Research

A quantitative and qualitative pilot study of

the perceived benefits of autogenic training for
a group of people with cancer
S. WRIGHT , PHD, BA (HONS), RGN, RM, DIP. CANCER COUNS., ONC. CERT., QUALIFIED AUTOGENIC TRAINER, ARC
Cancer Support Centre, Dublin, U. COURTNEY , MMEDSC, RGN, DIRECTOR, ARC Cancer Support Centre, Dublin,
Republic of Ireland, & D. CROWTHER , BSC (HONS), RGN, RCNT, RNT, FRCN, CHIEF EXECUTIVE, Wirral Holistic Care
Services, Therapeutic Cancer Centre and Centre for Autogenic Training, Birkenhead, Wirral, UK

WRIGHT S., COURTNEY U. & CROWTHER D. (2002) European Journal of Cancer Care 11, 122–130
A quantitative and qualitative pilot study of the perceived benefits of autogenic training for a group of people
with cancer

This paper describes the application of autogenic training (AT), a technique of deep relaxation and self-
hypnosis, in patients diagnosed with cancer ,with the aim of increasing their coping ability, and reports the
results of a questionnaire survey performed before and after an AT course. A reduction in arousal and anxiety
can help individuals to perceive their environment as less hostile and threatening, with implications for
improved perceived coping ability. Complementary therapies are considered useful in enhancing symptom
relief, overall well-being and self-help when used as adjuvant therapies to allopathic medical interventions.
The present study aimed to validate, in an Irish context, the effectiveness of AT as a complementary therapy
for patients with cancer. Each participant completed a Hospital Anxiety and Depression Scale and Profile of
Mood States questionnaire before and after a 10-week AT course. The results indicated a significant reduc-
tion in anxiety and increase in ‘fighting spirit’ after compared with before training, with an improved sense
of coping and improved sleep being apparent benefits of AT practice.

Keywords: psychosocial interventions, autogenic training, homeostasis, organ imagery, coping, quality of life.

INTRODUCTION some patients with cancer (Downer et al. 1994). Studies

Psychosocial interventions in cancer
Psychosocial interventions, including psychological
support and cognitive behavioural therapies, subsuming
some of the complementary therapies, are an essential
part of the multidisciplinary treatment and care of
patients with cancer (Spiegel & Bloom 1983; Spiegel 1990,
1993, 1996; Burish & Redd 1994; Downer et al. 1994;
Holland 1998; Souhami & Tobias 1998). Complementary
therapies fulfil an important psychological need for
Correspondence address: Dr Shelagh Wright, ARC Cancer Support Centre,
65 Eccles St, Dublin 7, Republic of Ireland (e-mail: t-swright@clubi.ie).
European Journal of Cancer Care, 2002, 11, 122–130
show that adjuvant psychological therapy produces sig-
nificant improvement in various measures of psycholog-
ical distress among patients with cancer (Watson 1983,
1991; Fawzy et al. 1990; Greer et al. 1992; Arathusik
1994). Research related to optimal management of symp-
toms associated with the experience of cancer, especially
pain and distress, continually impacts upon the clinical
practice of healthcare professionals (e.g O’Boyle et al.
1988; Breitbart 1994; Spiegel 1996; Breitbart et al. 1997;
Holland 1998). Evidence-based practice guidelines and
reviews of pain assessment and management indicate that
a combined treatment approach to cancer pain, utilizing
pharmacological along with non-pharmacological inter-
ventions, provides effective pain control in 85–95% of
cancer patients with pain (Abrahm 1999).

© 2002 Blackwell Science Ltd


Although pain is the symptom primarily associated
with advanced cancer, other symptoms can also severely
reduce patients’ coping ability and quality of life at all
stages of the disease (Derogatis et al. 1983; Mermelstein
& Lesko 1992; Twycross 1994). For many people the diag-
nosis of cancer or its recurrence precipitates reactions
of shock, denial, anger, dysphoria, emotional lability,
anxiety, depression and hostility (Gottschalk & Hoigaard-
Martin 1986; Edgar et al. 1992; Mermelstein & Lesko
1992). Psychological distress experienced by patients with
cancer may be compounded by lack of concentration as
well as fatigue, and accompanied by sleep disturbance and
an inability to participate in usual activities (Weisman &
Worden 1976; Mermelstein & Lesko 1992; Holland 1998).
