Abstract

The intentionality and content dimensions of mind wandering (MW) are important determinants of its costs and benefits. However, the relationship of intentionality with various combinations of different content dimensions has never been examined. In this study, we aimed to examine whether the content of intentional and unintentional MW differs in terms of temporal orientation, emotional valence, and combinations of these two factors. Results indicated that intentional and unintentional MW did not differ in the frequency of negative valence, whereas a difference was observed in the frequency of negative valence combined with temporal orientation. Unintentional MW was 4.88 times more likely than intentional MW to generate negative past-oriented content, while intentional MW was 2.61 times more likely to generate negative future-oriented content. Furthermore, when compared to intentional MW, unintentional MW was 1.94 times more likely to generate neutral past-oriented content, while intentional MW was 2.17 times more likely to generate positive future-oriented content. These findings show that intentional and unintentional MW have different effects on the content generated, depending on whether the content dimensions are considered separately or combined, which opens crucial new perspectives on understanding the functionality of MW.

The purpose of this study was to develop a Japanese version of the Work-related Acceptance and Action Questionnaire (WAAQ) and to examine its reliability and validity. In Study 1, we created a Japanese version of the WAAQ, examined its structural validity and internal consistency, and conducted hypothesis testing (convergent validity) using 180 workers. The Japanese version of the WAAQ was found to have high internal consistency, partial structural validity, and convergent validity. In Study 2, we examined the structural validity of the questionnaire and conducted hypothesis testing (convergent validity and comparison between subgroups) using 2,071 workers, of which 320 were involved in verifying test-retest reliability and measurement error. The results showed that the Japanese version of the WAAQ possessed high convergent validity and adequate structural validity, and displayed small effects in difference between subgroups in terms of age group, type of business, job type and measurement error. However, test-retest reliability remained an issue.

Self-compassion is regarded as a mediating or moderating variable in mindfulness-based interventions (MBI). However, few studies have investigated the role of self-compassion on MBI. Therefore, we conducted a randomized controlled trial to examine whether (1) MBI decreases depression and trait anxiety, while increasing trait mindfulness, trait self-compassion, self-compassionate behaviors (SC behaviors), and behaviors, along with improving mood; and (2) SC behaviors moderate the effect of mindful behaviors on mood in daily life. Participants were patients with depression and/or anxiety (N=19) in Japan. Of the 27 participants recruited, 19 participated in the study. Using stratified randomization, we allocated 10 participants to the intervention group, with an 8-week standard MBI, and nine to the waitlist control group. Depression, trait anxiety, trait mindfulness, and trait self-compassion were assessed using questionnaires, while SC behaviors, mindful behaviors, and mood were measured using an ecological momentary assessment-a method used to repeatedly record events and behaviors in daily life. The results revealed that depression, trait anxiety, trait mindfulness, and trait self-compassion did not significantly change. However, SC behaviors, mindful behaviors, and mood significantly improved with MBI. Moreover, the interaction between SC behaviors and mindful behaviors was significantly shown in the pre-intervention, suggesting that SC behaviors moderate the effect of mindful behaviors on mood in daily life.

【背景】片頭痛と緊張型頭痛は、有病率が高く(Penzien et al.,2005)、症状の慢性化や痛みによる生活への支障が見られる(Keefe et al.,2004)。慢性疼痛患者において、セルフ・コンパッション(Self-compassion:SC)は痛みによる生活への支障と負の相関関係にある(Wren et al.,2012)。【目的】本研究は、片頭痛、緊張型頭痛を有する学生に対してSCをベースとしたプログラムを行うことによる、SCの上昇(仮説1)および頭痛による生活への支障の低減(仮説2)について検討することを目的とした。【方法】対象者は19名(21.84±2.39歳)であった。介入期間は4週間で週に1度、計4回の対面セッションを設けて介入を実施した。介入はSCとマインドフルネスを主要素とした。介入の前後で各変数のデータを測定した。さらに介入の前後各1週間には、SC行動と頭痛の程度を測定する質問をメールで送信し、回答を求めた。分析は、対応のあるt検定、マルチレベル分散分析、マルチレベルロジスティック回帰分析を用いた。【結果と考察】SC尺度の下位尺度であるマインドフルネスの得点が介入後に増加した。理由としてはマインドフルネスに時間をかけたことが関係するかもしれない。一方で、それ以外の下位尺度のスコア上昇は認められなかった。日常生活場面における行動に限定したSC行動の尺度は、ほとんど全ての項目において有意に増加した。SC行動の尺度のスコアが上昇した理由としては、対象者が有する特性としてのSCの上昇が認められる一歩手前として、日常的なSCの行動が増加した可能性がある。頭痛による生活への支障は低減しなかった。理由としては、対象者に対し、痛みの維持と生活への支障と、破局的思考、逃避・回避行動の相互の関連についての十分な心理教育を行っていなかったことが関係している可能性がある。(著者抄録)

<bold>Background:</bold> The symptoms of attention-deficit hyperactivity disorder (ADHD) are known to exacerbate the effect of cognitive-behavioral impairments on emotional burden. Although adults with ADHD frequently experience procrastination and internalizing symptoms such as depression and anxiety, few studies have examined whether the association between procrastination and internalizing symptoms differs by ADHD symptoms.

<bold>Objective:</bold> This study aimed to examine the moderating effect of ADHD symptoms on the association between procrastination and internalizing symptoms.

<bold>Method:</bold> A cross-sectional survey was conducted among 470 adults (mean age=26.57, standard deviation=2.93) using self-reported questionnaires: Adult ADHD Self-Report Scale, General Procrastination Scales, Patient Health Questionnaire-9, and State–Trait Anxiety Inventory.

<bold>Conclusion:</bold> Participants with more substantial ADHD symptoms experienced more procrastination and internalizing symptoms than those with the less substantial ADHD symptoms. Therefore, procrastination constitutes the treatment target for those suffering from ADHD and comorbid internalizing symptoms. Alternatively, there was no enhancing effect of ADHD symptoms on the association between procrastination and internalizing symptoms. It is necessary to examine more precise and valid hypotheses and underlying mechanisms of procrastination in high and low ADHD symptom groups.

<title>Abstract</title>Self-focused attention (SFA) and other-focused attention (OFA) are central maintenance factors of social anxiety. Tomita et al., Cognitive Therapy and Research 44:511–525, 2020 investigated brain activities when manipulating SFA and OFA during speech tasks, after controlling for social anxiety, using near-infrared spectroscopy (NIRS) and eye-tracking. Compared with the control condition, the SFA condition demonstrated greater activity in the right frontopolar area (rFPA) and right dorsolateral prefrontal cortex. In the OFA condition, relative to controls, activity was greater in the left superior temporal gyrus. We investigated whether the activity in these brain areas increased in healthy individuals in proportion to their social anxiety tendency without manipulating SFA and OFA. Thirty-nine participants performed speech tasks under a no attentional manipulation (no-instruction) condition and a control (looking at various places) condition. Brain activity was measured using NIRS (oxy-Hb responses), and eye movements were tracked. We found that higher social anxiety was associated with higher rFPA activity in the no-instruction condition compared to the control condition and that higher subjective SFA during the no-instruction condition with higher social anxiety was associated with increased rFPA between the no-instruction and control conditions. These results suggest that greater activity in the rFPA is a useful objective measure of SFA related to social anxiety during speech tasks.

