1996-Krampen-EP-00061280-199612000-00001_1_

EuropeanPsychologist

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Evaluation of the Effectivenessof Autogenic Training inGerontopsychologyIts Role in Developmental Intervention and Its Effectson Development-Related Cognitions and Emotionsas well as Psychosomatic Complaints in the ElderlyGiinter KrampenUniversity of Trier, Germany

This paper presents the results of two studies on the promotion of person-al self-regulation of development, personal control over development anddevelopment-related emotions as well as generalized locus of control andpsychosomatic well-being in the elderly using autogenic training (AT),a psychophysiological self-control method using self-inductions of phys-ical and mental relaxation. Subjects were 120 adults aged 66-80 years.Study I had a randomized cross-over design with a waiting list group;Study II had a randomized cross-over design comparing the effects ofintroductory courses on autogenic training and of a general health edu-cation program. Each program phase continued for 8 weeks, with one

small group meeting per week. Tests were conducted in both studies beforeprogram start, during mid-program, after total program, and 6 monthsafter the end of the program. Data were gathered on development-relatedemotions, personal control over development, personal self-regulation ofdevelopment, psychosomatic complaints, and generalized locus of con-trol. The results point towards short-term as well as long-term effects ofautogenic training on these variables. Possible applications of autogenictraining in gerontopsychology are discussed as well as its role in devel-opmental intervention and its references to the action-theory orientedperspective in developmental psychology.

Keywords: Autogenic training, Treatment effectiveness evaluation, Developmental intervention, Internal external locus of control, Gerontopsychology.

To date, most empirical work on the effectiveness ofautogenic training as well as on its theoretical founda-tions in psychophysiology, learning theory, and behav-ior modification has been done with reference to its ap-plications in clinical and medical psychology (e.g.,Krampen, 1992 a; Luthe, 1969-1973). Only a few studieshave included applications in educational psychologyand industrial psychology, focusing for the most part onclinically relevant aspects in these domains (i. e., the re-duction of test anxiety or stress reactions, or the promo-tion of coping behavior; e. g., Krampen, 1992 a; Snider &Oetting, 1966). However, while the treatment effective-ness of autogenic training is confirmed by those studies(at least as an effective additional treatment techniqueaccompanying other methods), most of them remainEuropean Psychologist, Vol. 1, No. 4, December 1996, pp. 243-254 1996 Hogrefe & Huber Publishers

purely pragmatic and symptom-oriented, i. e., withoutdifferentiated reference to a psychological theory (Gor-ton, 1959; Pikoff, 1984). Even worse, up until now, thereare no conceptually sound nor empirically well-found-ed applications of autogenic training in applied devel-

Gunter Krampen is Professor in the Department of Psychology at theUniversity of Trier, Germany, and at the Institut Superieur d'Etudes etde Recherches Pedagogiques at Walferdange, Luxembourg. His mainareas of research are developmental psychology, personality re-search, educational psychology, social psychology, and selected top-ics of clinical psychology.

Correspondence concerning this, article should be~addressed to Gun-ter Krampen, University of Trier, Department of Psychology, D-54286Trier, Federal Republic of Germany, (tel +49 651 2012967 or +49651 38323, fax +49 651 309915, e-mail [email protected]).

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opmental psychology: Its utility as a developmental in-tervention has rarely been tested, either conceptuallynor empirically. This is astonishing in view of the clearand differentiated relationships of autogenic training tothe concept of developmental intervention and the ac-tion-theory oriented approach to human developmentin adulthood as well.

Three historical merits of Johannes H. Schultz, the founder ofautogenic training, must be considered when speaking of the de-velopment of modern psychological treatment methods. (1) Veryearly on in the 1920s he dismissed the heterosuggestive (di-rective) treatment strategy in favor of an approach focusing on theindividual's competencies and capabilities to actively regulatehis/her own development,behavior, and experience (Schultz, 1926,1970). Therefore, autogenic training has since been termed an auto-suggestive self-help technique. (2) From the beginning Schultz wasengaged in empirical studies (for the most part single-case reports,but also some group studies), which analyzed the applicability andthe effects of autogenic training not only in clinical samples, but inhealthy persons, too together with preventive treatment indica-tions. (3) This early research was conducted in group settings. Thus,autogenic training is historically one of the first if not the first psychological group treatment approach that aimed at preventiveoutcomes concerning the improvement of personal self-regulationcompetencies.

