Humanity is now facing an unprecedented crisis with medical, psychological, economic and social aspects. The COVID-19 December 2019 outbreak in Wuhan spread rapidly to all the world (Chen et al., 2020) and by March 2020 made its full impact on Spain. Exceptional measures were taken, including the confinement of all large sectors of the population (Arango, 2020; Ozamiz-Etxebarria et al., 2020b). Severe negative effects in mental health have been reported, mainly related to fear of contagion (Ammar et al., 2020b,c; Shigemura et al., 2020) and adaptation to the confinement (Qiu et al., 2020). Psychological resources have been applied to ease this psychological impact (de Rivera, 2020; Lupe et al., 2020; Ozamiz-Etxebarria et al., 2020a), including computer-assisted distance training in relaxation (Wei et al., 2020).

In a previous experimental study, we reported the efficacy of relaxation techniques, including autogenic training, on easing COVID-19-related anxiety on young university students in the Basque Country (Ozamiz-Etxebarria et al., 2020a). Autogenic training (AT), created by Johannes Heinrich Schultz (1932) as a method of “concentrative self-relaxation,” promptly became a standard tool in European psychosomatic medicine and clinical psychology (Hoffmann, 2017). Sustained regular practice decreases stress reactivity (Henry et al., 1991), enhances emotional stability (Carruthers, 1979), reduces trait anxiety, and increases the sense of personal control (Farnè and Jimenez-Muñoz, 2000). Initially, regarded as a variant of auto-hypnosis, autogenics is now more appropriately considered a non-Buddhist meditation/mindfulness method, able to facilitate personal development and to increase resilience to stress and sturdiness in emotional crisis (Carruthers, 1979; de Rivera, 2018).

The present survey focuses on the beneficial effects of the practice of AT during the pandemic in 75 usual practitioners of autogenic training (hereafter AT) living in Spain. Specifically, we inquired about their health status during the pandemic, their COVID-19-related anxiety, and how AT practice is helping them to maintain their physical, psychological, and relational health.

We anticipated that demographic variables, such as age, gender, and geographical location (see Section “Participants”), may have a relation with our outcome variables. Other variables that we anticipated having an effect on our outcome variables are the frequency of AT practice and the AT seniority (number of months practicing AT). The outcome variables are COVID-19-related anxiety and the evaluation by the participants of the degree in which AT practice helps in their psychological, physical, and relational health.

The descriptive data of the study show a similar proportion of women (54.7%) to men (45.3%). Nearly half of them were healthcare professionals, and almost half of the sample resided in the city of Madrid. The usual frequency of AT practice, measured by the number of AT exercises per week, is 8.64 times/week on average. The recommended frequency ranges from 7 to 21 times per week, being somewhat higher during the learning period of the technique (3 times/day), whereas experienced trainees tend to practice once a day (7 times/week). As for gender differences, men tend to practice AT more times per week than women, both during normal times and during the pandemic. In addition, both women and men increased their AT practice during the pandemic, women to a greater extent.

The increase of practice during the pandemic may reflect a response to higher levels of stress and anxiety, which is concordant with the findings of Ozamiz-Etxebarria et al. (2020a) on the effects of AT on easing COVID-related anxiety in an experimental study with university students. This increase is more significant in women probably because they tend to experience higher anxiety during the pandemic (Lai et al., 2020; Liu et al., 2020).

The positive correlation between age and AT seniority may seem obvious, as older people have had more years to practice than younger ones; but it may also indicate that AT practice, once initiated, tends to become a life-long habit. The somewhat counterintuitive negative correlation found between COVID-related anxiety and age corroborates other studies showing that older people present less anxiety than younger ones during the current pandemic (Picaza Gorrochategi et al., 2020).

In terms of professions, the most significant finding is that health professionals have been practicing longer than other professionals. This is probably because health professionals have had easier access to AT and therefore may have started practicing earlier than others.

Fear of contagion has been one of the most frequent psychological reactions in the population during the current pandemic. However, the fear levels are low in our overall sample, as on a scale from 1 to 10 women rated an average of 4.20 and men an average of 5. The tendency of men to show more COVID-19-related anxiety than women is in contradistinction to a study in Cuba reporting significantly greater fear of COVID-19 in women (Broche-Pérez et al., 2020) and to several other studies showing that women have had more anxiety during the pandemic (Lai et al., 2020; Liu et al., 2020). The lower anxiety scores in women in our sample may be explained by their greater increase of AT practice during the pandemic. These low levels of COVID-related anxiety in our sample may be related to the practice of autogenic training, and effect already shown in an experimental study by Ozamiz-Etxebarria et al. (2020a).

It is interesting that most participants (88%) remained healthy during the pandemic, and only 5.3%, all from the Madrid region, became infected by the COVID-19 virus. Taking into account that the calculated prevalence of infection at the time of the study was 13.3% for the Madrid region (Metroscopia, 2020), the results of the present sample are quite optimistic and may suggest that AT may have a protective effect against virus infection.

We found that participants who remained healthy increased significantly their AT practice during the pandemic, which may indicate that increased practice has both physical and psychological health benefits.