Disrupted sleep can exacerbate fatigue, anxiety and the
perception of pain (Twycross 1994; Winningham et al.
1994). Patients’ experience of cancer is also frequently
accompanied by a sense of loss of control, as ability
to make choices and exercise self-determination in
situations is reduced (Rosch 1984; Greer et al. 1992;
Skevington 1995). Quality of life for patients with cancer
may continue to decrease as the personal experience of
their illness impacts upon all areas of life, affecting rela-
tionships and interactions with others, including spouses
and family members (Wortman & Dunkel-Schetter 1979;
Dunkel-Schetter & Wortman 1982; Northouse et al. 1991;
Northouse & Peters-Golden 1993; Waldron et al. 1999).
Additional stressors may include side-effects of conven-
tional cancer treatment, along with strained relations and
poor communication between patient and healthcare pro-
fessional (Downer et al. 1994; Surbone & Zwitter 1997).
Psychotherapeutic interventions, which include cognitive
behavioural techniques, for patients with cancer have
been shown to improve sense of control, and to increase
self-esteem, confidence, sense of achievement and plea-
sure, thus helping to reduce anxiety and overall psycho-
logical distress (Golden et al. 1992; Greer et al. 1992;
Sloman 1995).
Although complementary therapies are not a replace-
ment for conventional forms of treatment for cancer and
associated psychological distress, they are considered
helpful when used as therapies adjuvant to allopathic
medical interventions (Crowther 1995; Sloman 1995;
Kassab & Stevenson 1996). An interview survey of
patients with cancer by Downer et al. (1994) showed that
patients satisfied with their choice of complementary
therapies perceived both physical and psychological
benefits. Patients reported feeling calmer, emotionally
stronger, better able to cope with the demands of their
illness and more optimistic in outlook. Physical benefits
included a reduction in nausea and breathing difficulties
© 2002 Blackwell Science Ltd, European Journal of Cancer Care, 11, 122–130
European Journal of Cancer Care
and increased energy (Downer et al. 1994). The use of
relaxation and related techniques helps patients with
cancer to gain therapeutic self-care skills, in line with
Orem’s self-care theory of nursing practice (Orem 1985).
These cognitive–behavioural techniques help to reduce
feelings of helplessness and hopelessness, provide distrac-
tion from the experience of pain and emotional reactions
associated with the diagnosis of cancer and help to break
the pain–anxiety–tension cycle (Cobb 1984; Sloman 1995).
This paper will outline the application of the principles of
autogenic training (AT), a technique of deep relaxation and
self-hypnosis (Luthe & Schultz 1969), to help patients
diagnosed with cancer to increase their coping ability,
either during or following orthodox treatment for cancer,
and will describe the findings of a questionnaire survey
conducted before and after an AT course for patients with
cancer.
LITERATURE REVIEW
Background to the study
It has been shown that the majority of patients with
cancer use a wide repertoire of coping responses (Jarrett et
al. 1992). Cancer as a stressor fits Lazarus’s (1966) concept
of a high-stake situation to which individuals respond psy-
chologically in several different ways. Transactional stress
theory emphasizes specific person–environment transac-
tions in which demands (external and internal) tax or
exceed coping resources or capabilities as perceived by
the individual (Lazarus 1981; Lazarus & Folkman 1984).
