Stress is the scourge of the 21st century. Irritants are everywhere: too much information, too much to do, and even more anxiety about not having enough to do and information. This rhythm of life leads to chronic stress, constant fatigue and apathy, which, in turn, lead to quite noticeable bodily ailments, depression, social isolation and burnout.
However, linking all these problems only with modern realities is not entirely correct. The problem of excessive stress was already a concern in the 20th century. It was then that scientists asked the question - how to help a person get out of the state of a clamped spring, at least for a short time, and even better - control his daily stress.
The answer was not long in coming. Already in the 30s of the last century, German psychiatrist Johann Schultz, based on the observations of neurologist Oskar Vogt, developed the method of autogenic training. However, the stigmatization of psychological and mental problems, which still has not left the mass consciousness, has not allowed this promising technique to become popular outside the clinical environment. Time to fix the situation.
To some extent, auto-training can be considered a special case of self-hypnosis, but there are differences
Rationale
Autogenic training (AT) is one of the most widely used methods of psychotherapy for patients with chronic somatic diseases (CSD). This is due to the high efficiency of the method in the framework of complex therapy, rehabilitation, sanatorium treatment and its cost-effectiveness [1]. A number of studies have shown an improvement in the psychological status of patients against the background of AT [2–4]. However, to date, the mechanisms of therapeutic action and predictors of the effectiveness of the method have not been sufficiently studied, which is necessary for the development of differentiated indications for its use.
The purpose of the study is to study the effectiveness of AT and identify factors that make it possible to predict it in the correction of the psychological state of patients with chronic disease.
Material and methods
Objects (participants) of the study
The study included 325 patients with chronic disease aged from 25 to 64 years (average age 40.6±1.2 years), including 82 with irritable bowel syndrome with constipation, 82 with hypertension, 81 with spinal osteochondrosis with pain syndrome, chronic nonspecific salpingoophoritis 80.
Analysis in groups
Using the randomization method (as all patients were included in the study, they were sequentially assigned a number; every even numbered patient was included in the main group, and every odd patient was included in the control group), the patients were divided into two groups: the main group and the control group.
Before the start of psychotherapy, the main and control groups were comparable in age, gender, prescribed physiotherapy complexes, drug treatment (prescription of psychotropic drugs was excluded), as well as indicators of psychological status.
Patients of the main group ( n
=163) were prescribed psychotherapy using AT; the control group (
n
=162) did not undergo psychotherapy.
To study predictors of AT effectiveness in the main group, two subgroups were identified. Subgroup A included 128 patients whose condition returned to normal during the observation period, subgroup B included 35 patients whose condition improved by the end of observation. A comparative analysis of the background indicators of the selected subgroups was carried out.
Study design
An open, single-center, observational study was conducted.
Eligibility Criteria
Inclusion criteria:
– patient age from 25 to 64 years;
– presence of chronic disease.
Exclusion criteria:
– mental illnesses (codes F01–F99 according to the International Classification of Diseases, 10th revision);
– taking psychotropic drugs.
Conditions
The study was conducted in a hospital setting at the National Medical Research Center for Rehabilitation and Balneology of the Russian Ministry of Health (Moscow).
Duration of the study
The duration of the study was 3 years (from 2014 to 2016), the observation period for each patient was 3 weeks.
Description of medical intervention
AT was carried out according to our modified method [5], which includes the following main elements:
1) verbal formulas of suggestion (suggestion) to achieve a feeling of relaxation, warmth and lightness in the face, neck, arms, back, abdomen, legs, whole body, as well as a feeling of peace;
2) visualization - patients were asked to remember not the formulas of suggestion, but the pleasant sensations that arise in a state of relaxation and peace, and associate these sensations with a visual symbol (“relaxation figure”).
During independent training, it was recommended to reproduce the state of relaxation by looking at the “relaxation figure” or imagining it. Classes were conducted in small groups (3–5 patients) 4 times a week (total course 12 lessons).