Autogenic training is defined as a psychophysiological self-control technique aiming at physical and mental relaxation (seee. g., Pikoff, 1984; Schultz & Luthe, 1969). It uses auto-suggestionsby which individuals learn to alter certain psychophysiologicalfunctions with, initially, minimal intervention by another personand, after the technique is learned, with no intervention by anotherperson. The individual learns postural and cognitive skills. In arelaxed sitting position (for technical details see below: Study I Procedure) the training uses seven short verbal standard formulas,emphasizing feelings of (1) general peace, (2) heaviness in thelimbs, (3) peripheral warmth, (4) respiratory regularity, (5) cardiacregularity, (6) abdominal warmth, and (7) coolness of the forehead.The formulas are introduced in this sequence, each one being prac-ticed in the introductory course group and alone at home until theintended effect is observed. Mastery of all formulas requires dailytraining for several weeks (at least 2 months). Once learned, auto-genic exercises provide not only relief from psychosomatic com-plaints and disorders, but should also become part of a daily relax-ation routine. Individuals use the exercises as a coping device inanticipation of and during stress as well as a self-management tech-nique for relaxation and recuperation: "In its most complete form,then, autogenic training represents the fusion of physiological, cog-nitive, and behavioral elements into what for some becomes a life-long method of emotional and physical self-control" (Pikoff, 1984,p. 622). The specific treatment objectives of autogenic training referto (1) the promotion of the person's capabilities to relax and to rest,(2) the reduction of overwhelming negative affects, (3) the reduc-tion of nervousness, (4) the promotion of performance (e. g., selec-tive attention and memory recall), (5) the self-regulation of auton-omous nervous system processes (like heart rate and body temper-ature), and (6) the promotion of self-control and self-actualizationthrough enhanced self-perception and self-regulation (see, e.g.,Krampen, 1992a; Schultz & Luthe, 1969; Pikoff, 1984).

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With its focus on primary prevention and competencedevelopment, autogenic training shows a priori markedcommon features with the concept and methods of de-velopmental intervention (e.g., Danish, 1981; Danish,Smyer, & Nowak, 1980). Whenever autogenic trainingtakes into account the developmental status and possi-bilities of the participants, and whenever it is conceptu-alized with reference to a theory of human develop-ment, it effectively becomes developmental interven-tion. Up until now, most existing, empirically evaluateddevelopmental intervention programs in gerontopsy-chology have focused on the enhancement of compe-tence in specific behavioral domains (e. g., cognitiveskills: Baltes & Willis, 1982; self-assertiveness: Hudson,1983; coping behavior: Danish, D'Augelli, & Hauer,1981). These programs are based on theories of humandevelopment which refer to the specific behavior andattitude domain found in the program. In contrast toexisting programs, the development-related treatmentobjectives of autogenic training refer to the promotionof more general self-regulatory competencies and self-efficacy as well as development-related emotions, cog-nitions, and efforts.

These variables development-related emotions,cognitions, and efforts are central concepts of action-theory-oriented, constructivistic approaches to humandevelopment (e.g., Brandtstadter, 1984, 1989; Brandt-stadter, Krampen, & Heil, 1986; Lerner & Busch-Ross-nagel, 1981). This theoretical orientation is based on thepremise that the individual is not simply a passive sub-ject of developmental changes, but rather actively triesto influence and to gain control of development and ag-ing. Therefore, the action perspective on life-span devel-opment focuses on (1) the development-related emo-tions of the person (his/her affective future outlook andautobiographical retrospect) and (2) the person's effortsactively to regulate his/her own development. In accor-dance with action theory, both variables are conceptual-ized within this approach as dependent on both subjec-tive evaluations of developmental goals and subjectiveself-efficacy beliefs (e.g., Bandura, 1981, 1989). Of cen-tral relevance is the concept of personal control over de-velopment, which is defined as the expectancy of theperson with regard to his/her possibilities to controland to regulate his/her own development (Brandt-stadter et al., 1986). Implications of this theoretical per-spective for developmental interventions include theobjectives of enhancing the self-regulation competenciesof the individual, strengthening his/her personal con-trol over development, optimizing his/her develop-ment-related emotions, and promoting his/her personal

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Evaluation of the Effectiveness of Autogenic Training in Gerontopsychology

self-regulation of development. These developmentalobjectives correspond to the treatment objectives ofautogenic training: the promotion of a person's capabil-ities of self-regulation and self-help.