Coping follows the primary and secondary appraisals of a
perceived stressor, the primary appraisal being the evalu-
ation of the stressor as benign, challenging or harmful and
the secondary appraisal, a person’s assessment of his or
her resources available to cope with the stressor, together
with evaluations as to whether something can or cannot
be done about the stressful situation (Lazarus & Folkman
1984). Coping consists of cognitive and behavioural efforts
to manage specific external and/or internal demands that
are appraised as taxing or exceeding the resources of the
person (Lazarus & Folkman 1984). Coping has two major
functions: to manage or alter the situation that is caus-
ing distress (problem-focused coping) and to regulate
emotional responses to the problem, for example anger,
anxiety and/or grief (emotion-focused coping). In general,
problem-focused forms of coping are relied upon more
when situations are appraised as amenable to change,
whereas emotion-focused forms of coping are relied upon
more when situations are appraised as unchangeable
(Folkman et al. 1991). In social cognitive theory, Bandura
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WRIGHT et al. Benefits of autogenic training for people with cancer
(1986) proposed that perceived self-efficacy in exercising
control over potentially threatening events plays a central
role in anxiety reduction. Bandura’s notion of ‘self-
efficacy’ overlaps with part of the coping process. A
high level of anxiety arousal results from an individual
focusing negatively on his or her own coping deficiencies,
and on those aspects of the environment that cause con-
cern, potentially increasing the perceived severity of
possible threats (Bandura 1992).
The experience of cancer reduces a person’s perception
of being able to exercise choice and self-determination in
many situations, contributing to perceived loss of control
(Skevington 1995). Adaptive coping, such as information
seeking, aids adjustment in chronic painful illness when
a person’s sense of control and self-efficacy are reduced.
Wish fulfilment, typified by longing for the illness to go
away, has been shown to be associated with poorer mood
and function (Skevington 1995). Cognitive–behavioural
approaches explore patients’ beliefs about the cancer diag-
nosis and its treatment, in order to elicit irrational or
unhelpful thoughts that lead to feelings of helplessness
and hopelessness, and attempt to correct these maladap-
tive thoughts, along with providing new coping behav-
iours (e.g. Moorey 1991; Passik et al. 1997; Watson 1999).
Stress and coping are dynamic processes and therefore
susceptible to change. A reduction in arousal and anxiety
can help individuals to perceive their environment as
less hostile and threatening (Lazarus & Folkman 1984).
For people with cancer this may have implications for
perceived coping ability, through the enhancement of
mastery and self-esteem.
Autogenic training: the technique and its application to
coping with cancer
The aim of autogenic training (AT) is to enable the person,
through passive concentration, to revert from a state of
arousal associated with sympathetic activity of the auto-
nomic nervous system to one of profound relaxation asso-
ciated with parasympathetic activity (Luthe & Schultz
1969; Kermani 1990; Benor 1996). Cannon (1935) proposed
that the aim of physiological functioning is to maintain
an inner state of stability or balance termed homeostasis.
The AT rationale also embraces this model (Linden 1990).
Alpha-waves, associated with calmness, relaxation and
well-being, seem to increase with the practice of AT
(Bailey 1985; Linden 1990). In general, the physiological-
and psychophysiological-orientated effects of AT may be
considered as being diametrically opposed to changes
brought about by stress (Luthe & Schultz 1969).
AT originated at the beginning of the twentieth century
124 © 2002 Blackwell Science Ltd, European Journal of Cancer Care, 11, 122–130
from research on sleep and hypnosis (Linden 1990; Benor
1996). Johann Schultz, a German neurologist, observed
that his hypnotized patients regularly reported two dis-
tinct sensations: ‘a heaviness especially in the limbs’ and
‘a sensation of warmth’. Through these findings Schultz
became convinced that ‘hypnosis was an experience that
the patient permitted to happen. In order for the patient
to enter a trance there had to be a “switch: which could
be provoked and subsequently controlled by the patient’
(Linden 1990). Schultz noticed that his patients moved
into a trophotropic or healing state when they practised
instructions directed at the autonomic nervous system
(Bailey 1985). From these observations and further study
of yoga methods, hypnotic suggestion, autohypnosis and
methods used by fakirs and street performers, Schultz
developed the system of AT, composed of basic and ad-
vanced stages. The basic stage is composed of six stand-
ard exercises for producing sensations of heaviness and
warmth in the extremities, warmth in the epigastric
region and coolness in the forehead and for regulation of
heart rate and breathing, while the advanced stage of AT
is the healing by ‘nirvana’ (nirvana therapy). Changes of a
somatic nature are achieved by the basic AT methods,
while the spiritual states are achieved by advanced
methods (Romen 1987). Luthe & Schultz (1969) stated
that AT, carried out individually by each person, is
designed to promote and give specifically adapted support
to brain-directed self-regulatory (autogenic) mecha-
nisms that promote homeostatic, recuperative and self-
normalizing processes diametrically opposed to changes
induced by stress. It allows the person, through training
him- or herself, to become the passive observer in the
autogenic state (altered state of consciousness) which pro-
motes certain self-normalizing functions. The shift to the
autogenic state is facilitated by conditions involving a sig-
nificant reduction in afferent and efferent impulses, and
the regular practice of short periods of passive concentra-
tion upon psychophysiologically adapted stimuli.