Main outcome of the study
The level of psychological adaptation, anxiety and depression was assessed according to survey data at the beginning and end of observation.
Methods for recording outcomes
Psychological examination was carried out at the beginning and end (after 3 weeks) of the course of treatment using the Abbreviated Multifactorial Personality Inventory (AMPI) [6], the Spielberger Anxiety and Anxiety Inventory (SATS) [7], and the Beck Depression Inventory (BDS) [8]. .
Ethical review
The study was approved by the local ethics committee of the Federal State Budgetary Institution “National Medical Research Center for Rehabilitation and Balneology” of the Russian Ministry of Health (protocol No. 2 of 06/01/16).
Statistical analysis
Principles for calculating sample size
: The sample size was not previously calculated.
Methods of statistical data analysis:
Statistical data processing was carried out using the Statistica v software package. 10.0 (StatSoft, USA). When analyzing the material, methods of mathematical statistics were used: Spearman's correlation coefficient, Wilcoxon test for paired measurements. The description of the results presents mean values and standard deviations.
Texts for relaxation material
Texts for relaxation
House of “magic” doors Clear your brain of all thoughts and concentrate on your breathing. Before moving to the next stage, remain in a state of relaxation for five to ten minutes. And after that, from a state of deep relaxation and calm... create conditions in your mind. Imagine or create the external environment in your mind, it should be pleasant. It may be mountains, plains or coastline... You should see it clearly. Walk mentally through this area. Examine this area carefully using all your senses. You should see colors, shapes, feel them to the touch, hear sounds, smell them. Pay attention to the time of day, weather, air temperature. Feel all this with your consciousness. You can make any changes you want, you can make in this imaginary area whatever you want, you should feel completely safe. (pause for a minute or two) Now place a house in the environment you have created. Just don’t go into it, but first take a good look around the outside. We are going to go on a tour of this house. So, now enter this house through the front door. Walk along the corridor, and you will find yourself in a mirrored room. There are mirrors around you. And in these mirrors you see your reflection. Now exit the mirrored room, You will come out and find yourself in a long corridor, This corridor seems endless, and on both sides of the corridor you see doors. You see that all the doors are of different colors. You walk along the corridor and pass doors... doors... doors, Then you stop in front of the door that is located on the left. You notice what color it is .On the door you may see a sign, an image or some kind of symbol. If there really is some kind of sign, image or symbol on the door, then you look at it and understand what it means. When you feel that you are ready, you open this door and enter the room that is behind it. You can examine the room and its furnishings as much as you like; it must be examined most carefully. (pause for one minute) While you are in this room, you change everything you want. Don't forget that you can change anything, and making those changes can take as long as you want. (pause one minute) You are about to leave the room. You may want to stay a little longer to complete what you want to complete. If you want to visit this room again, you can get there at any time. Now you leave this room back into the long corridor. You close the door behind you, but do not lock it; don't forget that you can come back here. You walk along the corridor again, passing one door after another. You walk along the corridor until you stop in front of the door located on the right. You should pay attention to the color of this door... as well as sign, image or symbol that you see on it. Feel that you are ready, open the door and enter the room. You can spend as much time inspecting the room as you need. (pause for one minute) Do not forget that you can produce any changes in this room. (pause for one minute) When you feel that you are ready, you can complete all changes. Remember that you can return to this room whenever you wish. Now leave the room. Go to the corridor, close there is a door behind you, but don't lock it. After that, follow the direction you came from. You should go past the first room you entered. After that, you should go through the mirror room. Pay attention to the changes that may have occurred in your appearance. Go through the first corridor. And exit through the front door. You return to the little world you have invented. You can change anything in it, then you must find a quiet place to sit... and meditate. The subject of your meditation should be something that what you experienced in the house of doors *And what it might mean. (pause one to two minutes) When you are ready, note a few key points to remember and not forget when you return to normal,Back to normal, you must remember where you were, what you felt and what those sensations and impressions gave you. Key points can be images, symbols, sensations, colors, emotions, words or phrases - in short, anything that will help you remember the experience . You should even remember the smells, sounds and sensations that accompanied you in your meditation. When you feel ready to return to your normal state, you can begin to approach the end of your meditation session. When you feel ready, you can allow yourself to return to normal state. Into reality. You come out of the meditative state and feel invigorated... and renewed. Take a few deep breaths and exhales and stretch. Open your eyes and return to reality.