Thus, autogenic training can be considered a formof developmental intervention. Moreover, as an inter-ventional method, it preceded the action and self-effica-cy perspective in life-span developmental psychologyby at least five decades. Yet, there is little empirical re-search regarding the relevance of autogenic training indevelopmental interventions. At most, some resultspoint towards the impact of autogenic training on theenhancement of generalized internal locus of controland self-concept as well as the indicative relevance ofthese variables for the effectiveness of autogenic train-ing (e. g., Johnson, 1976; Krampen, 1991 a; Krampen &Ohm, 1985). But these results refer directly neither todevelopment-related emotions, personal control overdevelopment, and self-regulation of development nor togerontopsychology. Therefore, the two studies present-ed below empirically test the conceptual compatibilityof autogenic training as a developmental interventionwithin the action-theory approach to human develop-ment. It is hypothesized that autogenic training im-proves prospective development-related emotions bydecreasing a person's depressive-resignative outlookand increasing his/her optimistic-active outlook towardown personal future. As well, personal control over de-velopment and self-regulation of development are im-proved. With reference to the specific treatment objec-tives of autogenic training, it is expected that psychoso-matic complaints as well as externality in generalizedlocus of control beliefs will be reduced and internality ingeneralized locus of control improved upon learningautogenic training.

Study I: Effectiveness of AutogenicTraining in the ElderlyMethod

Subjects. The participants of Study I were 60 Germanadults (M = 73.6, SD = 5.3 years; age range: 67-80 years;39 females and 21 males) who were receiving no psychi-atric or psychotherapeutic treatment and who lived intheir own houses or apartments. Regarding former oc-cupational status and level of education, subjects be-longed to the middle-class. They were recruited by theannouncement of introductory courses on "autogenictraining" within a community service program. The

European Psychologist, Vol. 1, No. 4, December 1996, pp. 243-254 1996 Hogrefe & Huber Publishers

courses were announced with preventive treatment ob-jectives for the healthy elderly in an institution for openadult education.

Measures. Data were collected before program start, atmidpoint, and at the end of the program as well as 6months after the program was over. The measures usedincluded (1) the "Scales for the Measurement of Prospec-tive Development-Related Emotions" (EM-P; Brandt-stadter et al., 1986), a German adjective list measuringpersonal depressive-resignative and optimistic-activefuture outlook via ratings of 13 different facets of posi-tive or negative emotional attitudes towards personaldevelopment over the next two years of life (e. g., "WhenI think of the coming two years in my life, I feel discour-aged; . . . I feel depressed;... I feel venturesome;... I feelhopeful"; internal consistency r > .81). (2) The "Scalesfor the Measurement of Personal Developmental Con-trol" (P-CON; Brandtstadter et al., 1986), a Germanquestionnaire measuring subjective evaluation of 20 de-velopmental goals and the expectancies about one's per-sonal impact on the attainment of these goals. Goal eval-uations and control expectancies are aggregated into anindicator of (weighted) internal developmental controlbeliefs (see Brandtstadter et al., 1986; internal consisten-cy in the present sample: r(f > .79). (3) The German ver-sion of "IPC Scales" (Krampen, 1981) of Levenson (1974)measuring generalized internality (I), powerful others'control (P), and chance control (C) in locus of control ofreinforcement; internal consistency rtt > .75. (4) The"Symptom Checklist for Autogenic Training" (AT-SYM;Krampen, 1991 b), a German symptom checklist includ-ing four-point rating scales of 48 mainly psychosomaticcomplaints with indicative relevance for autogenictraining; internal consistency rff > .91. Test-retest reliabil-ity and validity of all scales used were confirmed in test-construction studies (see Brandtstadter et al., 1986;Krampen, 1981,1991b).

Procedure. After randomization and pretest, the subjectsof Group 1 (n - 30) participated in two separate intro-ductory courses on autogenic training (15 participantsper course, one group-meeting per week for 8 weeks);the subjects of Group 1(n- 30) were the waiting controlgroup. After 8 weeks Group 2 became the treatmentgroup (in two separate AT-courses), and group sessionsin Group 1 stopped.

