By following specific requirements established by the pioneers in autogenic training, patients can achieve a state of reduced environ- mental stimulation without needing a flotation tank or an isolation chamber. First, at least during the initial phases of training, patients need to find themselves a quiet room (as noise free as possible) where they will not be disturbed for at least twenty to thirty minutes, the
length of a standard exercise. They may use a sign on the door, if nec- essary, to inform others that they do no wish to be disturbed. It is also important to close the drapes and dim the lights to the lowest possible levels and turn off phones and pagers.
Positions for Relaxation
The next step is to reduce physical stimulation by finding a posi- tion that places the least amount of tension on muscles and joints. First, patients need to be instructed to loosen all tight clothing, loosen belts, and remove shoes if necessary. Second, they need to discover a postural position that is most agreeable to them. Most people find it helpful to lie on their back on a couch or a comfortable bed. This po- sition may result in tension in the muscles of the lower back which will undoubtedly interfere with the ability to achieve the autogenic state. To remedy this, patients should be encouraged to experiment by placing pillows under their knees until their lower back muscles are in a neutral or stress-free position. The arms should be placed slightly away from the trunk in a comfortable, “unlocked” position.
Next, attention must be paid to the position of the neck. A soft pil- low may be used to place the muscles of the neck in a relaxed posi- tion. To avoid overextending or flexing the neck experiment with pillows of varying sizes. Photo 6.1 depicts a comfortable horizontal position. One of the drawbacks of this position, usually during the earlier stages of training, is that some people tend to fall asleep while practicing the exercise. To avoid this, the individual may choose one of the sitting positions.
The first sitting position (Photo 6.2) requires the use of a reclining chair with a high back and comfortable armrests that are neither too high nor too low. If the armrests of the recliner are uncomfortably po- sitioned, a possible remedy may be to use pillows or towels to dis- cover a position that is least stressful to the arms and the shoulders. Another problem with recliners is that they may place undue stress under the lower calves. Again, a soft pillow may be the solution.
Finally, the muscles of the lower back may be quite vulnerable in a reclined position because of the lower back extension that such chairs tend to promote. Pillows or rolled up towels may be used to reduce
PHOTO 6.1. The Horizontal Position
the stress on the lower back muscles. In my office I have several pil- lows that I use to make sure that the recliner fits the needs of all pa- tients. With each patient, the recliner is transformed into a custom- made chair that promises the most comfortable position. Take your time and experiment. The outcome of each training session may be significantly improved by finding out which positions work best for the patient.
Another sitting position which is of pragmatic utility is presented in Photo 6.3. To best benefit from this position, patients need to make sure that their feet are firmly placed on the floor. Next, they need to comfortably place their arms in their laps, with the palm of the hands facing down. Next, the head and the trunk may be dropped forward until a stress-free, relaxed position is achieved. Patients need to be cautioned not to place their upper body weight on their arms. If done correctly, the torso should comfortably balance the upper body’s weight. This postural position may be used at work or when neither a
bed nor a recliner is available. The position is also excellent for the abbreviated exercises which will be discussed later on.
A specific position is highly recommended for the third standard autogenic exercise, which focuses on cardiac activity. To best achieve the objectives of this exercise, the patient is asked to assume the hori- zontal position (see Photo 6.4). The next step is to comfortably place the right hand on the chest region, slightly to the left. To achieve this position with the least amount of tension, it is best to place a pillow under the right arm and elevate it slightly so that the arm is raised to the level of the chest. This position should be used for as long as nec- essary until the patient can comfortably make contact with the car- diac activity.
Finally, the horizontal position can be used effectively in the fifth standard exercise which focuses on generating warmth in the abdom- inal region. For this particular exercise, patients are asked to comfort- ably, but very lightly, place their right hand on the upper abdominal region, right below the tip of the sternum (see Photo 6.5). Again it may be helpful to place a pillow under the arm in order to minimize
PHOTO 6.4. The Horizontal Position for the Heart Exercise (Note the comfortable position of the right hand on the chest.)
any undue stress on arm. This posture can significantly expedite the objectives of the fifth exercise as will be discussed in Chapter 12.
THE SECOND REQUIREMENT: