Research Database -
International Updates

Anxiety / Stress / Hypnotherapy / Psychotherapy / Relaxation

Issue 72

KERR and colleagues, University of Victoria, British Columbia, Canada examined the use of music to increase the effectiveness of a cognitive reframing intervention in reducing anxiety and modifying/restructuring affect [mood, emotions and/or motivation].
Background: Affective [emotional, mood and motivational] processes are critical to understanding and promoting lasting therapeutic change.
Methods: In this randomized, controlled clinical trial, 40 anxious subjects were assigned to either a typical reframing intervention or a music-assisted reframing intervention. Subjects were assessed for anxiety reduction, affective modification and imagery vividness using the State-Trait Anxiety Inventory, the Subjective Units of Distress Scale, the Depression Adjective Checklist and a Think-Aloud measure.
Results: Music-assisted reframing appeared to be more efficacious than the typical reframing intervention in reducing anxiety, modifying affect and promoting imagery vividness.
Kerr T et al. Emotional change processes in music-assisted reframing. Journal of Music Therapy 38 (3): 193-211. 2001.

ZACHARIAE and colleagues, Psycho-oncology Research Unit, Aarhus University Hospital, Barthsgade 5, 3 DK8200 Aarhus N, Denmark, examined the influence of mood on skin reactivity to histamine by comparing the effects of hypnotically induced emotions on skin reactions to histamine prick tests.
Background: The severity of symptoms of asthma and other hypersensitivity disorders has been associated with changes in mood. However, little is known about the mechanisms that may mediate such a relationship.
Methods: Subjects were 15 highly hypnotically susceptible volunteers. Cutaneous reactivity to histamine was measured before hypnosis at 1, 2, 3, 4, 5, 10 and 15 minutes after cutaneous histamine prick. The measurements were repeated under three hypnotically induced emotions (sadness, anger and happiness) presented in a counter-balanced order. Skin reactions were measured as change in histamine flare and wheal area in mm2 per minute.
Results: The increase in flare reaction in the time interval from 1 to 3 minutes during happiness and anger was significantly smaller than that during sadness (p<0.05). No effect of emotion was found for wheal reactions. Hypnotic susceptibility scores were associated with increased flare reactions at baseline (r=0.56; p<0.05) and during the condition of happiness (r=0.56; p<0.05).
Conclusion: The authors report that their findings are consistent with those of previous studies showing mood to be a predictor of cutaneous immediate-type hypersensitivity and histamine skin reactions. They are also in concordance with earlier findings of an association between hypnotic susceptibility and increased reactivity to an allergen.
Zachariae R et al. Skin reactions to hisstamine of healthy subjects after hypnotically induced emotions of sadness, anger, and happiness. Allergy 56 (8): 734-40. Aug 2001.

BROWN and colleagues, Clinical Trials and Surveys Corp., 350 West Quadrangle, Baltimore, MA 21210, USA, investigated the effects of stress, anxiety and outdoor temperature on Raynaud’s phenomenon (RP) attack characteristics.
Background: The investigators reported that they expected stress and anxiety to be related to RP attack characteristics when mild outdoor temperatures produced partial or no digital vasoconstriction. They hypothesized that in warmer temperature categories in comparison with those below 40°F, higher stress or anxiety would be associated with more frequent, severe and painful attacks.
Methods: 313 subjects with primary RP were recruited. Outcome measures were attack rate, severity and pain. Predictors were average daily outdoor temperature, stress, anxiety, age, gender and a stress-by- temperature or an anxiety-by-temperature interaction. Outcomes were tested separately in multiple linear regression models. Stress and anxiety were tested in separate models.
Results: Stress was not a significant predictor of RP attack characteristics. Higher anxiety was related to more frequent attacks above 60°F, to greater attack severity at all temperatures, and to greater pain above 60°F and between 40°F and 49.9°F.
Brown KM et al. The effects of stress, anxiety, and outdoor temperature on the frequency and severity of Raynaud’s attacks: the Raynaud’s Treatment Study. Journal of Behavioral Medicine 24 (2): 137-53. Apr 2001.

