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Applied Psychophysiology and Biofeedback [apb] pp383-apbi-367321 February 18, 2002 12:11 Style file version Nov. 19th, 1999
45
1090-0586/02/0300-0045/0 °
C 2002 Plenum Publishing Corporation
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Applied Psychophysiology and Biofeedback [apb] pp383-apbi-367321 February 18, 2002 12:11 Style file version Nov. 19th, 1999
1. Primary hypotheses
a. Therapy with AT results in significant pre–post effects concerning the key symp-
toms of several psychosomatic or psychological disorders or clinical syndromes.
b. Therapy with AT is superior to real control conditions.
c. The effectiveness of a therapy with AT is similar to that of other psychological
treatments.
2. Secondary hypothesis: AT will demonstrate significant secondary effects on out-
comes such as mood, cognitive performance, quality of life, and physiological
variables.
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Applied Psychophysiology and Biofeedback [apb] pp383-apbi-367321 February 18, 2002 12:11 Style file version Nov. 19th, 1999
METHODS
Sampling Method
Studies were sampled by means of the Medline electronic database (search terms:
“autogenic training,” “autogenic relaxation”) and by means of bibliographies of relevant
reviews (Grawe et al., 1994; Linden, 1994; Stetter, 1998) and monographs (Binder & Binder,
1998; Hoffmann, Hoffmann, & Derra, 1997; Luthe, 1965). Unpublished dissertations of AT
were not included in the review. Inclusion criteria were as follows:
1. The study was published in periodical journals or books between 1932 and 1999.
Schultz’s original monograph on AT was published in 1932; thus, no clinical AT
trials were published prior to 1932.
2. The study addresses a clinically defined group of patients suffering from a specific
disorder or at least a syndrome or clinically significant symptom (e.g., anxiety).
Some syndromes were included that may not completely be related to the op-
erationalized diagnostic systems as the DSM-IV or the ICD-10 (e.g., “vegetative
dystonia,” which now may be classified as “somatoform pain disorder, unspecified
type”). This guideline was used because some studies had been carried out long be-
fore these diagnostic systems were available, and it was not appropriate to exclude
these studies from the analysis for that single reason.
3. At least one control group or control phase had to be included in the studies. These
were either psychologically nontreated groups (“real control groups”: participants
were in waiting status or on medical basic therapy only or received a placebo ther-
apy) or treatment groups receiving another (psychological) therapy. If all treatment
groups in a study received a basic medical therapy (e.g., nonpsychiatric medication),
it was included in the review.
4. AT had to be applied for therapeutic purposes in at least one group.
5. AT had to be the only or at least the main therapeutic method in one group or had to
be added as therapeutic component to one group only. Studies were excluded if AT
played an inferior or not clearly discernible role within an extensive therapy plan or
if AT was not administered in a way that at least some excercises were practiced by
the participants themselves without therapeutic guidance. To judge studies on this
criterion, a restrictive methodology was used by both authors and each voted for
the inclusion of a “critical” study. Interrater reliability was not determined statisti-
cally. However, discussion about inclusion or exclusion arose only with very few
studies.
6. At least one outcome criterion relating directly to the disorder or syndrome had to
be evaluated in the studies (physiological and behavioral or psychological).
7. At least 5 participants had to be in each treatment or control group.
8. If there was more than one publication relating to the same sample of patients, only
the most detailed report was included.
Use of random sampling was not an inclusionary criterion. However, separate meta-
analyses for randomized and nonrandomized controlled studies are presented in this paper.
Moreover studies were included in the analyses even if not all six standard exercises of AT
were included for the study. However, at least the heaviness and warmth concentration and
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Applied Psychophysiology and Biofeedback [apb] pp383-apbi-367321 February 18, 2002 12:11 Style file version Nov. 19th, 1999
the rest presentation had to be administered, as positive effects of AT had been demonstrated
even with such a basic procedure (Langen, 1959; Sellers, 1974).
As the main topic of this study was the clinical outcome of a therapy with AT, effect-
sizes (ES) were calculated on outcome variables related directly to the target symptoms of
the disorder or syndrome addressed in each study. Main outcome variables were grouped as
either “physiological” (e.g., blood pressure and other haemodynamic variables, skin tem-
perature, blood levels of hormones, etc.) or “behavioral and psychological” (Linden, 1994;
Smith & Glass, 1977). Examples for behavioral variables are frequency of attacks (panic,
asthma, seizures, etc.) drawn from protocols, duration of sleep, reduction in specific medi-
cation (e.g., pain medication). Examples for psychological variables are self-administered
questionnaires or structured investigations concerning key complaints or symptoms.
Unspecific effects do not relate directly to the target symptoms. In most cases they
concern mood (e.g., reduction of depressiveness and general feelings of tension), state
of mind (e.g., concentration, calmness), or quality of life. They deal for example with the
improvement of subjective feelings of being breathless and sleepless of patients with anxiety
(Ehlers, Stangier, & Gieler, 1995; Spiess et al., 1988) or with the improvement of feelings of
depressiveness of patients with headache (Van Dyck, Zitman, Linssen, & Spinhoven, 1991).
Moreover, some studies reported unspecific physiological effects, which were analyzed as
well (e.g., reduction of the heart rate in Raynaud patients (Keefe, Surwit, & Pilon, 1980;
Surwit, Pilon, & Fenton, 1978)).
some statistic informations were converted as proposed by Glass (1977); Glass, McGaw,
and Smith (1981); and Fricke and Treinies (1985):
t to d, F to d, and r to d
If only n E (experimental group), n c (control group), and the statement that the means
of both samples differed significantly at a given α-level were reported, the following re-
construction was used: The size tα;DF;two-tailed with DF = n E + n C − 2 was drawn from the
t-distribution table. In the same way the report of a nonsignificant result was transformed
using p = 1.00 as a conservative estimation as proposed by Kenny (1999).
If appropriate graphical illustrations of the results were presented and tables or other
presentations of the figures were missing, figures were reconstructed as far as possible
using a ruler. If means were presented without figures concerning the variance, any values
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Applied Psychophysiology and Biofeedback [apb] pp383-apbi-367321 February 18, 2002 12:11 Style file version Nov. 19th, 1999
of variance mentioned in the same study concerning the very group(s) were used. If even
that was not available, the variance of a similar population mentioned in other studies was
used as proposed by Linden (1994).
With the (reconstructed) information reported in each study the ES (Hedges corrected
estimator of the population effect size) were calculated. For each different question sep-
arate meta-analyses were performed. All available ES formed the data pool. If only one
study with one ES was available, the Hedges-corrected estimator of population ES was
used (“d”). If more ES were available, either the ES weighted by its own variance (“D W+ ”;
weighted integration method) or the ES weighted by the sample size (“1”; random effects
model) was used according to the result of the test of homogeneity. D W+ was used if the
population effect sizes were homogeneous, 1 if they were heterogeneous. To determine
this, the coefficient “H ” was calculated, and a test for statistical significance was performed
subsequently (Hedges & Olkin, 1985). Heterogeneity was assumed if the level of signifi-
cance was lower than .01. The significance of each ES was tested by the normal distribution
Z and its corresponding probability. A significant result indicates an ES that differs from
zero. Subsequently the 95%-confidence-interval for each ES was determined.
The fail-safe N (Orwin, 1983) for ES was also calculated. This is a hypothetical
estimator dealing with the problem of an uncomplete retrieval of studies. The fail-safe N
demonstrates how many file-drawer studies with an assumed ES of zero are necessary to
reduce the ES of the meta-analysis to a given level (e.g., 0.2 or 0.5).
According to Glass (1976), effect sizes are labeled in the following way: “Small”:
0.2–0.49, “Medium”: 0.50–0.79, “Large”: ≥0.8.
The Statistical Package for the Social Sciences, version 10.0.5 (SPSS for Windows;
SPSS, 1999) and the “Meta-Analysis Program” by Schwarzer (1995; http://www.fu-berlin.
de/gesund/)—checked by the meta-analysis program developed by Fricke and Kreft
(1986)—were used for the inferential statistics and meta-analyses. Furthermore the pro-
gram “META” by Kenny (1999) from the University of Connecticut (http://nw3.nai.net/
∼dakenny/) was used to calculate the single effects of each study.
RESULTS
Bibliographic features, the number of treatment and control groups, the number of
participants in the different groups, the duration of treatment and follow-up, and the key
results are presented for each study separately in Table I. The methodological comments
of Table I consider several details of the design of each study, describe the experimental
and control conditions, and put emphasis on the sample sizes .The terms “small” or “large”
sample size are defined as samples sizes of n ≤ 12 and n > 12 respectively. If sample sizes
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Table I. Controlled Clinical Studies Concerning Effects of Autogenic Training (AT) Published Between 1932 and 1999
50
Kröner & Heiß 1. N = 6 (1/1/2) 2 groups with Pre–post and Intensity and N = 73 1. 6 weeks Significant reduction of headache
(1982) mixed therapy pre–follow-up duration of (11/10/30) 22 (11/10/25) intensity at post only in the
2. AT vs. progressive relaxation (PR) for AT. AT vs. headache derived (mixed) 2. 4 months (no groups with PR and AT plus PR
vs. AT plus PR (self-control other from diaries. information without self-control training.