Autogenic training was imparted to the partici-pants of all (four) courses in the same way, using stand-ard procedure and formulas (see Schultz & Luthe, 1969):After exercise of the "simple sitting posture" (which was

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preferred to the horizontal training posture and the re-clining chair posture because of its higher practical val-ue), closure of eyes, and passive concentration (imply-ing a casual and functional passivity toward the intend-ed functional changes), and the technique of comingback to normal (flexing arms vigorously, breathingdeeply, opening eyes), the standard exercises of auto-genic training were introduced and trained. Two formu-las were introduced in each group meeting after an in-troductory discussion with the participants. The mentalstandard exercises refer to auto-suggestions of thestandard formulas (a) "I am at peace" - "Peace," (b) "Myright/left arm is heavy" - "Heaviness" (the dominantarm was selected), (c) "My right/left arm is warm" -"Warmth," (d) "Breathing calm and regular" - "Itbreathes me," (e) "Heartbeat calm and regular," (f) "Mysolar plexus is warm," and (g) "My forehead is cool."Participants were trained to practice passive concentra-tion and "mental contact with the part of the body indi-cated by the formula (e. g., the right arm), and mainte-nance of a steady flow of a film-like (verbal, acoustic orvisual) representation of the autogenic formula in themind" (Schultz & Luthe, 1969, p. 15). Thus, from a psy-chophysiological point of view, the stage is set for relax-ation and self-regulation during autogenic exercises bythe reduction of extero- and proprioceptive stimulation,and by the verbal content of the formula implying thatthe relevant psychophysiological system works auto-matically. Participants practiced the learned autogenicexercises alone at least twice daily.

Data were collected in both groups on all variablesbefore (pretest) and after (first posttest) the programstart in Group 1. After the first 8 weeks, Group 2 becamethe treatment group, and Group 1 did not receive fur-ther treatment. Following the treatment of Group 2, asecond posttest was performed in both groups on allvariables. In addition, a follow-up was carried out on allevaluative variables 6 months after the end of the entireprogram for both groups. Furthermore, the "Follow-upInventory for Autogenic Training" (AT-KATAM; Kram-pen, 1991 b) was included in the follow-up, measuringattitudes towards autogenic training, general well-be-ing, the frequency of autogenic exercises in everydaylife, and the subjective effectiveness of the differentautogenic formulas.

Results

Mean comparisons for all pretest variables indicatedthat the randomization procedure resulted in compara-ble groups ((58) < 1.43). There were four dropouts in

246

Group 1 and three dropouts in Group 2 during the train-ing program. All dropouts were due to acute physicaldisorders and the need for hospitalization. Thus, theevaluative results presented here are based on a total of53 participants. Means and standard deviations for pre-test, posttests, and follow-up measures are summarizedfor both experimental groups in Table 1.

A multivariate analysis of variance (MANOVA)with the factor Groups (1,2) and the repeated measure-ment factor Time (1,4) was computed, including all sev-en measures. Single mean comparisons between groupsand times of measurement were computed by univari-ate analyses of variance (resulting in estimates of effectsize d; Cohen, 1977) and validated by a posteriori tests(Duncan procedure). Significant results are presentedgraphically in terms of standardized T-scores (see Fig-ures 1-6).

MANOVA yielded significant main effects for thegrouping factor (F(7, 45) = 5.06, p < .01), the repeatedmeasurement factor (F(21,31) = 7.69, p < .01), and a sig-nificant interaction between Group and Time (F(21, 31)= 8.05, p < .01). Single mean comparisons betweengroups (treatment versus control group) for the firstposttest showed (1) significantly higher scores in active-optimistic future outlook (p < .01, effect size d = .82) andsignificantly lower scores in depressive development-

60 -i

58-

56-

54-bo3 5 2 -

50-

48-

Pretest 1st Posttest 2nd Posttest Follow-up

Figure 1Depressive future outlook at pretest, posttests and follow-up in Experimental Group 1 and Experimental Group 2(Study I).

European Psychologist, Vol. 1, No. 4, December 1996, pp. 243-254 1996 Hogrefe & Huber Publishers

Evaluation of the Effectiveness of Autogenic Training in Gerontopsychology

Table 1Means and standard deviations of dependent variables in Experimental Group 1 (n = 26) and Experimental Group 2 (n= 27) in Study I.

VariablePretest

M SDFirst posttestM SD

Second posttestM SD

Follow-upM SD

Depressive future outlookGroup 1Group 2

Optimistic-active future outlookGroup 1Group 2

Personal control over developmentGroup 1Group 2

Internality (IPC-I)Group 1Group 2

Powerful others control (IPC-P)Group 1Group 2

Chance control (IPC-C)Group 1Group 2

Psychosomatic complaints (AT-SYM)Group 1Group 2

8.28.0

22.021.8

154.1150.4

29.230.0

27.326.9

30.530.3

56.357.2

5.35.8

5.14.9

44.246.0

4.84.1

3.94.1

4.94.7

18.419.2

6.48.1

26.122.0

173.5149.7

33.829.8

28.127.4

25.729.9

35.857.3

5.45.7

4.95.1

43.047.3

4.94.2

4.14.1

4.94.6

17.919.0

6.56.7

26.327.2

175.6178.1

33.934.0

27.727.9

25.224.1

35.235.4

4.94.7

5.04.9

45.246.5

4.44.3

4.04.0

5.04.8

17.818.5

5.75.4

28.127.9

189.4188.3

34.534.2

26.927.4

24.924.7

32.133.3

5.05.4

5.15.1

44.345.2

4.14.3

4.04.1

4.84.9

17.617.8

60-i

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52-an]

