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

Eunju Seo; Soukyoung Kim

doi:10.4040/jkan.2019.49.4.361

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

Review Article

J Korean Acad Nurs 2019;49(4):361-374.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.4.361

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

Eunju Seo¹, Soukyoung Kim^2,

¹Department of Nursing, Shinsung University, Dangjin

²College of Nursing, Eulji University, Daejeon, Korea

Address reprint requests to : Kim, Soukyoung College of Nursing, Eulji University, 77 Gyeryong-ro, Jung-gu, Daejeon 34824, Korea Tel: +82-42-259-1717 Fax: +82-42-259-1709 E-mail: ksy@eulji.ac.kr

Received 20 December 2018 Revised 25 April 2019 Accepted 21 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

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

Methods

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.

Results

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.

Conclusion

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.

Keywords: Autogenic Training, Stress, Psychological, Stress, Physiological, Systematic Review, Meta-Analysis

References

1. Reich JW, Zautra A, Hall JS. Handbook of adult resilience. New York: Guilford Press;2010. p. 213–237.

2. Park E, Choi SJ. Prevalence of suicidal ideation and related risk factors among Korean adults. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2013; 22(2):88–96. https://doi.org/10.12934/jkpmhn.2013.22.2.88.

3. Chang SJ, Koh SB, Kang MG, Cha BS, Park JK, Hyun SJ, et al. Epidemiology of psychosocial distress in Korean employees. Journal of Preventive Medicine and Public Health. 2005; 38(1):25–37.

4. Chang SJ, Koh SB, Kang D, Woo J, Jo J, Chae J, et al. Development of manual and support programs for job stress high risk groups according to job characteristics. Incheon: The Occupational Safety and Health Research Institute;2009. Nov. Report No.: 2009-118-1268.

5. Cox T, Griffiths A, Rial-González E. Research on work-related stress. Luxembourg: European Agency for Safety and Health at Work;2000. Jun. Report No.: TE-28-00-882-EN-C.

6. Selye H. Stress in health and disease. Boston (MA): Butterworths;2013. p. 14–34.

7. McEwen BS. Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews. 2007; 87(3):873–904. https://doi.org/10.1152/physrev.00041.2006.

8. Lazarus RS. Stress and emotion: A new synthesis. New York: Springer;2006. p. 101–128.

9. Kim ML, Song KY. Changes of the level of physical self-efficacy, depression and stress of middle-aged men according to the stage of exercise change. The Journal of the Korea Contents Association. 2009; 9(9):393–402. https://doi.org/10.5392/JKCA.2009.9.9.393.

10. Yun YJ, Lee JH. Effects of exercise participation on the level of stress and coping behavior among children. Korean Journal of Sport Psychology. 2008; 19(2):81–95.

11. Gu JG. The effects of clinical art therapy on change into concentration of salivary cortisol. Journal of the Korean Academy of Clinical Art Therapy. 2010; 5(1):26–32.

12. Park SK, Kim EH, Kwon YC. Effect of the yoga program on health related fitness, depression, stress related factors and immune cell in middle-aged women. Journal of Sport and Leisure Studies. 2008; 33(2):999–1010.

13. Heo DG. Effect of meditation program on stress response reduction of the elderly. The Journal of the Korea Contents Association. 2009; 9(3):232–240. https://doi.org/10.5392/JKCA.2009.9.3.232.

14. Bahk WM, Lee KU. Pharmacotherapy of posttraumatic stress disorder. Korean Journal of Psychopharmacology. 2004; 15(1):22–29.

15. Rhee JH. Is Korea burning out? - The autogenic training as the proper solution. The Korean Journal of Stress Research. 2006; 14(2):139–159.

16. Crocker PR, Grozelle C. Reducing induced state anxiety: Effects of acute aerobic exercise and autogenic relaxation. The Journal of Sports Medicine and Physical Fitness. 1991; 31(2):277–282.

17. Sakakibara M, Hayano J, Oikawa LO, Katsamanis M, Lehrer P. Heart rate variability biofeedback improves cardiorespiratory resting function during sleep. Applied Psychophysiology and Biofeedback. 2013; 38(4):265–271. https://doi.org/10.1007/s10484-013-9232-7.

18. Kanji N, White A, Ernst E. Autogenic training to reduce anxiety in nursing students: Randomized controlled trial. Journal of Advanced Nursing. 2006; 53(6):729–735. https://doi.org/10.1111/j.1365-2648.2006.03779.x.

19. Solberg EE, Ingjer F, Holen A, Sundgot-Borgen J, Nilsson S, Holme I. Stress reactivity to and recovery from a standardised exercise bout: A study of 31 runners practising relaxation techniques. British Journal of Sports Medicine. 2000; 34(4):268–272. https://doi.org/10.1136/bjsm.34.4.268.

20. Asbury EA, Kanji N, Ernst E, Barbir M, Collins P. Autogenic training to manage symptomology in women with chest pain and normal coronary arteries. Menopause. 2009; 16(1):60–65. https://doi.org/10.1097/gme.0b013e318184762e.

21. Golding K, Kneebone I, Fife-Schaw C. Self-help relaxation for post-stroke anxiety: A randomised, controlled pilot study. Clinical Rehabilitation. 2016; 30(2):174–180. https://doi.org/10.1177/0269215515575746.

22. Kanji N, White AR, Ernst E. Autogenic training reduces anxiety after coronary angioplasty: A randomized clinical trial. American Heart Journal. 2004; 147(3):508. https://doi.org/10.1016/j.ahj.2003.10.011.

23. Stetter F, Kupper S. Autogenic training: A meta-analysis of clinical outcome studies. Applied Psychophysiology and Biofeedback. 2002; 27(1):45–98. https://doi.org/10.1023/A:1014576505223.

24. Seo E, Hong E, Choi J, Kim Y, Brandt C, Im S. Effectiveness of autogenic training on headache: A systematic review. Complementary Therapies in Medicine. 2018; 39:62–67. https://doi.org/10.1016/j.ctim.2018.05.005.

25. Everly GS, Lating JM. A clinical guide to the treatment of human stress response. 2nd ed. New York: Kluwer Academic/ Plenum;2002. p. 131.

26. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley-Blackwell;2008. p. 266–278.

27. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Clinical Epidemiology. 2009; 62(10):1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005.

28. Luthe W, Schultz JH. Autogenic therapy. New York: Grune & Stratton;1973. p. 164–168.

29. Charlesworth EA, Murphy S, Beutler LE. Stress management skill for nursing students. Journal of Clinical Psychology. 1981; 37(2):284–290. https://doi.org/10.1002/1097-4679(198104)37:2<284::AID-JCLP2270370210>3.0.CO;2-8.

30. Sakakibara M, Takeuchi S, Hayano J. Effect of relaxation training on cardiac parasympathetic tone. Psychophysiology. 1994; 31(3):223–228. https://doi.org/10.1111/j.1469-8986.1994.tb02210.x.

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
			home
			(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 min2/day8 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)
		problem
		patient
	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
			home
			(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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