A Mind-Body Approach to the Treatment of Fibromyalgia
Autogenic Training: A Mind-Body Approach to the Treatment of Fibromyalgia and Chronic Pain Syndrome
by Micah R. Sadigh, PhD
Haworth Medical Press, 10 Alice Street, Binghamton, New York 13904 USA
Mind-body therapies in the treatment of illnesses such as fibromyalgia will often raise the defenses of patients. Many perceive such therapies as just another way of saying that the illness is all in their heads. Micah R. Sadigh, PhD, in his book Autogenic Training: A Mind-Body Approach to the Treatment of Fibromyalgia and Chronic Pain Syndrome offers such a clear and concise explanation for this intricate connection, that it may go far in overcoming such resistance.
Softcover, 200 pp., 2001, $24.95
Utilizing a review of literature, the book begins with an examination of the fibromyalgia syndrome. It is estimated that six million Americans suffer from this illness. Historically, the illness can be traced back to 1850 when reports in Germany described a peculiar musculoskeletal condition they called "hard muscles." Since that time, many names have been given to the condition and there have been many explanations of its etiology.
When the author examines the psychiatric labels often attributed to those with fibromyalgia and chronic pain, we find they are actually clues to a greater understanding of the illness. Though symptoms of depression and anxiety are prevalent in these patients, most patients do not have a psychiatric diagnosis. Studies suggest the explanation is more likely that living with a chronic condition and the inability to conquer the pain would promote the depression and anxiety. And the fibromyalgia personality, defined as perfectionistic, driven and highly ambitious, may actually indicate an exhaustion of biochemical resources that may contribute to the syndrome.
Sleep disturbance is a common complaint of people with fibromyalgia. In one study it was found that depriving people of delta (deep) sleep resulted in increased muscle stiffness and aching in normal volunteers. The biochemical changes during delta sleep are not fully understood but serotonin appears to play a role. This takes on meaning when we learn that fibromyalgia patients have lower levels of this neurotransmitter and have been known to respond well to antidepressants that increase serotonin levels in the brain.
At the conclusion of the literature review, Sadigh suggests that fibromyalgia is not really an illness limited to the musculoskeletal system as it is so often treated, rather it is more likely a systemic phenomenon. He suggests a reconceptualization of the illness as a system-wide state of psychobiological disregulation. The author contends that when the regulatory mechanisms of the body are re-established, the patient will achieve a state of order that will finally give relief of symptoms.
Autogenic training fits into this model as it was founded on the premise that the body maintains within itself a mechanism for achieving balance -- or homeostasis. And that mechanism is activated during the sleep process.
Though not as well known in the US as it is in Europe and Japan, the history of this therapy goes back to the late 1800s. A prominent neuropsychiatrist of the time, Oskar Vogt, studied mind-body medicine through research in hypnosis, hypnoanalysis and especially sleep and the possibility of utilizing its recuperative powers. By the early 1900s another physician, Heinrich Schultz, expanded on Vogt's work and developed autogenic therapy, which is defined as a self-generated process of repair and healing by achieving a relaxed state similar to that which we experience just prior to sleep.
The process for achieving the recuperative state is for the patient to learn very specific phrases, called formulas, and repeat them to induce sensations of heaviness and warmth of the extremities; a calm heart beat; regular breathing; abdominal warmth; and a cool forehead. After some practice, the patient will be able to shift from a stressed and active state to a relaxed state of repair and recovery. The patient would learn to do this under the guidance of a practitioner but with the goal of learning to achieve that state independently at home.
One of the principal elements of the autogenic process is the need for the patient to achieve and maintain what is called passive concentration. This is a state of detachment and indifference to the outcome that may result from the repetition of the phrases. Many may find this contrary to other forms of relaxation therapies where the focus on achieving certain goals is desired. And for those who have found goal oriented relaxation techniques just another source of stress, the autogenic process and its passive concentration may be more promising.
This book was written primarily as a training manual for practitioners. The author offers several cautions for those seeking to incorporate this therapy into their practice. First, the autogenic training should only be part of a multidisciplinary approach to treating illnesses. He lists the diseases that must be under control before a patient can embark on this therapy, such as diabetes, thyroid and asthma. There are also several psychological illnesses that if present, must be monitored by a physician or mental health professional while practicing autogenic training.
Avery detailed step-by-step guide is included. This section should not only provide the practitioner with a thorough understanding of the autogenic process, but also warns of the difficulties one could expect during each exercise and suggestions for overcoming them.
Autogenic Training has much to recommend it. Micah Sadigh, PhD has written a book that offers a promising treatment for a difficult to manage illness and it is a book that is so skillfully written it is a joy to read.
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