"This preliminary investigation aims to develop a new measure for
momentary experiential avoidance in daily life using ecological momentary
assessment (EMA) and a small sample. To measure momentary experiential
avoidance, this study devised a new method that involves capturing
reductions in unwanted experiences after a behavior has occurred based on
negative reinforcement characteristics. A daily life investigation on students (N = 25) indicated that although “a momentary experiential avoidance index” did not correlate with acceptance and commitment therapy or symptomrelated questionnaires, it could partially predict a decrease in “irritation” and an increase in “satisfaction” after a behavior that is measured separately from an unpleasant private experience preceding the behavior. Moreover, the momentary experiential avoidance index predicted a number of positive mood states only in a group with high global experiential avoidance defined by a self-report questionnaire. Although the momentary experiential avoidance index may measure one aspect of experiential avoidance, consistent results were not obtained. Thus, this preliminary investigation only suggests the potential of expanding the measurement framework and reveals issues that require further examination."

This study aimed to investigate the neurocognitive effects of the Attention Training Technique (ATT) on brain activity in healthy participants. The participants included 20 university students who were asked to practice ATT as a homework assignment for 20 days. The intracerebral source localization of their electroencephalogram during rest and the ATT task, which comprised selective attention, attention switching, and divided attention conditions, was evaluated by standardized low-resolution brain electromagnetic tomography. Brain activity during rest was subtracted from that during the ATT task, and that was compared before and after the homework assignment. The results for the divided attention condition indicated significantly decreased alpha 1 frequency band power in the left orbital frontal cortex (OFC) and alpha 2 power in the right inferior temporal cortex. Further, decreased alpha 1 power in the left OFC correlated with reduced subjective difficulty during the divided attention condition. One possibility is that the brain activity changed as the effect of ATT practice, although this study cannot confirm causality. Further studies are required which include a control group that would complete similar training without the ATT task.

<p>We describe the process of introducing online cognitive and behavioral therapies at a primary care psychosomatic clinic during the novel coronavirus pandemic. The preparation period was relatively short, due to some helpful references and the use of "Zoom," the off-the-shelf web conference service. In total, 92 sessions were implemented over six months for 22 cases, whose diagnoses and intervention methods were similar to those used in in-person counseling. There were no dropout cases, and the sustained rate was higher than that of the last year. Concerning the intervention's quality, the patients' satisfaction level was as high as it was last year, with both the main and sub-therapists reporting more merits than demerits. Significant effects were observed on first-grade master's course students through the attendance training, which should be prioritized as a new form of clinical training.</p>

This research examined the reliability and validity of the Change Agenda Implicit Relational Assessment Procedure (CA-IRAP). Change agendas that lead people to think that "reducing or removing undesirable thoughts and feelings will solve problems and lead to a more successful life" are considered unworkable in acceptance and commitment therapy (ACT). For acceptance-based interventions to succeed, relinquishing change agendas is important. However, currently available methods for measuring these types of change agendas are limited to explicit measures, which are vulnerable to distortion from social desirability and demand characteristics. The authors attempted to measure change agendas using the IRAP. A total of 131 undergraduate and graduate students (40 male, 91 female; mean age = 21.93,SD= 3.19) participated. First, we examined the CA-IRAP's discriminant validity in relation to explicit measures such as the Acceptance and Action Questionnaire-II in 83 participants who were able to pass the CA-IRAP. The correlations between the CA-IRAP and the explicit measures were low, confirming the discriminant validity of the CA-IRAP. Second, we examined the predictive validity of the CA-IRAP. Nineteen respondents had learned ACT and 34 respondents had never learned ACT. Non-ACT learners' CA-IRAP scores were higher than those of ACT learners, which confirmed the CA-IRAP's predictive validity. Finally, we examined the CA-IRAP's test-retest reliability, which was confirmed across some CA-IRAP trial types. In conclusion, the authors submit that the CA-IRAP has strong potential as a valid instrument for measuring the relative strength of relational responses around change agendas while controlling for variables such as demand characteristics.

Recent studies have suggested that sensory-processing sensitivity correlates to poor psychological and physical health. However, it remains unclear how this occurs. Sensory-processing sensitivity can be understood as sensitivity to sensations without the presence of intentional awareness and a nonreactive attitude, which are the components of mindfulness. We tested the hypothesis that dispositional mindfulness mediates the relationship between sensory-processing sensitivity and trait anxiety, well-being and psychosomatic symptoms. We analyzed data from 563 participating young adults living in Japan. Multiple mediation analysis showed that the four facets (nonreactivity, nonjudging, describing, and acting with awareness) of mindfulness partially mediated the effects of sub-factors of sensory-processing sensitivity (low sensory threshold and ease of excitation) on trait anxiety. Nonreactivity, describing, and acting with awareness partially mediated the effect of low sensory threshold on well-being and fully mediated the effect of ease of excitation. Nonjudging and acting with awareness partially mediated the effects of low sensory threshold and ease of excitation on psychosomatic symptoms. As a whole, the mediation hypotheses were supported, and it was determined that the improvement of dispositional mindfulness may prove effective for the psychological and physical problems of people with high sensory-processing sensitivity.

The mechanisms of efficacy in mindfulness-based interventions for depression and anxiety are not fully understood. To clarify these mechanisms, we tested the hypotheses that mind-wandering, daydreaming, cognitive fusion, and experiential avoidance will decrease through mindfulness group therapy, and this decrease will correlate with improvements in depression and anxiety. Participants self-reported depression and/or anxiety (<italic>N</italic> = 28) took part in an 8-week mindfulness group therapy program. They were assessed using self-report scales at pre- and post-intervention, and at 2-month follow-up. Results indicated that depression and trait-anxiety decreased between pre- and post-intervention with moderate effect sizes, which were maintained at follow-up. Mind-wandering and cognitive fusion also decreased between pre- and post-intervention with small to moderate effect sizes, and maintained at follow-up. The decreases in mind-wandering and cognitive fusion moderately correlated with improvements in depression and anxiety, suggesting that decreases in mind-wandering and cognitive fusion might underlie efficacious mechanisms of mindfulness group therapy.

Previous studies have demonstrated that when faced with stimuli in the form of internal or external threats, people with social anxiety exhibit attentional bias as a result of their metacognitive strategies. This study developed the Metacognition of Focused Attention in Subjects with High Social Anxiety Questionnaire (MFAQ) and investigated its reliability and validity. The MFAQ consists of positive and negative metacognitive beliefs regarding self-focused attention and attention bias. A total of 253 undergraduates completed the MFAQ and several questionnaires measuring social anxiety, internal and external attention bias, and metacognitive beliefs. Exploratory and confirmatory factor analyses were performed to identify factors and determine structural validity, and Cronbach's alpha was calculated to examine internal consistency. Correlation analyses were performed to indicate criterion-related validity and construct validity. Reliability was verified using the test-retest method within a 2-week intervening period. Consequently, factor analyses identified four factors. The alpha scores for each factor indicated good internal consistency. The MFAQ demonstrated good test-retest reliability. Criterion-related validity and construct validity were indicated except for "positive metacognition of self-focused attention." The MFAQ may prove useful in assessing the relationship between self-focused attention and attention bias in social anxiety.

Several studies have revealed that fear recovery is prevented when extinction training is conducted after retrieval of a fear memory. Postretrieval extinction training is related to modification of memory during reconsolidation. Providing new information during reconsolidation can modify the original memory. We propose that avoidance behavior is a relevant factor that prevents subjects from obtaining new safety information during reconsolidation. Postretrieval extinction training without avoidance behavior reduced the fear response to conditioned stimulus and prevented spontaneous recovery in the current study, which corresponded with previous studies. Under the condition of postretrieval extinction training with avoidance behavior, the fear response was not reduced as much as it was in the condition without avoidance. It is possible that avoidance behavior prevents receiving new safety information during postretrieval extinction training.