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therapy in all three groups) vs. AT psychological Analgetic and about dropouts) Pre–follow-up significant
plus PR (without self-control treatment (post migraine reductions in all three groups who
therapy) vs. placebo relaxation and follow-up). medication received PR (two groups had AT
(false biofeedback) vs. waiting AT vs. real additionally). Nearly similiar
control in a mixed population of control (post results concerning headache
tension headache and migraine and follow-up) frequency, analgetic and migraine
patients (65% had both diagnosis). medication
The two mixed groups (AT + PR)
were not suitable for comparisions
(mixed therapy). Basic medical
Stetter and Kupper
treatment all
Style file version Nov. 19th, 1999
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taught via tape recordings effect: anxiety. N = 20 (7/13) AT group. Improvement in 10/13
Dropouts patients in the biofeedback group
(follow-up) and 5/12 patients in the AT group.
Autogenic Training: A Meta-Analysis
(1986) patients with tension headache; for AT in three duration of headache: 2. 25 weeks (no group (tension headache and
patients with migraine; patients different headache (5/5/0), information migraine) only. AT seems to have
with both diseases. Basic medical samples. AT (headache-score/ Migraine: about dropouts) a little superiority. In patients
treatment both. Three independent vs. other Janssen-Scale). (6/6/0), with tension headache PR was
samples were analyzed in this one psychological Unspecific Combined: significantly superior to AT,
study treatment in effects: (9/10/0) which showed no effect. No
3. Randomized study. Multitude of three different neuroticism and marked effects in the migraine
comparisons is not adequate in samples (post somatization group. Stable at follow-up for
light of the sample sizes (no and follow-up) both treatments in the migraine
February 18, 2002
and treatments
Sargent, Solbach, 1. N = 4 (1/2/1) Pre–post and Intensity and N = 193 1. 8 weeks (no Significant reduction of intensity
Coyne, Spohn, 2. AT vs. thermal biofeedback vs. pre–follow-up frequency of No information and frequency in all four groups.
& Segerson EMG biofeedback vs. real control for AT. AT vs. headache information about dropouts) Reductions less pronounced in the
(1986) in patients with migraine (some real control about the 2. 24 weeks control group. Significant effects
suffered from tension headache (post and initial sample (N = 136) in favor for treatment groups
(Continued )
51
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Table I. (Continued )
52
too). Basic medical treatment and follow-up). AT sizes of the only if all three treatment groups
daily records in all groups vs. other groups were combined and compared
3. Randomized study. Sophisticated psychological At follow-up: with the control group
study protocol. Poor objectivity of treatments (34/34 +
presentation (post and 34/34)
follow-up)
Reich (1989) 1. N = 8 (2/6/0) Pre–post and Weekly hours of N = 1,015, 1. 15 weeks (no Significant pre–post and
2. AT combined in same cases with pre–follow-up headache. Degree No information pre–follow-up reduction of
cognitive therapy, PR or hypnosis for AT in two of headache pain information about dropouts) symptoms and the use of
pp383-apbi-367321
vs. biofeedback (thermal or EMG different about the 2. 36 months prescribed and “over-the-counter”
or photopletysmograph) vs. samples. AT vs. initial sample (N = 703) medication in all four treatment
microelectrical therapy (TENS or two other sizes of the groups (including the “autogenic
electrical-neurotransmitter psychological groups training” group). Biofeedback was
modulation) vs. multimodal treatments At follow-up: most effective in reducing
treatment (combinations of any of (post and Tension duration and degree of headache
the treatments mentioned above) follow-up) headache: in both populations
in two populations: patients with (78/152/0),
February 18, 2002
3. Randomized study psychological from SCL 90) same results were obtained
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et al. (1991) groups and follow-up) questionnaire. hypnotic induction) was superior
3. Sophisticated study protocol and Medication. to AT. As unspecific effect a
Autogenic Training: A Meta-Analysis
Parkinson, 2. AT vs. AT plus EMG-biofeedback pre–follow-up and density of 22 dropouts N = 35 variables in all groups. The
Fobich, vs. AT plus thermal-biofeedback. for AT. headache. before 2. 12 months, combination of AT plus
Bedard, & Basic medical treatment in all Conclusions Analgetic treatment; 5 N = 34 EMG-biofeedback showed a
Marlin groups AT vs. other medication dropouts (12/22/0) significant better outcome than AT
(1992) 3. Sophisticated study protocol psychological during alone or the combination of AT
treatment only treatment, plus thermal biofeedback (post
descriptive, as 1 dropout up and follow-up) except for the
all groups to follow-up, variable “medication” in which AT
received AT N = 34, plus EMG-biofeedback showed a
February 18, 2002
Linssen, waiting-list control in patients for AT. AT vs. Analgetic (41/40/53) treatment groups, not in control
Zitman, & with chronic headaches recruited real control medication. 2. 6 months, group. Significant difference of
Van Dyck from a neurological outpatient (post). AT vs. Responders/ N = 72 both treatments compared with
(1994) and facility and via newspaper and via other nonresponders at (37/35/0) waiting-list control. No
Ter Kuile, advertisment in a student facility. psychological follow-up. differences between treatments
Spinhoven, Basic medical treatment in all treatment (post Unspecific (post). Results stable at follow-up.
& Linssen groups and follow-up) effects: Intention-to-treat analysis: 29%
(1995) psychological responders in AT
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(Continued )
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Table I. (Continued )
54
2. AT vs. AT plus thermal pre–follow-up frequency, 2. 6 months (N = 30) frequency and duration in both
biofeedback vs. waiting-list for AT. AT vs. duration, and treatment groups. Significantly
control in children suffering real control headache index more improvement in treatment
from migraine headache (post and groups compared to control
3. Randomized study follow-up). group. Results stable at follow-up.
Conclusions AT plus biofeedback showed in
AT vs. other some outcome variables better
psychological results than AT alone (e.g., 80%
treatment only symptom-free in combined group,
February 18, 2002
Katzenstein, 1. N = 1 (1/0/0); N = 2 (1/0/1) Pre–post for AT. Systolic and N = 33 (33/0/0) 1. In both pilot After one initial session of AT there
Kriegel, & 2. AT pre–post; AT vs. AT vs. real diastolic blood N = 20 (10/0/10) studies evaluation was a significant reduction in
Gaefke unassissted self-relaxation control (post) pressure (SBP, after the first SBP and DBP in both studies. In
(1974) (placebo) DBP) session (N = 33) the second study, there was a
3. Two pilot-studies followed by 2. N = 20 reduction in the control group as
the study mentioned next in well, however not a significant
this table. First pilot study: one. Both groups differed highly
pre–post for AT; second pilot significantly in SBP and DBP in
study At vs. real control. Only favor for the AT group
short-term effects of AT were
Stetter and Kupper
evaluated
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Katzenstein 1. N = 6 (4/0/2) Pre–post and SBP and DBP N = 150 1. 25 sessions Reduction of SBP and DBP in all
et al. (1974) 2. AT plus antihypertensive drugs pre–follow-up Group 1–4: (40 + probably weekly groups. Reduction less
vs. antihypertensive drugs. AT for AT. AT vs. 21/0/14 + 14) (no information pronounced in the AT plus
plus antihypertensive drugs real control Group 5: n = 46 about dropouts) psychopharmaka group.
plus psychopharmacological (post and Group 6: n = 15 2. 2 years Reduction still proved at
drugs vs. antihypertensive and follow-up) follow-up. AT plus psychotherapy
psychopharmacological drugs. most effective. AT additional to
(AT plus psychotherapy and two different pharmacological
AT plus psychopharmaka treatments revealed only small
without control conditions) advantages
Applied Psychophysiology and Biofeedback [apb]
Baer (1984) 3. Randomized study. for AT. AT vs. 2. 3 years (N = 32) the waiting group. After
Sophisticated study protocol. real control introduction of AT to the waiting
AT as essential component of (post) group: significant positive
a stress management program outcome in this group as well.
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Table I. (Continued )
56
Yurenev, & untreated control vs. real control 2. 1 year (N = 82) had a smaller positive effect.
Patrusheva “psychological placebo.” (post and Results stable at follow-up.