The term ‘autogenic’ also emphasizes that the patient
is largely responsible for carrying out his or her own treat-
ment by regular training that is focused on specific mech-
anisms (Luthe & Schultz 1969). The training process is a
form of self-help and works on the important principle
that, given the basic techniques and a degree of advice
and encouragement, trainees can proceed safely to apply
the method themselves and make it part of a health-
promoting lifestyle (Carruthers 1979). The original
method was extended in 1940 when Scultz and Luthe met
(Crowther 1995). Luthe’s subsequent research extended
the application of the technique, so that, in addition to
the six standard exercises, AT therapeutic combinations

focus on organ-specific changes, intentional formulae and
meditative exercises (Luthe & Schultz 1969). AT improves
self-regulatory functions, increases bodily resistance to
stress and makes unconscious material more readily avail-
able, so that dream material and memories are reproduced
more easily by AT trainees than by other patients (Luthe
& Schultz 1969). Autogenic modifications include (a) the
use of intentional formulae that allow the expression of
anger, anxiety and negative emotion when not in the auto-
genic state, which help a person to offload repressed neg-
ative feelings, and (b) positive affirmations which, when
used in the autogenic state, can help a person to develop
a positive mental attitude towards him- or herself
(Kermani, 1990, 1996; Kanji, 2000).
Pain is considered a multidimensional subjective
experience, composed of and exacerbated by physical,
psychological, social and spiritual factors (Saunders 1967;
Twycross 1994). AT, similar to other relaxation-based
cognitive–behavioural interventions, aims to reduce
stress and anxiety (Kanji & Ernst 2000), thus breaking
the pain–anxiety–tension cycle (Sloman 1995) and pos-
sibly facilitating adaptive coping responses by the per-
ception of a less hostile and threatening environment
(Lazarus & Folkman 1984). Adequate sleep is a vital factor
in pain management (Twycross 1994), and AT has been
shown to be effective in reducing sleep onset latency in
relaxation-based studies of people with insomnia (e.g.
Nicassio & Bootzin 1974; Espie 1991). It has also has been
shown to be effective in reducing anticipatory nausea and
anxiety in cancer patients receiving chemotherapy
(Crowther 1995; Palekar 1995).
METHODOLOGY
Aim
The present study aimed to validate, in an Irish context,
the effectiveness of autogenic training (AT) as a comple-
mentary therapy for patients with cancer.
Study sample
From September 1998 to December 2000 a total of 35
trainees, in six consecutive groups, commenced, and 30
trainees completed, a course of AT in ARC Cancer
Support Centre, Dublin (four training periods lasting 10
weeks and two lasting 9 weeks). Of these, 18 adult par-
ticipants, whose ages ranged from 40 to 80 years, and who
were diagnosed with cancer, fully participated in the AT
validation study. Study participants had either received or
were currently undergoing treatment. Type and stage of
© 2002 Blackwell Science Ltd, European Journal of Cancer Care, 11, 122–130
European Journal of Cancer Care
cancer varied in the groups; however, patients with a diag-
nosis of breast cancer were predominant. All participants
recruited to the study were either pain free or their pain
was well controlled with non-opioid or weak opioid
medication.
