Autogenic therapy refers to a particular technique of mental exercises involving relaxation and autosuggestion, which aims to teach individuals to switch off the fight/flight/fight stress response at will.
Supportive care
Four randomized controlled trials and two uncontrolled trials of autogenic therapy have been carried out in cancer patients.
- Sleep: one large RCT (n=229) reports AT and progressive muscle relaxation (PMR) as equally effective in improving various sleep parameters and reducing need for sleep medication, and better than standard treatment controls.
- Anxiety and depression: An RCT (n=60) reports decreased anxiety perioperatively for breast cancer patients compared to control.
A pilot RCT (n=31) reports significant improvements in anxiety and depression (HADS) with AT added to standard care; all studies have significant methodological limitations. - Pain: An RCT (n=60) did not find differences in pain or analgesic use perioperatively for breast cancer patients, compared to control.
- Immune function: results from two small pilot RCTs are inconclusive; one (n=14) reported higher salivary immunoglobulin A levels compared with controls receiving standard care while the other (n=31) not report any effects on immune function.
Autogenic therapy has a good safety record.
Citation
Lorenc A, CAM Cancer Consortium. Autogenic therapy [online document], October 2023.
Document history
Summary first published in August 2011, authored by Helen Cooke.
Updated in May 2015 and June 2012 by Helen Cooke.
Assessed as up to date in August 2020, January 2019, February 2017 and August 2013 by Barbara Wider.
Latest update: October 2023 by Ava Lorenc.
Next update due: October 2026.
Description
Autogenic therapy refers to a particular technique of mental exercises involving relaxation and autosuggestion, which aims to teach individuals to switch off the "fight-flight stress response" at will. The term “autogenic” means generated from within. Having been taught the method, the patient is encouraged to carry out the exercises regularly as a form of self-help (Ernst 2000; Payne 2010).
Background and prevalence
Autogenic therapy dates back to the 1930s and is a form of self-hypnosis. Johannes Schultz, a German psychiatrist and neurologist, developed autogenic therapy after having observed that some patients were able to learn to put themselves in a hypnotic state by concentrating on images of heaviness and warmth and reciting a series of phrases. He believed that their state of mental health benefited from going into such a self-generated trance-like ‘autogenic’ state (BAS 2023).
Schultz’s work was further developed by Wolfgang Luthe who introduced additional elements, including organ-specific techniques and ‘intentional exercises’, which are supposed to affect the person’s emotional level. These latter elements are not generally included in standard autogenic training (Hidderley 2004).
Although prevalence data for autogenic therapy are not available, a population-based study found that 8.3% to 15.4% of cancer survivors used mind-body medicine in a 12-month period (Campo 2016)
Alleged indications
It has been claimed that autogenic therapy can be beneficial for a wide range of disorders such as high blood pressure, asthma, colitis, migraines, acute anxiety and sleep disturbances associated with stress (Hidderley 2004).
Mechanism of action
Possible mechanisms of action include cognitive, by means of its attention-focusing phrases and physiological, by means of a reduction in physiological arousal (Hidderley 2004). It has been proposed that autogenic therapy may be beneficial for people who have been diagnosed with cancer by helping them to reduce their level of stress and pain, and by assisting them to confront any fears arising from after cancer diagnosis (Kanji 2000). Although not autogenic therapy, it has been suggested similar stress management interventions in cancer may reduce chronic stress and adversity, and alter immune cell activity, which may mitigate the impact of stress early in treatment, and potentially influence disease progression and clinical outcomes (Antoni 2019).
Application and providers
Autogenic therapy in its standard form involves a series of six mental exercises. The mental exercises involve the patient focusing on (a) heaviness of the limbs, (b) warmth of the limbs, (c) regularity of the heartbeat, (d) ease of breathing, (e) warmth of the abdomen, and (f) cooling of the forehead (Hudcek 2007).
Autogenic therapy is taught over a series of eight to ten weekly sessions which last approximately sixty minutes for individual sessions and up to two hours for small group sessions. People are encouraged to practice the exercises for about 10 minutes three times a day, until they have mastered the technique and can practice when needed (BAS 2023). The technique is taught in a quiet, comfortable setting. Participants are invited to sit or recline in a relaxed position. Once taught, it has been suggested that the exercises can be used anywhere in everyday situations which might induce stress (BAS 2023).