(1988) Discontinuation of medication follow-up). AT Decrease of SBP and DBP in
4 weeks before study vs. other psychological placebo group,
3. Randomized study. psychological but less than in AT group. At
Unsophisticated study protocol. treatment (post follow-up high dropout rate in
Treatment groups were pooled and follow-up) placebo group (65%) and return
in some analysis of the study to initial levels of BP. At
February 18, 2002
(1988) and 2. AT vs. thermal biofeedback vs. pre–follow-up (6 dropouts both treatments in all.
McCoy et al. “self-relaxation controls” (real for AT. AT vs. were replaced) Significant decrease of SBP in
(1988) placebo); unmedicated male real control 2. 12 months Soviets only. AT superior to
patients with mild hypertension (post). AT vs. (N = 59) biofeedback in Americans. At
3. Randomized study. other follow-up results stable for
Sophisticated study protocol. psychological Soviets not for Americans (who
Small sample sizes. American treatment (post practiced relaxation less)
vs. Soviet patients and follow-up)
Yurenev et al. 1. N = 5 (1/3/1) Study not N = 134 1. 12 weeks Reduction of SBP and DBP
(1988) 2. AT plus breathing-relaxation included in (40/74/20) (dropout rates: significant for all treatments
plus biofeedback “called quantitative physical 86%; (physical training > acupuncture
Stetter and Kupper
psychological treatment” vs. analyses as acupunture 37%; > medical > psychological
Style file version Nov. 19th, 1999
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& Volkov relaxation vs. antihypertensive treatment about dropouts) antihypertensive drug group
(1989) drugs vs. antihypertensive (post) ( p < .001). Other drug
drugs plus treatments and AT also effective
psychopharmacological drugs ( p < .05) (AT >
vs. psychopharmacological psychopharmaka >
drugs psychopharmaka plus
3. Additional relaxation antihypertensives).
components in AT group not Recommendation: AT most
February 18, 2002
(1952a, 2. AT plus psychotherapy vs. control infarctions (31/0/30) to 1 year of of equal degree in both groups.
1952b) psychologically untreated (follow-up) treatment) Within 4 years no cardiac
control in patients suffering 2. 4 years infarction in the AT group. 4
from angina pectoris. Basic patients with cardiac infarction
medical treatment in both in the control group
groups
3. Unsophisticated outcome
measures
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(Continued )
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Table I. (Continued )
58
Polácková, 1. N = 2 (1/0/1) Pre–post for AT. Anxiety, N = 189 1. 4 months (no Anxiety, depression, neuroticism,
Bocková, & 2. AT vs. no psychological AT vs. real depression, (131/0/48) information about and heart rate were highly
Sedivec treatment in patients 2 months control (post) neuroticism as dropouts) significantly reduced in the AT
(1982) after myocardial infarction. Basic psychological only, compared to the control
medical treatment in both groups risk factors for a group without significant
3. Poor objectivity of presentation reinfarction (EPI, changes (post). No significant
MAS, MHQ). reduction of blood pressure in
Heart rate, blood any group
pressure
pp383-apbi-367321
Simma & 1. N = 2 (1/0/1) Study not N = 19 1. 32 weeks, Different effects of the two
Benzer 2. AT vs. no psychological included in the (11/8) N = 12 (8/4) treatment modalities not
(1985) treatment in patients after cardiac quantitative reported. It was reported that
infarction. Basic medical analysis both groups showed a reduction
treatment and physical in both because the of type A behavior (Bortner
groups control group Scale). AT facilitated the
3. Very small and varying sample was too small practice of physical training,
sizes. At the end of treatment the (n < 5) at post which resulted in a lower
February 18, 2002
et al. (1993) 2. AT vs. real control in patients’ AT vs. real left ventricular (16/0/14) information about microcirculation and higer
coronary heart disease and control (post) ejection fraction dropouts) LVEF in the AT group. In
hypertonia. Basic medical (LVEF), muscle controls microcirculation
treatment in both groups circulation, SBP decreased. Significant reduction
3. Very sophisticated study protocol and DBP, heart of SBP in the AT group only.
and outcome measures rate Significant decrease in blood
pressure, increase of muscle
circulation and LVEF.
Significant mean differences of
all outcome variables
Stetter and Kupper
(1997) disease after aortocoronary lipids, bicycle 2. 4 months metabolism in the AT group
bypass operation. Basic medical ergometry. compared to the control group
Autogenic Training: A Meta-Analysis
Asthma bronchiale
Sauer & 1. N = 2 (1/0/1) Study not N = 30 (7/0/16), 1. 4 weeks Reduction of nervousness and
Schnetzer 2. AT vs. real control. Basic included in the 7 dropouts (N = 23) psychosomatic complaints (FPI)
(1978) medical treatment in both groups quantitative more pronounced in the AT
3. Small sample sizes. Only analyses as no group vs. control group
possible psychological assessment of
correlations of asthma focussed. target
Poor statistical analyses symptoms
available
February 18, 2002
Deter & Allert 1. N = 3 (1/1/1) Study not N = 31 (9/10/12) 1. 1 year (40 The use of sympathomimetic
(1983) 2. AT plus 9 months of group included in the sessions) drugs in the treatment groups
psychotherapy vs. functional quantitative 2. 1 year (N = 23) was significantly reduced
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(Continued )
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Table I. (Continued )
60
Henry, de Rivera, 1. N = 2 (1/1/0) Pre–post for AT. Objective lung N = 24 1. 8 months (no Relevant clinical improvement of
Gonzalez-Martin, 2. AT vs. support group therapy. AT vs. other variables (e.g., (12/12/0) information about objective lung function variables
& Abreu (1993) Basic medical treatment in both psychological vital capacity, dropouts) (>15%) in the AT group only
groups treatment (post) different flow
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vs. real control (participants of passive and tired, general well-being, passive and
an educational program) open to others, tired, open to others, anxious
3. Sample sizes differ emotional and depressive. Improvement in
12:11
(Continued )
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62
Table I. (Continued )
1. Total no. of groups (AT/other
treatment/real control) Total sample 1. Length of
2. Description of comparisons of Variables size [N ] (sizes treatment
different treatment (or real Possible included pre: AT/other (N post)
control) conditions quantitative in quantitative treatment/real 2. Follow-up Descriptive assessment
Disease/studies 3. Methodical comments analyses analyses control) (N follow-up) (clinical main symptoms)
Applied Psychophysiology and Biofeedback [apb]
3. Randomized study.
7 participants of waiting-list
obviously put on AT during the
study
Carruthers 1. N = 3 (1/1/1) Pre–post for AT. SBP and DBP. Heart beat N = 48 1. 6 weeks In the AT group significant
(1984, 1988) 2. AT vs. physical training vs. no AT vs. real frequency (BPM). Cholesterol, (16/16/16) (N = 45, improvement of all
psychological treatment in control (post). triglycerides, free fatty acids, 16/13/16) outcome variables except
managers in an extraordinary AT vs. medical HDL, glucose, uric acid for uric acid and HDL. In
pp383-apbi-367321
Raynaud’s disease
Surwit et al. 1. N = 2 (1/0/1) Pre–post for AT. Skin temperature during cold N = 30 1. 4 weeks In all AT groups a
(1978) 2. AT and AT plus thermal AT vs. real stress test (dramatic decrease of (15/0/15) (N = 30) significant improved
biofeedback vs. waiting-list control (post) room temperature). Frequency ability to maintain digital
control in patients with and intensity of Raynaud skin temperature in the
idiopathic Raynaud’s disease. attacks (diaries). Unspecific presence of cold stress
Both treatments were either effects: heart rate challenge was observed
applied in laboratory or home (post). Highly significant
sessions. Both treatment groups improvement in AT
were combined in most analyses groups compared to
of the study as there were no waiting-list control
differences between AT and AT concerning stress test.
Applied Psychophysiology and Biofeedback [apb]
biofeedback vs. progressive for AT. AT vs. Raynaud attacks. Unspecific 4 weeks treatment conditions
relaxation (PR) in patients with real control effects: heart rate 2. About compared to 4-week
idiopathic Raynaud’s disease. (baseline as 5 weeks baseline. Significant
Baseline was evaluated for all control: of home improvement in
groups during 4 weeks and, baseline was training frequency of attacks in
treatment effects were reported evaluated in (N = 20) the AT and the PR group
for 4 and 9 weeks of training. the same after 4 weeks and even
For quantitative meta-analyses manner during more pronounced
the AT and PR groups were used the same time improvement after
February 18, 2002
other group
psychological
treatment (post
and follow-up)
Surwit, Allen, 1. N = 4 (2/1/1), 2 dependent Pre–post for AT. Skin temperature during cold N = 20 1. 4 weeks (no Neither prazosin nor AT
Gilgor, & groups AT vs. real stress test (20/10/10), information alone were effective in
Duvic 2. Baseline was evaluated. In the control 2 dependent about improving the reaction to
(1982) first 4 weeks of treatment (placebo groups dropouts) the cold stress test.