Apparatus
A questionnaire was completed by each participant before
and after each AT training course to determine levels of
anxiety and depression (Hospital Anxiety and Depression
scale – HADS; Zigmond & Snaith 1983) and mood status
(Profile of Mood States – POMS; McNair et al. 1971/1981).
Procedure
Following screening by their physician if not currently
undergoing treatment for cancer, or by their medical con-
sultant if they were undergoing treatment for cancer, par-
ticipants were offered an explanation of the method of AT
and the reasons for the validation study. The facilitator
explained to each group member that participation in the
study was optional. Participants signed a consent form,
and then completed the HADS and POMS questionnaires
and a health questionnaire. Participants underwent an AT
programme, which consisted in learning the series of
standard exercises. Participants were informed that prac-
tice of the exercises three times daily was required for
optimal outcome, that adherence to the formulae as prac-
tised was essential and that keeping a diary of the experi-
ence and bringing it to the weekly sessions was obligatory.
It was also explained to participants that the use of tapes
for AT was not appropriate, as the aim of AT was for the
individual him or herself to have full mastery of the tech-
nique rather than relying on an outside agency (Kanji &
Ernst 2000). Each week built upon the skills acquired in
the previous week, the aim being to facilitate a physio-
logical shift in autonomic function from the sympatheti-
cally enhanced stress-dominated state to a more relaxed
state enhanced by parasympathetic function (Selye 1956;
Gregson & Looker 1996). At the end of each training
period, participants were asked to complete the HADS
and POMS questionnaires again and to provide an overall
evaluation of the AT course.
RESULTS
As illustrated in Table 1, analyses of the data of the pilot
study revealed a statistically significant reduction in
participants’ anxiety (HADS) (t = 2.782, d.f. 17, P < 0.01),
an increase in participants’ fighting spirit (POMS
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WRIGHT et al. Benefits of autogenic training for people with cancer
Table 1. Significant effects of autogenic training on mood
Mood state Pre–post t-test P-value
Anxiety (HADS) t = 2.782, d.f. 17 <0.01
Fighting spirit POMS) t = 2.449, d.f. 16 <0.01
Vigour (POMS) t = 2.032, d.f. 16 <0.059
Table 2. Participants’ qualitative evaluations of the benefits of
AT
• A useful method to reduce anger and tension
• Very helpful for sleep induction
• Promotes a calming effect; a useful stress management
technique
• Promotes a greater overall sense of well-being
• Facilitates a focus on self, inner feelings and their expression
• A means of increasing effort, self-encouragement and help
anger/hostility) (t = 2.449. d.f. 16, P < 0.01) and a non-
significant trend towards increased vigour (POMS) (t =
-2.032; d.f. 16; P < 0.059) before compared with after auto-
genic training. Participants’ qualitative evaluations of the
benefits of the AT course are outlined in Table 2.
DISCUSSION
The subjective qualitative viewpoints of participants are
interrelated with the quantitative finding of the present
study. Participants especially considered AT very helpful
for restoring disrupted sleep patterns (Table 2). A number
of interacting factors may promote better sleep for people
with cancer who acquire the AT technique. Firstly, insom-
nia is thought to be associated with autonomic and psy-
chological arousal, involving both cognition and emotion
(Espie 1991). The results of the present study showed a
significant reduction in levels of anxiety after compared
with before AT intervention (Table 1). The aim of AT is
to achieve a low state of physiological arousal and requires
the subject to concentrate on the imagery of organs while
repeating subvocal verbal formulae with associated
meaningful images (Linden 1990). These cognitions may
provide selective attention to help distract from other-
wise sleep-disturbing, intrusive, affect-laden thoughts and
tension (Espie 1991) associated with the trauma of the
experience of cancer (Mermelstein & Lesko 1992). Sec-
ondly, the acquisition of the AT technique may restore
some sense of control to the person with cancer, as noted
by participants’ increasing sense of feeling encouraged to
make coping efforts (Table 2), in line with Bandura’s (1986,
1992) proposal that self-efficacy overlaps with coping and
126 © 2002 Blackwell Science Ltd, European Journal of Cancer Care, 11, 122–130
anxiety reduction. Lastly, it is possible that patients with
cancer anticipate the possible onset of pain at some future
point in time. The sense of confidence and mastery pro-
vided by the acquisition of the AT technique may help to
allay fears associated with such anticipation, in that the
patient perceives that he or she will be able to utilize the
AT technique to break the tension–pain–anxiety cycle
(Sloman 1995) and therefore exercise some control over
the situation (Skevington 1995). The knowledge and expe-
rience that sleep, a major factor in effective pain control,
is enhanced by the regular practice of AT, may also serve
to increase sense of control and reduce fear when patients
know that pain perception and experience can be reduced
through breaking the pain–fatigue–anxiety–insomnia
cycle (Twycross 1994). Thus, the possibility of a placebo
effect being inextricably linked to the study outcomes
cannot be excluded, as participants, possibly with prior
expectations of the benefits of relaxation therapies,
selected themselves into the study. The reduction in auto-
nomic arousal brought about through the regular practice
of AT may impact on the cognitive aspects of anxiety to
reduce fears associated with many aspects of the cancer
experience (Richardson 1995).
