the efficacy of different relaxation methods revealed that biofeedback and breathing-relaxation training resulted in the greatest reduction in blood pressure. The antihypertensive effect of relaxation therapy correlated positively with pretreatment blood pressure levels and negatively with the duration of illness and certain psychological features.