63
(Continued )
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Table I. (Continued )
64
placebo
3. Randomized study. Small
sample sizes. Conclusions
concerning effects of AT were
only possible using intragroup
comparisons
Freedman, Ianni, 1. N = 4 (1/3/0) Pre–post and Skin temperature N = 32 1. 5 weeks Significant improvement in the
& Wenig (1983) 2. AT vs. EMG-biofeedback vs. pre–follow-up during cold stress (8/24/0) (N = 32) cold stress test and frequency of
February 18, 2002
thermal biofeedback vs. thermal for AT. AT vs. test. Vasospastic 2. 1 year attacks in both thermal
biofeedback with cold stress other attacks. (N = 30) biofeedback groups only with
training in patients with psychological Unspecific the group with additional cold
idiopathic Raynaud’s disease. treatment (post) effects: stress training being superior.
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any group
Freedman (1989) 1. N = 2 (1/1/0) Pre–post for AT. Finger blood flow N = 16 1. 5 weeks Significant improvement of blood
Autogenic Training: A Meta-Analysis
2. AT vs. thermal biofeedback in AT vs. other (venous (8/8/0) (N = 16) flow and skin temperature in the
patients with idiopathic psychological occlusion biofeedback group only.
Raynaud’s disease treatment (post) plethysmogra- Baseline blood flow and skin
3. Randomized study. Small phy), skin temperature (long-term effects
sample sizes temperature of treatment) did not improve
before and during from beginning to end of the
pp383-apbi-367321
Prill (1965) 1. N = 2 (1/0/1) Pre–post for AT. Duration of N = 404 1. 6–8 weeks Duration of opening phase was
2. AT vs. no psychological AT vs. real dilatation period (104/0/300) (N = 404) 3 hr in the mean shorter in
treatment. Basic medical care in control (post) of delivery. women who had learned AT
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(Continued )
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Table I. (Continued )
66
Zimmermann-Tansella 1. N = 2 (1/1/0) Study not N = 90, only 34 1. 9 weeks The RAT patients tended to
et al. (1979) 2. Respiratory AT (“RAT”) vs. included in women could (N = 34, report less pain during
preparation for childbirth quantitative be follow-up 14/20/0) delivery and showed
according to Lamaze. Basic analyses until delivery significantly less anxiety
medical care in both groups before labour compared to
3. Randomized study. As RAT control. The duration of
combines components of AT, dilatation tended to be shorter
progressive relaxation, and and the duration of expulsion
respiratory relaxation, this period was significantly
pp383-apbi-367321
irritable bowel syndrome. (follow-up) (abdominal pain, (N = 26) symptoms or much improved
Style file version Nov. 19th, 1999
P1: GCQ
unspecific effects
significantly more
Autogenic Training: A Meta-Analysis
treatment in patient (post and Bowel Disease (N = 69, over the study year.
inflammatory bowel disease follow-up) (IBD) Stress 37/0/32) Significant reduction in IBD
(M. Crohn and Colitis Index in the AT group only
ulcerosa). Basic medical
treatment in both groups
3. Randomized study.
Sophisticated study protocol
Epilepsy
De Rivera, De Pre–post for AT. Frequency of 1. 9 months Patients with a low frequency of
February 18, 2002
1. N = 2 (1/1/0) N = 21
Montigny, & 2. AT vs. support type of AT vs. other seizures drawn (11/10/0) (N = 20, seizures (1 seizure/week or
Remillard (1977) psychotherapy in patients with psychological from a diary. 10/10/0) less; n = 15) in both groups
temporal lobe epilepsy. Basic treatment Unspecific showed a small decrease (not
12:11
(Continued )
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P1: GCQ
68
Table I. (Continued )
1. Total no. of groups (AT/other
treatment/real control) Total sample 1. Length of
2. Description of comparisons of Variables size [N ] (sizes treatment
different treatment (or real Possible included pre: AT/other (N post)
control) conditions quantitative in quantitative treatment/real 2. Follow-up Descriptive assessment
Disease/studies 3. Methodical comments analyses analyses control) (N follow-up) (clinical main symptoms)
Applied Psychophysiology and Biofeedback [apb]
fokal, and atypical seizures. untreated patients patients with unchanged. The treated group
Basic medical treatment in was only mentioned fokal seizures, was superior to a not defined
both groups including in the discussion 8 patients with group of epileptic patients
antiepileptic medication and data were not atypical without psychological
12:11
(1995) technique in patients with treatment (post) points, quality of proved difficult to apply in
fibromyalgia sleep, dropouts this setting. While there was a
3. Randomized study clear improvement in all
Autogenic Training: A Meta-Analysis
Atopic eczema
Ehlers et al. 1. N = 5 (1/3/1) Pre–post and Severity of skin N = 149; 1. 12 weeks Significant improvement in all
(1995) 2. AT vs. cognitive behavioral Pre–follow-up for lesions. Topical 12 patients (N = 126, four treatment groups
therapy (BT) vs. AT. AT vs. real steroids. Different droped out 23/81/22) concerning all outcome
dermatological education (DE) control (post and measures of before 2. 12 months variables. No significant
vs. combination of BT and DE follow-up). AT vs. itching and treatment (N = 120, differences were observed
vs. no psychological treatment. other psychological scratching. (N = 137, 22/77/21) between the treatment groups.
Basic medical treatment in all and Measures of 28/85/24) All treatments were superior
February 18, 2002
(Continued )
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70
Table I. (Continued )
1. Total no. of groups (AT/other
treatment/real control) Total sample 1. Length of
2. Description of comparisons of Variables size [N ] (sizes treatment
different treatment (or real Possible included pre: AT/other (N post)
control) conditions quantitative in quantitative treatment/real 2. Follow-up Descriptive assessment
Disease/studies 3. Methodical comments analyses analyses control) (N follow-up) (clinical main symptoms)
Applied Psychophysiology and Biofeedback [apb]
Infertility
O’Moore, 1. N = 2 (1/0/1) Pre–follow-up Number of N = 23 couples 1. 8 weeks (N = 23) In the AT group one woman got
O’Moore, 2. AT vs. no psychological for AT. AT vs. pregnancies. (13/0/10) 2. 2 months pregnant during follow-up (and
Harrison, treatment in couples with real control Plasma levels of (N = 22, 12/010) delivered a healthy female child
Murphy, & idiopathic infertility. Basic (follow-up) prolactin in the later) and two women had
Carruthers medical treatment in both women. unusually prolonged periods, but
(1983) groups Unspecific didn’t allow to test for pregnancy
3. Follow-up period probably too effects: anxiety (not rated as success). No woman
pp383-apbi-367321
Strempel 2. AT vs. waiting-list control pre–follow-up (IOP). Long-term (11/0/12) (N = 23, 11/0/12) long-term IOP in the AT group as
(1995) group in patients with for AT. AT vs. changes 2. 10 months basic AT was administered. An
open-angle glaucoma. Basic real control measured by IOP (N = 23, 23/0/0) additional significant reduction of
medical treatment in both (post) before each IOP was observed, when 4 months
12:11
Morrow
Assessment of
Nausea and
Emesis (MANE),
pain
Infection with HIV
Fukunishi, 1. N = 3 (1/1/1) Study not N = 19 1. 3 months A significant improvement after the
Hosaka, 2. AT plus progressive relaxation included in (6/6/7) (N = 19) relaxation training was observed
Matsumoto, & (PR) vs. supportive quantitative concerning anxiety, fatigue,
February 18, 2002
Table I. (Continued )
72
Banner & 1. N = 6 (1/3/2) Pre–post and Tension rating scale, N = 63 1. 9 weeks There was a significant decrease in
Meadows 2. AT vs. EMG biofeedback vs. pre–follow-up duration, severity, (9/11 + 12 + (N = 63) tension on all cognitive measures
(1983) thermal biofeedback vs. EMG for AT. AT vs. and frequency of 12/9 + 10) 2. 3 months except for the tension rating scale
plus thermal biofeedback vs. real control problems, ability to (N = 57, 8/11 + in all groups, even the control
unspecific music (placebo) vs. (post, relax, Fear of 9 + 11/9 + 8) groups (post and follow-up).
waiting-list control in follow-up). Negative evaluation There were no significant
participants suffering from AT vs. other Scale, social distress, differences between the six groups
“tension” without severe psychological anxiety (STAI-X1,
organic diseases or psychosis treatment X2)
3. Randomized study (post,
Stetter and Kupper
follow-up)
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P1: GCQ
Bailey (1984) 1. N = 2 (1/0/1) AT vs. real Sickness absence N = 45 1. 6 weeks (no The AT group had significantly fewer
2. AT vs. no psychological control records (total days (25/0/20) report about total days off and certificated days
treatment in student nurses (follow-up) off, certificated and dropouts). off compared to the control group.