Participants who were infected by the COVID-19 virus had the least COVID-related anxiety whereas those who became ill for other causes had the greatest. This may seem obvious, as those who had already experienced the COVID-19 infection may have felt relieved by the mild course of the illness and also protected against repeated infection, whereas those ill for other causes may have increased fear of their condition being complicated by COVID-19.

Another positive fact of the present study, which points to the benefits of AT, is that the people who have remained healthy throughout the pandemic, without contracting any type of disease, are precisely those who have been practicing AT for more years, with an AT seniority about twice those who became ill. This finding confirms previous data showing that, besides the immediate effects of the AT exercises on neurovegetative function, regular practice over a number of years permanently increases the body’s homeostatic functions and thus increases resilience to illness (Luthe and Schultz, 1970a). More recent research has shown that AT improves the immune function (Minowa and Koitabashi, 2014).

According to the participants, AT has a positive effect on their psychological and physical health and in their ability to understand others. This perception tends to be somewhat higher in women, although it does not reach statistical significance. Nor are there any statistically significant differences when comparing the psychological, physical, and relational effects in terms of professions. This leaves the question open for further studies with a larger number of participants. In terms of site of residence, it seems that people living in other regions of Spain perceive that AT is helping them more than those living in Madrid. This occurs at both psychological and physical levels, as well as in understanding others. Madrid is one of the hardest hit cities, not only by COVID-19 but also by constant changes in confinement regulations (Mucientes, 2020), which may create discouragement among its population. However, although the difference is not significant, it seems that they also tend to have less anxiety about COVID-19. Perhaps, the fact of observing so much contagion in the city diminishes the fear because the virus is better known to the people of Madrid.

Participants value AT highly as helpful in maintaining psychological health. The degree of positive evaluation of the benefits of AT correlates with the usual frequency of AT practice. This is a well-known effect of AT, and achieving emotional stability is one of the main reasons for its application in clinical psychology (Luthe and Schultz, 1970b; Hoffmann, 2017). Autogenic training has also been reported to improve psychological wellbeing in chronic medical patients (Ramirez-Garcia et al., 2020).

Participants also value AT as highly helpful in maintaining physical health. As previously, this perception correlates with the usual frequency of practice and is concordant with research showing that AT practice increases the body’s homeostatic functions and the resilience to illness (Luthe and Schultz, 1970a). Furthermore, a meta-analysis of clinical outcome studies has shown positive effects of AT for tension headache, migraine, mild-to-moderate essential hypertension, coronary heart disease, bronchial asthma, unspecified somatoform pain disorder, Raynaud’s disease, anxiety disorders, dysthymia, mild-to-moderate depression, and functional sleep disorders (Stetter and Kupper, 2002).

In terms of relating better to others, the average scores are also high, showing that AT may help to overcome the relationship difficulties associated with confinement (Brooks et al., 2020). The practice of AT is known to increase empathy and other positive personality traits, an effect called “the third autogenic switch” (de Rivera, 2018; Ross, 2020). As expected, this third autogenic switch is correlated in our sample with the frequency of practice, both in usual times and during the pandemic.

Social relationships have also been damaged during this pandemic, as strong measures of social distancing and confinement have totally changed the way people relate to each other. Isolation and loneliness have been the major relational problems of this pandemic (Brooks et al., 2020; Smith and Lim, 2020). Therefore, the perception that AT helps to understand others better is a further argument in favor of its practice.

AT seniority does not significantly influence the evaluations of the effects of AT on physical, psychological, and relational health, which may indicate that people who have been practicing AT for a short time are as aware of its benefits as those who have been practicing over longer periods. In other words, it seems that the positive effects of autogenic training are noticeable from the very beginning of its practice.

The strength of this research is that it is the first study on the benefits of autogenic training in coping with the adverse psychological effects of the pandemic. The two main limitations of the study are the small size of the sample, which may prevent several tendencies to reach statistical significance, and the failure of taking into account in the selection criteria the health status of the participants, so to exclude its influence in our results. These aspects should be taken into account in the future studies.

Practitioners of autogenic training consider this practice highly helpful to their physical and psychological health and for the better understanding of others. These three aspects are very important during the COVID-19 pandemic. Social relations have deteriorated due to social isolation (Ammar et al., 2020a; Hickie, 2020), and AT is useful in facilitating empathy. Psychological health has suffered during the pandemic, as shown in different studies (Ozamiz-Etxebarria et al., 2020b), and the physical dimension is obvious in times when the risk and fear of getting sick, especially of COVID-19, have increased significantly (Ornell et al., 2020). Therefore, we recommend the practice of autogenic training to people who are living moments of anxiety, are afraid of the disease or feel they have lost the quality of relationships with others.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by the Ethics Committee for Research Involving Human Subjects. The patients/participants provided their written informed consent to participate in this study.

LR, LR-M, and NO-E were involved in the conceptualization of the project and in the acquisition and analysis of the data. MD-S was involved in the interpretation of the data. All authors were involved in the drafting and revising of the work for intellectual content, provided approval for submission of the contents for publication, and agreed to be accountable for the accuracy and integrity of the project.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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