5 4 8 -C3

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4 2 -

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60-i

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| Group 2^ ^

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m 1 54~ 1 52-B 3 50-H - 48-H 8 46-^ B g 44-^ H 42-

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iiipB_Pretest 1st Posttest 2nd Posttest Follow-up Pretest

Group 1

Group 2

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L-PJ

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L-P-1st Posttest 2nd Posttest Follow-up

Figure 2Optimistic-active future outlook at pretest, posttests andfollow-up in Experimental Group 1 and ExperimentalGroup 2 (Study I).

Figure 3Personal control over development at pretest, posttests andfollow-up in Experimental Group 1 and ExperimentalGroup 2 (Study I).

European Psychologist, Vol. 1, No. 4, December 1996, pp. 243-254 1996 Hogrefe & Huber Publishers 247

Gunter Krampensc

ore

s)

b"

Evaluation of the Effectiveness of Autogenic Training in Gerontopsychology

that all positive changes last for at least 6 months (p .83), the IPC Scales (r >.73), and the AT-SYM (rtt > .88). The very extensive P-CON-Scales were dropped in favor of the more econom-ical German research questionnaire "Questionnaire forthe Measurement of Development-Related Action Ef-forts" (E-REGU; Krampen, 1992 b), which assesses tenlife and behavior domains in which subjects havechanged actively over the last 6 months (e. g., "In the last6 months of my life I have actively changed somethingfor the better in the life domain of social relations"; "...of family relations"; "... of mass media consumption";"... of eating habits"; r > .64).

Procedure. After randomization and pretest, the subjectsof Group 1 (n = 30) participated in two separate intro-ductory courses on autogenic training (15 participantseach, one group-meeting per week for 8 weeks), andsubjects of Group 2 (n = 30) participated in two separatecourses of a General Health Education Program. The lat-ter program lasted for eight weeks with one group-meeting per week. It was implemented to control fornonspecific treatment factors resulting from group-meetings and related social activities (see above). Ittherefore included only simple group discussions ofgeneral health topics (i.e., diets, sleep disorders, andphysical exercise) and after short lectures was re-alized in a nondirective group leadership style. After thefirst posttest, Group 1 changed to the Health EducationProgram and Group 2 to the introductory AT-courses.Following the entire program, a second posttest was in-troduced as well as a follow-up 6 months later, includ-ing all variables and, again, the follow-up inventory AT-KATAM.

Results

Mean comparisons in all pretest-variables confirmedthat the randomization procedure resulted in compara-ble groups ((58) < 0.91). There were four dropouts ineach group during the course program and in the fol-low-up. Six participants dropped because of acute phys-ical disorders and hospitalization, and two died. Thus,evaluative results are based on a total of 52 subjects.Means and standard deviations of all variables for allpretest, posttest, and follow-up-measures are summa-rized for both experimental groups in Table 2.

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Gunter Krampen

Table 2Means and standard deviations of dependent variables in Experimental Group 1 (n = 26) and Experimental Group 2 (n= 26) in Study II.