【問題と目的】不登校の児童生徒に対する支援の提供は、喫緊の課題である。しかしながら、不登校経験者が不登校期間中の自身の心理面・行動面・身体面の変化や家族機能についてどのように捉えているかという観点から研究したものは十分ではない。本研究では、不登校を経験したことのある当事者からのインタビューによって、不登校から回復するまでの共通する通過点となる出来事や要因や変容のプロセスを検討すること、また、どのような周囲の関わりが不登校当事者の社会再接続に作用するのかを検討することを目的とした。【方法】思春期に不登校を経験し、現在18歳以上で研究協力の同意が得られた7名を対象とした。得られたデータは、録音内容を文字に起こし、複線径路・等至性モデル(TEM)の技法に基づき分析を行った。【結果】TEMの分析の結果、不登校の回復のプロセスにおいて、4つの時期をたどることが示された。回復のプロセスでは、第2期において家族が不登校改善のために主体となる必要があり、それによって外部機関との関わりが増大した。登校開始に至るまでには、第3期で自分自身の変化を知覚し、不登校の状態を抜け出していく様子が確認された。登校開始後では、ソーシャルサポートの知覚や認知の変化、コーピングスキルの獲得がみられ、不登校の回復を自覚し、長期的な社会と関わりのある生活を送り始めることが示された。【考察】TEMを用いることで、個々の事例の具体性や時系列を捨象せずに、プロセスを検討することが可能となった。不登校の回復過程に関しての研究において、本人の語りから時期区分をしたことは、本人からみた不登校への理解の一助となり、時期ごとにおける研究や支援の必要性を示すことができたと考えられる。(著者抄録)

This study examined the effects of the time of conducting a combined physical and cognitive exercise program on cognitive functions and the mood of older adults. We randomly assigned 17 participants (8 men, 9 women, age 73,24±3,75) to the morning group (AM Group), 18 (8 men, 10 women, age 73,11±4,84) to the afternoon group (PM Group), and they completed a 12-week, dual-task exercise program in the morning or the afternoon, respectively. Moreover, the waiting-list control group consisted of 12 participants (6 men, 6 women, age 73,25±5,93). The cognitive functions and the mood of the participants were assessed before and after the program by using the Neurobehavioral Cognitive Status Examination, and the short version of the Profile of Mood States, respectively. As a result, the exercise program conducted in the afternoon had broader effects on cognitive functions (increased Repetition and Memory) than in the morning (increased Repetition), or the waiting-list control group (increased Judgment). Moreover, the program in the afternoon tended to reduce Anger-Hostility, and Fatigue. In conclusion, conducting the exercise program in the afternoon might be more effective for improving cognitive functions and the mood of older adults than in the morning. However, there was heterogeneity between the groups despite the randomization. Therefore, we suggest conducting a more rigorously controlled study using a larger sample to validate these findings.

The purpose of the current study was to develop a method of measuring self-compassionate behaviors(SCBs) in daily life based on the framework of functional analysis in clinical behavior analysis. The current study used theEcological Momentary Assessment, which is a method of recording events and behaviors in daily life. Multi-level simpleregression analysis revealed that most of the items classified as SCBs significantly predicted an increase in state selfcompassion60 minutes after SCBs. In addition, most of the items classified as SCBs significantly predicted an increase inacceptance. However, most of the items classified as SCBs did not predict an increase in well-being. The method ofmeasuring SCBs in daily life developed in this study may present a new paradigm for the study of self-compassion.Moreover, this method should be a clinically useful method of measuring SCBs as it enables the assessment of changes inSCBs in daily life following an intervention. Further research is needed to examine the relationship between SCBs andwell-being in detail.

Our own ongoing motor actions are perceived through sensory feedback pathways, and are integrated with neural processes to modulate further actions. This sensory feedback mechanism is known to contribute to the rehabilitation of impaired motor functions. Recent evidence also suggests that mindfulness meditation improves our awareness to sensation; therefore, enhancement of awareness to sensory feedback through mindfulness meditation training may have potential clinical applications. This study investigated an effect of eight-week practice of mindfulness meditation on speech perception/production processes. Among the thirty healthy participants, half of them engaged in regular meditation practice of 10 min per day for eight weeks, and the other half were not given any instructions for their daily life. The change of speech performance in sentence reading under 200 ms delayed auditory feedback (DAF) condition were assessed compared to without delay condition. Also, event-related potential response to the short sound of /a/, were measured. The result showed that, after the eight-week practice, the meditation group showed significantly improved speech fluency in the DAF condition, when 16-min meditation was introduced before the experiments. Furthermore, significantly increased auditory evoked potentials were observed in the central-parietal region when the participants listened to the delayed auditory feedback sound of their own voice. These findings provide the first glimpses into the possible relationship between mindfulness meditation and auditory feedback. Different instructions for daily activity between the meditation and control groups should be considered in further studies.

BackgroundMindfulness-based interventions are increasingly being implemented worldwide for problems with depression and anxiety, and they have shown evidence of efficacy. However, few studies have examined the effects of a mindfulness-based group therapy based on standard programs for depression and anxiety until follow-up in Japan. This study addresses that gap. Furthermore, this study explored the mechanisms of action, focusing on mindfulness, mind wandering, self-compassion, and the behavioral inhibition and behavioral activation systems (BIS/BAS) as possible mediators.MethodsWe examined 16 people who suffered from depression and/or anxiety in an 8-week mindfulness group therapy. Measurements were conducted using questionnaires on depression and trait-anxiety (outcome variables), mindfulness, mind wandering, self-compassion, and the BIS/BAS (process variables) at pre- and post-intervention and 2-month follow-up. Changes in the outcome and process variables were tested, and the correlations among the changes in those variables were explored.ResultsDepression and anxiety decreased significantly, with moderate to large effect sizes, from pre- to post-intervention and follow-up. In process variables, the observing and nonreactivity facets of mindfulness significantly increased from pre- to post-intervention and follow-up. The nonjudging facet of mindfulness and self-compassion significantly increased from pre-intervention to follow-up. Other facets of mindfulness, mind wandering, and the BIS/BAS did not significantly change. Improvements in some facets of mindfulness and self-compassion and reductions in BIS were significantly correlated with decreases in depression and anxiety.ConclusionsAn 8-week mindfulness group therapy program may be effective for people suffering from depression and anxiety in Japan. Mindfulness and self-compassion may be important mediators of the effects of the mindfulness group therapy. Future studies should confirm these findings by using a control group.Trial registrationUniversity Hospital Medical Information Network (UMIN CTR) UMIN000022966. Registered July 1, 2016, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000026425

BACKGROUND:
The purpose of this study was to determing which psychological traits of Japanese type 2 diabetes patients would provide reliability and validity to the Japanese version of the Acceptance and Action Diabetes Questionnaire (AADQ-J).
METHODS:
Various questionnaires were administered to type 2 diabetes patients who were registered on the database of the research service provider; data from a total of 600 patients (mean ± SD age was 57.50 ± 9.87 years, female 21.83%) were analyzed.
RESULTS:
Three items were excluded because of psychometric concerns related to the original 11-item AADQ. Confirmation factor analyses revealed that the eight-item version demonstrated the best indicators of a goodness of fit. The questionnaire showed adequate internal consistency. The questionnaire demonstrated high measurement accuracy in broad trait values by the test information function of Item Response Theory. The questionnaire showed stronger positive correlations with self-care activities and HbA1c than with diabetes distress and depressive mood.
CONCLUSIONS:
The eight-item Japanese version of AADQ has reliability and validity for type 2 diabetes patients.

