“The greatest weapon against stress is our ability to choose one thought over another.”
In a time when we are alone with our thoughts more often than usual, and interactions with our support systems are limited, we must find new ways to practice self-care. The following is an excellent paper, written by Dr. Erik Peper and Elizabeth Ann Williams, about autogenic training.
Peper, E. & Williams, E.A. (1980). Autogenic Therapy. In: Hastings, A.C., Fadiman, J. & Gordon, J.S. (Eds.). Health for the Whole Person. Boulder: Westview Press, 131-137.
Autogenic training (AT) is a highly systematized technique designed to generate a state of psychophysiologic relaxation—a state diametrically opposed to that elicited by stress. Through the generation of this state, termed the autogenic (selfgenerated) state, the recuperative and self-healing processes of the trainee are facilitated, presumably through effects on the autonomic nervous system. This technique forms the foundation for the more inclusive system known as autogenic therapy.
AT grew out of work in the late nineteenth century by O. Vogt and K. Brodmann of the Berlin Neuro-Biological Institute. In the course of their studies with sleep and hypnosis, they observed that patients were able to put themselves into a state similar to hypnosis—autohypnosis—and that this state had positive, recuperative effects. J. H. Schultz, psychiatrist and neurologist in Berlin, was stimulated by their work to investigate the therapeutic potential of hypnosis. He observed that there were certain experiences common to his hypnotized patients (e.g., heaviness and warmth in the extremities) and that those patients who were most successful in relaxing were those that assumed a casual (i.e., passive, nonstriving) attitude. Based on these observations and on his desire to decrease the client’s dependency on the therapist, Schultz developed autogenic training. In subsequent work, Schultz, along with W. Luthe and others, developed the adjunctive autogenic methods that, along with autogenic training, make up the techniques of AT.
Six standard exercises or orientations form the foundation of autogenic training. These exercises are taught in a structured fashion. Following the completion of a detailed medical psychological history, the trainee is instructed in a specific training posture (intended to reduce to a minimum any distracting stimuli), the proper mode of terminating the exercises, and the phrases themselves (discussed below). The trainee then practices these techniques for several minutes at least three times a day and keeps a log of his or her experiences. The trainer/therapist monitors the trainee’s progress and determines from observations of the trainee and his or her reports from the training sessions and from home practice (log entries) whether the trainee is ready to move on to the next exercise. When appropriate, the trainer offers suggestions to enhance the learning of passive attention and the autogenic shift (entry into the autogenic state) or suggests the use of an adjunctive technique. Hence, despite the structured approach, through the trainee-trainer interaction, AT allows for adaptation to the individual needs of the trainee.
Each exercise involves the use of a specified phrase intended to generate a particular physiological state. While practicing, the trainee is instructed to passively attend to a particular body part while mentally repeating one of the phrases. For example, the first exercise is concerned with the generation of heaviness in the extremities. The trainee begins by passively attending to his dominant arm and mentally repeating a number of times “my right (left) arm is heavy.” Following the focus on the dominant arm, the trainee is encouraged to generalize the heaviness to all limbs (i.e., “my left (right) arm is heavy,” ‘both arms are heavy,” “my arms and legs are heavy”) before moving on to the second exercise. Table 8.1 summarizes the six standard exercises.
The four adjunctive techniques of AT are autogenic modification, autogenic neutralization, autogenic meditation, and interdisciplinary techniques.
- Autogenic modification uses the autogenic state as a vehicle for effecting changes of a specific nature. This approach involves a phrase, used in addition to or in combination with the standard exercises, that focuses either on physiologic change (an organ-specific formula) or on attitudinal or behavioral change (an intentional formula). Using an organ-specific formula, a trainee with chronic constipation added the phrase “my lower abdomen is warm” to the standard exercises in order to stimulate peristalsis in the colon (Luthe, 1977). The use of ‘breath carries the words” by a stutterer (Rosa, 1976) and “I am satiated” by an obese individual (Luthe and Schultz, 1969, vol. 2) are examples of intentional formulas.
In the process of practicing AT, the trainee may experience again some of the
Six Standard AT Exercises
|Standard Exercise||Physiological State||Phrase|
|heaviness in the extremities
warmth in the extremities
calm and regular function of the heart
calm and regular respiration solar plexus warm
|“my arms and .1egs are heavy”
“my arms and legs are warm”
“my heart is calm and regular”
“my breath is calm and regular” or fit breathes me”
“my solar plexus is warm”
“my forehead is cool”
sensations associated with a past event (i.e., experience discharge of material that has nothing to do with the content of the standard exercises). For example, during the practice of the second AT exercise a twenty-eight-year-old male trainee experienced the image of his partially paralyzed, drooling grandmother as he let go of his habitually clenched jaw. He was confronted with his early decision to always hold his jaw tight, lest he be like his grandmother (Peper, 1976).
- Autogenic neutralization allows the structured release of material in order to neutralize or reduce its disturbing effects. The trainee is encouraged to verbalize either material related to a theme (autogenic verbalization ) or whatever comes to mind (autogenic abreaction). Of crucial importance in the practice of these techniques is the maintenance of an attitude of passive acceptance by both trainee and trainer—an attitude of neither suppressing nor enhancing the sensations, allowing the sensations to be while continuing AT. For example, when aggressive dynamics were found to underlie an obese individual’s drive to overeat, autogenic verbalization around the theme of hostility was found to be useful (Luthe and Schultz, 1969, vol. 2).
- Autogenic meditation consists of a series of seven exercises begun only after the trainee has developed the ability to maintain passive concentration for at least thirty minutes (usually after at least six months of AT practice). The focus of the exercises progresses from color, concrete objects and images, feelings, and persons to a state where the trainee directly poses questions to the unconscious.
- Interdisciplinary techniques have been developed that integrate AT with other therapeutic techniques. These techniques include autogenic biofeedback, autogenic behavior therapy, and graduated active hypnosis. For example, temperature biofeedback training has been used with modified autogenic phrases for the successful treatment of migraines (Sargent, Green, and Walters, 1973).
Clinical experience suggests certain areas where caution should be exercised in the application of AT (Luthe, 1977). The International Committee on Autogenic Therapy states that “autogenic therapy is a psychophysiological form of medical treatment. The application of this therapy requires a medical evaluation of the prospective trainee, critical adaptation of the method, clinical guidance, and regular control of the patient’s technique and progress by a qualified physician” (International Committee on Autogenic Therapy, 1961). It is important that any individual teaching AT be aware of cautionary areas; in fact, these precautions may apply equally well to other relaxation techniques, meditation practices, and biofeedback. Briefly, situations where the training is not recommended include those where (1) the trainee cannot or will not follow instructions (e.g., acute schizophrenics, children less than five years of age, and unmotivated individuals); (2) where differential diagnosis must be established in order to differentiate a discharge from a clinical symptom (e.g., a heart patient may have angina or a pain in the chest that is not angina as an autogenic discharge); (3) where pathology is present and its course cannot be monitored to indicate whether there is a worsening of the symptoms of the disease process (e.g., hypertension, diabetes, or glaucoma).
Conditions where the trainee should either omit or postpone a phrase include those where (1) the trainee reports the experience of an undesirable reaction (e.g., while repeating the phrase “my heart is calm and regular,” the trainee experiences tachycardia or major vasodilation causing flushing of the face); (2) the formula focuses on an area of pathology or concern (e.g., with peptic ulcer, the trainee should skip “my solar plexus is warm” or with cardiac neurosis, the trainee should skip “my heart is calm and regular”); (3) a unique situation exists (e.g., omission of “my solar plexus is warm” by pregnant women).
Research and Theory
Although there has been little controlled research, the clinical evidence is suggestive that AT is efficacious, both as a primary and as a supportive technique, in promoting healing in a broad range of illnesses such as gastritis, hypertension, asthma, diabetes mellitus, arthritis, premature ejaculation, sinus tachycardia, anxiety reaction, and alcoholism. Autogenic therapy is not an instant cure; it requires practice over a long period (from two to six months) in most cases for the reversal of pathology. In addition to this remedial use, AT has application both in preventive and self-growth areas. Specifically, AT has been used in the areas of education, industry, and sports where such variables as performance, ability to concentrate, endurance, and anxiety level have been explored (Luthe and Schultz, 1969, vols. 2 and 3).