Walk to the sea Take a comfortable position... Relax your muscles... and make sure... that your body... is still... Breathe calmly... Feel... and control only yourself... your... body... You are lying on a soft, green meadow... Flowers are growing around you... Inhale the aroma of flowers... Warm breeze gently envelops your body... The body is light and weightless... All worries and affairs... recede... into the background... Peace... pleasant peace... takes possession... of the body... You feel well... how your body calms down... and relaxes... Music calms you... You are resting... peace and rest...The body... calmed down... and relaxed... All muscles... relax... Every muscle of the body... calms down... and relaxes... The body is relaxed... the body is calm... The stomach... warms up... the stomach feels pleasant... warms... The stomach warms up... with a pleasant... deep... warmth... With with every exhalation... warmth from the belly... in soft waves of peace... spreads... throughout the body... The body warms up... Warmth... and calm... Warmth... and peace... pass through the body... Rest is pleasant... consciousness calms down... and slows down... You feel good... peace... Peace... and well-being... throughout... the body...
Now feel your face... Feel... how the facial muscles... relax... The face is calm... the face is indifferent... Peace... complete peace... You are slowly plunging into a warm... pleasant... fog... peace... You are plunging into the fog... The fog envelops your body... The fog... envelops your head ...A pleasant fog... envelops... the head... The brain... calms down... Thoughts... slow down... Slower... slower... slower... You breathe easily... and evenly... Breathing is calm... rhythmic... Close your eyes... You are in a cloud of fog... The fog completely surrounds you... Pleasant, soft, silvery fog... The fog begins to dissipate... A stream of golden light flows through the fog... Take a step forward into the golden sunlight... Step out of the fog... A white sandy beach stretches out before you... Beyond the edge of the beach begins an endless sea with clear bluish-green water... Look ...to the majestic expanse of the sea...before you...The water stretches as far as...as far as the eye can see...Walk forward until you reach the place where the dry sand meets the wet sand at the edge of the water...Stop...
Quiet waves... run onto the shore... and rustle at your feet... Feel... how the waves approach you... and retreat back... This is a sea... of endless life... and consciousness... Absorb all the sounds and images... The sea fills you with life... and consciousness ...You are filled with love for life... and all living beings... You enjoy the touch of the warm rays of the sun... You are completely surrounded by a powerful energy field of golden light... The light protects you from all negative external influences... Feel the energy of this light... Let the light flow freely through your body... Absorbs into the pores of your skin...Fills you with its energy...Sea gulls circle in the sky above...Their cries echo far above the water...This is your place...Your deeply personal, inner place...Here you are free...Free to be who you really are in fact...free to do whatever you want...
— Independent work 5 — 15 min. —
It's time to return... A silvery fog envelops you... You are in a cloud of soft, cool fog... A pleasant, cool fog picks you up... You float smoothly to the beginning of the journey...
You have returned to the clearing... A light, cool breeze dispels the fog... Pleasant white sunlight has completely dispelled the fog... Rest has refreshed you... You have rested well... Your head is clear... light... A feeling of lightness... and coolness is growing throughout your whole body... Pleasant cheerfulness... throughout your body... You are charged with energy... a desire for activity... You have deeply and fully rested... In a minute the session will end... and you will be cheerful... rested... Strength flows to your arms... and legs... Consciousness becomes clearer... you want to stretch... Stretch! Be more active! Now... take a deep breath... and smile... Smile, smile! The session is over.
Joy of love
Take a comfortable position... Relax your muscles... and make sure... that your body... is still... Breathe calmly... Feel... and control only yourself... your... body... The body is light and weightless... All worries and affairs... fade... into the background... Peace... pleasant peace... takes over... the body... You feel well... how your body calms down... and relaxes... Music calms you down... You rest... peace and relaxation... The body... calms down... and relaxes... All muscles... relax... Every muscle of the body... calms down... and relaxes... Body relaxed... the body is calm... The stomach... is warming... the stomach is pleasant... warming... The stomach is warming up... with a pleasant... deep... warmth... With each exhalation... warmth from the stomach... in soft waves of peace... spreading... throughout the body... The body is warming up... Warmth... and calm... Warmth... and peace... pass through the body... Rest is pleasant... consciousness calms down... and slows down... You feel good... peace... Peace... and well-being... throughout... the body... Now feel your face... Feel... how the facial muscles... relax... The face is calm... the face is indifferent ...Pleasant coolness smoothes the forehead...Smoothes out all the wrinkles on the face...The face is calm...the face is relaxed...Breathing is free...and easy...Light, free breathing warms...and calms...Peace...complete peace...in the whole...body...Listen to how calmly and evenly it beats your heart…
Your breathing is calm and serene... Your whole body... is in a state of peace... Only your consciousness works clearly... An image of the one who loves you is born inside your consciousness... You look carefully into his eyes... Together with this look, serenity and calmness enters you... You hear the magical sounds of music...You feel the warming power of love, its warmth...Love is like music and music is like love...You feel an inextricable connection with the person who loves you...You experience an extraordinary feeling of unity with him...A feeling of great reciprocal love is born in your heart...This feeling begins to grow like a beautiful spring flower...And your magical feeling of love also expands...It covers all your loved ones and your friends...The warmth of your love spreads to all the people you meet in your life...You experience a feeling of great unity with everyone, who you meet...The warmth of your soul is enough for everyone...You are immersed in a feeling of love...and you get to know yourself and other people...Together with your love, you feel your life more deeply...You love all the people living with you on this earth...You love equally both yourself and others...You acutely feel how your life is permeated with love for everything living on earth...You feel that your love makes life harmonious and joyful...You feel your love as a particle of world harmony...Your love lifts you up to absolute perfection and harmony of the world...Your being is like a life-giving sun, from which rays of love flow...Music has changed...Music brings you cheerfulness...energy...health...
Your body is filled with the energy of love... You have received a huge charge of renewal... youth... The powerful healing power of love... has cleansed your soul...
Your strength is restored... Rest has refreshed you... You are well rested... Your head is clear... light... A feeling of lightness... and coolness is growing throughout your whole body... Pleasant cheerfulness... in your whole body... You are charged with energy... with a desire for activity... You are deeply and fully rested... After a minute, the session will end...And you will be cheerful...rested...Strength will flow to your arms...and legs...Consciousness becomes clearer...you want to stretch...Stretch! More active! Now... take a deep breath... and smile... Smile, smile! The session is over.
Relaxation Take a comfortable position... The body position should be such... that with the deepest relaxation of the muscles... the posture... does not change... Relax the muscles... and make sure... that the body... is motionless... Breathe calmly... attention... focused... on the activity... You feel... and control only yourself... your... body... All worries and affairs... fade... into the background... Peace... pleasant peace... takes over... the body... You feel well... how your body... calms down... and relaxes... Your body... calms down... and relaxes... All muscles... relax... you you feel... how... the muscles relax... Every muscle of the body... calms down... and relaxes... The body is relaxed... the body is calm... Peace... complete peace... The stomach... warms up... the stomach is pleasant... warmer... The stomach is warmed... with a pleasant... deep... warmth... Warm... and pleasant... warm... and calm... With each exhalation... warmth from the stomach... soft waves of peace... spreads... throughout the body... With each exhalation... warm waves of peace... pass... through the body... The body... warms up... Warmth... and calm... Warmth... and peace... pass ... throughout the body... Peace... and serenity... peace... and serenity... Peace... complete... peace... The body and consciousness are calm... and indifferent... They... rest... Rest is pleasant... consciousness calms down... and slows down... You feel good... peace... peace... and well-being... in the whole... body...