<p>The purpose of the present study was to explore influences of depression and anxiety on self-care behavior in patients with type 2 diabetes. Outpatients with type 2 diabetes (N＝65) were recruited from an endocrinology and metabolism clinic. Hierarchical multiple regression analyses showed that anxiety affected diet therapy and depression affected foot-care, both as components of diabetes-related self-care behavior. On the other hand, depression and anxiety did not significantly affect exercise therapy. Before providing medical-treatment instruction in alimentary therapy or foot care for type 2 diabetes mellitus patients with depression or anxiety, the patients' strategies for coping with the depression and anxiety that may arise when performing self-care behavior should be investigated. For doing that, assessment and intervention by behavior analysis may be effective.</p>

Background: The neurophysiological mechanisms of cognitive reactivity, the primary vulnerability factor of major depressive disorder (MDD) recurrence, remain unclear in individuals with recovered MDD (rMDD). Because gamma-band responses (GBRs) can be used to measure cognitive processing, they may also be useful for elucidating the mechanisms underlying cognitive reactivity. Identifying these mechanisms may permit the development of an index for predicting and preempting MDD recurrence. Here, to identify the neurophysiological mechanisms of cognitive reactivity, we examined the characteristics of the GBRs evoked/induced by emotional words in participants with and without rMDD after inducing a negative mood. Methods: Thirty-three healthy control participants and 18 participants with rMDD completed a lexical emotion identification task during electroencephalography along with assessments of cognitive reactivity after negative mood induction. Results: No between-group differences were identified for the task reaction times; however, the rMDD group had significantly higher cognitive reactivity scores than did the control group. Furthermore, the power of late GBRs to positive words was significantly greater in the rMDD group, with the greater power of late GBRs being related to higher cognitive reactivity. Limitations: Considering the population studied, our findings cannot be completely generalized to populations other than adolescents, people with rMDD, and those without a history of co-morbid disorders and early life stress. Conclusions: Our findings indicate that the dysfunction of neural circuits related to higher-order processes like memory and attention might underlie cognitive reactivity. Altered late GBRs to positive information may be persistent biomarkers of the depression recurrence risk.

Mind-wandering (MW), task-unrelated thought, has been examined by researchers in an increasing number of articles using models to predict whether subjects are in MW, using numerous physiological variables. However, these models are not applicable in general situations. Moreover, they output only binary classification. The current study suggests that the combination of electroencephalogram (EEG) variables and non-linear regression modeling can be a good indicator of MW intensity. We recorded EEGs of 50 subjects during the performance of a Sustained Attention to Response Task, including a thought sampling probe that inquired the focus of attention. We calculated the power and coherence value and prepared 35 patterns of variable combinations and applied Support Vector machine Regression (SVR) to them. Finally, we chose four SVR models: two of them non-linear models and the others linear models; two of the four models are composed of a limited number of electrodes to satisfy model usefulness. Examination using the held-out data indicated that all models had robust predictive precision and provided significantly better estimations than a linear regression model using single electrode EEG variables. Furthermore, in limited electrode condition, non-linear SVR model showed significantly better precision than linear SVR model. The method proposed in this study helps investigations into MW in various little-examined situations. Further, by measuring MW with a high temporal resolution EEG, unclear aspects of MW, such as time series variation, are expected to be revealed. Furthermore, our suggestion that a few electrodes can also predict MW contributes to the development of neuro-feedback studies.

While dichotic listening (DL) was originally intended to measure bottom-up selective attention, it has also become a tool for measuring top-down selective attention. This study investigated the brain regions related to top-down selective and divided attention DL tasks and a 2-back task using alphanumeric and Japanese numeric sounds. Thirty-six healthy participants underwent near-infrared spectroscopy scanning while performing a top-down selective attentional DL task, a top-down divided attentional DL task, and a 2-back task. Pearson's correlations were calculated to show relationships between oxy-Hb concentration in each brain region and the score of each cognitive task. Different brain regions were activated during the DL and 2-back tasks. Brain regions activated in the top-down selective attention DL task were the left inferior prefrontal gyrus and left pars opercularis. The left temporopolar area was activated in the top-down divided attention DL task, and the left frontopolar area and left dorsolateral prefrontal cortex were activated in the 2-back task. As further evidence for the finding that each task measured different cognitive and brain area functions, neither the percentages of correct answers for the three tasks nor the response times for the selective attentional task and the divided attentional task were correlated to one another. Thus, the DL and 2-back tasks used in this study can assess multiple areas of cognitive, brain-related dysfunction to explore their relationship to different psychiatric and neurodevelopmental disorders.

<p>The purposes of the present study were to develop a questionnaire to measure the Acceptance and Commitment Therapy (ACT) core behavior processes of "Values" and "Committed Action" and to confirm the questionnaire's reliability and validity. In Study 1, exploratory factor analysis indicated that the new questionnaire had a 3-factor pattern: "Increased Motivation," "Continuing Behavior," and "Awareness of Reinforcement." Furthermore, Study 1 indicated that the questionnaire had adequate internal consistency and convergent and discriminant validity. Study 2 examined the questionnaire's construct validity, using structural equation modeling (SEM). The results revealed that as "Awareness of Reinforcement" and "Increased Motivation" increase, "Continuing Behavior" ensues; subjective well-being was enhanced and resulted in a decrease in experiential avoidance. In the future, the questionnaire's efficiency should be confirmed by conducting surveys with different participants, for instance, clinical patients, and a broader range of age groups and, subsequently, demonstrating its reliability and validity.</p>

<p>The present study aimed to develop a questionnaire to measure acceptance, a behavioral process that is emphasized in the third-wave cognitive and behavioral therapies, and to confirm its reliability and validity. Undergraduate and graduate students completed questionnaires. The results of a factor analysis indicated that the new 13-item questionnaire, the Acceptance Process Questionnaire (APQ), had a 4-factor pattern. The middle- or long-term results factors were "expanding behavioral repertoire" and "being receptive to the real world". The behavioral content factors were "making a choice not to avoid private events" and "stopping reactions". The questionnaire had adequate structural validity and internal consistency. Additionally, it is assumed that the Acceptance Process Questionnaire measures acceptance on the entire scale. However, more refinement is needed concerning convergent validity and test-retest reliability. Future research should aim to increase the workability of the questionnaire by confirming its test-retest reliability with a larger sample and by indicating the relation between questionnaire scores and behavioral tendencies in real-life.</p>

<p>Background : As of March 2014, three years after the Fukushima nuclear power plant disaster, 58,624 residents were relocated to other regions within the Fukushima prefecture, and 47,683 residents were relocated to other prefectures. Attenuation of human relationships due to the disruption of regional ties nurtured in the past heightens stress. This highlights the need to create a new community focused on establishing ties with neighbors. Among evacuees, providing support for elderly adults suffering from a decline in physical functioning and a deteriorating mental health is necessary. Objective : This study investigated the relationship between individual social capital and mental health in elderly adults, specifically focusing on the role of social capital in reconstruction after the earthquake. Methods : A self-report questionnaire was conducted at Waseda University and Shinsai Shien Network, Saitama. Evacuees from Fukushima prefecture (n=3,599) who lived in Saitama prefecture and Tokyo were asked to complete the Stress Response Scale-18 comprising questions related to social capital with cognitive and structural indicators. There were 772 replies (response rate=21.5%) and 229 respondents were analyzed. In addition, a multiple logistic regression analysis was performed to examine the relationship between social capital and mental health in elderly adults. Results : The group with low confidence in neighbors relative to the group with high confidence in neighbors had a 5.192 times higher chance of being in the high-stress group (95%CI=1.042-25.865). In addition, the group with lower confidence in acquiring their neighbors assistance if a disaster occurred again, had a 2.172 times higher chance of being in the high-stress group (95%CI=1.051-4.487). Furthermore, people who have never participated in regional activities (e.g., hobbies, sports, entertainment, etc.) had a 3.112 times higher chance of being high-stressed relative to the group who participated two or three times (95%CI=1.059-9.150). Finally, the group that never greeted neighbors had a 3.317 times higher chance of being high-stressed relative to the group that had five or more greeted neighbors (95%CI=1.177-9.346). Conclusion : Lower social-capital cognitive indicators such as "trusting one's neighbors" and "helping one's neighbors" were correlated with higher stress levels. Therefore, elderly adults can presumably maintain good mental health by developing a neighborhood relationship and building mutual trust. Furthermore, lower social-capital structural indicators such as "number of greeted neighbors" and "participation frequency in regional activities" were correlated with higher stress levels. It is important to encourage social participation of evacuees and provide them with support.</p>

