Autogenic training for tension type headaches: A systematic review of controlled trials
Introduction
Headache is one of the most common conditions experienced in western society, though there is considerable variation in prevalence and severity in different settings. Episodic tension-type headache (TTH) on several days per month is reported by an average of 37% of the population.1 The social and economic consequences of headache are considerable2, due to loss of work days and days with reduced work efficiency.3, 4 Pharmacological treatment is often disappointing and patients frequently use various forms of complementary therapies including physical methods such as massage, reflexology and spinal manipulation2, 5 and behavioural techniques. An effective self-help therapy that is non-pharmacological and is cheap and simple to use would be of considerable interest to patients and health providers.
Autogenic training (AT) is a self-help relaxation technique that was invented by a German psychiatrist named Johannes Schultz6 and further developed by Luthe.7 The AT technique consists of six standard exercises. The first exercise aims at muscular relaxation, which is achieved mainly by repeating a verbal formula to encourage heaviness. Subsequently, the concentration is focussed passively on feeling warm, then calming the cardiac activity, slowed respiration, warmth in the abdominal region and finally coolness in the head. The technique is usually learnt in groups over a period of 8 weeks and home practice of the exercises at least three times daily is encouraged.8
Relaxation techniques including AT are particularly recommended for prophylaxis of conditions which are caused or exacerbated by mental stress, which include tension-type headache.9 A meta-analysis of various forms of biofeedback and relaxation therapy for tension headache found their effect to be superior to no treatment.10 However, that review did not consider AT individually, so we decided to perform a systematic review to investigate the effectiveness of AT for tension-type headache when compared to no additional treatment, to other treatments or to sham interventions.
Section snippets
Data sources and search strategy
The following databases were searched in January 2005: Medline (1969–2005), EMBASE (1974–2005), AMED (Allied & Complementary Medicine, 1985–2005), CENTRAL (2005), PsychInfo (1974–2005) and CINAHL (Cumulative Index of Nursing and Allied Health Literature, 1982–2005) for possible controlled trials. Searches were performed using the keywords “autogenic training” or “autogenic” and “headache”. Reference lists of retrieved reports, published review articles, various textbooks and Luthe's extensive
Results
Twelve reports of controlled trials of AT for headaches were retrieved13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, of which five had to be excluded for the reasons given in Table 3. Essential data of the included studies are presented in Table 4.
Data synthesis
The single study that compares AT with cognitive coping13 is not interpretable because of its small group sizes. The authors state that, by the end of the study ‘all participants had been able to achieve zero levels of headache activity’, but the success cannot be causally attributed to any particular component of the therapy as distinct from ‘relaxation’ in general or expectation effects.
In two studies involving a total of 49 patients, biofeedback with either galvanic skin resistance (GSR)15
Discussion
This systematic review of seven controlled trials has found only limited evidence that AT is superior to waiting list control for TTH; limited evidence that it is less effective than biofeedback; and consistent evidence that the effect of AT on TTH is no different from hypnosis. There are considerable difficulties in drawing conclusions about the effectiveness of ‘standard AT’ from this material because of various limitations.
The evidence overall may be limited by not meeting the quality
Conclusions
The present evidence is insufficient to allow any conclusions to be drawn about the effectiveness of standard AT for TTH. There is consistent evidence that limited forms of AT are similar in effectiveness to hypnotherapy for TTH, and limited evidence that they are less effective than biofeedback. Further research is warranted, using standardised AT and particularly comparing it with biofeedback for acceptability and effectiveness, in primary care patients with moderate symptoms.
References (43)
Autogenic training
Complem Ther Med
(1997)- et al.
Within-subject analysis of autogenic training and cognitive coping training in the treatment of tension headache pain
J Behav Ther Exp Psychiat
(1981) - et al.
Long-term efficacy of combined relaxation: biofeedback treatments for chronic headache
Pain
(1992) - et al.
Autogenic training and progressive relaxation in the treatment of three kinds of headache
Behav Res Ther
(1986) - et al.
Autogenic training and self-hypnosis in the control of tension headache
Gen Hosp Psychiat
(1992) - et al.
Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups
Pain
(1994) - et al.
Cognitive coping and appraisal processes in the treatment of chronic headaches
Pain
(1996) - et al.
Hypnosis and autogenic training in the treatment of tension headaches: a two-phase constructive design study with follow-up
J Psychosom Res
(1992) - et al.
Mean hemispheric blood perfusion during autogenic training and hypnosis
Psychiat Res
(1989) Epidemiology of headache
Cephalalgia
(2001)
Impact of headache on sickness absence and utilisation of medical services in a Danish population study
J Epidemiol Commun Health
A Canadian population survey on the clinical, epidemiologic and societal impact of migraine and tension-type headache
Can J Neurol Sci
Epidemiology of tension-type headache
JAMA
Trends in alternative medicine use in the United States, 1990–1997
JAMA
Autogenic Methods
Autogenic Training. Vol. 1: Autogenic Methods
Mechanisms of tension-type headache
Cephalalgia
Treatment of recurrent tension headache: a meta-analytic review
Clin J Pain
Guidelines for trials of drug treatments in tension-type headache
Cephalalgia
Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders
Spine
Temperature biofeedback in the treatment of migraine headaches: a controlled evaluation
Arch Gen Psychiat
Cited by (33)
Mind-Body Interventions for Rehabilitation Medicine: Promoting Wellness, Healing, and Coping with Adversity
2020, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :There is also evidence of a potential positive effect for diagnosis-related outcomes for cancer,41 cardiac surgery,42 critical illness/ICU,39 and motor imagery for stroke.43 There is unclear or insufficient evidence for headaches44 and musculoskeletal pain.45 There is no evidence of a positive effect for fibromyalgia, but potential positive effects on secondary outcomes including psychological distress and coping with pain.46
Effectiveness of autogenic training on headache: A systematic review
2018, Complementary Therapies in MedicineCitation Excerpt :A previous systematic review of the impact of AT on tension headache in adults was performed. However, the risk of bias was high in that review because it included both controlled clinical trials (CCTs) as well as RCTs.21 Thus, a systematic review of published RCTs only was conducted to investigate the impact of length of AT use and addition of adjunct treatments on intensity and duration of primary headache.
Characteristics of patients with internal diseases who use relaxation techniques as a coping strategy
2013, Complementary Therapies in MedicineCitation Excerpt :Especially meditation has been shown to reduce hypertension and other cardiovascular risk factors,9 pain,10,11 depression, and stress.12,13 Both progressive relaxation and autogenic training seem to be effective in reducing stress and pain.14–16 In 2007, 12.7% of American adults used deep breathing exercises, and 9.4% used meditation.17
Mind-body therapies for the self-management of chronic pain symptoms
2014, Pain Medicine (United States)Citation Excerpt :Neither of the two studies reported or mentioned adverse events. Although autogenic training presents no apparent risks [108], and systematic reviews have found no adverse events reported in the literature [109,110], neither of the two included studies described any adverse events, leaving the safety of autogenic training unknown. Both studies showed favorable effects of autogenic training, with one study reporting a small effect size (d = 0.45); however, both studies were poor quality, suffering from methodological flaws, low sample sizes, and complete lack of safety reporting.
Supporting the treatment of infertility using psychological methods
2023, Annals of Agricultural and Environmental Medicine
- 1
The author is a nurse and therapist in autogenic training, registered with United Kingdom Council for Psychotherapy.
- 2
Tel.: +44 1752 764448.
- 3
Tel.: +44 1392 430802; fax: +44 1392 424989.