1. the psychiatric illness iceberg  psychiatric inpatients 0.6%  mental illness services 2.4%  conspicuous psychiatric morbidity 10.2%  recognised morbidity amongst GP attenders 23%  whole community 26 - 31.5% psychiatric morbidity rates per year in the UK: Shah A The burden of psychiatric disorder in primary care International Review of Psychiatry 1992;4:243-50

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

3. relaxation research meta-analysis  29 prospective randomised controlled trials of PMR published between 1981 and 1992  1,206 subjects; males =females; average age 18 to 74 years  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

4. relaxation meta-analysis results  number of sessions: it seems that about 12 sessions over 12 weeks is necessary for optimal results  audiotapes: studies that provided practice tapes obtained stronger effects than those that did not  maintenance of improvement: benefits tended to increase between conclusion & follow-up “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”

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

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

7. progress chart – autogenic group 11.99 weeks problem severity 09183 61215 problem severity 18.6 (12-25) average score on Beck Anxiety Inventory 0-7 minimal; 8-15 mild; 16-25 moderate 9.2 (2-19) (6-37) 17.0 (5-11) 7.4 average score on Beck Depression Inventory 0-9 normal; 10-18 mild; 19-29 mod/severe BDI – 57% BAI – 51% 7.4 (4-9) 3.2 (2-4) SSS – 57% Symptom Severity Scale – trouble in last week 0=not at all; 10=couldn’t be worse

8. progress chart – autogenic group 02.00 weeks problem severity 09183 61215 problem severity 6.9 (1-12) average score on Beck Anxiety Inventory 0-7 minimal; 8-15 mild; 16-25 moderate 4.9 (0-9) (3-27) 10.7 (1-18) 5.5 average score on Beck Depression Inventory 0-9 normal; 10-18 mild; 19-29 mod/severe BDI – 49% BAI – 29% 6.6 (3.5-8) 4.0 (0-7) SSS – 40% Symptom Severity Scale – trouble in last week 0=not at all; 10=couldn’t be worse

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

10. medium term effects of relaxation  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  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  blood pressure, plasma noradrenaline & sympathetic outflow lowering: Blanchard EB Biofeedback treatments of essential hypertension Biofeedback & Self-Reg 1990;15:209-28  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  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

11. the learning circle of experience genuine, personal experience observation and reflection time testing implications in new situations forming ideas & generalizations Kurt Lewin’s model of experiential learning 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