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self-selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin-related, head-related, auditory and vestibular, musculoskeletal, allergy-related, sensory, and heart/chest-related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test-retest analysis, and high Cronbach's coefficients (0.853-0.953) from each subscale. A comparison of scores of each subscale between self-selected EHS subjects and age- and sex-matched controls using bivariate logistic regression analysis, Mann-Whitney U- and (2) tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353-372, 2016. (c) 2016 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

Objective
This study investigated post-traumatic stress symptoms in relation to the population affected by the Fukushima Nuclear Disaster, one year after the disaster. Additionally, we investigated social factors, such as forced displacement, which we hypothesize contributed to the high prevalence of post-traumatic stress. Finally, we report of written narratives that were collected from the impacted population.
Design and Settings
Using the Impact of Event Scale-Revised (IES-R), questionnaires were sent to 2,011 households of those displaced from Fukushima prefecture living temporarily in Saitama prefecture. Of the 490 replies; 350 met the criteria for inclusion in the study. Multiple logistic regression analysis was performed to examine several characteristics and variables of social factors as predictors of probable post-traumatic stress disorder, PTSD.
Results
The mean score of IES-R was 36.15 +/- 21.55, with 59.4% having scores of 30 or higher, thus indicating a probable PTSD. No significant differences in percentages of high-risk subjects were found among sex, age, evacuation area, housing damages, tsunami affected, family split-up, and acquaintance support. By the result of multiple logistic regression analysis, the significant predictors of probable PTSD were chronic physical diseases (OR = 1.97), chronic mental diseases (OR = 6.25), worries about livelihood (OR = 2.27), lost jobs (OR = 1.71), lost social ties (OR = 2.27), and concerns about compensation (OR = 3.74).
Conclusion
Although there are limitations in assuming a diagnosis of PTSD based on self-report IES-R, our findings indicate that there was a high-risk of PTSD strongly related to the nuclear disaster and its consequent evacuation and displacement. Therefore, recovery efforts must focus not only on medical and psychological treatment alone, but also on social and economic issues related to the displacement, as well.

<p>Backgrounds : This study reports the results of a questionnaire survey conducted in the households consisting of inhabitants of Fukushima Prefecture who have evacuated to Saitama Prefecture or Tokyo Metropolis at one and two years after the Great East Japan Earthquake. The Great East Japan Earthquake in 2011 has been expanded to the nuclear power plant disaster. Consequently, approximately 56,920 inhabitants of Fukushima evacuated to other prefectures as of March 2013. This consequence sets the 2011 earthquake apart from previous natural disasters. Method : This survey was conducted by "Earthquake and human sciences project" of Waseda University and Shinsai Shien Network Saitama. Psychological stress of the evacuees (2,011 households in 2012 ; 1,875 households in Saitama and 2,393 households in Tokyo in 2013) were examined one year and two years after the disaster respectively. The questionnaire also contained such items as severity of housing destruction, Tsunami affection, worries about livelihood sustainability etc. In this study, psychological stress was measured using the Stress Response Scale-18 (SRS-18). Results : The results revealed that the stress reaction level of the evacuees from Fukushima Prefecture living in other prefectures is still "somewhat higher" despite two years passed since the disaster. A chi-square test was used to determine psychosocial factors influencing stress reactions. Results of the survey in 2012 revealed that anxiety about living costs or joblessness influenced stress reactions in men, whereas damaged houses, personal relationships, and compensation problems related to the nuclear power plant influenced stress reactions in women. However, according to the results of the 2013 survey, difficult economic conditions, aggravated health conditions, negative labeling as an evacuee, and dissatisfaction with relationships with family and neighbors influenced stress reactions in both men and women. Conclusion : The results revealed that the psychological stress is strongly related to several social factors ; economic conditions, health status, family and community relationships, and dwelling environments. By the comparison between first year result and second year result, the causes of stressors have been changed from the damage of earthquake disaster itself into the circumstances of shelter life over time. Therefore, the work in cooperation among medicine, clinical psychology, social welfare, and legal support is necessary in order to obtain mental health recovery.</p>

<p>Extinction training establishes extinction learning and, thus, inhibits conditioned fear responses. However, fear responses may return because extinction learning cannot affect memory trace that is the origin of fear. Exposure therapy, which is based on the extinction learning paradigm, is used to treat anxiety disorders. Relapses of anxiety disorders after exposure therapy have also been reported. Consequently, treatments, which can prevent the return of fear responses, are needed. Recently, a mechanism known as memory reconsolidation has been receiving much attention. Consolidated memory traces are destabilized after they have been retrieved. Those memory traces are stabilized again by means of the reconsolidation process. During reconsolidation, retrieved fear memory can be updated. Furthermore, recent studies have shown that extinction training during reconsolidation updates fear memory and prevents the return of fear responses. Further studies are required to determine the effects of reconsolidation interventions on anxiety disorders.</p>

<p>Post-Event Processing (PEP) is defined that ruminating about anxiety-evoking social events; it is a key factor contributing to social anxiety. Although previous studies have shown that rumination and worry similar to PEP in terms of repetitive thinking style are related to attentional control functions, the relevance of PEP and attentional control functions has not been clarified. Moreover, no instrument has been developed to measure the observer's perspective during PEP. We investigated the relation between the PEP of an experimental social situation and attentional control functions with developing the Functional Recall Vantage Perspective Scale during PEP. Undergraduate students completed several questionnaires and a cognitive task measuring their attentional control functions. They then participated in a speech task. The following day, we measured the PEP of the speech task and conducted a correlation analysis between the PEP scores and the attentional control function scores. The results indicated that the Observer–Avoidance perspective subscale of the Functional Recall Vantage Perspective Scale can measure the observer's perspective of PEP. Furthermore, they also showed that negative PEP and the Observer–Avoidance perspective are negatively correlated with selective attentional control functions. Therefore, to decrease PEP in particular, focusing on selective attention may be beneficial.</p>