supposed to be under a high uncertificated days Results were The result concerning
risk of stress. Stress off) taken after the uncertificated days off was not
information sessions in both first two school significant. The control group had
groups blocks and nearly twice as much average time
3. Sophisticated and “realistic” wards sick compared to the AT group
outcome measures
Stetter, Walter, 1. N = 2 (1/1/0) Pre–post and Trait-Anxiety N = 27 1. 6 weeks A significant reduction of trait
Zimmermann, 2. AT vs. group hypnosis in pre–follow-up (STAI-X2), (14/13/0) (N = 26, anxiety and the frequency of panic
Applied Psychophysiology and Biofeedback [apb]
Zähres, & outpatients with anxiety for AT. AT vs. frequency of panic 13/13/0) attacks was observed in both
Straube (1994) disorders (ICD 10) without other attacks. Unspecific 2. 12 weeks treatment groups. Both treatment
other psychiatric disorders and psychological effects: (N = 26) groups did not differ significantly
Autogenic Training: A Meta-Analysis
meta-analysis
Reed & Meyer 1. N = 2 (2/0/0) Study not N = 21 1. 3 weeks There was a significant reduction in
(1974) 2. Active instructions of AT vs. included in (N = 18, test anxiety in both groups at the
passive instructions of AT in the 8 active/10 end of treatment with a tendency
self-referred students with quantitative passive toward a greater improvement in
some degree of test anxiety analyses: No instructions) the active group. 14 of 16
3. Randomized study. No real or proper control participants who completed the
other treatment control. Small condition self-report forms reported
February 18, 2002
(Continued )
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P1: GCQ
Table I. (Continued )
74
1. N = 3 (1/1/1) N = 30
2. AT plus behavior therapy AT vs. real (respiratory stress (10/10/10) (N = 30) reactivity as physiological
(BT) vs. BT only vs. control (post) reactivity) measure concerning
medication plus “unspecific (concerning “dysthmic-neurotic” states in
psychotherapy” in dysthymic both groups the AT group ( p = .01) and in
patients receiving BT). the unspecific psychotherapy
3. Outcome measure indirectly AT vs. medical group ( p = .05), however, not
related to dysthymia treatment (post) significant concerning the BT
only group. At the end of
February 18, 2002
(1977) 2. AT vs. frontalis biofeedback AT vs. real adjective list). reported) group (placebo 1) were
vs. placebo 1 (tone only) vs. (placebo) Unspecific superior concerning the
placebo 2 (unassisted control. effects: Egotism reduction of anxiety compared
self-relaxation) Because of (mood adjective to the biofeedback group and
3. Very small sample sizes. Only shortcomings of list) the self-relaxation group
15/20 “psychiatric” inpatients the protocol and (placebo 1). Concerning the
received a diagnosis of of the reduction of egotism there was
depression. The diagnosis of presentation the a tendency for a superiority of
5 patients was not reported. study is at the the tone only group (placebo 1)
Basic psychiatric treatment in threshold for over all other groups. Because
Stetter and Kupper
relaxation treatment
Krampen (1997, 1. N = 3 (1/1/1) Pre–post for AT Symptoms of N = 55 1. 10 weeks In the first 10 weeks all outcome
1999) 2. AT vs. psychotherapy (after 10 depression (BDI, (19/18/18) (N = 48, variables improved in the AT
Autogenic Training: A Meta-Analysis
(cognitive behavioral therapy weeks). AT vs. H-Scale 19/15/14) and group. In the waiting-list
and client centered therapy real control [hopelessness], another 10 weeks control there was a tendency
PT) vs. waiting-list control in (waiting list, ICD-10 criteria), of treatment toward a deterioration. PT was
outpatients with ICD-10 post 10 weeks). control beliefs, (N = 48) significantly superior to AT (20
diagnosed depression. After AT vs. control self-efficacy. 2. Follow-up 1: 8 sessions PT vs. 10 sessions
10 weeks the AT group (post 20 weeks Unspecific months (N = 48) AT) concerning symptoms of
pp383-apbi-367321
Table I. (Continued )
76
treatment
Engel-Sittenfeld, 1. N = 3 (1/2/0) Pre–post and Time to fall asleep, N = 35 (including 1. 14 weeks In the client centered therapy
Engel, Huber, 2. AT vs. EMG and EEG (theta) follow-up for use of sleeping a waiting-list Dropouts: AT: 2, group significantly more
& Zangl biofeedback vs. client centered AT. AT vs. other medication, time control, which biofeedback:1, patients droped out than in
12:11
(1980) therapy in patients with psychological and periods was not analyzed client centered: 6 both relaxation groups.
functional chronic sleep treatment (post, awake during the any further) (N = 22, Concerning all other
disorders (<3 years) without follow-up) night, duration of 8/8 + 6/0) outcome variables there
psychiatric disorders and sleep, feelings of 2. 40 weeks were no significant
organic disorders that may recreation in the (N = 22) differences between the
cause sleep disorders morning drawn three groups. Concerning
3. Small sample sizes, large from diaries. the use of medication, time
standard deviations. Poor Dropouts and periods awake during
objectivity of presentation the night, and feelings of
recreation all groups showed
Stetter and Kupper
a significant improvement
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P1: GCQ
Coursey, Frankel, 1. N = 3 (1/2/0) Pre–post for AT. General success N = 22 1. 6 weeks In the AT group 2/6, in the BF
Gaarder, & 2. AT vs. EMG biofeedback (BF) AT vs. other index derived (6/6 + 10/0) (N = 22) group 3/6, and in the EL
Mott (1980) vs. electrosleep (EL) in psychological from polygraph group 0/10 patients
patients with functional treatment recordings (e.g., succeeded in achieving a
chronic sleep onset insomnia (EMG sleep latency, meaningful improvement in
(<35 min) without psychiatric biofeedback, total sleep, their sleep difficulties based
disorders and organic disorders post). AT vs. percentage of on the different variables.
that may cause sleep disorders. medical REM and Delta This result was significant
Any sleep medication was treatment sleep) and diaries for BF vs. EL ( p = .036)
discontinued before the study (electrosleep, and not significant for AT
started post) vs. EL ( p = .125)
Applied Psychophysiology and Biofeedback [apb]
Alcoholism
Sharp, Hurford, 1. N = 2 (1/0/1) Pre–post for AT. Drinking-related N = 25 1. 4 weeks A significant improvement in
Allison, 2. Thermal biofeedback assisted AT vs. real locus of control (12/0/13) (N = 25) the drinking-related locus of
Sparks, & AT vs. no additional control (post) (DRIE). control was observed in
Comeron psychological treatment in Unspecific effect: the AT group only. AT
(1997) alcohol dependent adolescents finger was significantly superior
pp383-apbi-367321
biofeedback
(Continued )
77
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78
Table I. (Continued )
1. Total no. of groups (AT/other
treatment/real control) Total sample 1. Length of
Applied Psychophysiology and Biofeedback [apb]
Stutter
Alarcia, Pinard, 1. N = 4 (1/2/1) Pre–post and Objective measures N = 48 1. 12 weeks Concerning objective measures
Serrano, & 2. AT vs. behavioral therapy (BT) pre–follow-up of stutter (e.g., (12/24/12) (N = 44, of stutter significant
Tetreault vs. reeducation of language vs. for AT. AT vs. reading aloud, 12/23/9) improvement compared with
pp383-apbi-367321
(1982) no treatment at all. Patient real control conversation). 2. 36 weeks (no the control group is observed
were excluded if they received (post). AT vs. Rating of information about in the reeducation group only.
any psychiatric or neurological other patient’s relatives dropouts) However effects reversed at
diagnosis or were on any psychological concerning follow-up. Concerning
psychiatric or neurological treatment (post improvement. relative’s ratings significant
medication and follow-up) Unspecific improvement compared with
3. Sophisticated study protocol effects: anxiety the control group is observed
and outcome measures (IPAT), in the behavioral and AT group
February 18, 2002
within one study differed in more than 5 participants, the term “varying sample sizes” is
used ([Ni 6= Ni+1 ] > 5). As demonstrated by Linden (1994), the descriptive review regards
some studies that were not included in the subsequent meta-analysis. Reasons are mentioned
in Table I. This relates to studies comparing different modalities of the AT application (e.g.,
active vs. passive learning, single vs. group stetting, patients vs. healthy controls), studies in
which only unspecific effects were analyzed in a controlled design (e.g., patients with HIV
infection) and studies in which AT did not play a clearly discernible role and in which not
enough statistical material was reported to conduct a meta-analysis. A total of 73 controlled
clinical studies were found. Fourty-one of the studies were randomized trials (Table I).