Training for AT teachers are provided by e.g. The German Society for Medical Relaxation Methods, Hypnosis, Autogenic Training and Therapy which offers training courses and certification for practitioners and teachers. The British Autogenic Society is the professional, regulatory organisation in the UK. It offers a post graduate certificate which allows people to teach autogenic training to others.
Legal issues and cost
There is no information available regarding the legal issues of autogenic therapy from a European perspective.
Autogenic therapy is usually taught over a ten- to twelve-week period. The cost of 10 sessions depends on the provider and can vary between EUR 150-300.
Supportive care
Four randomized clinical trials of autogenic therapy have been carried out in cancer patients. (Hidderley 2004; Minowa 2013, Minowa 2014; Simeit 2004) These RCTs were summarized in one systematic review (SR; Sivero 2023) together with two uncontrolled trials (Wright 2002, Marafante 2016). As the authors did not perform a quality/risk of bias assessment and a meta-analysis, the SR does not add any additional information to the RCTs summarized below. A further uncontrolled trial of autogenic training for stress is also available (Sahdev Singh 2022).
Two of the RCTs were small pilot studies (Hidderley 2004; Minowa 2014) and two were larger RCTs (Minowa 2013; Simeit 2004). Simeit 2004 assessed the effects on sleep in cancer patients and Minowa 2013 the effects on perioperative pain and anxiety in breast cancer. All studies have considerable methodological limitations. Due to the difficulty in creating appropriate and credible placebo conditions that are not obvious to research participants, blinded studies cannot be carried out for this intervention.
The American Society of Clinical Oncology does not make any recommendations for AT for mental health, citing inconclusive evidence (Carlson 2023)
Description of included studies
Sleep
A randomised trial examining the effects of a multi-modal psychological sleep management programme for people with a variety of different cancers (n=229), found that Progressive Muscular Relaxation (n=80) and autogenic therapy (n=71) were equally effective in enhancing various sleep parameters and reducing the need for sleep medication (Simeit 2004). The control group (n=78), which received only the standard rehabilitation programme, reported no changes in the use of sleep medication. Patients in all groups improved on all scales of the quality-of-life EORTC-QLQ-30 questionnaire, with the exception of pain, which started at a low level and did not alter significantly. Limitations of this study include lack of a non-treatment control group.
Anxiety and depression
An RCT (n=60) assessed the effects of autogenic therapy on anxiety perioperatively for women with breast cancer (Minowa 2013). Results showed significant reductions in anxiety for compared to control (day 1 p=0.005; day 2 p=0.001; day 3 p=0.001). However, there was high dropout in the autogenic therapy group.
A pilot randomised study (n=31) assessed the effects of autogenic therapy on the psychological status and immune system responses over a two-month period in women with early-stage breast cancer who had undergone a lumpectomy (Hidderley 2004). Women receiving autogenic therapy in addition to home visit showed a statistically significant improvement in the Hospital Anxiety and Depression Scale (HADS) score (inter-group difference: anxiety p=0.0027, depression p=0.0001) compared to those receiving only a home visit. Limitations of this study include the small sample size and subjective evaluation of the participants’ meditative state.
The three uncontrolled trials all report positive findings for psychological health outcomes such as stress (Sahdev Singh 2022; n=60), anxiety (Marafante 2016; Wright 2002), sense of coping and sleep (Wright 2002), stress and depression (but not fatigue) (Marafante2016). But these results are inconclusive due to lack of a control group, and two were small pilot studies (n=25; Marafante 2016) (n=35; Wright 2002), with one only reported in a conference abstract (Marafante 2016).
Pain
An RCT (n=60) assessed the effects of autogenic therapy on pain perioperatively for women with breast cancer (Minowa 2013). Results showed significant reductions in pain for the AT group pre-post, but not compared to control, and no difference in analgesic use.