Your consciousness... calms down... Consciousness is leisurely... and peaceful... Peace... complete... peace... Peace... and serenity... Now feel your face... feel your... face... Feel... how the facial muscles... relax... Face... calm... face... indifferent... Peace... complete peace...You are slowly plunging into a warm... pleasant... fog... of peace... You feel that you are slowly plunging... into a warm... pleasant fog... of peace... You are plunging... You are plunging into the fog... The fog... envelops... your body... The fog... envelops... your head ...A pleasant fog... envelops... the head... The brain... calms down... Thoughts... slow down... Slower... slower... slower... You breathe easily... and evenly... The breathing is calm... rhythmic... The chest is light... the air is light and free... passes deep into the body... Even, light breathing... calms... You... calm down... Calm down... and relax... The circle of attention... narrows to the boundaries... of your... body... You feel and perceive only... your... body... You feel well that the body is calming down... calming down... Every muscle of the body... calming down... and relaxing ...The body is relaxed...the body is calm...
Peace... complete peace... Your whole body... is in a state of rest... Now pay attention to your breathing... Light inhalation... Light calm exhalation... Light inhalation... Light smooth exhalation... Breathing is even... And calm... With every breath... You are filled with calmness... Calmness... fills your head... chest... body... Peace... and pleasant warmth... in your whole body... You rest... peace and rest... rest... peace... rest... Breathing is even... calm... rhythmic... Breathing is light... and pleasant... The body is clean... and transparent... the body is clean... and transparent... Kindness... and love... fill... the body...
Activation
Your strength is restored... Rest has refreshed you... You are well rested... Your head is clear... light... A feeling of lightness... and coolness is growing throughout your whole body... Pleasant cheerfulness... in your whole body... You are charged with energy... with a desire for activity... You are deeply and fully rested... After a minute, the session will end...And you will be cheerful...rested...Strength will flow to your arms...and legs...Consciousness becomes clearer...you want to stretch...Stretch! Be more active! Now... take a deep breath... and smile... Smile, smile! The session is over.
Great peace
Get comfortable... Feel completely at ease... The pose itself causes relaxation... of the muscles... Lie completely still... and rest... Breathe calmly... Attention is focused... on the activity... You feel... and control only yourself... your... body... All worries and affairs... go... to background...Peace... pleasant peace... takes over the body... You feel well... how your... body calms down... and relaxes... Peace... complete peace... Extraneous sounds are gradually muffled... moving away... Sounds rush from afar... past consciousness... All worries... worries of the day go away ... There is only rest... and peace... Tender, pleasant warmth warms the feet... The feet are filled with pleasant... pulsating... warmth... You clearly feel this warmth... and pleasant... heaviness... Pleasant warmth fills the calves... The calves are relaxed and warm... The muscles of the thighs relax... The thighs relax... completely relaxed... Thigh muscles... completely relaxed... Your legs are heavy... warm... motionless... Warmth envelops your legs... Legs are completely relaxed... and warm... Warmth rises in soft waves to your stomach...
Warmth spreads throughout the abdomen... The abdomen warms up... and relaxes... All abdominal muscles relax... The abdomen warms up... The abdomen warms up with pleasant... deep... warmth... Soft... warm belly... Warmth flows to the chest... Breathing is even... calm... rhythmic... Breathing is light... and pleasant... The chest muscles relax...You exhale...and the chest warms up...Soft warmth...warms...the chest...The back muscles relax...The back lies comfortably...on the support...The back gets warmer...The back is warmed with soft...pleasant warmth...The back lies freely on the support...Spreads over the support...The back warms up... and relaxes... Pleasant peace... throughout the body... Quiet... cozy... comfortable... calm... Everything is quieter around... deeper and deeper relaxation... Complete relaxation... complete peace... Shoulders become warmer... Warmth spreads from the shoulders to the forearms... Arms become warmer... Arm muscles relax ...Hands are completely relaxed...