VariableDepressive future outlook

Group 1Group 2

Optimistic-active future outlookGroup 1Group 2

PretestM

8.68.8

20.220.6

Personal self-regulation of developmentGroup 1Group 2

Internality (IPC-I)Group 1Group 2

Powerful others control (IPC-P)Group 1Group 2

Chance control (IPC-C)Group 1Group 2

0.40.5

28.629.7

29.128.9

31.631.2

Psychosomatic complaints (AT-SYM)Group 1Group 2

57.056.9

SD

5.85.7

5.15.0

0.91.0

4.14.2

4.03.9

4.95.0

17.818.9

FirstM

6.98.3

25.324.9

2.32.2

31.829.4

28.228.4

31.130.6

38.553.0

posttestSD

5.25.7

4.94.9

0.70.9

4.34.7

4.14.0

5.04.8

18.119.5

SecondM

6.07.1

26.325.4

2.72.5

33.931.7

28.327.9

32.031.5

36.739.4

posttestSD

5.25.6

5.14.8

0.80.9

4.74.1

4.54.1

4.94.9

16.517.8

Follow-upM

5.86.3

28.527.6

4.84.2

33.732.9

29.328.9

31.430.9

37.238.0

SD

5.04.9

5.15.7

0.91.0

4.34.2

4.14.0

5.04.7

17.918.4

60 -i

5 8 -

40-

6 0 -

Pretest 1st Posttest 2nd Posttest Follow-up

Figure 7Depressive future outlook at pretest, posttests and follow-up in Experimental Group 1 and Experimental Group 2(Study II).

Pretest 1st Posttest 2nd Posttest Follow-up

Figure 8Optimistic-active outlook at pretest, posttests and follow-up in Experimental Group 1 and Experimental Group 2(Study II).

250 European Psychologist, Vol. 1, No. 4, December 1996, pp. 243-254 1996 Hogrefe & Huber Publishers

Evaluation of the Effectiveness of Autogenic Training in Gerontopsychology

30Pretest lstPosttest 2ndPosttest Follow-up

Figure 9Personal self-regulation of development at pretest, post-tests and follow-up in Experimental Group 1 and Experi-mental Group 2 (Study II).

E'a

oo

a

o

Group 1

Group 2

Pretest lstPosttest 2nd Posttest Follow-up

Figure 11Psychosomatic complaints at pretest, posttests and follow-up in Experimental Group 1 and Experimental Group 2(Study II).

Pretest 1 st Posttest 2nd Posttest Follow-up

Figure 10Internality at pretest, posttests and follow-up in Experimen-tal Group 1 and Experimental Group 2 (Study II).

A multivariate analysis of variance (MANOVA)with the factor Groups (1,2) and the repeated measure-ment factor Time (1,4) was computed including all sev-en measures. Again, single mean comparisons betweengroups and times of measurement were computed byunivariate analyses of variance (resulting in estimates ofeffect size d; Cohen, 1977) and validated by a posterioritests (Duncan procedure). Significant results are pre-sented graphically in terms of standardized T-scores (seeFigures 7-11).

MANOVA yielded significant main effects for thegrouping factor (F(7, 44) = 4.19, p < .01), the repeatedmeasurement factor (F(21,30) = 5.45, p < .01), and a sig-nificant interaction between Group and Time (F(21, 30)= 5.64, p < .01). Single mean comparisons for time andbetween groups for the first treatment part (i. e., AT in-troduction versus Health Education Program participa-tion) showed the following results (see Table 2 and Fig-ures 7-11):1) Positive effects of both treatments (AT and Health Ed-

ucation Program) leading to an increase of optimistic-active future outlook (Group 1: p < .01, d = 1.02; Group2: p < .01, d = .86; between groups: p > .10) and of

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Gunter Krampen

personal self-regulation of development (Group 1: p .10). As indicated, these effects proved to be sig-nificant in time comparisons for both treatmentgroups, but not to be significant in between-groupcomparisons. Thus, with reference to these two vari-ables, both treatments show similar effects for twocentral variables of the action-theory approach to de-velopment.

2) Specific positive effects of the autogenic training inthe reduction of psychosomatic complaints (betweengroups: p < .01, d - .77; within group 1: p < .01, d =1.03), in the reduction of depressive future outlook(between groups: p < .01; within group 1: p < .05, d =.31), and in the increase of generalized internality inlocus of control (between groups: p < .01, d = .53; with-in group 1: p < .01, d = .77)). As indicated, these specificeffects of autogenic training are significant with refer-ence to pretest-first posttest comparisons for Group 1as well as with reference to between-group compari-sons for the first posttest data.

3) There were no specific positive effects of the HealthEducation Program implemented in Group 2 (be-tween groups: p > .10; within group 2: p > .10).

4) There were no treatment effects neither in the be-tween- (p > .10) nor in the within-group comparisons(p > .10) for powerful other's control and chancecontrol in generalized locus of control beliefs.

The results found for the (second) posttest data (collect-ed after the total program) indicate cumulative effects ofthe two treatment elements, an increasing tendency be-ing observed for all described positive changes (see Ta-ble 2 and Figures 7-11). The results show some advan-tages for Group 1, which participated first in the AT-in-troduction and then in the Health Education Program(pretest-second posttest comparisons for Group 1: p