Although on the surface AT appears to be mainly verbal formula and techniques, in fact it is an encompassing system with a broad philosophical foundation. Many of its beliefs, assumptions, and goals are common to other relaxation and meditative techniques. They include:
- The body has an innate capacity for self-healing and it is this capacity that is allowed to become operative in the autogenic state. Neither the trainer nor trainee has the wisdom necessary to direct the course of the self-balancing process; hence, the capacity is allowed to occur and not be directed.
- Homeostatic self-regulation is encouraged.
- Much of the learning is done by the trainee at home; hence, responsibility for the training lies primarily with the trainee. The trainer must be self-experienced in the practice.
- The attitude necessary for successful practice is one of passive attention; active striving and concern with results impedes the learning process. An attitude of acceptance is cultivated, letting be whatever comes up. This quality of attention is known as •mindfulness’ in meditative traditions.
A major and unique contribution of AT has been the systematic investigation and follow-up of trainees. Out of this practice have come over 2,600 scientific publications discussing the procedures, efficacy, applications, and precautions of AT, most reported in Luthe and Schultz (1969). Both this vast literature and the highly systematic approach make AT a rich tool for the interested professional.
International Committee on Autogenic Therapy, ICAT Regulations. Proceedings of the Third World Congress of Psychiatry (Vol. 3). Montreal: University of Toronto and McGill University Press, 1961.
Luthe, W. Introduction to the Methods of Autogenic Therapy. Manual for a workshop sponsored by the Biofeedback Society of America in Orlando, Florida, March 8-10, 1977. Denver, Colo.: Biofeedback Society of America, 1977.
Luthe, W., and Schultz, J. H. Autogenic Therapy (Vols 1-6). New York: Grune and Strattcn,
Peper, E. Unpublished case study, 1976.
Rosa, K. R. You and AT. New York: Saturday Review Press/E. P. Dutton, 1976.
Sargent, J. D.; Green, E. E.; and Walters, E. D. Preliminary report on the use of autogenic feedback training in the treatment of migraine and tension headaches. Psychosomatic Medicine, 1973. 35, 129-135.
Lindemann, Hannes. Relieve Tension the Autogenic Way. New York: Peter H. Wydon, 1974.
This is a guide and review of autogenic therapy for the lay reader with a number of suggestions for clinical applicability.
Luthe, Wolfgang. A Training Workshop for Professionals: Introduction to the Methods of Autogenic Therapy. Denver, Colo.: Biofeedback of America, 1977.
This provides a concise description and summary of autogenic therapy. It includes a detailed guide to errors in posture and provides samples of medical history forms and a summary of precautions. This workbook is an expanded version of “Autogenic Therapy,’ by W. Luthe and S. R. Blumberger in E. D. Wittkower and H. Warnes (Eds.), Psychosomatic Medicine: Its Clinical Applications. New York: Harper and Row, 1977.
Luthe, Wolfgang, and Schultz, J. H. Autogenic Therapy (Vols. 1-6). New York: Grune and Stratton, 1969.
These volumes are the basic and essential literature on autogenic therapy. Poorly written and often difficult to read, they nevertheless provide the most extensive compilation of methods, applications, effects, and precautions of the autogenic techniques.
Volume l: Autogenic Methods. This summarizes the actual methods of autogenic therapy with emphasis on the standard exercises. It includes detailed case reports of trainees subjective experiences.
Volume 2: Medical Applications. This volume covers the applications of autogenic therapy to medical disorders, organized in terms of functional systems. Evaluations of effectiveness are included.
Volume 3: Applications to Psychotherapy. The uses of autogenic therapy in psychotherapy are described, organized by illness category. The volume includes discussions of efficacy.
Volume 4: Research and Theory. This volume contains studies of psychophysiological changes concomitant with the practice of autogenic training.
