Journal List > J Korean Acad Nurs > v.49(4) > 1131249

Seo and Kim: Effect of Autogenic Training for Stress Response: A Systematic Review and Meta-Analysis



This study was conducted to evaluate the effectiveness of autogenic training on stress responses through a systematic review and meta-analysis.


A systematic search was conducted using eight core electronic databases (Embase, CENTRAL, Medline, CINAHL, PsycInfo, DBpia, KISS, and RISS). To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3.5 program.


A total 21 studies out of 950 studies were included in the review, and 11 were included for meta-analysis. These studies showed that autogenic training decreased anxiety and depression, and increased the high frequency of heart rate variability. Calculations to understand the effect of autogenic training on anxiety, through a meta-analysis, observed a reduction effect of anxiety score by 1.37 points (n=85, SMD=-1.37: 95% CI -2.07 to -0.67), in the studies on short-term intervention targeting healthy adults. On the other hand, similar calculations to understand the effect of autogenic training on depression observed, a reduction effect on the depression score by 0.29 point (n=327, SMD=-0.29: 95% CI -0.50 to -0.07), in the studies on long term intervention targeting the patient group.


Autogenic training is effective for adults’ stress management, and nurses will be able to effectively perform autogenic training programs for workers’ stress relief at the workplace.


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Figure 1.
Flow diagram of the study selection process.
Figure 2.
Assessment risk of bias in included studies.
Figure 3.
Forest plot of meta analysis on effects of autogenic training.
Figure 4.
Funnel plot of standard error by standardized mean difference.
Table 1A.
Summary of Randomized Controlled Trials Examining Autogenic Training
Stress response First Author (year) Subject Intervention (Regime) Main outcome measures Inter-group differences
Psychological Shapiro Healthy Short term (1) Anxiety (1) A↓,B→,C↓ p<.05
(1980) person (A) AT (n=9) 6 standard exercises (SCL-90scales) (2) A↓,B→,C↓ p<.05
(B) Rest (n=9) (2) Depression (SCL-90)
(C) Progressive relaxation (n=12)
Crocker Healthy Short term Anxiety (STAI) A↓,B→,C↓ p<.01
(1991) person (A) AT (n=28) 30 min using tape
(B) No intervention (n=29)
(C) Aerobic exercise (n=28)
Solberg Healthy Long term Anxiety (STAI) A↑,B↑,C↑ NS
(2000) person (A) AT (n=11) 90 min* 7 weeks+Practice using tape at
(B) No intervention (n=10)
(C) Meditation (n=11)
Kanji Healthy Long term Anxiety (STAI) (A)A↓,B→ p<.005
(2006) person (A) AT (n=32) 20 min*8 weeks
(B) No intervention (n=30)
Sujithra Menopausal Long term Depression (CDR) A↓,B→ p<.05
(2014) women (A) AT (n=12) 30 min daily*1 week
(B) No intervention (n=12)
Sakaki- Healthy Short term Anxiety (STAI) A↓,B→,C↓ NS
bara person (A) AT (n=15)
(2013) (B) No treat (n=15)
(C) HRV biofeedback (n=15)
Vandyck Tension Long term (1) Anxiety (STAI) (1) A↓,B↓ p<.001
(1991) headache (A) AT (n=28) 2.5 hr*7 weeks+home practice using tape (2) Depression (SDS) (2) A↓,B↓ p<.001
patient (B) FI (n=27) 2 sessions*7 weeks
Kang Chronic Long term (1) Anxiety (HAM-A) (1) A↓,B→ p<.01
(2008) tension (A) AT (n=18) 45 min*2/day*8 weeks using (2) Depression (HAM-D) (2) A↓,B→ p=.019
headache tape+biofeedback
patient (B) No intervention (n=17)
Farnè Minor Long term (1) Anxiety (POMS) (1) A↓,B→ p<.001
(2000) psycho- (A) AT (n=87) 5~10 min 2 times a day*8 weeks (2) Depression (POMS) (2) A↓,B→ p<.001
logical (B) No intervention (n=47)
McGrady Neuro- Long term (1) Anxiety (STAI) (1) A↓,B→ p=.02