Warm... motionless... hands... Soft, pleasant warmth... spreads... and flows... Spreads through your hands... Fills your hands... pulsates in your fingertips... Facial muscles relax... teeth unclenched... Tongue relaxed... Lips relaxed... A cool, soft breeze smoothes your forehead... Smoothes out all the folds of the forehead...Complete serenity...Complete peace...Neck muscles relax...The head lies freely and easily on the support...All neck muscles are relaxed and calm...The whole body is enveloped in a pleasant, gentle warmth...The heat dissolves all sensations...carries them away...The warmth penetrates into every cell of the body... The body dissolves... in the surrounding space... The boundaries of the body disappear... The whole body dissolves in the air... The head is enveloped in fog... Pleasant... warm fog... All sounds are muffled in the fog of indifference... and peace... Deeper... and deeper... peace... You feel... that slowly immersing yourself in a warm... pleasant... fog of peace... You are immersing yourself in a fog... The fog envelops your body... Envelops... your... body...
The fog envelops the head... A pleasant fog... envelops the head... The brain calms down... Thoughts slow down... Slower... Slower... Slower... You breathe easily... and evenly... The breathing is calm... rhythmic... The chest is light... The air is light and free... passes deep into... the body... Even, light breathing... calms... You... calm down... Calm down... It's good and pleasant... to lie down... and rest... Complete peace... and relaxation... You are completely calm... Your body is resting... Peace... complete peace... Peace and rest... in the whole... body...
— 5 — 15 minutes for independent work —
The music has changed...Music brings you cheerfulness...energy...health...Your strength is restored...Rest has refreshed you...You are well rested...
The head is clear... light... There is a growing feeling of lightness... and coolness throughout the body... Pleasant cheerfulness... throughout the body... You are charged with energy... the desire for activity... You have deeply and fully rested... In a minute the session will end... And you will be cheerful... rested... Strength flows to you arms... and legs... Consciousness becomes clearer... I want to stretch... Stretch! Be more active! Now smile. Smile, smile!
Mountain walkGet comfortable...Feel completely at ease...The pose itself causes muscle relaxation...You lie on a soft, green meadow...The sun is shining brightly above...Flowers grow around you...A warm breeze gently blows over your body...The breeze sways the grass and stems of flowers around you...Inhale the aroma of flowers... Extraneous sounds are gradually muffled... moving away... Sounds rush from afar... past consciousness... All worries, worries of the day go away... there is only rest... and peace... The absence of tension is pleasant... The muscles of the arms relax... The arms are completely relaxed... The muscles of the legs are relaxed... The legs are completely relaxed ...The muscles of the torso relax...The abdominal muscles relax...The back muscles relax...The chest muscles relax...Pleasant warmth throughout the body...The facial muscles relax...the teeth are unclenched...The tongue is relaxed...The lips are relaxed...The forehead is smoothed out...All the folds of the forehead are smoothed out...Complete serenity...Quiet...comfortable ...comfortable...calm...
The whole body is enveloped in a pleasant, gentle warmth... The heat dissolves all sensations... takes them away... The heat penetrates every cell of the body... The body dissolves in the surrounding space... The boundaries of the body disappear... You are enveloped in fog... Pleasant, warm, silvery fog... The whole body dissolves in the fog... The brain... calms down... Thoughts... slow down... Slower... slower... slower... You breathe easily... and evenly... Breathing is calm... rhythmic... Close your eyes...
You are in a cloud of fog...The fog completely surrounds you...Pleasant, soft, silvery fog...Through the fog you can hear the gentle murmur of a stream...The stream carries with it streams of bright sunlight...Take a step forward into the golden sunlight...Come out of the fog...