Thirteen of the 73 studies described in Table I were excluded from the meta-analysis:
In two studies one of the groups had a sample size smaller than five. Two studies provided no
proper control condition as revealed by careful analysis. In four studies AT was combined
with other therapy modalities in such a way that effects for AT itself could not be analyzed. In
five studies no data for AT effects were reported. Sixty controlled clinical studies remained.
Thirty-five of the remaining studies were randomized controlled trials (RCT).
Most of the meta-analytic results are presented in tables (Tables II–XI). Within each part
of the tables from left to right the following results are presented: pre–post (pre–follow-up)
effects for AT, comparisons of the outcome between the AT group and real control groups,
and comparisons between AT and other psychological treatment groups. Results concerning
clinical main symptoms and unspecific effects are presented separately in Tables II–V to
deal with the primary and with the secondary hypotheses. Moreover, results of the two
domains of outcome (behavioral/psychological or physiological) and results of all outcome
variables together are presented separately (from left to right) in all tables. For each row of
all tables a separate meta-analysis was performed.
For methodological reasons the presentation of all ES is supported by the presentation
of the number of participants (N ) and of studies (Nstudies ) on which they are based and by an
indicator of the number of single ES derived from these studies (NES ) that were aggregated
to the ES. Additionally other significant indicators necessary for the interpretation of meta-
analytic results are presented.
Overall meta-analytic results of the therapy with AT derived from 33 RCTs are pre-
sented in Table II (In two of the 35 RCTs follow-up data is presented only).
Pre–Post for AT. Disease specific (main) pre–post effects for AT (0.68–0.75) were in
the range of medium ES. Unspecific effects were somewhat larger (0.73–0.78; Table II).
AT Versus Real Control Treatments (Posttreatment). For this group of analysis medium
ES in favour for AT were observed for all main effects (0.59–0.63). Unspecific effects were
at the borderline of large ES in favour for AT (0.65–0.88; Table II).
AT Versus Other Psychological Treatments (Posttreatment). Small disease specific
(main) effects in favour for other psychological treatments were found (−0.25 to 0.46).
Outcomes based on unspecific effects varied considerably (0.14 to −1.23): The psycho-
logical variables showed a small positive ES in favour for AT. The physiological variables
resulted in a large negative ES (Table II).
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Table II. Results of the Meta-Analysis of 35 Randomized Controlled AT-Studies, Post (Total of 33 Studies)
Main effects Unspecific effects
Phys. Psy. Total Phys. Psy. Total
Pre–post for AT
N 546 1232 1530 100 366 450
NStudies 17 23 33 5 9 13
NES 45 72 117 3 19 22
H 14.28 41.87∗∗ 47.76∗ 1.42 25.46∗∗ 27.15∗∗∗
D W+ 0.68∗∗∗ — 0.75∗∗∗ 0.78∗∗∗ — —
1 — 0.68∗∗∗ — — 0.74∗∗ 0.73∗∗∗
95%-confid. 0.52–0.87 0.54–0.82 0.65–0.85 0.38–1.19 0.23–1.25 0.37–1.08
VESE (%) 100 89.78 100 100 24.50 40.21
Fail N 0.2/0.5 42/7 55/8 91/16 15/3 24/4 34/6
AT vs. real control
N 458 729 1039 25 347 372
NStudies 13 17 25 1 7 8
NES 34 54 88 1 17 18
H 27.46∗∗∗ 11.87 35.26† — 32.96∗∗∗ 33.97∗∗∗
D W+ — 0.59∗∗∗ 0.61∗∗∗ 0.88 — —
1 0.63∗∗∗ — — — 0.65∗ 0.67∗
95%-confid. 0.24–1.02 0.44–0.74 0.49–0.74 — −0.09 to 1.39 0.02–1.31
VESE (%) 34.44 35.17 53.72 — 13.78 16.58
Fail N 0.2/0.5 28/3 33/3 49/5 — 16/2 19/3
AT vs. other psychological treatment
N 166 1057 1207 16 225 241
NStudies 4 15 18 1 6 7
NES 10 52 62 2 7 9
H 5.19 24.84 ∗ 29.96∗ — 16.75 ∗ 25.00∗∗∗
D W+ −0.46 ∗∗ −0.25 ∗∗∗ −0.28∗∗∗ −1.23 — —
1 — — — — 0.38† 0.14
95%-confid. −0.77 to −0.15 −0.38 to −0.12 −0.40 to −0.16 — −0.18 to 0.95 −0.53 to 0.34
VESE (%) 64.29 96.52 74.54 — 29.86 21.37
Fail N 0.2/0.5 6/0 1/−8 1/−10 — 5/−1 −2/−5
Note. Phys. = physiological outcome variables; Psy. = behavioral/psychological outcome variables; Total =
combination of all outcome variables (physiological and behavioral/psychological); N = sample size of all pa-
tients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating
the result of the test of homogeneity; level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
homogeneity is assumed if p ≥ .01; D W+ = effect size (ES) d weighted by its own variance; 1 = ES d
weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10,
∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; 95%-confid. = 95%-confidence interval of population ES; VESE (%) =
amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical delta of
0.20/0.50.
AT Versus Medical Treatments. Only four RCTs were found, in which AT was com-
pared to effects of medical (nonpsychological) treatment. The results are not presented in
tables: Postcomparisons showed no effects (physiological: D W+ = −0.04, psychological/
behavioral: D W+ = +0.04, combined: D W+ = −0.03). One single ES from one single
study related to a follow-up comparison and revealed a strong negative effect (D W+ =
−1.12).
Pre-Follow-Up for AT. Main effects were at the borderline of strong ES (0.74–0.89).
Unspecific effects were in the medium range (0.53: Table III).
AT Versus Real Control Treatments (Follow-Up). For this group of analysis medium
ES in favour for AT were observed for all main effects (0.51–0.56). Large unspecific effects
in favour for AT were found (1.09; Table III).
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Table III. Results of the Meta-Analysis of 35 Randomized Controlled AT-Studies, Follow-Up (Total of 19 Studies)
Main effects Unspecific effects
Phys. Psy. Total Phys. Psy. Total
Pre–follow-up for AT
N 400 860 1138 — 224 224
NStudies 8 14 19 — 5 5
NES 18 43 61 — 14 14
H 34.62∗∗∗ 15.73 43.71∗∗∗ — 6.28 6.28
D W+ — 0.74 ∗∗∗ — — 0.53∗∗∗ 0.53∗∗∗
1 0.88∗∗ — 0.89∗∗∗ — — —
95%-confid. 0.18–1.58 0.60–0.88 0.60–1.19 — 0.26–0.80 0.26–0.80
VESE (%) 19.25 64.67 40.44 — 65.45 65.45
Fail N 0.2/0.5 27/6 41/8 66/15 — 9/1 9/1
AT vs. real control
N 326 334 617 — 106 106
NStudies 4 9 12 — 3 3
NES 11 34 45 — 5 5
H 11.18∗ 14.06† 24.37∗ — 15.42∗∗∗ 15.42∗∗∗
D W+ 0.56∗∗∗ 0.51∗∗∗ 0.52∗∗∗ — — —
1 — — — — 1.09∗ 1.09∗
95%-confid. 0.34–0.78 0.29–0.74 0.36–0.69 — −0.03 to 2.22 −0.03 to 2.22
VESE (%) 11.72 32.17 18.08 — 15.56 15.56
Fail N 0.2/0.5 −2/−3 19/2 18/0 — 13/4 13/4
AT vs. other psychological treatment
N 233 945 1079 — 272 272
NStudies 3 10 12 — 5 5
NES 11 58 69 — 15 15
H 5.71† 10.75 11.49 — 5.24 5.24
D W+ 0.03 −0.21∗∗ −0.21∗∗∗ — 0.05 0.05
1 — — — — — —
95%-confid. −0.25 to 0.30 −0.35 to −0.07 −0.33 to −0.08 — −0.21 to 0.30 −0.21 to 0.30
VESE (%) 42.43 100 100 — 48.20 48.20
Fail N 0.2/0.5 −2/−3 1/−6 1/−7 — −5/−5 −5/−5
Note. Phys. = physiological outcome variables; Psy. = behavioral/psychological outcome variables; Total =
combination of all outcome variables (physiological and behavioral/psychological); N = sample size of all pa-
tients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the
result of the test of homogeneity; level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homo-
geneity is assumed if p ≥ .01; D W+ = effect size (ES) d weighted by its own variance; 1 = ES d weighted by the
sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01,
∗∗∗ p < .001; 95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance ex-
plained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical delta of 0.20/0.50.
Pre–Post for AT. Disease specific (main) pre–post effects for AT were in the range
of small ES (0.36–0.43). Unspecific effects were generally larger; however, they varied
significantly (0.25–0.81; Table IV).