(2003) cardiogenic (A) AT (n=12) 50 min 2 times a day*6 weeks using tape (2) Depression (BDI) (2) A↓,B→ p=.001
syncope with biofeedback
patient (B) No intervention (n=10)
Table 1B.
Summary of Randomized Controlled Trials Examining Autogenic Training
Stress response First author (year) Subject Intervention (Regime) Main outcome measures Inter-group differences
Psychological Hidderley Breast CA Long term (1) Anxiety (HADS) (1) A↓,B→ p=.003
(2004) patient (A) AT weekly session*8 weeks (2) Depression (HADS) (2) A↓,B→ p=.001
(B) No intervention
Kanji Coronary Long term Anxiety (STAI) A↓,B↑ p<.001
(2004) angioplasty (A) AT (n=30) 60 min daily practice*8 weeks
patient (B) Usual treat (n=29)
(C) Laughter (n=30)
Nakatani Obsessive Long term (1) Anxiety (HAM-A) (1) A→,B→,C↓ p<.01
(2005) compulsive (A) AT+pill placebo (n=8) (2) Depression (HAM-D) (2) A→,B→,C↓ p<.001
disorder 5 sessions*12 weeks+homework 6 standard exercises s
patient (B) Behavior+pill placebo (n=10)
(C) AT+Fluvoxamine (n=10)
Sutherland d Multiple Long term Depression (CES-D) A↓, B→ p=.03
(2005) sclerosis (A) AT (n=11) daily practice*8 weeks using diary 6
patient standard exercises
(B) No intervention (n=11)
Asbury Cardiac Long term (1) Anxiety (STAI) (1) A→,B→ NS
(2009) syndrome X (A) AT (n=22) 90 min*8 weeks 6 standard exercises (2) Depression (HADS) (2) A↓,B→ p<.05
women (B) No intervention (n=24)
Shinozaki Irritable bowl Long term (1) Anxiety (STAI) (1) A→,B→ NS
(2010) syndrome (A) AT (n=11) 30~40 min session*8 weeks 6 standard (2) Depression (SDS) (2) A→,B→ NS
patient exercises
(B) No intervention (n=10)
Luciano Fibromyalgia Long term (1) Anxiety (FIQ) (1) A↓,B→ p<.001
(2011) patient (A) AT (n=108) 4 sessions*8 weeks+practice at home (2) Depression (FIQ) (2) A↓,B→ p<.001
(B) Usual treat (n=108)
Golding Stroke Long term (1) Anxiety (HAD-A) (1) A↓,B→ p=.002
(2016) patient (A) AT (n=10) 5 times a week*4 weeks using CD
(B) No intervention (n=10)
Table 1C.
Summary of Randomized Controlled Trials Examining Autogenic Training
Stress response First author (year) Subject Intervention (Regime) Main outcome measures Inter-group differences
Physical Sakakibara Healthy Short term (1) HRV;HF (1) A↑,B→ p=.008
(1994) person (A) AT (n=?) 5 min 3 standard exercise (2) HRV;LF (2) A↑,B→ NS
(B) Rest (n=?) (3) HRV;LF/HF (3) A→,B→ NS
Sakakibara Healthy Short term (1) HRV;HF (1) A→,B→,C↑ p<.01
(2013) person (A) AT (n=15) (2) HRV;LF/HF (2) A→,B→,C→ NS
(B) No treat (n=15)
(C) HRV biofeedback (n=15)
Nolan Hypertension Long term HRV;HF A→,B→ NS
(2010) patient (A) AT(n=30) 1 hr*8 weeks using tape+daily practice at
(B) BNT (n=35)
Minowa Breast cancer Long term HRV;HF A↑,B→ p<.05
(2014) surgery (A) AT(n=7) 3 times*1 week using CD
patient (B) No intervention (n=7)

↑: increased compared with baseline, →: no change, ↓: decreased compared with baseline; NS=Not significant. AT=Autogenic training; BDI=Beck depression inventory; BNT=Behavior neurocardiac training; CDR=Cornell dysthymia rating scale; CES-D=The centre for epidemiological studies depression scale; FI=Future oriented hypnotic imagery; FIQ=Functional status includes 10 questions; HADA=Hospital anxiety and depression scale-anxiety; HADS=Hospital anxiety and depression scale; HAM-A=Hamilton rating scale for anxiety; HAMD=Hamilton rating scale for depression; HF=High frequency; HRV=Heart rate variability; LF=Low frequency; LF/HF:Low frequency/high frequency ratio; POMS=The profile of mood states; SCL-90s=Symptom check list 90; STAI=State-trait anxiety inventory; SDS=Self-rating depression scale.

Sakakibara (2013): Psycho/Physical outcome measured.

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