Issue 61

BERGGREN, HAKEBERG and CARLSSON, Department of Oral Diagnosis, Institute of Odontology, Goteborg University, Sweden ulf.berggren@odontologie.gu.se compared cognitive therapy with relaxation for the treatment of dental phobia.
Background: Comparisons of behavioral treatments for dental phobia are scarce.
Methods: The study included 112 adult patients with dental phobia. Patients received either cognitive therapy or relaxation therapy prior to dental treatment. Patients filled out questionnaires with regard to their backgrounds and the outcome (results) of treatment. A specialist dentist made ratings of successful or non-successful outcome.
Results: A higher number of patients who received cognitive therapy completed the [dental] treatment program, while anxiety was reduced more among patients who received relaxation therapy. Dropout during phobia (cognitive or relaxation) therapy was related to a lower motivation to engage in treatment, while dropout during dental treatment was related to higher levels of general fear and anxiety. However, statistical analysis revealed that the risk of dropout was only slightly increased by general fears, whereas patients with low motivation were 3.6 times more likely to drop out.
Conclusions: Both phobia treatments were effective in reducing dental phobic reactions. Cognitive therapy resulted in higher numbers of patients completing treatment, while relaxation therapy resulted in a more significant reduction in dental fear as well as general fear and anxiety.
Berggren U et al. Relaxation vs. cognitively oriented therapies for dental fear. Journal of Dental Research 79 (9): 1645-51. Sep 2000.

NODA, OONO and HAMADA, Osaka Prefectural Mental Health and Welfare Center, Osaka, Japan evaluated the efficacy of stress management classes (SMCs) in comparison with an educational program in improving mental health.
Background: Interest in mental health promotion has been increasing, but it is unclear what are the most appropriate approaches.
Methods: The study evaluated individuals who attended SMCs, which incorporated education in the concept of stress and instruction in autogenic training as a relaxation technique, held at the Higashi Osaka City Naka Health Center four times over 2 months. Controls for the study were individuals who attended health promotion classes (HPCs), which were aimed at preventing chronic physical diseases and consisted mainly of exercise, at the Osaka Prefectural Kaizuka Health Center once a week for 3 months.
Results: People who attended SMCs were more likely to have mental health problems than those who attended HPCs. Both SMC and HPC attendees reported improvements in their mental health status as assessed on the Profile of Mood States (POMS) and exhibited significant decreases in blood pressure.
Conclusions: Both SMCs and HPCs were effective in improving mental health status. However, mentally ill patients in the SMC group could be diagnosed and treated at an earlier stage. The term ‘stress management’ was useful because people suffering stress were likely to be interested in it.
Noda T et al. (Efficacy of stress management classes at a health center). Nippon Koshu Eisei 47 (6): 476-85. Jun 2000.

Issue 59

Travis and Durchholz, Psychology Department, Maharishi University of Management, Fairfield, IA 52557, USA. investigated whether an electronic device could improve mood and well-being, and decrease anxiety.
Methods: This study used a double-blind crossover design to investigate the effect of a small electronic device, the Quantum Companion, on mood, quality of life and anxiety levels. Thirty-four subjects were stratified on age, sex, and current stress levels and randomly assigned to receive either a placebo or a Quantum Companion, and then after a two week ‘recovery period,’ the other instrument. Standardized tests were administered before and after each two-week experimental period, along with an open-ended questionnaire of other life-events during the past two weeks.
Results: The two weeks with the placebo were marked by 1) more immediate positive and fewer immediate negative effects; 2) greater reductions in anxiety; and 3) nonsignificant improvement in mood and quality of life, compared to the two-week Quantum Companion periods.
Conclusions: This study brings out the power of a placebo for changing mood, and the importance of using rigorous designs to test claims
Travis F and Durchholz C. Can an electronic device improve mood and well-being, and decrease anxiety? International Journal of Neuroscience 103(1-4): 91-9. Jul-Aug 2000.

