Autogenic training in cancer disease
In the face of the numerous evidences on the use of autogenic training in various contexts, the application of this technique in the oncological field is interesting, that is, in the reduction of pain and in the general improvement of the perceived quality of life.
Autogenic Training (TA) is a relaxation technique developed by JH Schultz in 1932 with the aim of making the patient less attached to the therapist and consequently of developing an autonomous relaxation ability. It is a mind to muscle technique, which starts from the premise of achieving body relaxation through mental concentration. The basic concept is ideoplasia, the phenomenon whereby thought is able to modify a body state, while the operating principle is classical conditioning: through the repetition of mental exercises aimed at achieving a physiological goal, constant association is reached among them (Mauti, 2012).
Autogenic training, in its form, has six basic exercises:
The above exercises follow a first phase of breathing modulation, deeper and slower and an induction to calm and relaxation.
The positive effects of this technique have been reported in the literature in the treatment of numerous disorders, in particular in migraine, asthma, eczema, hypertension, tachycardia, somatoform disorders, insomnia, anxiety, depression and chronic pain (Linden, 1994; Stetter & Kupper , 2002; Varvogli & Darviri, 2011).
In the face of the numerous evidences on the use of autogenic training in various contexts, the application of this technique in the oncological field is interesting, that is, in the reduction of pain and in the general improvement of the perceived quality of life; TA allows the patient to carry out this technique independently and in a domestic and family context, making it easier and more accessible to use the relaxation technique on a daily basis. Generally the diagnosis of neoplastic disease generates feelings of uncertainty, fear, anger, insomnia and stress in patients (Campolmi et al., 2019; Williams et al., 2016) that often persist during the oncological process, reverberating on numerous aspects of life of the patient and the family member;
A study (wright et al., 2002) examined the effect of Autogenic Training on a group of cancer patients, after administering the HADS (Hospital Anxiety Depression Scale) and POMS (Profile of Mood States) questionnaires before and after the treatment, analyzing the data both quantitatively and qualitatively.
The main results after 10 weeks of training highlighted a reduction in anxiety measured with the HADS questionnaire and higher scores of vigor and fighting spirit (POMS); in addition, the patient’s self-report reports showed less anger and perceived tension, greater ease in falling asleep, a calming and relaxing effect as well as a greater focus on themselves and their thoughts and a better expression of the same, favoring an increase in perceived well-being. The authors comment on these results underlining that the sense of confidence and mastery conferred by the acquisition of the training could allay the fears associated with the anticipation of the future, the use of the technique independently allows you to have a greater mastery and to carry it out in the moments of greatest need.
Another study (Hidderley, 2004) examined how teaching autogenic training in a group of cancer patients affects immune response and anxiety and depression variables (HADS). By dividing the sample of 31 subjects into two subgroups, one experimental and one control, the results showed a reduction in the anxiety and depression scores of the subjects who had participated in the autogenic training course; moreover, in the same subgroup, a greater immune response was observed through the analysis of T and B lymphocytes both with respect to the period prior to training and with respect to the control subgroup. This figure also appears to be confirmed by another study (Minowa & Koitabashi, 2014) where there was an increase in the immune response through the analysis of salivary immunoglobulin A, in a group of cancer patients undergoing TA treatment compared to the control group. The authors comment that the stimulation of the parasympathetic system induced by the use of training could induce a greater immune response, where the effect of stress in reducing it is well documented (Taylor, 2014).
Generally, during the oncological process, a critical phase is represented by medical treatment, both pharmacological and surgical, where it is frequent to find ambivalent feelings such as the hope for relief from pain or the progression of the disease and at the same time fear and anxiety for the invasiveness or the outcome of the treatment (Stark & House, 2000)
Minowa and Koitabashi (2013) examined the effect of the practice of autogenic training on the variables of anxiety and pain perceived through the STAI test (Stait-Trait Anxiety Inventory) and VAPS (Visual Analogue Pain Scale), respectively. sample of 60 breast cancer patients following surgery. One group of patients followed a TA protocol for 20 minutes, 3 times a day in the 3 days following the intervention, while the other group followed the usual assistance. The results show a significant reduction in the post-test anxiety parameters within the group that participated in the training compared to the control group; the authors comment on this data, in line with what Wright et al. (2002) that stimulation of the parasympathetic system may have induced a state of calm and relaxation, helping to interrupt the vicious circle of anxiety, tension and pain. As regards pain scores, there was a significant reduction in the group that participated in the TA compared to the control group, despite the same medical therapy being followed. The authors specify that the relaxation effect of the training, in the present study, was maintained for about a day, while according to the literature, it takes about 8 weeks to effectively master the technique and have a longer lasting effect. there was a significant reduction in the group that participated in the TA compared to the control group, despite the same medical therapy being followed. The authors specify that the relaxation effect of the training, in the present study, was maintained for about a day, while according to the literature, it takes about 8 weeks to effectively master the technique and have a longer lasting effect. there was a significant reduction in the group that participated in the TA compared to the control group, despite the same medical therapy being followed. The authors specify that the relaxation effect of the training, in the present study, was maintained for about a day, while according to the literature, it takes about 8 weeks to effectively master the technique and have a longer lasting effect.
Autogenic training has also proven effective in the prognosis of insomnia in patients with chronic diseases, where stress and anxiety can be both a cause and a consequence of sleep difficulties.
Therefore, Robinson and colleagues (2010) examined the effect of TA practice in a sample of 153 patients with chronic health problems and a significant increase in perceived sleep quality emerged: specifically, less nocturnal awakenings were reported , a sleep perceived as more refreshing and less latency in falling asleep.
Similar results were found in a study by Simeit and collaborators (2004), where less latency in falling asleep, quality and longer duration of sleep hours was found in a sample of cancer patients following a course of TA.
The data also demonstrated an improvement in the quality of life perceived through the administration of QLC-30, underlining a general psychological benefit of the intervention.
The above results are encouraging taking into consideration that the prevalence of sleep disturbances is present in 23-60% of cancer patients in relation to 9-30% of the general population (Semeit et al., 2004).
In conclusion, although there are numerous studies that examine the psychological and care needs of the cancer patient, there are relatively few studies that insert and study Autogenic Training as a complementary intervention in cancer practice.
The above results highlight the positive aspects of the use of TA in increasing perceived well-being, in reducing variables of anxiety, stress and sleep problems; potentially it can be inferred that this relaxation technique, especially for the possibility of being carried out independently and relative ease of learning, represents an important aid in the intervention with the cancer patient, improving multiple psychological and physical variables which, interconnected, can increase the quality of life of the patient. It would also be interesting to deepen the research in this field by extending the use of autogenic training to the families of patients with cancer, the latter being a disease that inevitably reverberates on the relationship system of the person affected by it,