Backgrounds : Fukushima nuclear power plant disaster occurred following the Great East Japan Earthquake on March 11, 2011. It bears comparison with the incident in Chernobyl in 1986 in the degree of radiological contamination to the surrounding environment. 164,218 residents were displaced losing their home-land by this serious incident, of which 97,321 were relocated to other regions within the Fukushima prefecture, and 57,135 residents were relocated to other prefectures. The evacuees from Fukushima can be considered the largest number of 'internally displaced persons' or 'domestic refugees' in Japan after the world war two. Objective : This study investigated the scale of post-traumatic stress (PTS) symptoms in the evacuees as of two years after the Fukushima nuclear power plant disaster. It also tried to identify the impact of bio-psycho-social factors related to PTS symptoms. Samples and methods : Questionnaire survey was conducted by Waseda University and Japan Broadcasting Corporation (NHK). 2,425 households living at temporary housings within Fukushima prefecture were asked to answer the Impact of Event Scale-Revised (IES-R) and the self-report questionnaires that we generated in order to evaluate the damage by the disaster in relation to several bio-psycho-social factors in refugee lives. There were 745 replies (the cooperation rate ; 30.7%), of which 661 were analyzed. Besides, multiple logistic regression analysis was performed to examine several bio-psycho-social factors as predictors for probable PTSD. Results : High level PTS symptoms were found. The mean score of IES-R was 34.20±20.56, and 62.56% were over 24/25 cut-off point determined as broadly defined PTSD which means high-risk presence of probable PTSD. The significant differences by chi-square test of high-risk subjects were found among economic difficulty (p=.000), concerns about compensation (p=.000), lost jobs (p=.023), unsatisfying housing (p=.025), unsatisfying environment around temporary housing (p=.000), having chronic disease (p=.003), aggravation of chronic disease (p=.000), affection of new disease (p=.000), lack of necessary information (p=.000), family split-up (p=.031), and lack of acquaintance support (p=.000). By the result of multiple logistic regression analysis, the significant predictors of probable PTSD were economic difficulty (OR : 2.34, 95%CI : 1.30-4.24), concerns about compensation (OR : 4.16, 95%CI 1.26-13.76), aggravation of chronic disease (OR : 2.94, 95%CI : 1.63-5.30), affection of new disease (OR : 2.20, 95%CI : 1.21-3.99), and lack of acquaintance support (OR : 1.92, 95%CI : 1.07-3.42). Conclusion : The findings revealed that there is a high-risk presence of probable PTSD strongly related to a number of bio-psycho-social factors due to the nuclear power plant disaster and its consequent evacuation. Our findings underscore the specific characteristics of the nuclear disaster as man-made disaster. Since the socio-economic problems such as compensation and reparation have not been solved, it is suggested that prolonged uncertainty regarding the insufficient salvation of the evacuees might account for the high-level PTS symptoms.

Recently, it has been demonstrated that children who stutter (CWS) have attentional difficulties. But little is known about attentional function in adults who stutter (AWS). Two groups of 17 AWS and 18 adults who do not stutter (AWNS) participated in the present study. We aimed to confirm (1) whether AWS also show attentional difficulties like CWS and (2) how attentional function relates to stuttering severity in AWS. Results indicated that AWS and AWNS showed similar levels of attentional function, but those who tended to react faster and more incorrectly to the experimental task showed worse stuttering severity. This outcome suggests that cognitive strategies non-specific to speech production can influence stuttering severity. We discussed intervention for the attentional function in AWS.

Recently, it has been demonstrated that children who stutter (CWS) have attentional difficulties. But little is known about attentional function in adults who stutter (AWS). Two groups of 17 AWS and 18 adults who do not stutter (AWNS) participated in the present study. We aimed to confirm (1) whether AWS also show attentional difficulties like CWS and (2) how attentional function relates to stuttering severity in AWS. Results indicated that AWS and AWNS showed similar levels of attentional function, but those who tended to react faster and more incorrectly to the experimental task showed worse stuttering severity. This outcome suggests that cognitive strategies non-specific to speech production can influence stuttering severity. We discussed intervention for the attentional function in AWS.

This study investigated the validation of the Japanese version of the 13-item Cognitive Fusion Questionnaire (CFQ) whose content was revised and the 7-item CFQ. Results of a survey of university students showed that the revised CFQ-13 reflects a two-factor structure, whereas the CFQ-7 reflects a one-factor structure similar to the previous study. Results of item analysis showed that treating each factor independently is appropriate. It was previously assumed that the two structures corresponded to "cognitive fusion" (Factor I) and "cognitive defusion" getting out of cognitive fusion (Factor II), respectively. However, results showed that Factor II corresponds to "a component of the function of defusion." Therefore, Factor I or the CFQ-7 is equivalent to cognitive fusion, and Factor II is appropriate to measure a part of defusion that is "the discrimination of self and thought." Moreover, the CFQ-13 requires an additional and different validation strategy by investigating the relationship with overt behavioral measurements in future studies.

In-situ real-time monitoring of volatile organic compound (VOC) exposure and heart rate variability (HRV) were conducted for eight multiple chemical sensitivity (MCS) patients using a VOC monitor, a Holter monitor, and a time-activity questionnaire for 24 h to identify the relationship between VOC exposure, biological effects, and subjective symptoms in actual life. The results revealed no significantly different parameters for averaged values such as VOC concentration, HF (high frequency), and LF (low frequency) to HF ratio compared with previous data from healthy subjects (Int. J. Environ. Res. Public Health 2010, 7, 4127–4138). Significant negative correlations for four subjects were observed between HF and amounts of VOC change. These results suggest that some patients show inhibition of parasympathetic activities along with VOC exposure as observed in healthy subjects. Comparing the parameters during subjective symptoms and normal condition, VOC concentration and/or VOC change were high except for one subject. HF values were low for five subjects during subjective symptoms. Examining the time-series data for VOC exposure and HF of each subject showed that the subjective symptoms, VOC exposure, and HF seemed well related in some symptoms. Based on these characteristics, prevention measures of symptoms for each subject may be proposed.

Brain imaging studies of social anxiety disorder (SAD) were reviewed. Structural brain imaging studies of SAD have shown smaller gray matter volumes of amygdala and hippocampus, as well as abnormalities of white matter of uncinate fasciculus in SAD patients. Moreover, functional brain imaging studies of SAD have consistently reported hyperactivity of the amygdala during public speaking and in responses to emotional faces. Furthermore, changes in limbic system and prefrontal cortex (PFC) have been correlated with pharmacotherapy and cognitive behavioral therapy (CBT). Additionally, the predicted outcome of CBT has been associated with pretreatment activities of visual and prefrontal regions (i.e., dosolataral PFC, ventrolateral PFC), and not with amygdala activity. Also, resting state studies have shown dysfunctional connections between amygdala and orbitofrontal cortex (OFC). These studies are suggestive of structural and functional abnormalities of the limbic system (e.g., amygdala, hippocampus, anterior cingulate cortex)—prefrontal regions (e.g., ventromedial PFC), which are neural circuits modulating fear and anxiety.

The purpose of this study was to examine variations of coping during depressive moods in terms of behavioral activation and the relationship between patterns of coping and severity of depression.First, we collected items of coping during depressive moods by interviewing 29 undergraduate students. Then, based on the data the COPING ASSESSMENT QUESTIONNAIRE during depressive moods (CAQ-D) was developed. To investigate the factor structure of CAQ-D, CAQ-D was completed by 209 undergraduates. The results of a factor analysis indicated that CAQ-D consisted of three factors: (a)Activation , (b)Observing One's Experience , and (c)Distraction. Activation was positively related to Behavioral Activation for Depression Scale(BADS), and Observing One's Experience was positively correlated with Observing (Five Facet Mindfulness Questionnaire; FFMQ). However, Distraction showed no correlation with the Acceptance and Action Questionnaire-II(AAQ-II).Secondly, we defined coping style against depressive mood based on the CAQ-D, and investigated the relationship between coping styles and depression. The results showed that there were 4 coping styles : (a)all high Coping group, (b)high Activation and Distraction group, (c)Distraction group, and (d)Activation and Observing One's Experience group. Moreover, the high Activation and Distraction group felt more positive feelings than Distraction group. Although no consideration was placed on the relation between coping styles and stressors, these results suggest that one who has many variations of coping can gain more positive reinforcements.