Ost and Breitholtz, Department of Psychology, Stockholm University, Sweden examined applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder.
Background: This study investigated the efficacy of a coping-technique, applied relaxation (AR) and cognitive therapy (CT), in the treatment of generalized anxiety disorder.
Methods: Thirty-six outpatients fulfilling the DSM-III-R criteria for generalized anxiety were assessed with independent assessor ratings and self-report scales before and after treatment and at a 1 yr follow-up. The patients were randomized and treated individually for 12 weekly sessions.
Results: Both treatments yielded large improvements, which were maintained, or furthered at follow-up. There was no difference between AR and CT on any measure. The drop-out rate was 12% for AR and 5% for CT. The proportions of clinically significantly improved patients were 53 and 62% at post-treatment and 67 and 56% at follow-up for AR and CT, respectively. Besides affecting generalized anxiety the treatments also yielded marked and lasting changes on ratings of worry, cognitive and somatic anxiety and depression.
Conclusions: Both AR and CT have potential as treatments for generalized anxiety disorder but they have to be developed further in order to increase the efficacy to the level usually seen in panic disorder, 80-85% clinically improved
Ost LG and Breitholtz E. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behaviour Research and Therapy 38(8): 777-90. Aug 2000.

Zonierczyk-Zreda , Department of Ergonomics, Central Institute for Labour Protection, Warsaw, Poland. dozol@ciop.pl discussed modification of pathological type A as worksite stress management and disease prevention intervention.
Discussion: The importance of helping an employee to better cope with occupational stress as the aim of stress management interventions is presented. It particularly concerns the employees who have the poorest temperamental and personality potential for effective coping and should be the target of primary stress intervention and prevention. According to evidence, Type A workers are at risk of occupational stress and disease, especially when some personality features of Type A are accompanied by high reactivity. The concept of pathological Type A is introduced. The already existing programmes of modifying Type A and the framework of a programme based on the elements that have been established to be the most therapeutic for pathological Type A are presented.
Zonierczyk-Zreda D. Modification of pathological type A as worksite stress management and disease prevention intervention. International Journal of Occupational Safety and Ergonomics 6(2): 169-88. 2000.

Issue 32

HERNANDEZ and KOLB, Northside Habilitation Program, Nellie M. Reddix Center, San Antonio, Texas USA evaluated the effects of self-applied breathing and guided imagery relaxation techniques, separately and in combination, and a reinforcement tool on primary caregivers (PCGs), coping with anxiety while caring for a chronically ill child.
Methods: 20 PCGs aged between 25-57 years, who were caring for chronically ill children were randomly assigned to either an experimental or control group. State anxiety was measured using the State Anxiety Scale of the State-Trait Anxiety Inventory (Form Y).
Results: There were no statistically significant changes in state anxiety between the groups. However, behavioural evaluations demonstrated that PCGs utilised both the self-applied relaxation techniques and the reinforcement tool more than twice daily.
Conclusions: Relaxation techniques are useful for people caring for chronically ill children.
Hernandez NE and Kolb S. Effects of relaxation on anxiety in primary caregivers of chronically ill children. Pediatr Nurs 24(1): 51-6. Jan-Feb 1998.

MARKS and colleagues, Institute of Psychiatry and Bethlem-Maudsley Hospital, London UK I. Marks@iop.bpml.ac.uk compared the value of cognitive restructuring on its own and in combination with prolonged exposure therapy in the treatment of posttraumatic stress disorder.
Methods: 87 patients with posttraumatic stress disorder of at least 6 months’ duration were randomly assigned to have 10 sessions of one of four treatments: 1) prolonged exposure (imaginal and live) alone 2) cognitive restructuring alone 3) combined prolonged exposure and cognitive restructuring or 4) relaxation without prolonged exposure or cognitive restructuring. The integrity of the audio taped treatment sessions was satisfactory as judged by an assessor who was unaware of the treatment assignment. 77 patients completed treatment.
Results: The pattern of results was similar, regardless of the rater, statistical method, measure, occasion and therapist. Exposure and cognitive restructuring, singly or in combination, improved posttraumatic stress disorder considerably on a broad front. The gains continued to 6-month follow-up and were significantly greater than the moderate improvement from the relaxation group.
Conclusions: Both prolonged exposure and cognitive restructuring were each therapeutic on their own, they were not mutually enhancing in combination, and were each superior to relaxation.
Marks I et al. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Arch Gen Psychiatry. 55(4): 317-25. Apr 1998.