You are at the foot of a majestic mountain... Approach a mountain stream... Stop... Absorb all the sounds and images... Listen to the melodic murmur of streams on the shallows and rifts... You enjoy the touch of the warm rays of the sun... You are completely surrounded by a powerful energy field of golden light... The light protects you from all negative external influences... Feel the energy of this light... Let the light flow freely through your body... Absorb into the pores of your skin... Fill you with its energy... Bend over and dip your fingers in the cold water... Take a sip of this absolutely pure, refreshing water... Walk along stream... upstream... Your goal is the top of the mountain... Walking forward, listen to the birds chirping... Inhale the smell of pine resin... You walk easily and freely... Each step brings you closer to the top... The wind brings the aroma of cedar... You are approaching the top... You come to peak and see a deep canyon on the other side...You can shout the most important questions into the canyon beneath your feet...And read the answers in the sky above your head...Now ask your questions...and see the answers in the sky above...
It's time to return... A silvery fog envelops you... You are in a cloud of soft, cool fog... A pleasant, cool fog picks you up... You float smoothly to the beginning of the journey...
The journey ends... A light, cool breeze dispels the fog... Pleasant white sunlight has completely dispelled the fog...
results
Main results of the study
According to the data obtained (see table),
Dynamics of psychological test scores for 1 month in patients of the main and control groups (DM±m) Note. * — p<0.05; ** — p<0.01; *** — p<0.001. in the main group by the end of the observation there was a significantly more pronounced decrease in indicators on scales 1, 2 and 7 and an increase in values on the 9th scale of the SMOL test, which indicates a decrease in the level of anxiety, tension, fixation of attention on one’s own sensations, increased activity and mood against the background of AT.
In the main group, a significantly more pronounced ( p
<0.001) compared to the control, a decrease in the level of reactive and personal anxiety according to the ShTT and a decrease in indicators according to the BDS.
The study of the mechanisms of action of AT revealed the following correlations: changes in indicators on the ShTT and the 2nd SMOT scale correlated with the dynamics of systolic blood pressure in patients with hypertension ( r
=0.51,
p
<0.001 and
r
=0.46,
p
<0.01, respectively);
dynamics of indicators on the ShTT, ShDB, 2nd and 9th SMOL scales - with the severity of pain according to the visual analog pain scale in patients with chronic nonspecific salpingo-oophoritis ( r
=0.54,
p
<0.001;
r
=0.44
p
<0.01;
r
=0.55,
p
<0.001 and
r
=–0.45,
p
<0.01, respectively), spinal osteochondrosis (
r
=0.50,
p
<0.001;
r
=0.42,
p
<0.01;
r
=0.48,
p
<0.01 and
r
=–0.41,
p
<0.01, respectively) and irritable bowel syndrome (
r
=0.57,
p
<0.001;
r
=0. 39,
p
<0.05;
r
=0.48,
p
<0.01 and
r
=–0.38,
p
<0.05, respectively).
Analysis of predictors of the effectiveness of AT revealed in the subgroup with an improvement in the psychological state significantly higher background (before treatment) indicators for the 4th (62.1 ± 1.58 and 47.2 ± 0.96 T) than in the subgroup with its normalization -score accordingly; p
<0.001) and 6th (61.3±1.97 and 50.1±0.87 T-scores, respectively;
p
<0.01) SMOL scales.
BDS scores above 20 points (indicating the presence of a moderate or severe degree of depression) before treatment were detected in 11 (31%) patients in subgroup B, and only 2 (1.6%) patients in subgroup A (χ2 = 29, 5; p
<0.01).
Additional Study Findings
Analysis of the effectiveness of AT depending on the nature of the underlying pathological process did not reveal significant differences in the dynamics of psychological status in patients with various chronic diseases.
Adverse events
There were no adverse events.
