the psychiatric illness iceberg psychiatric morbidity rates per

the psychiatric illness iceberg psychiatric morbidity rates per year in the UK: z psychiatric inpatients 0. 6% z mental illness services 2. 4% z conspicuous psychiatric morbidity 10. 2% z recognised morbidity amongst GP attenders 23% z whole community 26 - 31. 5% Shah A The burden of psychiatric disorder in primary care International Review of Psychiatry 1992; 4: 243 -50

challenge: to respond effectively calming skills time management problem focused coping social support physical exercise

relaxation research meta-analysis v 29 prospective randomised controlled trials of PMR published between 1981 and 1992 v 1, 206 subjects; males =females; average 18 to 74 years v chronic headache & migraine (8 studies); cancer chemotherapy (6 studies); essential hypertension (5 studies); other disorders stress, depression, dysmenorrhea, low back & neck pain, menopausal flushes, immunity Carlson CR et al Efficacy of abbreviated PMR training: a quantitative review of behavioral medicine research J Consult Clin Psychol 1993; 61: 1059 -67

relaxation meta-analysis results “overall the results of this review present an encouraging picture. . . (such) methods have a strong record of efficacy and should be viewed as an experimentally sound treatment intervention … a broad-spectrum tool for treating clinical disorders related to overactivation” v number of sessions: it seems that about 12 sessions over 12 weeks is necessary for optimal results v audiotapes: studies that provided practice tapes obtained stronger effects than those that did not v maintenance of improvement: benefits tended to increase between conclusion & follow-up

autogenic & exercise training various questionnaires clinical & laboratory tests z 100 healthy participants aged 25 to 60 years z 25 women & 25 men in each group z eight weeks of training z autogenic training involved one class weekly+practice z exercise training involved two to three classes weekly z assessed by questionnaires and various clinical tests

the two trainings compared + means a statistically significant improvement ++ means a highly statistically significant improvement Carruthers M Health promotion by mental & physical training British Journal of Holistic Medicine 1984; 2: 136 -47

progress chart – autogenic group 11. 99 average score on Beck Anxiety Inventory 0 -7 minimal; 8 -15 mild; 16 -25 moderate problem severity (12 -25) BAI – 51% (6 -37) 17. 0 9. 2 (2 -19) BDI – 57% (5 -11) 7. 4 (4 -9) SSS – 57% 3. 2 (2 -4) 0 3 6 9 weeks 12 15 18 problem severity average score on Beck Depression Inventory 0 -9 normal; 10 -18 mild; 19 -29 mod/severe Symptom Severity Scale – trouble in last week 0=not at all; 10=couldn’t be worse 18. 6

progress chart – autogenic group 02. 00 average score on Beck Anxiety Inventory 0 -7 minimal; 8 -15 mild; 16 -25 moderate problem severity (3 -27) 10. 7 BDI – 49% 6. 9 (1 -12) (1 -18) 5. 5 BAI – 29% 6. 6 4. 9 (3. 5 -8) (0 -9) SSS – 40% 4. 0 (0 -7) 0 3 6 9 weeks 12 15 18 problem severity average score on Beck Depression Inventory 0 -9 normal; 10 -18 mild; 19 -29 mod/severe Symptom Severity Scale – trouble in last week 0=not at all; 10=couldn’t be worse

the importance of active coping ² Smith RE Effects of coping skills training on generalized self-efficacy and locus of control J Personal Soc Psychol 1989; 56: 228 -33 ² Keefe FJ et al Analyzing chronic low back pain: the relative contribution of pain coping strategies Pain 1990; 40: 293 -301 ² Newman S et al Patterns of coping in rheumatoid arthritis Psychology and Health 1990; 4: 187 -200 ² Holahan CJ et al Life stressors, personal & social resources, and depression: a 4 -year structural model J Abnorm Psychol 1991; 100: 31 -8 ² Affleck G Daily coping with pain from rheumatoid arthritis: patterns and correlates Pain 1992; 51: 221 -229 ² Fawzy FI et al Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence & survival 6 years later Arch Gen Psychiatry 1993; 50: 681 -689 ² Garcia L et al Psychological factors & vulnerability to psychiatric morbidity after myocardial infarction Psychother Psychosom 1994; 61: 187 -94

medium term effects of relaxation ² anxiety & panic reduction: Stetter F et al Ambulatory short-term therapy of anxiety patients with autogenic training & hypnosis. Results of treatment & 3 month follow-up Psychother Psychosom Med Psychol 1994; 44: 226 -34 ² headache improvement: ter Kuile MM et al Autogenic training and cognitive self -hypnosis for the treatment of recurrent headaches in three different subject groups Pain 1994; 58: 331 -40 ² blood pressure, plasma noradrenaline & sympathetic outflow lowering: Blanchard EB Biofeedback treatments of essential hypertension Biofeedback & Self-Reg 1990; 15: 209 -28 ² circulatory, hormonal & brain EEG effects: Jevning R et al The physiology of meditation: a review. A wakeful hypometabolic integrated response Neurosci Biobehav Rev 1992; 16: 415 -24 ² stress-related disorders helped: Carlson CR et al Efficacy of abbreviated progressive muscle relaxation training: a quantitative review of behavioral medicine research J Consult Clin Psychol 1993; 61: 1059 -67

the learning circle of experience Kurt Lewin’s model of experiential learning genuine, personal experience testing implications in new situations observation and reflection time forming ideas & generalizations note the particular importance of here-and-now concrete experience in generating and testing out ideas, and also the importance of the feedback loop in checking whether one is really on track; ineffectiveness is often due to an imbalance between active experience and reflective observation