SPIEGEL, College of Physicians & Surgeons, Columbia University, New York, New York 10128 USA writes that a useful way to capture the placebo-nocebo theme is to examine the tension and interaction between conviction and responsibility.
Results and Discussion: Within the mainstream biomedical paradigm today, it is tempting to reply to Dr Engel’s patient (who characterised his cancer pain in terms of “male” and female”, with female cancers being less painful): “That is utter nonsense. Cancer pain is not classified as “male” or “female” pain varies with the location within the body and other factors.” Although this response is technically honest, it would in reality have the impact of a nocebo, by impairing the patient’s hope and morale. The doctor’s honesty and conviction would serve as blinders to the patient’s suffering, which would result in a diminished sense of responsibility for the patient’s well-being. By also considering the biopsychosocial context, Dr Engel achieved a balance between conviction and responsibility. The patient’s question was understood within the meaning and metaphorical terms of her belief system and his answer was delivered in a way which respected her private view toward pain and utilised her suggestibility, guiding her toward a probable placebo effect. “Female cancer” resonated with her personal beliefs and wish for less pain. Dr Engel was true both to his conviction and and was responsible for providing the highest standard of care by understanding the patient’s convictions and needs for comfort. This biopsychosocial concept provides a blueprint to impart the old-fashioned art of “humanness” to modern scientific care. By identifying the interactions of the problem, the individual within the totality of resources enables a focus upon therapeutic strategies which are capable of promoting placebo effects and preventing the consequences of nocebo.
Spiegel H. Nocebo: the power of suggestibility. Prev Med 26 (5 Pt 1): 616-21. Sep-Oct 1997.

DOWDEN and ALLEN, Department of Psychology, University of Connecticut, Storrs USA studied the relationships between anxiety sensitivity, hyperventilation and emotional reactivity.
Methods: 24 undergraduate women who scored within the top 15% and 24 within the bottom 15% on the Anxiety Sensitivity Index looked at randomly counterbalanced sets of 3 neutral and 3 dysphoric faces after having either hyperventilated or relaxed. The participants rated the change they experienced in Happiness, Sadness, Fear, Anger, Surprise, Disgust and Contempt after viewing each face.
Results: Women who were High Anxiety Sensitive (AS) reported significantly greater changes in six of the 7 emotions, despite pretreatment differences in somatically experienced anxiety having been covaried out. There were significant 3-way interactions found for participants’ self-rated changes in Fear and Surprise, and tendencies toward significance also emerged for Anger and Disgust. The pattern of interactions was identical for all four variables. Women who were low AS showed greater reductions in these four emotions when looking at neutral as opposed to dysphoric faces, whether they had hyperventilated or relaxed. Women who were high AS and who relaxed showed similar discriminative abilities. High AS women who hyperventilated reported no relative changes in emotional arousal to dysphoric or neutral faces.
Conclusions: The blunted discrimination shown by high AS women who hyperventilated suggests that when these people are in a physiologically challenged state they may be less responsive to “early warning” indicators of social distress shown by others which may lead them to experience subsequent interpersonal difficulties.
Dowden SL and Allen GJ. Relationships between anxiety sensitivity, hyperventilation, and emotional reactivity to displays of facial emotions. J Anxiety Disord 11(1): 63-75. Jan-Feb 1997.

Comments: How we feel has a profound effect upon our own health, and also upon our interactions with others. All of the above research studies explore different facets of the mind/body connections and suggest various techniques which may be helpful to individual patients, but also for their families and friends, carers and practitioners. These findings have profound implications for so many aspects of our personal and professional lives.