Social anxiety disorder (SAD) is characterized by strong fear and anxiety during social interactions. Although ventrolateral prefrontal cortex (VLPFC) activity in response to emotional stimuli is related to pathological anxiety, little is known about the relationship between VLPFC activity and social anxiety. This study aimed to investigate whether VLPFC activity was involved in SAD and whether VLPFC activity was related to the level of social anxiety. Twenty-four drug-naive patients with SAD and 35 healthy controls underwent near-infrared spectroscopy (NIRS) scanning while performing a verbal fluency task (VFT). Results indicated that, compared to the healthy controls, the SAD patients exhibited smaller changes of oxygenated hemoglobin (oxy-Hb) concentrations in the VLPFC during the VFT. Furthermore, the right VLPFC activation was negatively correlated with social avoidance. In contrast to the latter, the healthy controls exhibited a positive correlation between changes of oxy-Hb concentrations in the bilateral VLPFC and social fear. Our findings provide evidence for VLPFC dysfunction in SAD, and indicate that the VLPFC dysfunction may contribute to the difference between normal and abnormal social anxiety. (C) 2015 The Authors. Published by Elsevier Inc.

The present study aimed to develop a Three Senses of the Selves Questionnaire (TSSQ) and confirm its reliability and validity. Furthermore, the functions involved in the 3 selves were examined in order to identify more appropriate behavior classes (sets of behaviors with similar functions) than the 3 conventional behavioral processes. A new questionnaire, comprised of 33 items, was completed by college students. Exploratory factor analysis indicated that the Three Senses of the Selves Questionnaire had a 4-factor pattern: "acting actively and flexibly in the world," "conceptualized self," "distancing from private events," and "feeling the present moment." Additional structural equation modeling indicated that the 3 selves had 2 valid behavioral classes. Cronbach's α for all the factors was sufficiently high (α=.72-.83), and the questionnaire met the standards for content and convergent validity. Future studies should examine the relations between the 3 selves and other behavioral processes relevant to Acceptance and Commitment Therapy (ACT) and various clinical symptoms, and develop an understanding of how these senses of the 3 selves aggravate or assuage mental pain.

Background : Body image dissatisfaction (BID) tendency is a diagnostic item for an eating disorder (ED) and body checking (BC) is a behavioral feature of ED. A relationship between BID and BC has been hypothesized. It has been reported that mirror exposure (ME) is an effective intervention method for improving BID and BC. In ME, the client looks at the whole body in a mirror for about 1〜2 minutes, doing as little evaluation as possible. However, the precise relationship between BID and BC has not been shown and the cognitive processing style during ME has not been clarified. The purpose of this research was to clarify the relationship between BID and BC by using questionnaire survey, and to experimentally examine the subjective way of viewing the whole body in a mirror based on the differences in BID tendency. Method : Participants were female college students (n=382 : mean age 20.0 years, SD=1.69) attending the Waseda University, in Tokyo, Japan. Participants responded to the following questionnaires : (1) Eating Attitude Test-26 Japanese version (EAT-26), (2) Body Image Dissatisfaction measure (BID measure), and (3) Body Checking Cognitions Scale Japanese version (BCCS). Seven participants (Mean age 21.7 years, SD=5.02) who consented to the participation in an experiment were divided into two groups based on their BID measure ; namely those with an average score of 59.1, +0.5 SD were included in the high BID group (H group) and the others in the normal BID group (N group). In the experiment, participants were asked to freely look at their whole body in a mirror for 5 minutes. After that, the participants responded to a questionnaire inquiring about their feelings when looking at the mirror, as well as their usual feelings about their body. Results : In EAT-26, BID measure, and BCCS, a moderate significant positive correlation was shown, respectively (r=0.412〜0.538, p<0.01). Moreover, a weak but significant positive correlation was shown in the partial correlation of BID measure and BCCS, after controlling EAT-26 score (r=0.253, p<0.01). When the numbers of body parts that H and N groups intentionally looked at were compared using a Wilcoxon rank sum correlation test, H group inclined to look at larger numbers of body parts than N group did (p=0.0692). Similarly, H group showed a significantly larger difference represented by the absolute value between the degree of usual negative feelings about the most disliked body part and negative feelings when looking at it in a mirror than N group did (p=0.0498). Considerations : The study indicated a relationship between BID and BC regardless of ED tendency. Moreover, people with strong BID experienced different feelings when they usually think of their body and when they look at their body in a mirror. It is suggested that this could be because they avoid looking at the parts of their body resulting in negative feelings in their daily life when looking in a mirror. Conclusion This study indicated a relationship between ED and BID and BC, and a possibility that people with strong BID avoid looking at the parts of their body. Therefore, it is expected that presenting ME to people with strong BID will stop avoiding their body image and improve body image overestimation (/underestimation).

The cognitive behavioral treatments for panic disorder and agoraphobia are the most representative evidence-based psychotherapies for psychiatric disorders, and many treatment studies and meta-analyses have been conducted. Exposure and behavioral experiments, relaxation and breathing re-training, psycho-education and cognitive intervention, and homework assignment are included in most of the empirically-supported treatment programs for panic disorders, and a recent meta-analysis indicated that exposure and relaxation are the most effective treatment components. It was assumed to be necessary for the evoked fear and anxiety to be reduced thoroughly through long enough exposure in order to extinguish fear conditioning, but many recent studies showed that the newly associative inhibitory learning is indispensable for the extinction. The reduction of fear in an exposure trial is not mandatory for the inhibition learning to be promoted, but fully experiencing feared symptoms and sensations without safety behaviors and recognizing that negative consequences do not pursue are vital. The role of acceptance during exposure has attracted much attention for those purposes.

The present article reports effects of cognitive behavioral group therapy (CBGT) on adults with depression, using a controlled clinical trial. The cognitive behavioral group therapy consisted of 12 sessions developed by psychologists, consisting of Beck's cognitive therapy and problemsolving therapy. Participants (n=10) received this treatment from a psychologist, including pharmacotherapy (treatment as usual; TAU) combined with the cognitive behavioral group therapy program (TAU+CBGT group). The other participants (n=10) received only pharmacotherapy (TAU group). The Beck Depression Inventory-II (BDI-II) which measures depression was completed by the participants at 3 times (pre-, mid-, and post) during the cognitive behavioral group therapy program. The results revealed that after the therapy, depression in the group receiving cognitive behavioral therapy with pharmacotherapy improved significantly more than in the treatment-as-usual group. These results suggest that for adults with depression, the administration of pharmacotherapy combined with cognitive behavioral group therapy managed by a psychologist may be more effective than treatment with pharmacotherapy only.

Experienced Qigong meditators who regularly perform the exercises "Thinking of Nothing" and "Qigong" were studied with multichannel EEG source imaging during their meditations. The intracerebral localization of brain electric activity during the two meditation conditions was compared using sLORETA functional EEG tomography. Differences between conditions were assessed using t statistics (corrected for multiple testing) on the normalized and log-transformed current density values of the sLORETA images. In the EEG alpha-2 frequency, 125 voxels differed significantly; all were more active during "Qigong" than "Thinking of Nothing," forming a single cluster in parietal Brodmann areas 5, 7, 31, and 40, all in the right hemisphere. In the EEG beta-1 frequency, 37 voxels differed significantly; all were more active during "Thinking of Nothing" than "Qigong," forming a single cluster in prefrontal Brodmann areas 6, 8, and 9, all in the left hemisphere. Compared to combined initial-final no-task resting, "Qigong" showed activation in posterior areas whereas "Thinking of Nothing" showed activation in anterior areas. The stronger activity of posterior (right) parietal areas during "Qigong" and anterior (left) prefrontal areas during "Thinking of Nothing" may reflect a predominance of self-reference, attention and input-centered processing in the "Qigong" meditation, and of control-centered processing in the "Thinking of Nothing" meditation.