Volume 5: Dynamics of Autogenic Neutralization. This is an exhaustive discussion of the process and dynamics of autogenic neutralizations, with extensive subjective reports of patients.
Volume 6: Treatment with Autogenic Neutralization. The use of autogenic neutralization in treatment is discussed with special focus on the resistance process.
Rosa, K. R. You and AT. New York: Saturday Review Press/E. P. Dutton, 1976.
A practical guide for the lay reader to the system of autogenic therapy, this book emphasizes the autonomy of the trainee.
Shealy, Norman. Ninety Days to Self-Health. New York: Dial, 1977.
A elf-help guide that is upon a greatly modified autogenic therapy structure. It includes many self-help exercises.
Information about Autogenic Therapy may be obtained from:
International Center for Autogenic Therapy
5300 Cotes des Neiges, Room 550
Montreal H3T IYE
VARIABLES TO OPTIMIZE TRAINING
In order to learn unstressing techniques, you need to optimize the conditions under which you may relax. These conditions involve the reduction of stimuli impinging upon you, both physical/environmental and psychological/internal. You can also adopt behaviors that encourage success.
- Select an environment where the following conditions are met:
- Training, once begun, will not be interrupted. (Unplug the phone, put a note on the outside of the door, inform others that you are going to begin training, etc.) It may be important to explain what you are doing to your family, housemates, or significant others. Enlist their support. With young children, you may need to time your relaxation during their naps.
- Noise is minimal. (Don’t begin training next to the TV or recreation room.)
- The lighting is subdued, not harsh or glaring.
- The temperature is comfortable (a cold room makes it difficult to relax, an overly warm room may induce sleepiness).
- The chair, bed, or carpet on which training is done is comfortable and provides good support.
- Choose the position for training that is most comfortable for you—either lying down or sitting.
- If lying down, you may want to place a pillow underneath your head so your neck and shoulders are comfortable. Place a pillow underneath your knees so that your lower back is not strained. Be sure the surface beneath is comfortable (use carpet or foam). Make sure your legs are not crossed and that your toes are pointing outward. Keep your arms at your side and not touching your trunk. (If you tend to fall asleep very easily or are very tired when doing these practices, you will probably do better in a sitting position.
- If sitting, make sure the chair offers sufficient support so that you do not fall over when you relax. Make sure the height of the chair is such that your feet are flat on the floor and that there is not undue pressure on your thighs (if the chair is too high, place a telephone book or stool under your feet). Sit with your legs and feet uncrossed and with thighs relaxed so that your legs are slightly separated. Let your arms rest on the arms of the chair or rest them gently in your lap. Let your head either hang forward or be supported by the back of the chair. Be sure your neck is not strained. A recliner is great, with support for head and arms.
- Scan your body and check if there is anything impinging upon and/or constricting it; if so, loosen or remove the constricting or impinging items.
- Often we become unaware of the constricting nature of our clothing. For example, when you first put on your shoes in the morning, you may feel the shoe enclosing your foot, yet after a few minutes you are unaware of the shoe. When you scan (i.e., feel what is going on inside) your body and attention is brought to your foot, you again become aware of the shoe. During relaxation, we often become aware of the constricting sensation and are distracted from the process of relaxation. Check for such items as shoes, a tight collar, tie, wig, glasses, contact lenses, socks with elastic tops, hair barrette or rubber band, watch, ring, heavy pendant, wallet or keys in pocket, belt, bra, and girdle. If you are working in a group and are uncomfortable about loosening personal items, go through the exercise as best you can and next time you practice make sure to dress so that these items are not a problem.
- Items that appear comfortable in our normal posture may physically prevent the process of relaxation. For example, jeans that are tight across the abdomen prevent the letting go and expansion of the abdominal wall. They force thoracic breathing and prevent the more relaxing diaphragmatic breathing. Check for such items as belt, tight pants, panty hose, or tight corset.
- An item that appears comfortable in our normal posture may demand bracing while we relax. For example, if you are wearing glasses and your head tilts forward during relaxation, you may tend to tighten your neck muscles to prevent your head from nodding and your glasses from falling. Similarly, a woman with a short skirt may hold her knees together and not let her legs relax, and people with dentures may tighten their jaw because of the fear that the dentures may fall out.