Issue 30

TAN and LEUCHT, Graduate School of Psychology, Fuller Theological Seminary, Pasadena, California 91101, USA review the literature (125 references) and write that since Tan’s published review of 1982 regarding cognitive and cognitive-behavioural methods for pain control, significant advances have been achieved in cognitive-behavioural therapy for pain. The authors review the now much more substantive scientific evidence for its efficacy for clinical pain attenuation. In fact, cognitive-behavioural therapy for chronic pain was recently listed as one of 25 empirically validated or supported psychological treatments available for a number of disorders. The authors further discuss various emerging issues, as well as the relationship of cognitive- behavioural therapy to hypnosis for pain control, providing suggestions for the integration of hypnotic and cognitive-behavioural techniques.
Tan SY and Leucht CA. Cognitive-behavioral therapy for clinical pain control: a 15-year update and its relationship to hypnosis. Int J Clin Exp Hypn 45(4): 396-416. Oct 1997.

HARDING, Wildara Psychogeriatric Assessment and Treatment Team, St Georges and Inner East Geriatric Service, Melbourne, Victoria, Australia writes that although the benefits of relaxation are widely acknowledged, clinicians must remain aware of possible adverse effects. Some people with mental illness may experience an exacerbation of their symptoms with injudicious use of relaxation techniques using imagery. The author explores two conditions where vivid, emotionally charged images are problematic: 1) post traumatic stress disorder and 2) hallucinoses. Individuals with these disorders may have difficulty controlling shifts between these internal and external events, or difficulty recognising events as internal rather than external. Using a relaxation technique which encourages imagery may produce a stronger reaction because the impact of the imagery is increased by relaxation, resulting in an increase in arousal, the antithesis of relaxation. CONCLUSIONS: This paper suggests that relaxation techniques avoiding imagery or which consider the patient’s experience are less likely to provoke undesirable reactions.
Harding S. Relaxation: with or without imagery? Int J Nurs Pract 2(3): 160-2. Sep 1996.

COMMENTS: The above finding appears to be common sense, but I bet that, just as many depressed people are treated inadvisably with hypnosis, which usually deepens the person’s depression, many people who cannot distinguish their inner and exterior realities are being treated inadvisedly with techniques such as visualisation. It all comes down to the training and competence of the practitioner. This is why working in a multi-disciplinary integrated practice must be a better solution that working in an isolated way, without recourse to other colleagues who may have a better treatment strategy. After all, who of us is all-knowing?

Issue 29

SCHWEIZER and RICKELS, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104-2649 USA write that new treatment development for anxiety disorder has been sabotaged by a high placebo-response rate, with the result that only one new anxiolytic drug has been approved by the US Food and Drug Administration during the past 15 years. The authors review (51 references) the factors contributing to the placebo response in treatment studies of generalised anxiety. They note that since anxiety is a normal emotion, sensitive to a variety of life stresses, it is difficult to achieve the primary goal of a clinical trial, that is to extract the "signal" of a drug effect from the "noise" of symptoms background fluctuations. The authors review data from published research literature and their own research unit regarding trends in placebo-response results.
Schweizer E and Rickels K. Placebo response in generalized anxiety: its effect on the outcome of clinical trials. J Clin Psychiatry 58 (11): 30-8. 1997.

MUIR, Broxburn Health Centre, West Lothian, describes a project which is designed to offer an alternative to traditional treatment for stress. The author discusses techniques – patient education, relaxation techniques, psychological adaptation – taught to clients to help them cope with stress and how users may evaluate the service.
Muir J. Stress in the community: teaching relaxation. Nurs Stand. 11(51): 36-8. Sep 10 1997.

MAROOF and colleagues, Department of Anaesthesiology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia studied the influence of therapeutic intraoperative auditory suggestions upon incidence and severity of nausea in patients undergoing elective surgery. METHODS: 50 women undergoing elective abdominal hysterectomy were randomly assigned to one of two groups, each of 25. In Group 1, a blank tape was played in Group 2, positive suggestion was played via headphones throughout the anaesthetic period. RESULTS: Compared to Group 1 (blank tape) (60%), Group 2 had a statistically significant reduction in vomiting (36%). Vomiting episodes per patients was 1.7 in Group 2 compared to 3.1 in Group 1, a statistically significant difference. Patients needing rescue antiemetic was significantly higher in Group 1 (66.6%) compared to Group 2 (22.2%). CONCLUSIONS: Positive therapeutic suggestion can be considered as an alternative to antiemetic therapy.
Maroof M et al. Intra-operative suggestions reduce incidence of post hysterectomy emesis. J Pak Med Assoc 47(8): 202-4. Aug 1997.

