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Conditioned relaxation in a case of ulcerative colitis
1X05-7908/78/OWl-0283
J. Behov. Thu. & Exp. Psvchrar. Vol. 9, p. 283. Perpmon Press Ltd.. 1978 PrInted m Great Brnain
CONDITIONED
RELAXATION
IN A CASE OF ULCERATIVE
GERHARD
$02.00/O
COLITIS
R. SUSEN
Summary-A case of ulcerative colitis was treated by conditioned relaxation of the abdopinal area. In the course of three months symptoms subsided and had not recurred after a period of one year. At this point, the client was instructed to interrupt as often as possible whatever she might be doing, and to spend a few minutes to induce abdominal relaxation. In the following three weeks there were some occasions on which the pain was reduced by this practice. By the fifth week the attempt to relax almost always succeeded in reducing the pain. From this time onwards, at the perception of pain the client was to think of and induce abdominal relaxation and then to continue her ongoing activity. During this period, pain-free hours and, later, days were noted. The beginning of the pain served as a stimulus for immediate relaxation. The duration and intensity of the pain decreased steadily and after the twelfth week both disappeared completely. At a follow-up one year later there had been no recurrence. Although emotional factors have long been regarded as having a role in at least some cases of ulcerative colitis, e.g. Isselbacher (1976), the effects of conventional psychotherapy have been notoriously unimpressive. The wellknown tendency of the illness to remissions and exacerbations must make one.cautious in interpreting a causeeffect relation from the findings in a single case. However, the absence of prolonged remissions during the four years before the treatment started in the present case, does suggest that it would be worthwhile trying out the relaxation treatment in other cases.
In this case the main therapeutic method consisted of the This conditioned relaxation of the visceral area. corresponds to the headache therapy of Budzynski ef al. (1973), Tasto and Hinkle (1973) and Lutker (1971).
CASE HISTORY The illness of the client had begun about four years previously when, at the age of 35, she had taken on a job as a cashier in a department store to improve her financial situation. She underestimated the difficulty of the work to which she was not accustomed and gave up after a fortnight. She then complained of deep exhaustion, pains in the abdominal area, and diarrhea. After a further fortnight she resumed that job and became slowly accustomed to it. However the symptoms persisted and were not diminished by medication. The illness followed a fluctuating course in which there were two to three month periods of pain accompanied by bloody and slimy diarrhea, separated by intervals without symptoms, which seldom lasted longer than two or three weeks. Since she had very rarely mentioned her complaints to her husband, it is improbable that his behavior had any symptom-reinforcing consequences. The client found out later that diverting activities were somewhat effective in removing attention from her pain. Therefore, after work she would do her housework, read, knit or have coffee with friends.
REFERENCES
METHOD
AND RESULTS
Budzynski T. H., Stoyva J. M., Adler C. S. and Mullaney D. J. (1973) EMG-biofeedback and tension headache: a controlled outcome study. Psychosom. Med. 35, 484-496. lsselbacher K. J. (1976)In Harrison’s Principles of Medicine (6th Ed), McGraw-Hill, New York. Luthe W. (1969) Aurogenic Therapy, Grune & Stratton, New York. Lutker E. R. (1971) Treatment of migraine headache by conditioned relaxation: a case study. Behav. Therupy 2, 592-593. Miller N. E. (1969) Learning of visceral and glandular responses. Science 163,434-445. Tasto D. L. and Hinkle J. E. (1973) Muscle relaxation treatment for tension headaches. Behuv. Rex & Thempy 11, 347-349.
Although in general it has not been definitively determined to what extent ulcerative colitis is a psychosomatic disorder, the use of conditioned relaxation seemed to be appropriate, especially since organic factors were excluded in this case. Therapy began by instructing the client in autogenic training, with special emphasis on abdominal relaxation. Daily records were made of the duration and intensity of pain on a scale of O-100. The teaching of relaxation actually began in the middle of a pain-free period that lasted two weeks. After four weeks of training the client reported that she could produce noticeable relaxation and often warmth in the abdominal area. The relaxation was at this time not associated with any reduction of pain. Requests for reprints West Germany.
should
be addressed
to Gerhard
R. Susen,
283
Diplom-Psychologe
BDP, Germaniastr.