- A physical state may also distract us from relaxing. For example, having a full bladder or being either very hungry or full may make it difficult to relax. Being extremely tired may either cause sleepiness and mind wandering or a state of feeling keyed-up. Avoid caffeine for at least 2 hours prior to relaxation.
There are certain attitudes of the trainee that encourage relaxation. These include the following:
- Passive attention. This is an attitude of nonstriving—of allowing versus forcing or trying—and is characterized by the absence of concern for performance and end result.
- Nonjudgmental acceptance. This attitude includes not explaining, interpreting, or labeling an experience as good or bad but letting it be and describing it without judgment. It implies not comparing one experience to another but, rather, experiencing each new situation afresh (watch out for words like because, and should and for expressions like the reason is).
- This is an attitude of remaining present, watchful, and aware of what is happening without becoming involved or captured by the images or feelings. Being truly present implies the absence of anticipating, ruminating, or mind wandering.
There are a number of strategies that facilitate home practice and generalization of relaxation skills. The following are a few suggestions:
- Keep log notes. As previously mentioned, these notes concerning your experience, time of day, mood before and after the practice will provide valuable data to help you choose the best times and settings. Notice situations when it is easy and when it is more difficult for you to practice. This enables you to select those situations that encourage practice. For example, you may find that you practice relaxation skill with another person more often than by yourself; it so, structure your practice time with a friend or fellow classmate. Also, some participants have reported that looking over their log notes reinspired them.
- Schedule a regular practice time and associate it with an existing behavior. For example, you may practice after watching the evening news or before dinner. It is preferable not to practice too soon after a large meal. If you tend to fall asleep easily, it is best not to practice late in the evening. It is also best initially not to tide relaxing with going to sleep.
- Give yourself a reinforcer meaningful to you when you practice. For example, if you practice for a week, treat yourself to a movie or special meal (Thorenson & Mahoney, 1974; Watson & Tharp, 1981).
PERSONALIZING YOUR EXPERIENCE
Making Your Own Audiofiles
I was not used to hearing gentle, pleasant, encouraging words from myself.
For each if the relaxation practices there is a script, which is designed to be read aloud and taped by the trainee. There are many benefits involved in making your own relaxation tapes. The extra time required can be well worth it. Making your own tapes gives you the ability to tailor a relaxation sequence to your own needs. For example, if you have lower back pain, you might choose to eliminate or change those instructions that might affect your back. If you typically do the practice before starting a work period, you might want to conclude the tape with a suggestion that you are now awake, alert, and mentally focused. If you have trouble relaxing a particular part of your body, you might decide to repeat the tensing and relaxing instructions an extra time for that area. You may want to tape the instructions with your favorite music playing softly in the background. When you make the tape with your personal relaxation imagery, in Practice 4, you can provide background sounds such as ocean waves, birds singing, and so forth. Certain words may have more pleasant associations for you than those in the scripts, and you can substitute them. For example, some people initially respond negatively to the word relax because of having been told impatiently, “Would you relax!!”
If English is your second language, deep relaxation may be more successful if you translate all the scripts into your native language.
Relaxation is not different from self-acceptance. Listening to your own voice telling you to relax helps you to internalize the instructions and promotes self-acceptance. Many people who began by disliking the sound of their voice ended by enjoying listening to themselves. One woman said that making her own audiofile, with the appropriate pauses, helped to learn to listen more in dialogue with other people and to slow down the pace of her hectic life.
Here are some helpful hints for making your tapes:
- Before making your audiofile, practice reading the script aloud, if possible to a friend or family member, to get feedback on your pacing. As you make the audiofile, imagine doing the practice or actually do it (or lead another person through it). This will help your pacing.
- Make the audiofile at a time when you’re not feeling rushed so that your voice will convey relaxation. Be sure to speak slowly and breathe diaphragmatically throughout. Allow your voice to drop to a slightly lower pitch than you use in everyday speech.
- Allow plenty of time for the relaxation phase after muscle tensing. A good rule is to allow 7 to 10 seconds for tensing and 15 to 30 seconds for relaxation. Whenever the script indicates…, pause for a few seconds. Most people tend not to allow enough time for relaxation. Quiet space on the tape is OK.
Like the first pancake, the first attempt at making a tape is not always successful. Think of your first one as an experiment, and if need be, do it over. It will be a good learning experience!
Development of a Personal Ritual for Relaxation
A wonderful fact about the mind is that our responses can be conditioned. Just as we learn to associate certain cues (e.g., a ringing phone or the sight of an angry person) with tension, so too can we learn to associate certain cues with relaxation. As soon as we encounter a relaxation cue, we begin to release tension almost automatically. This can work for you to help deepen your relaxation practices and to allow you to begin relaxing more quickly. The following are some examples of rituals and cues:
- Putting on comfortable, loose sweatpants
- Getting into your favorite chair
- Lighting a candle or stick of incense
- Ringing a meditation bell or bowl
- Taking three slow, deep breaths
- Putting on some quiet, soothing background music
- Putting a favorite stuffed animal, blanket, or other comforting item nearby
When you are beginning your relaxation practice, it sometimes helps to use a checklist so that important items are not forgotten (see checklist in Chapter 2).
Why Keep Log Notes?
Writing is an important way of bringing language to our experiences, which helps us to understand, assimilate, and integrate what has happened. Writing brings the amorphous into a concrete form and gives it a sense of containment. It allows us to transport the subtle, evanescent, and easily forgotten inner experience into our everyday consciousness, thus providing the bridge between insight and action. Later, the written words make it possible to look back and reflect upon patterns in our experience that would otherwise not be knowable because so much of our behavior and responses occur automatically.
Another important function of writing is the cultivation of that part of the mind that is the “witness,” the part that observes, with calm detachment, everything that we experience. This form of awareness is also developed through meditation. Such awareness can be very valuable in aiding behavior changes. For example, one can simply observe a desire to run away from a frightening stimulus, without giving in to it. Or one can observe, perhaps many times an hour, a desire or craving for, say, alcohol or sugar, again without having to at on it. Thus, we come to know ourselves and to create greater freedom from old habits patterns. Journal keeping is transformative.
Reflection and Integration: Summarizing Your Experiences
Looking over my logs and questions over the last four weeks, I could really notice the improvement. The emotions which were hidden for so long finally came to the surface. I could feel them and accept them for what they were. I was mindful and realized that these are patterns I have repeated for many years. With distance, I could accept and notice movement and change. I finally know that I am growing.
Looking back over the previous weeks’ experience offers a possibility of integration, acceptance, and growth. We recommend highly that after every major chapter of this workbook, you look back over your comments in the logs and discussion pages. Looking back allows you to organize your experience. As you review the previous weeks’ experiences, you may note that significant changes have occurred. These can include increases awareness of more subtle cues of tension; recognition of helpful and destructive life patterns; reduction or disappearance of symptoms such as tension headaches, migraine, or insomnia; and even an enhanced appreciation of the remarkable self-healing potential intrinsic in each of us.
Instructions for Writing a Summary Paper.
After having practiced a series of the exercises, write a summary paper (three to five pages) about your experiences. Write these papers after Dynamic Relaxation (Practice 8); Cognitive Balance (Practice 12), and Self-Healing Through Imagery and Behavior Change (Practice 14). Reflect back over the previous practices by rereading your Log sheets, Question sheets, and Discussion and Conclusions sheets. In these papers address some of the following concerns:
- What was your experience with the different practices?
- How did each practice deepen different components of your self?
- What benefits did you observe as a result?
- What common patterns underlay your experiences?
- What difficulties or challenges did you encounter, and how did you cope with them?
- In what ways were the small group discussions helpful?
- What have you learned about yourself through the practice of these techniques?
- If you could do it over again (repeat the practices), what would you do differently?
- What have you learned that you will apply to the next practice?
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See more from Dr. Erik Peper at The Peper Perspective