TUSEK et al, Guided Imagery Program, Cleveland Clinic Foundation, USA write that patients undergoing surgery usually experience fear and apprehension and that guided imagery is a simple, low-cost therapeutic tool which can help to alleviate patients' fear and anxiety. METHODS: 130 patients undergoing elective colorectal surgical procedures were randomly assigned to one of two groups: Group 1 received routine perioperative care Group 2 listened to guided imagery tapes for three days prior to surgery, during anaesthesia induction, intraoperatively, in the postanaesthesia care unit and for six days following surgery. The authors measured patients' anxiety levels, pain perception and narcotic medication requirement. RESULTS: Compared to patients in Group 1, patients in the guided imagery group had less preoperative and postoperative anxiety and pain and required almost 50% less narcotic medication following surgery. CONCLUSIONS: Guided imagery is an effective tool in reducing anxiety in surgical patients.
Tusek D et al. Guided imagery as a coping strategy for perioperative patients. AORN J 66(4): 644-9. Oct 1997.

Issue 24

LUTGENDORF and colleagues, Department of Psychology, University of Miami, Coral Gables, Florida USA tested the effects of a 10-week group cognitive-behavioural stress management (CBSM) intervention upon mood and immunological parameters in HIV-seropositive gay men whose disease had progressed to a symptomatic stage. METHODS: The men were randomised to either CBSM or a modified waiting-list control group. RESULTS: The CBSM intervention significantly decreased self-reported dysphoria, anxiety and total distress. Men who practised relaxation more consistently had significantly greater drops in dysphoria. Compared to the control group, which showed no significant changes in either mood or antibody titres, herpes simplex virus-Type 2 (HSV-2) and immunoglobulin G antibody titres were decreased in the CBSM group. Decreases in dysphoria significantly predicted lower HSV-2 antibody titres by the end of the 10-week period. Neither group showed changes in HSV-Type 1 antibody titres or in CD4+ or CD8+ cell numbers. CONCLUSIONS: The practice of cognitive-behavioural stress management (CBSM) techniques favourably affected mood and immune response parameters in HIV-seropositive gay men.
Lutgendorf SK et al. Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. J Consult Clin Psychol 65(1): 31-43. Feb 1997.

COMMENTS: These results have major health implications and such stress management technique programmes ought to be incorporated into clinical practice with HIV patients, as well as many other illnesses with a significant immune component, such as heart disease, cancer, rheumatoid arthritis - are there any health problems without an immune component?

ROTH and CREASER, Stress Reduction Program, Community Health Center, CT, USA describes a bilingual mindfulness meditation-based stress reduction programme within an inner-city setting. METHODS: Practices defined and described are mindfulness meditation, breathing, eating, walking meditation and mindful yoga. Data analysis studied compliance, medical and psychological symptom reduction and changes in self-esteem of the English and Spanish speaking patients completing the 8-week Stress Reduction and Relaxation Program. RESULTS: There occurred statistically significant decreases in medical and psychological symptoms and improvement in self-esteem. Many of the programme completers reported dramatic changes in attitudes, beliefs, habits and behaviours. CONCLUSIONS: Despite the limitations of this research design, these findings suggest that a mindfulness meditation course can be an effective health care intervention within an inner-city community health centre. The article discusses factors to be considered regarding the establishment of a mindfulness meditation-based stress reduction programme within a health care setting.
Roth B and Creaser T. Mindfulness meditation-based stress reduction: experience with a bilingual inner-city program. Nurse Pract 22(3): 150-2, 154, 157. Mar 1997.

COMMENTS: An extract from the book Full Catastrophe Living, which describes the above programme completely, authoritatively and eloquently, is published in the supplement to Issue 24 of Positive Health (see Positive Health 24(S): 1-2, Dec 1997).