AT was also shown to be helpful in encouraging a sense
of mastery by being seen as a means of increasing effort,
self-encouragement and help (Table 2). Hospital environ-
ments may reduce the sense of control even of hardy
people, depending upon illness, patient–professional inter-
actions and organizational factors. Once removed from a
situation that fosters dependence, a patient may require
support to regain self-confidence in his or her ability to
feel in control (Skevington 1995) and to regain sense of
mastery (Pearlin et al. 1981). Underlying life- events
research is the assumption that adverse events lead to
stress because the organism is fundamentally intolerant
of change (Cannon 1935; Selye 1956). Life events may gen-
erate role strains wthathich result in a diminution of self.
When people are faced with persistent role strains, as typi-
fied by prolonged hospitalization with chronic illness,
resulting in loss of ability to fulfil the usual daily activi-
ties, these may be construed as personal failure and inabil-
ity to exercise self-determination and control over the
negative circumstances of their lives, with consequent
reduction of self-esteem and sense of mastery (Skevington
1995; Pearlin et al. 1981). Research by Pearlin & Schooler
(1978) indicated that coping resources in the form of
mastery, beliefs and self-esteem were more effective in
buffering the effects of role strains over which the person
has little control, whereas active coping responses were
more effective in diminishing the consequences of strains
in areas over which the person had some control. Thus,

coping may be considered as being sensitive to situational
constraints (Eckenrode 1991). In the context of a person’s
experience of cancer, both types of role strain may be
experienced as the illness fluctuates in severity and sense
of personal control increases or decreases.
Cognitive behavioural interventions may facilitate
sense of self-esteem by cognitive restructuring, whereby
a more problem-focused coping becomes possible, through
a patient viewing his or her personal situation differently
and adapting plans to take account of reduction in time
and energy. This process may be further facilitated by
the emotional support afforded by a group intervention
(Spiegel 1993, 1996). The ability to maintain sense of per-
sonal worth, confidence and reduced levels of anxiety may
depend upon patients with cancer acquiring effective
emotional coping responses through learning cognitive–
behavioural techniques that help to distract from the
anxious preoccupation and helplessness associated with
their illness (Greer et al. 1992). Personal control over
anxiety arousal requires the development of behavioural
coping efficacy along with ability to control disturbing
cognitions. Perceived self-efficacy in thought control, the
ability to control disturbing cognitions, is a key factor in
the regulation of cognitively generated arousal (Bandura
1992). Reduction in anxiety levels (Table 1) achieved by
the participants in the present study may be a conse-
quence of additional factors in conjunction with the
reduction of arousal and distraction facilitated by acqui-
sition of the AT technique. A study by Edelman et al.