AT Versus Real Control Treatments (Post). For this group of analysis medium ES in
favour for AT were observed for all main effects (0.62–0.74). Unspecific effects were large
in general; however, they varied widely (0.00–1.10; Table IV).
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Table IV. Results of the Meta-Analysis of 25 Nonrandomized Controlled AT-Studies, Post (Total of 22 Studies)
Main effects Unspecific effects
Phys. Psy. Total Phys. Psy. Total
Pre–post for AT
N 874 1206 1720 28 326 354
NStudies 8 16 22 1 5 6
NES 17 57 74 7 10 17
H 13.16† 7.32 14.90 — 17.07∗∗ 19.29∗∗
D W+ 0.36∗∗∗ 0.41∗∗∗ 0.43∗∗∗ 0.25 — —
1 — — — — 0.81∗∗∗ 0.73∗∗∗
95%-confid. 0.22–0.49 0.30–0.52 0.33–0.53 — 0.42–1.19 0.37–1.09
VESE (%) 74.31 100 100 — 49.85 51.09
Fail N 0.2/0.5 7/−2 17/−3 25/−3 — 15/3 16/3
AT vs. real control
N 850 1063 1423 35 189 224
NStudies 7 11 16 1 4 5
NES 21 44 65 3 5 9
H 14.30∗ 57.20∗∗∗ 56.18∗∗∗ — 51.30∗∗∗ 56.33∗∗∗
D W+ 0.62∗∗∗ — — 0.00 — —
1 — 0.74∗∗ 0.71∗∗∗ — 1.10 0.88
95%-confid. 0.47–0.77 0.20–1.29 0.33–1.09 — −0.90 to 3.10 −0.73 to 2.49
VESE (%) 61.13 16.94 22.46 — 6.23 6.90
Fail N 0.2/0.5 12/1 30/5 41/7 — 18/5 17/4
AT vs. other psychological treatment
N — 306 306 27 139 166
NStudies — 9 9 1 3 4
NES — 42 42 3 9 12
H — 3.08 3.08 — 0.59 0.59
D W+ — — — 0.33 0.34∗ 0.34∗
1 — −0.09 −0.09 — — —
95%-confid. — −0.33 to 0.14 −0.33 to 0.14 — −0.008 to 0.69 0.02–0.65
VESE (%) — 100 100 — 100 100
Fail N 0.2/0.5 — −5/−7 −5/−7 — 2/−1 3/−1
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes;
H = coefficient indicating the result of the test of homogeneity; level of significance of H : † p < .10, ∗ p < .05,
∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = Hedges corrected effect size (ES); D W+ = ES
d weighted by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by
the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; 95%-confid. = 95%-confidence interval
of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 =
fail-safe N for critical delta of 0.20/0.50.
Pre–follow-up for AT
N 122 416 538 — 238 238
NStudies 1 9 10 — 5 5
NES 4 29 33 — 2 2
H — 6.94 8.82 — 5.03 5.03
D W+ 0.30 0.58∗∗∗ 0.52∗∗∗ — 0.61∗∗∗ 0.61∗∗∗
1 — — — — — —
95%-confid. — 0.39–0.78 0.34–0.69 — 0.34–0.87 0.34–0.87
VESE (%) — 100 100 — 62.71 62.71
Fail N 0.2/0.5 — 17/1 16/0 — 10/1 10/1
AT vs. real control
N 89 184 273 — — —
NStudies 1 5 6 — — —
NES 4 12 16 — — —
H — 1.66 1.65 — — —
D W+ 0.31 0.31∗ 0.31∗∗ — — —
1 — — — — — —
95%-confid. — 0.01–0.61 0.06–0.56 — — —
VESE (%) — 100 100 — — —
Fail N 0.2/0.5 — 3/−2 3/−2 — — —
AT vs. other psychological treatment
N — 193 193 — 92 92
NStudies — 6 6 — 2 2
NES — 43 43 — 5 5
H — 0.37 0.37 — 0.76 0.76
D W+ — −0.18 −0.18 — 0.33† 0.33†
1 — — — — — —
95%-confid. — −0.48 to 0.11 −0.48 to 0.11 — −0.10 to 0.77 −0.10 to 0.77
VESE (%) — 100 100 — 100 100
Fail N 0.2/0.5 — 0/−4 0/−4 — 1/0 1/0
Note. Phys. = physiological outcome variables; Psy. = behavioral/psychological outcome variables; Total =
combination of all outcome variables (physiological and behavioral/psychological); N = sample size of all patients
of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of
the test of homogeneity; level of significance of H: † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is
assumed if p ≥ .01; D W + = effect size (ES) d weighted by its own variance; 1 = ES d weighted by the sample size;
significance of ES-coefficients tested by the normal distribution Z: † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling
error in percent; Fail N 0.2/0.5 = fail-safe N for critical delta of 0.20/0.50.
Linden (1994) presented results for psychosomatic and psychological disorders sep-
arately. Following his example, overall results for psychosomatic disorders (randomized,
n = 31, and nonrandomized studies, n = 15) and for psychological disorders (random-
ized, n = 4, and nonrandomized studies, n = 10) are presented separately. In the following
sections and Tables (VI–XI) the results of each disorder are presented in detail, as this led
to more homogeneous ES.
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Table VI. Results of the Meta-Analysis (Total of Clinical Main Effect Sizes) Concerning Randomized Controlled AT-Studies Dealing With Different Psychosomatic Disorders
Post Follow-up
84
Pre–post AT AT vs. real control AT vs. other psych. treatment Pre–follow-up AT AT vs. real control AT vs. other psych. treatment
(D,D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1)
Disorders N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES
Tension headache/migraine 626 7 20 251 4 13 827 7 29 588 6 17 88 2 7 793 6 26
1 = 0.84∗∗∗ D W+ = 0.59∗∗∗ D W+ = −0.28∗∗∗ D W+ = 0.75∗∗∗ 1 = 1.53∗ D W+ = −0.27∗∗∗
Hypertension 12 4 10 182 4 12 134 2 8 318 5 14 283 3 11 134 2 8
Applied Psychophysiology and Biofeedback [apb]
d = 0.55 d = 0.60
Fibromyalgia 22 1 3 — — — 35 1 4 — — — — — — — — —
d = 1.54 — d = −1.11 — — —
Atopic eczema 46 1 12 45 1 4 50 1 1 44 1 12 43 1 8 99 1 24
12:11
Infertility — — — — — — — — — — — — — — — — — —
— — — — — —
Glaucoma 22 1 4 23 1 2 — — — — — — 23 1 1 — — —
d = 1.05 d = 0.43 — — d = 0.36 —
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of the test of homogeneity;
level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = Hedges corrected effect size (ES); D W+ = ES d weighted
Stetter and Kupper
by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical
delta of 0.20/0.50.
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Applied Psychophysiology and Biofeedback [apb] pp383-apbi-367321 February 18, 2002 12:11 Style file version Nov. 19th, 1999
Psychosomatic Disorders
–medium main ES (0.74) and medium unspecific ES (0.52) for pre–post comparisons,
–medium main ES (0.62) and small unspecific ES (0.27) for AT versus real control
comparisons,
–small main ES (−0.32) in favour for other treatments and no unspecific ES (0.008)
concerning AT versus other psychological treatments,
–large main ES (0.89) and medium unspecific ES (0.53) for pre–follow-up compar-
isons,
–borderline medium ES (0.46–0.49) for main and unspecific effects concerning AT
versus real control comparisons (follow-up), and
–small main ES (−0.22) in favour for other treatments and no unspecific ES (0.05)
concerning AT versus other psychological treatments (follow-up).
–small main ES (0.38) and small unspecific ES (0.45) for pre–post comparisons,
–medium main ES (0.56) and small unspecific ES (0.35) for AT versus real control
comparisons,
–no main ES (−0.03) and small unspecific ES (0.30) in favour for AT concerning AT
versus other psychological treatments,
–small main ES (0.36) and medium unspecific ES (0.52) for pre–follow-up compar-
isons,
–small main ES (0.25) concerning AT versus real control comparisons (follow-up),
and
–small main ES (−0.22) in favour for other treatments and a small unspecific ES (0.21)
in favour for AT concerning AT versus other psychological treatments (follow-up).
suggests that patients suffering from fibromyalgia benefit more from hypnosis. With the
exception of atopic eczema (medium positive ES) the other direct comparisons of AT with
other psychological treatments resulted in small-to-medium negative ES (headache, hyper-
tension, Raynaud’s disease). Other techniques as symptom-biofeedback (all), progressive
relaxation (tension headache), or hypnosis (migraine) turned out to be more effective. The
pattern of results at follow-up was similar to that mentioned before. Most of the positive
effects of AT were stable until follow-up; some proved to be even larger. One study dealing
with infertility revealed a positive effect for AT at follow-up.
