|
Dr Paul Freedman M.D. An AT group in a day treatment centre.
This is a summary statement of a paper I wrote a number of years ago that was never published. It was based on a study performed in a day treatment center operated by the Community Mental Health Service of San Francisco. This was almost 20 years ago now, but I think the results are still relevant for practice today. I still use AT in my private practice but no longer have access to groups of patients. In the past, AT has been applied to psychotic states with extreme caution because of concern that those with weakened ego functions could be made worse by such a procedure. However, recent experience indicates that with the protection of psychotropic drugs, and with strict adherence to the basic Standard Exercise format, benefits could be obtained. This paper presents the experience of one year's operation of an AT group in a psychiatric day treatment centre. Patients were evaluated in terms of their physical and mental condition and whenever primary medical control was not possible, the person was not taken into training. The procedure was explained as an exercise in passive concentration to be practised several times daily for several months. Acutely psychotic persons frequently reported hearing voices and seeing colours, forms, or whole scenes. Those in more chronic states tended to have many motor discharge phenomena and often bizarre sensory experiences. Few had formula-related responses at first, but occasional excessive or paradoxical responses were observed. Those with disturbing or uncomfortable responses were continued in smaller group or individual sessions, using very brief periods of concentration. Progress through the six Standard Exercises was slower than with a more healthy group. Patients who were motivated and enjoyed the practise showed benefits even in the absence of formula-related responses. Gradually, those who attended and practised regularly began to experience distinct muscular relaxation, warming of the extremities, deeper respiration, and increased bowel activity. They were able to stay in the autogenic state for longer periods (up to 10 minutes) without strain, feeling relaxed and refreshed. Of the first 50 people introduced to AT, half had substantial time in practise (2-8 months) and completed the basic exercises. Improvements were most notable in those with affective disorders (7), moderate with schizophrenics (13) and were least in those with organic brain disorders (4). Benefits reported included improved sleep, greater ability to relax and to be at ease with others, feeling more energetic and less fatigued and having more enjoyment of pleasures (including eating and sex). Some described being able to turn off obsessive thoughts and preoccupations, others found that their hallucinations receded or were less insistent. Certain physical symptoms were improved, including hyperventilation, neck and shoulder pains, tooth grinding, constipation, spasms of the alimentary tract, and cravings for food, stimulants or depressants. We concluded that AT can be applied safely in major mental disorders, provided that patients are screened medically and that they are closely supervised in the early phase of training, with adequate discussion, modification when necessary, and repeated emphasis on the attitude of passive concentration - of assuming the role of "the observing ego". Despite initial disturbing manifestations, patients were generally able to increase their tolerance over these symptoms. Withdrawal, passivity and hypochondriasis were not aggravated. Some manifestations of anxiety and emotional distress responded dramatically. Anti-anxiety drug use could be reduced, but the need for anti-psychotic and anti-depressant drugs was not changed. Introducing patients to the concept and practice of self-regulation seems to produce more positive attitudes towards self and others and, consequently, more involvement in other areas of treatment. |