TELLO-BERNABE and colleagues, Centro de Salud El Naranjo, Fuenlabrada, Madrid Spain evaluated the impact of group relaxation upon women suffering distress and general anxiety disorders. METHODS: 32 women aged between 25 and 55 were assigned (nonrandomly) to either intervention or control group. The intervention group were trained in group techniques and relaxation. Anxiety was evaluated with the STAI state-characteristic test, prior to and following intervention for both groups. A qualitative evaluation was also made using discussion groups. RESULTS: At the outset of the study, the intervention and control groups were homogeneous with respect to all variables. Compared to the control group who scored in the post-test a mean of 33.3 +/- 13.17, the anxiety-state post-test mean of the study group was 22.96 +/- 13.3, representing a significant difference. Compared to the control group’s post-test mean of anxiety characteristic – 35.26 +/- 9.84, the study group’s mean post-test anxiety characteristic was 28.62 +/- 12.28, again statistically significant. CONCLUSIONS: This type of intervention is effective in reducing temporary anxiety and improves an inbuilt tendency to react with anxiety. These groups provide a qualitative improvement in self-esteem and in the network of the women’s relationships.
Tello-Bernabe ME et al. Group techniques and relaxation in the treatment of several subtypes of anxiety: a non-randomized controlled trial. Aten Primaria 19(2): 67-71. Feb 15 1997.

SMITH and colleagues, Roosevelt University, Chicago, Illinois 60605 USA catalogued the treatment experiences of massage, abbreviated progressive muscle relaxation (PMR), yoga stretching, breathing, imagery meditation and various combinations thereof. METHODS: 940 practitioners of the above therapies described their experiences on an 82-item wordlist. RESULTS: Analyses yielded 10 interpretable relaxation categories: 1) Joyful Affects and Appraisals (Joyful); 2) Distant; 3) Calm; 4) Aware; 5) Prayerful; 6) Accepted; 7) Untroubled; 8) Limp; 9) Silent; and 10) Mystery. The relaxation response and cognitive/somatic models predict Calm and Limp, which account for merely 5.5% of the variance of the relaxation experience. The authors discovered important technique differences: PMR and massage are associated with Distant and Limp; yoga stretching, breathing and meditation with Aware; meditation with Prayerful; and all techniques except PMR with Joyful. These results are consistent with cognitive-behavioural relaxation theory and have important implications regarding relaxation theory, treatment, training, assessment and research. CONCLUSIONS: The authors end with a revised model of relaxation which suggests three global dimensions: tension-relief, passive disengagement and passive engagement.
Smith JC et al. Relaxation: mapping an uncharted world. Biofeedback Self Regul 21(1): 63-90. Mar 1996.

SAKAI, Department of Psychiatry, Saga Medical School Japan studied the effects of autogenic training for anxiety disorders. METHODS: 55 patients who met the DSM-III-R criteria for anxiety disorders were treated individually with autogenic training by the author between October 1981-95 in a psychiatric setting of a medical school hospital. The patients’ medical records were investigated retrospectively. RESULTS: The autogenic training was successful. 28 patients (51%) were cured; 14 (25%) were much improved; 8 (15%) improved and 5 (9%) were unchanged at the end of the treatment. 46 patients (76%) were evaluated as having been successfully treated. Pretreatment variables, including patients’ clinical characteristics, were not a useful predictor of outcome. Four treatment variables had a bearing upon outcome: 1) Practising the second standard autogenic training exercise was a satisfactory predictor of better outcome; 2) practising generalisation training was a useful predictor; 3) The use of other behavioural treatment techniques was positively associated with outcome; 4) Longer treatment periods were associated with improved outcome. CONCLUSIONS: Autogenic training may be of significant benefit in the treatment of anxiety disorders.
Sakai M. Application of autogenic training for anxiety disorders: a clinical study in a psychiatric setting. Fukuoka Igaku Zasshi. 88(3): 56-64. Mar 1997.

COMMENTS: This study was not controlled in any of its elements – type of autogenic training; length of autogenic training; combination with other techniques. There is no mention of the length of time of treatment, except that the total duration for these 55 patients was 14 years. Nevertheless, a majority of the patients were cured and most were at least improved with Autogenic Training. A detailed article regarding autogenic training was published in Issue 22 (Sept/Oct 1997) of Positive Health.