37, 415 Krefeld,
J. Behov. Thu. & Exp. Psvchrar. Vol. 9, p. 283. Perpmon Press Ltd.. 1978 PrInted m Great Brnain
CONDITIONED
RELAXATION
IN A CASE OF ULCERATIVE
GERHARD
$02.00/O
COLITIS
R. SUSEN
Summary-A case of ulcerative colitis was treated by conditioned relaxation of the abdopinal area. In the course of three months symptoms subsided and had not recurred after a period of one year. At this point, the client was instructed to interrupt as often as possible whatever she might be doing, and to spend a few minutes to induce abdominal relaxation. In the following three weeks there were some occasions on which the pain was reduced by this practice. By the fifth week the attempt to relax almost always succeeded in reducing the pain. From this time onwards, at the perception of pain the client was to think of and induce abdominal relaxation and then to continue her ongoing activity. During this period, pain-free hours and, later, days were noted. The beginning of the pain served as a stimulus for immediate relaxation. The duration and intensity of the pain decreased steadily and after the twelfth week both disappeared completely. At a follow-up one year later there had been no recurrence. Although emotional factors have long been regarded as having a role in at least some cases of ulcerative colitis, e.g. Isselbacher (1976), the effects of conventional psychotherapy have been notoriously unimpressive. The wellknown tendency of the illness to remissions and exacerbations must make one.cautious in interpreting a causeeffect relation from the findings in a single case. However, the absence of prolonged remissions during the four years before the treatment started in the present case, does suggest that it would be worthwhile trying out the relaxation treatment in other cases.
In this case the main therapeutic method consisted of the This conditioned relaxation of the visceral area. corresponds to the headache therapy of Budzynski ef al. (1973), Tasto and Hinkle (1973) and Lutker (1971).
CASE HISTORY The illness of the client had begun about four years previously when, at the age of 35, she had taken on a job as a cashier in a department store to improve her financial situation. She underestimated the difficulty of the work to which she was not accustomed and gave up after a fortnight. She then complained of deep exhaustion, pains in the abdominal area, and diarrhea. After a further fortnight she resumed that job and became slowly accustomed to it. However the symptoms persisted and were not diminished by medication. The illness followed a fluctuating course in which there were two to three month periods of pain accompanied by bloody and slimy diarrhea, separated by intervals without symptoms, which seldom lasted longer than two or three weeks. Since she had very rarely mentioned her complaints to her husband, it is improbable that his behavior had any symptom-reinforcing consequences. The client found out later that diverting activities were somewhat effective in removing attention from her pain. Therefore, after work she would do her housework, read, knit or have coffee with friends.
REFERENCES
METHOD
AND RESULTS
Budzynski T. H., Stoyva J. M., Adler C. S. and Mullaney D. J. (1973) EMG-biofeedback and tension headache: a controlled outcome study. Psychosom. Med. 35, 484-496. lsselbacher K. J. (1976)In Harrison’s Principles of Medicine (6th Ed), McGraw-Hill, New York. Luthe W. (1969) Aurogenic Therapy, Grune & Stratton, New York. Lutker E. R. (1971) Treatment of migraine headache by conditioned relaxation: a case study. Behav. Therupy 2, 592-593. Miller N. E. (1969) Learning of visceral and glandular responses. Science 163,434-445. Tasto D. L. and Hinkle J. E. (1973) Muscle relaxation treatment for tension headaches. Behuv. Rex & Thempy 11, 347-349.
Although in general it has not been definitively determined to what extent ulcerative colitis is a psychosomatic disorder, the use of conditioned relaxation seemed to be appropriate, especially since organic factors were excluded in this case. Therapy began by instructing the client in autogenic training, with special emphasis on abdominal relaxation. Daily records were made of the duration and intensity of pain on a scale of O-100. The teaching of relaxation actually began in the middle of a pain-free period that lasted two weeks. After four weeks of training the client reported that she could produce noticeable relaxation and often warmth in the abdominal area. The relaxation was at this time not associated with any reduction of pain. Requests for reprints West Germany.
should
be addressed
to Gerhard
R. Susen,
283
Diplom-Psychologe
BDP, Germaniastr.
37, 415 Krefeld,