Psychological Disorders
Table VII. Results of the Meta-Analysis (Total of Clinical Main Effect Sizes) Concerning Nonrandomized Controlled AT-Studies Dealing With Different Psychosomatic
Disorders
Post Follow-up
Pre–post AT AT vs. real control AT vs. other psych. treatment Pre–follow-up AT AT vs. real control AT vs. other psych. treatment
(D, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1)
Disorders N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES
Tension headache/migraine 102 3 11 36 1 8 134 3 18 88 3 11 36 1 4 111 3 18
D W+ = 0.45∗ d = 0.14 D W+ = −0.02 D W+ = 0.41∗ d = 0.14 D W+ = −0.22
Asthma bronchiale 98 1 12 86 1 16 — — — — — — — — — — — —
d = 0.24 d = 0.28 — — — —
Autogenic Training: A Meta-Analysis
Epilepsy — — — — — — — — — — — — — — — — — —
— — — — — —
Fibromyalgia
February 18, 2002
Atopic eczema — — — — — — — — — — — — — — — — — —
— — — — — —
Infertility — — — — — — — — — 22 1 1 32 1 1 — — —
— — — d = 0.80 d = 0.15 —
12:11
Glaucoma — — — — — — — — — — — — — — — — — —
— — — — — —
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of the test of homogeneity;
level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = Hedges corrected effect size (ES); D W+ = ES d weighted
87
by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical
delta of 0.20/0.50.
Style file version Nov. 19th, 1999
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Table VIII. Results of the Meta-Analysis (Total of Clinical Main Effect Sizes) Concerning All Controlled AT-Studies (Randomised and Nonrandomized) Dealing With Different
Psychosomatic Disorders
Post Follow-up
88
Pre–post AT AT vs. real control AT vs. other psych. treatment Pre–follow-up AT AT vs. real control AT vs. other psych. treatment
(D, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1)
Disorders N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES
d = 0.55 — d = 0.00 — — —
Fibromyalgia 22 1 3 — — — 35 1 4 — — — — — — — — —
d = 1.54 — d = −1.11 — — —
Atopic eczema 46 1 12 45 1 4 50 1 1 44 1 12 43 1 8 99 1 24
12:11
Glaucoma 22 1 4 23 1 2 — — — — — — 23 1 1 — — —
d = 1.05 d = 0.43 — — d = 0.36 —
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of the test of homogeneity;
Stetter and Kupper
level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = Hedges corrected effect size (ES); D W+ = ES d weighted
by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical
delta of 0.20/0.50.
Style file version Nov. 19th, 1999
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Table IX. Results of the Meta-Analysis (Total of Clinical Main Effect Sizes) Concerning Randomized Controlled AT-Studies Dealing With Different Psychological Disorders
Post Follow-up
Applied Psychophysiology and Biofeedback [apb]
Pre–post AT AT vs. real control AT vs. other psych. treatment Pre–follow-up AT AT vs. real control AT vs. other psych. treatment
(D, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1)
Autogenic Training: A Meta-Analysis
Disorders N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES
Anxiety disorders, 18 1 9 28 1 9 44 1 9 16 1 9 25 1 9 25 1 9
test anxiety d = 1.05 d = 0.00 d = 0.00 d = 1.15 d = 0.00 d = 0.00
Depression/dysthymia 38 1 4 37 1 8 37 1 4 — — — 37 1 5 — — —
d = 0.72 d = 0.65 d = −0.60 — d = 0.54 —
pp383-apbi-367321
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of the test of homogeneity;
February 18, 2002
level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = Hedges corrected effect size (ES); D W+ = ES d weighted
by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical
delta of 0.20/0.50.
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89
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90
Applied Psychophysiology and Biofeedback [apb]
Table X. Results of the Meta-Analysis (Total of Clinical Main Effect Sizes) Concerning Nonrandomized Controlled AT-Studies Dealing With Different Psychological Disorders
Post Follow-up
Pre–post AT AT vs. real control AT vs. other psych. treatment Pre–follow-up AT AT vs. real control AT vs. other psych. treatment
(D, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1)
Disorders N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of the test of homogeneity;
level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = Hedges corrected effect size (ES); D W+ = ES d weighted
12:11
by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001;
95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N for critical
delta of 0.20/0.50.
Stetter and Kupper
Style file version Nov. 19th, 1999
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Table XI. Results of the Meta-Analysis (Total of Clinical Main Effect Sizes) Concerning All Controlled AT-Studies (Randomised and Nonrandomized) Dealing With Different
Psychological Disorders
Applied Psychophysiology and Biofeedback [apb]
Post Follow-up
Pre–post AT AT vs. real control AT vs. other psych. treatment Pre–follow-up AT AT vs. real control AT vs. other psych. treatment
(D, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1) (d, D W+ resp. 1)
Autogenic Training: A Meta-Analysis
Disorders N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES N NSTUD. NES
Note. N = sample size of all patients of all groups; NStudies = number of studies; NES = number of effect sizes; H = coefficient indicating the result of the test of homogeneity;
February 18, 2002
level of significance of H : † p < .10, ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001; homogeneity is assumed if p ≥ .01; d = unbiased estimator of population effect size (ES); D W+ =
ES d weighted by its own variance; 1 = ES d weighted by the sample size; significance of ES-coefficients tested by the normal distribution Z : † p < .10, ∗ p < .05, ∗∗ p < .01,
∗∗∗ p < .001; 95%-confid. = 95%-confidence interval of population ES; VESE (%) = amount of variance explained by sampling error in percent; Fail N 0.2/0.5 = fail-safe N
for critical delta of 0.20/0.50.
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91
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positive effects in stutter. Compared to a training of speech abilites, AT was less effective.
However, in this study the training of speech and the test of the main outcome variable were
very much the same, and the positive results of the training of speech were not stable at
follow-up. Concerning the outcome variable of the rating of speech ability in everyday life
given by the patients’ relatives, AT was clearly superior. With the exception of depression
for which a medium negative ES (in favour for cognitive therapy in one study) occurred,
direct comparisons to other psychological treatment resulted in very small or no relevant
ES. This pattern of results was stable at follow-up.
DISCUSSION
In this study 73 controlled trials concerning effects of the therapy with AT are quan-
titatively reviewed. The number of 35 RCTs included in the quantitative analysis is about
50% greater than that in the Linden (1994) paper. The main reason for this is the period of
time, as additional studies that had been published between 1992 and 1999 were included.
However another minor reason is that some studies were included that were either difficult
to retrieve or had to be translated (e.g., from Russian language). Therefore it was possible
to include studies from many countries and from different continents. This quite represen-
tative cross-section of different therapeutic applications of AT is presented in a descriptive
manner for all studies. On the one hand, this allows a structured and comprehensive insight
into what is known about controlled outcome of AT applications in various settings. On the
other hand, the methodological comments and the reported figures demonstrate the large
variety of the methodological quality in AT outcome research.
Some of the studies, especially the older ones, suffer from more or less severe
shortcomings concerning either the study protocol (only a little more than a half of the
studies were RCTs) or the objectivity of the presentation. Other studies are of limited
validity concerning the AT procedures. As a result of this descriptive part of the review,
two major points should be discussed to stimulate further research so as to overcome such
shortcomings:
in these disorders. For the interpretation of the results it is crucial to keep in mind that in
nearly all of the studies a basic medical treatment was applied for all patients in all groups.
However, the results indicate that AT can play a serious role as one part of “psycho-somatic”
therapy.
In the field of psychological disorders AT turned out to be effective in anxiety, mild-
to-moderate depression, and functional sleep disorders. Concerning anxiety disorders, one
has to keep in mind that AT was not compared with cognitive or exposure therapy. As AT
had not been compared with psychopharmacological treatment (especially for depression
and anxiety disorders), one should not conclude from the results that AT is an alternative
to such a treatment at least for moderate and surely for severe forms of the disorders. One
study (Krampen, 1999) showed that in moderate depression cognitive therapy was more
effective than AT (medium ES). However, in the same study those patients receiving AT and
cognitve therapy showed the best outcome at follow-up. This result can stimulate further
clinical research: Study protocols in which one group receives AT whereas the other group is
treated otherwise and in which afterwards both treatments are switched between groups may
answer questions, if AT may play a role as a “preparation-therapy” or an “add-on-therapy.”
As a result of this meta-analysis, AT proved to be an effective relaxation method
being about as effective as other relaxation methods. This replicates the general findings
of Linden (1994) and contradicts the results of Grawe et al. (1994). However, perhaps all
relaxation methods should not be considered as stand-alone therapies especially in severe
forms of the disorders. In the psychosomatic area, relaxation, of course, should be an add-on
therapy to medical treatment. Its combination with behavioral and cognitive as well as with
psychotherapeutic components should be worth further investigation.
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