Immune function
A small randomised study (n=14) investigated the effects of autogenic therapy on salivary immunoglobulin A (sIgA) in surgical patients with breast cancer (Minowa 2014). The participants were instructed to conduct autogenic therapy by themselves three times a day for seven days following surgery. SIgA levels were significantly higher in the intervention group than the control (usual care) group which suggests autogenic therapy may improve immune function in breast surgery patients. Limitations include a small sample size. The authors note that surgery affects physiological function including sIgA, which may affect the reliability of the results.
The above-mentioned pilot RCT (Hidderley 2004) reported no effects on immune function.
Adverse events
There are no known adverse effects (Ernst 2008). No adverse events were reported in the studies analysed for this summary.
Contraindications
It is suggested that autogenic therapy is not suitable for children under the age of five (Payne 2010). People who are actively psychotic or with schizophrenia should refrain from putting themselves into trans-like states (Ernst 2008).
Interactions
No known interactions.
Warnings
See contraindications.
Antoni M and Dhabhar F, The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer, 2019; 125: 1417-1431.
British Autogenic Society website, accessed 4th October 2023.
Campo R, Leniek K, Gaylord-Scott N. et al. Weathering the seasons of cancer survivorship: mind-body therapy use and reported reasons and outcomes by stages of cancer survivorship. Support Care Cancer 2016; 24: 3783–3791
Carlson L, Ismaila N, Addington E, Asher G, Atreya C et al. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology–ASCO Guideline. Journal of Clinical Oncology, 2023; 41:28:4562-4591
DGAEHT, Deutsche Gesellschaft für ärztliche Entspannungsmethoden, Hypnose, autogenes Training und Therapie (German Society for Medical Relaxation Methods, Hypnosis, Autogenic Training and Therapy), accessed 4th October 2023.
Ernst E, Kanji N. Autogenic training for stress and anxiety: A systematic review. Complement Ther Med 2000; 8(2): 106-110.
Ernst E, Pittler M, Wider B and Boddy K. Oxford. Handbook of Complementary Medicine. Oxford: Oxford University Press, 2008.
Gansler T, Kaw C, Crammer C, Smith T. A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer 2008; 113(5): 1048-57.
Hidderley M, Holt M. A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses. Eur J Oncol Nurs 2004; 8(1): 61-5.
Hudacek KD. A review of the effects of hypnosis on the immune system in breast cancer patients: a brief communication. Int J Clin Exp Hypn 2007; 55(4):411-25.
Kanji N. Management of pain through autogenic training. Complement Ther Nurs Midwifery 2000; 6(3): 143-8.
Marafante G, Bidin L, Seghini P, Cavanna L N08 - Mood and distress in cancer patients after Autogenic Training (AT): a pilot study in an Italian Oncologic Unit Annals of Oncology. 2016; 27 S4: iv93
Minowa C, Koitabashi K. Effects of Autogenic Training on Perioperative Anxiety and Pain in Breast Cancer Patients: A Randomized Controlled Trial. Kitakanto Med Jour 2013; 63: 1-11
Minowa C, Koitabashi K. The effect of autogenic training on salivary immunoglobulin A in surgical patients with breast cancer: a randomized pilot trial. Complement Ther Clin Pract 2014; 20(4): 193-6.
Payne, R and Donaghy, M. Fourth Edition. Payne’s Handbook of Relaxation Techniques: a practical guide for the health care professional. London: Churchill Livingstone, Elsevier, 2010.
Sahdev Singh VV, Premavathy R. Assess the effectiveness of autogenic training exercise on stress among cancer patients. Int J Community Med Public Health 2022;9:2970-3.
Simeit R, Deck R and Conta-Marx B. Sleep management training for cancer patients with insomnia. Supp Care Cancer 2004; (3): 176-83.
Sivero S, Maldonato N, Chini A, Maione R, Vitale R, Volpe S, Siciliano S, Bottone M,Sivero L. Evaluation of the effect of autogenic training as psychological support to patients operated for cancer: a systematic review. Chirurgia 2023;36(1): 34-7
Wright S, Courtney, U, Crowther, D. A quantitative and qualitative pilot study for the perceived benefits of autogenic training for a group of people with cancer. Eur J Cancer Care 2002; 11(2): 122-130.