(2000), in a review of the literature, found greater per-
ceived benefits in patients with cancer who attended
psychoeducative groups than in those attending purely
supportive groups. Functional social support, such as
emotional and informational support, is considered to
have the capacity to buffer major life events (Wills 1985),
with emotional support considered to be the most stress-
buffering type of social support. (e.g. Turner 1981). The
psychoeducative group support may help people who have
similar problems to act as role models to each other, espe-
cially by the use of adaptive coping responses, as well as
being sources of information and non-stigmatizing affir-
mation (Spiegel 1993; Skevington 1995). Social support,
although defined in many different ways, can be construed
as access to relationships that meet basic interpersonal
emotional needs, validation of personal identity, help with
tasks and support in handling and controlling emotions
(Cobb 1976; Kaplan et al. 1977; Lin 1986). Social support
is associated with decreased likelihood of physical and
psychological disorder (e.g. Orford 1992). Relationships
with others provide social integration, reassurance of
worth, emotional aid and guidance and reliable alliance –
© 2002 Blackwell Science Ltd, European Journal of Cancer Care, 11, 122–130
European Journal of Cancer Care
factors which are consistent with well-being and stress
reduction (Weiss 1974; Turner 1981; Thoits 1986).
Another aspect of group experience is the opportunity for
people to compare themselves favourably or otherwise
with those in similar situations. Some types of meaning-
ful comparisons can enhance feelings of self-esteem and
well-being and reduce negative feelings. Upward com-
parisons may be helpful when trying to learn coping skills.
People in similar situations with good coping skills may
be perceived as role models by others keen to improve
their own coping ability (Skevington 1995). Thoits (1986)
suggested that social support might be construed as
coping assistance, which facilitates a person to either
change the situation, change its meaning change his or her
reaction to it or change all of these factors. Also, belong-
ing to a group of similar others may be emotionally ben-
eficial for patients with cancer, by reducing the sense of
stigmatization brought about by being perceived as differ-
ent by significant others and offering opportunities for
more problem-solving tasks such as accompanying each
other for medical appointments (Spiegel 1993).
As shown in Table 1, the results of the present study
showed an increase in vigour, although not statistically
significant, possibly due to improved energy as a result of
an increase in the ability to control feelings of anxiety
(Thoits 1986). A reduction in levels of anxiety and fear
might also have allowed expression of participants’ anger
and hostility, defined in the POMs as ‘readiness to fight
one’s illness’, which increased significantly during the AT
course (Table 1). Participants were instructed in the use
of intentional exercises to allow non-destructive expres-
sion of anger, anxiety and distress. The increase in this
type of anger might represent an increase in fighting spirit
rather than a self-destructive anger. Fighting spirit has
been shown to be associated with longer survival, com-
pared with responses characterized as fatalistic, anxious
preoccupation and helplessness/hopelessness (Greer et al.
1979). Patients with energy and will to fight may procure
better support and information and be actively involved
in treatment, leading to a more adjusted outcome with
less anxiety and depression (Spiegel 1993).
In contrast to conventional medical treatments,
patients themselves exercise their own preference in
choice of complementary therapies. However, there may
be possible side-effects to any therapy, and when intro-
ducing complementary therapy into nursing practice
careful guidelines are required. There is little research to
date on the effectiveness, safety and costs associated with
usage of complementary therapies because of the lack of
clarity about individual patient preferences and profes-
sional lack of knowledge surrounding their use. These
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WRIGHT et al. Benefits of autogenic training for people with cancer
issues are clouded by individual patient preference,
making the application of randomized clinical trials a con-
tentious issue with regard to evaluation of the efficacy of
certain complementary therapies. However, considera-
tions of efficacy and safety apply equally to the areas of
complementary and conventional treatment (Ernst 1997;
Penson 1998). For many therapies, work continues
towards developing and monitoring educational standards
and practice competencies. Therapies must be carefully
evaluated and consideration given to professional and
legal issues along with those of policy, accountability and
standards. AT is known to be a very powerful technique,
and for people with cancer the possible side-effects may
be more intense than usual. Care needs to be taken to
ensure participants ‘cancel’ (induce a small level of phys-
iological arousal) frequently when starting to learn the
technique and to ensure that participants understand the
importance of cancelling to prevent dizziness and weak-
ness. Participants in the present study were willing to
share both negative and positive experiences related to AT.
A private diary session was also held regularly to allow for
problems to be evaluated that were considered too per-
sonal for group discussion. Any difficulties were referred
to the study supervisor, Ms Crowther, with whom the
researcher maintained frequent and regular contact.
Carruthers (1979) described AT as follows: ‘AT is expe-
rienced as a pleasant relaxation technique. It is simple,
easy and requires no special practice clothing or difficult
postures. Proceeding through gentle mental exercises in
body awareness progressively involving the limbs, heart
and circulatory system, the breathing and nervous system,
almost anyone can learn to experience passive concentra-
tion, which is the essence of the autogenic state. The
ability to do this at will breaks through the vicious circle
of excessive stress whatever the origins’. AT aims to
obtain voluntary control over the involuntary nervous
system (Carruthers 1979). Through training the trainee
can easily recognize the heaviness of deep muscle relax-
ation and the warmth of vasodilatation. Therein lies the
importance of adhering to the training formulae as these
are specific formulae found by Schultz to be the most
effective for bringing about an autogenic shift to a
parasympathetic mode of function. Sensations of warmth
and heaviness allied to the induction of relaxation through
AT were experienced at different stages by individual par-
ticipants in the study. Participants were reassured of the
benefits of persevering with the training even if not ini-
tially experiencing sensations of warmth and heaviness.
All participants in the groups were feeling sensations of
warmth, heaviness and deep relaxation at the end of the
training periods.
128 © 2002 Blackwell Science Ltd, European Journal of Cancer Care, 11, 122–130
CONCLUSION
Assessing the benefits of a complementary therapy for any
individual necessitates taking a subjective evaluation, as
well as completing standard scales because each partici-
pant will prioritize his or her own individual issues related
to quality of life. Overall, participants most frequently
commented that they felt better able to cope, had
improved confidence and sense of mastery, felt more
relaxed and more in control following the AT course
(Table 2). Improved sleep for participants was the salient
benefit of AT practice and restoration of disrupted sleep
patterns was an outcome for a number of participants in
this study (Table 2). These are important elements in con-
tributing to psychological aspects of quality of life and
demonstrate how effective cognitive–behavioural nursing
interventions could potentially enhance the quality of life
for patients with cancer (Arathusik 1994).
Although pain per se was not a study variable, fear of
pain in the future may have contributed to participants’
anxiety experience. A patient who is confident in the use
of a technique to help break the pain–anxiety–tension
cycle may experience enhanced sense of control by
knowing he or she can initiate the technique rather than
relying on an outside agency (Sloman 1995). Knowledge of
the effectiveness of various cognitive and behavioural
coping strategies on pain perception and control would
assist nurses in planning and implementing effective
nursing interventions for cancer patients suffering from
pain (Arathusik 1994). Nurses are showing a clear and
increasing interest in complementary therapy, and its
introduction into nursing practice allows a truly holistic
and compassionate approach to patient care (Lewith 1996).
Although analgesic medication remains the mainstay of
treatment for cancer pain, the overall management of pain
and facilitation of comfort may be enhanced through the
use of non-invasive techniques aimed at the promotion of
physical and mental relaxation. Research shows that there
is a relationship between muscle tension, autonomic
hyperarousal, anxiety and pain (e.g. Fishman & Loscalzo
1987). Non-invasive behavioural techniques may help
people with cancer pain and related distress. Research sug-
gests that relaxation is antagonistic to anxiety (Sloman
1995; O’Boyle et al. 1998). Syrjala et al. (1995) concluded
that relaxation and imagery reduces cancer treatment-
related pain. Complementary therapies do not claim to
cure cancer but to offer additional support. Penson (1998)
commented that both palliative care and complementary
therapy are committed to a holistic approach. Behavioural
techniques such as AT can be incorporated into nursing
educational interventions with considerable implication

for improved quality of life for patients with cancer
(Arathusik 1994; Crowther 1995;Sloman 1995).
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