Issue 21

DAVIDSON and colleagues, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Caroline USA write that homoeopathy, although a well-established therapeutic system of relevance to psychiatry, has been as yet largely untested. The authors report on the use of homoeopathic treatment for patients suffering with depression and anxiety. METHODS: 12 adults with major depression, social phobia or panic disorder were treated on an outpatient basis with individually selected homoeopathic remedies, following a partial or poor response to conventional treatment. Treatment duration was from 7 to 80 weeks. Response was assessed using a clinical global scale (n=12), the self-rated SCL-90 scale (n=8) and the Brief Social Phobia Scale (n=4). RESULTS: Overall response rates were 58% according to the clinical global improvement scale and 50% based upon the SCL-90 or Brief Social Phobia Scale. CONCLUSIONS: Homoeopathy may be a useful treatment for affective and anxiety disorders in patients with mild to severe symptomatic conditions.
Davidson JR et al. Homeopathic treatment of depression and anxiety. Altern Ther Health Med. 3(1): 46-9. Jan 1997.

MULLER-POPKES and HAJAK, Klinik und Poliklinik fur Psychiatrie, Universitat Gottingen, Germany write that there has not been much research conducted regarding psychotherapeutic treatment for people suffering with primary insomnia. The authors conducted a study using interpersonal psychotherapy for the treatment of insomnia (IPT-1), representing a new causal strategy. METHODS: 25 patients were treated in 12 individual sessions either with IPT-1 or with progressive relaxation training. RESULTS: Compared to the progressive relaxation group, the IPT-1 patients showed significant improvement of total sleep time, sleep efficiency and wake after sleep onset, according to the preliminary polysomnographic data. CONCLUSIONS: IPT-1 appears to be a promising strategy in the treatment of patients suffering from primary insomnia.
Muller-Popkes K and Hajak G. Interpersonal psychotherapy in treatment of patients with primary insomnia – preliminary data of polysomnographic macro-analysis. Wien Med Wochenschr 146 (13-14): 303 - 5. 1996.

HOUGHTON and colleagues, Department of Medicine, University Hospital of South Manchester UK quantified the effects of severe irritable bowel syndrome upon the quality of life and economic functioning and assessed the impact of hypnotherapy upon these features. METHODS: A quality of life questionnaire which contained questions relating to symptoms, employment and health seeking behaviour was administered to 25 patients (aged 25—55 years, 4 male) who were treated with hypnotherapy and to 25 control patients (aged 21—58 years, 2 male) with irritable bowel syndrome of comparable severity. Scores were derived from visual analogue scales to assess patients’ symptoms and quality of life. RESULTS: Compared with the control patients, the hypnotherapy-treated patients reported less severe abdominal pain, bloating, bowel habit, nausea, flatulence, urinary symptoms, lethargy, backache and dyspareunia. Also favourably influenced by hypnotherapy were aspects of quality of life, including psychic well being, mood, locus of control, physical well being and work attitude. Compared to the controls, those patients in employment treated with hypnotherapy were less likely to take time off work and visit their general practitioner. Three out of four hypnotherapy patients who had been out of work prior to treatment resumed employment compared with none out of the six in the control group. CONCLUSIONS: Hypnotherapy profoundly improved the patients’ quality of life and reduced absenteeism from work, in addition to relieving the symptoms of irritable bowel syndrome. Therefore, it would appear that hypnotherapy, despite being relatively expensive to provide, could be a beneficial long-term investment.
Houghton LA et al. Symptomatology, quality of life and economic features of irritable bowel syndrome – the effect of hypnotherapy. Aliment Pharmacol Ther 10(1): 91-5. Feb 1996.

COMMENTS: I thoroughly recommend the outstanding book IBS: A complete guide to relief from Irritable Bowel Syndrome, Christine P Dancey and Susan Backhouse, Robinson, 1997, describing the many painful and frustrating symptoms of irritable bowel syndrome, as well as the many treatment approaches, including hypnotherapy. It is estimated that as many as 1 in 5 adults in the UK currently suffer from some form of IBS, thus it behooves us to explore successful therapeutic treatment approaches.