Biofeedback, Autogenic Training, and Progressive Relaxation in the Treatment of Raynaud's Disease: A Comparative Study

Abstract

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 260 to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.DESCRIPTORS: Raynaud's Disease, progressive relaxation training, autogenic training, behavioral medicine, female patients Raynaud's Disease is a painful vasospastic disorder usually affecting the digits in the hands and feet. The etiology of the disorder in its idiopathic form is unclear and the efficacy of current surgical and pharmacologic treatments is questionable (Spittel, 1972). During a vasospastic episode the affected area goes through a three-stage color change; first blanching, then turning cyanotic blue, and finally becoming bright red as the vasospasm is relieved and reactive hyperemia ensues. Although the pathophysiology of the disease is not understood, it is widely accepted that activity of the sympathetic nervous system is a major contributing factor (Spittel, 1972).

A Comparison of Psychological and Physiological Responses to Autogenic Training and Autogenic Feedback Training: The Response of Athletes New to Autogenic Training

“…Therefore, the increase in skin temperature observed in the current study may not necessarily be an outcome of AT. In addition, previous AFT studies indicate that AFT does not increase skin temperature any more than AT (Keefe et al, 1980;Surwit et al, 1978). The results of this current study support such findings.…”

Thermal Biofeedback for Primary Raynaud’s Phenomenon: A Review of the Literature

“…Similarly, Middaugh et al (2001) reported that only 35% of TBF subjects met the study criteria for increasing finger temperature. Keefe, Surwit, and Pilon (1980), trained subjects in small groups that met for 3 one-hour sessions. Although subjects in Keefe et al's (1979) study achieved digital temperature responses after four weeks of training, results did not persist at a 9-month follow-up.…”

“…The total hours of TBF training ranged between 2 and 23.5 hours held over a 3-to 20-week period. One study (Keefe et al, 1980) adopted a group-approach to TBF training while others (Freedman & Ianni, 1983, 1988Jacobson et al, 1979;Guglielmi et al, 1982;Middaugh et al, 2001;RTS Investigators, 2000;Surwit et al, 1978;Thompson et al, 1999) used an individual approach.…”

Behavioral Approaches to Raynaud’s Disease

“…The second study of this series [Keefe et al, 1980] served as a partial replication as well as an extension of the study just described. This second study attempted to provide a more rigorous test of home biofeedback train ing by having patients on home practice regimens use more sophisticated and sensitive temperature feedback equipment than had been used in the prior study.…”