Method of exiting the autogenic state
In a broad sense, an autogenic state is a natural state of relaxation, thoughtfulness, and contemplation. It occurs when a person is in a quiet place, concentrating on something, and in other similar situations. In such an environment, it is necessary to conduct autogenic training.
When returning to an active life, you should adhere to certain rules that will allow you to quickly be “in the right condition”
:
- It is necessary to stop performing the current task and concentrate on the fact that you are well rested and will soon leave the autogenic state.
- You need, without changing your general posture, to slowly clench your hands into a fist and feel the strength throughout your body.
- Without unclenching your fists, you should extend your arms towards your knees.
- Wait until the end of the exhalation and on the next inhalation, raise your arms and face up, arch your back.
- Wait a second or two, then exhale sharply through your mouth, unclench your fists, and open your eyes. After this, you can calmly give up.
If a person has high blood pressure, then when leaving the autogenic state, he should concentrate on the calm, pacifying energy received during the session. If blood pressure is low, then you should concentrate on strength and vigor.
It is important that all steps to exit the autogenic state are carried out correctly. Exiting the exit incorrectly will lead to the opposite result compared to the expected one: the state will be broken, lethargic, and fatigue will be felt for a long time.
Discussion
Summary of the main finding of the study
The use of AT not only improves the psychological status of patients, but also has a positive effect on the main manifestations of the disease. Pronounced changes in mental status, an increased level of rigidity and a reduced level of control over one’s behavior make it possible to predict the insufficient effectiveness of A.T. Predictors of the high effectiveness of the method were a moderate decrease in the level of psychological adaptation, as well as such features as determination and perseverance in achieving the goal.
Discussion of the main result of the study
The positive effect of AT on the psychological status of patients with CHD occurs mainly due to the reduction of anxiety, tension, fixation of attention on negative sensations, sensitivity to stress, as well as due to an increase in the activity and mood of patients. Action of A.T. nonspecific, i.e. its effectiveness does not differ in patients with different chronic diseases. Application of A.T. allows not only to improve the psychological status of patients, but also has a positive effect on the main manifestations of the disease. Thus, a decrease in blood pressure in patients with hypertension was associated with a decrease in the level of anxiety, and a decrease in the severity of pain in people with nonspecific salpingoophoritis, osteochondrosis of the spine and irritable bowel syndrome was associated with an increase in psychological stress resistance, activity, mood and a decrease in the level of anxiety and tension .
The study of predictors of AT effectiveness revealed that an increase in indicators on the BDS, 4th and 6th SMOL scales allows predicting the insufficient effectiveness of the method. Increased levels of rigidity appear to reduce the effectiveness of AT due to the tendency of patients to make excessive efforts to achieve a state of relaxation. In addition, due to the rigidity of patients’ beliefs, they are difficult to correct if there is insufficient motivation for psychotherapy. At the same time, the effectiveness of AT, the mastery of which requires regular training, was higher in patients with a high level of control over their behavior, determination and perseverance in achieving the goal.
The insufficient effectiveness of AT in patients with more pronounced changes in psychological status may be due, in particular, to the fact that significant psychological maladaptation in them significantly complicates the development of almost all psychotherapeutic techniques. It should be noted that similar data were obtained when studying predictors of the effectiveness of other methods of psychorelaxation therapy [4], which suggests common mechanisms of their action in patients with chronic disease, which determine common approaches to the use of non-drug psychocorrection.
The data obtained indicate the need for a differentiated approach to prescribing AT, the effectiveness of which is closely related to the personal characteristics of patients with chronic disease. Application of A.T. indicated in the treatment and rehabilitation of patients with chronic disease with an increased level of anxiety, a slight decrease in activity and mood. If pronounced impulsivity, rigidity, and depressive disorders are detected, the insufficient effectiveness of AT can be predicted. In these cases, it is recommended to use other methods of psychotherapy or the combined use of AT and psychopharmacotherapy.
Limitations of the study
The results of this study require clarification on samples of patients with other chronic diseases in outpatient settings.