The present case study describes treatment given to a man in his 40s who was reported to have pnigophobia (fear of choking) and some physical symptoms such as dysphagia (difficulty in swallowing). The treatment was based on a behavior analysis of the link between his covert cognitive responses and swallowing. The results of the behavior analysis suggested that simultaneous presentation of food in his mouth and his pnigophobic cognitions elicited the dysphagia which, in turn, reinforced his avoidance behavior. The treatment included exposure to body sensations and reciprocal inhibition of the cognitive response during swallowing. The client was asked to describe his body sensations in all phases of swallowing continuously. After this intervention, the client's physical symptoms were reduced; at 1-month and 3-month follow-ups, this improvement was found to have been maintained.

This chapter focuses on depression and stress-related conditions to discuss possible strategics for the prevention or early management of such conditions. Health education constitutes the first important strategy, and we outline a school-based educational activity using a case-method approach. We next illustrate the impact of stressful events on psychological health with the results of a survey among Chinese individuals conducted after an unexpected epidemic of severe acute respiratory syndrome in 2003. Communication plays an important role in the assessment and management services provided by medical practitioners to sick individuals, with very diverse backgrounds and levels of medical knowledge, who consult health care providers with concerns about their health. In this context, we introduce a recent advance in patient-doctor communication. Finally, we address the cognitive and behavioral features of those who suffer from depression and psychosocial stress. Based on our recent activities and on evidence pertaining to health promotion and education, we emphasize the importance of health education and communication in the prevention of stress-related diseases and the promotion of physical and psychological health.

While various volatile organic compounds (VOCs) are known to show neurotoxic effects, the detailed mechanisms of the action of VOCs on the autonomic nervous system are not fully understood, partially because objective and quantitative measures to indicate neural abnormalities are still under development. Nevertheless, heart rate variability (HRV) has been recently proposed as an indicative measure of the autonomic effects. In this study, we used HRV as an indicative measure of the autonomic effrects to relate their values to the personal concentrations of VOCs measured by a real-time VOC monitor. The measurements were conducted for 24 hours on seven healthy subjects under usual daily life conditions. The results showed HF powers were significantly decreased for six subjects when the changes of total volatile organic compound (TVOC) concentrations were large, indicating a suppression of parasympathetic nervous activity induced by the exposure to VOCs. The present study indicated these real-time monitoring was useful to characterize the trends of VOC exposures and their effects on autonomic nervous system.

Background: This study was performed to examine whether patients with type 2 diabetes have cognitive deficits associated with the prefrontal cortex (PFC).Methods: Twenty-seven middle-aged patients with newly diagnosed type 2 diabetes and 27 healthy controls underwent physical measurements and neuropsychological tasks. Response inhibition, reward prediction, and executive function were assessed by the Go/NoGo task, the reversal and extinction tasks, and the Wisconsin Card Sorting Test (WCST). To examine the interactions of being overweight with diabetes on cognitive performance, performance data were analysed by two-way ANCOVA with diabetes and overweight as factors and age as a covariate.Results: Patients with type 2 diabetes showed significantly decreased response inhibition in the Go/NoGo task (discriminability index: P = 0.001). There was an interaction of being overweight with diabetes on reaction time in the Go trials of the Go/NoGo task (P = 0.009). Being overweight was related to retained responses to the presentiment of reward in the extinction task (P = 0.029). The four groups showed normal cognitive performance in the WCST.Conclusions: Our results showed that middle-aged, newly diagnosed and medication-free patients with type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight. © 2010 Ishizawa et al
licensee BioMed Central Ltd.

Many meditation exercises aim at increased awareness of ongoing experiences through sustained attention and at detachment, i.e., non-engaging observation of these ongoing experiences by the intent not to analyze, judge or expect anything. Long-term meditation practice is believed to generalize the ability of increased awareness and greater detachment into everyday life. We hypothesized that neuroplasticity effects of meditation (correlates of increased awareness and detachment) would be detectable in a no-task resting state. EEG recorded during resting was compared between Qigong meditators and controls. Using LORETA (low resolution electromagnetic tomography) to compute the intracerebral source locations, differences in brain activations between groups were found in the inhibitory delta EEG frequency band. In the meditators, appraisal systems were inhibited, while brain areas involved in the detection and integration of internal and external sensory information showed increased activation. This suggests that neuroplasticity effects of long-term meditation practice, subjectively described as increased awareness and greater detachment, are carried over into non-meditating states.

Objectives The Quick Environment Exposure Sensitivity Inventory (QEESI) has been used as a questionnaire to evaluate subjective symptoms of patients with multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance, in Japan. However, no cutoff value for Japanese subjects has yet been established. We designed this study to establish a cutoff value for Japanese subjects using QEESI(©) for screening of MCS patients. Methods A questionnaire using the QEESI© was administered to 103 MCS patients and 309 healthy control subjects matched for age and sex. QEESI© scores of the two groups were compared using logistic regression analysis, receiver operating characteristic analysis, and the Mann-Whitney test. Results Cutoff values for Japanese subjects were determined for the Chemical Intolerance subscale (40), Symptom Severity subscale (20), and Life Impact subscale (10). The subjects whose scores exceeded the cutoff values in any two subscales accounted for 88.4% of the patients but only 14.5% of the controls. Conclusions Our results suggest that subjects meeting two out of three subscale criteria can be screened as patients suffering from a low level of environmental chemicals such as MCS in Japan. © 2009 The Japanese Society for Hygiene.

Objective: This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients.
Methods: Tell studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen&apos;s effect size d was computed for each category.
Results: MBSR may indeed be helpful for the mental health of cancer patients (Cohen&apos;s effect size d = 0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen&apos;s effect size d = 0.18).
Conclusion: The results suggest that MBSR may improve cancer patients&apos; psychosocial adjustment to their disease. Copyright (C) 2008 John Wiley & Sons, Ltd.

A consistent association between low endogenous 5HT function and high alcohol preference has been observed, and a number of serotonergic manipulations (uptake blockers, agonists) alter alcohol consumption in animals and humans. Studies have also shown an inverse relationship between alcohol use and cerebrospinal fluid levels of serotonin metabolites, suggesting that chronic alcohol consumption produces alterations in serotonin synthesis or release.
The objective of the study was to characterize regional brain serotonin synthesis in nondepressed chronic alcoholics at treatment entry in comparison to normal nonalcoholic controls using PET and the tracer alpha-[(11)C]-methyl-l-tryptophan.
Comparisons of the alcoholics and controls by SPM found that there were significant differences in the rate of serotonin synthesis between groups. Serotonin synthesis was significantly lower among alcoholics in Brodmann Area (BA) 9, 10, and 32. However, serotonin synthesis among the alcoholics group was significantly higher than controls at BA19 in the occipital lobe and around the transverse temporal convolution in the left superior temporal gyrus (BA41). In addition, there were correlations between regional serotonin synthesis and a quantity-frequency measure of alcohol consumption. Regions showing a significant negative correlation with QF included the bilateral rectus gyri (BA11) in the orbitofrontal area, the bilateral medial frontal area (BA6), and the right amygdala.
Current alcoholism is associated with serotonergic abnormalities in brain regions that are known to be involved in planning, judgment, self-control, and emotional regulation.

I will review the brain imaging studies on panic disorder (PD), and show the significance that they propose for the development of psychosomatic medicine. The major neuroanatomical models of PD have been proposed by Gorman and Coplan. The sufficient evidence has been accumulated these 5 years for supporting their hypotheses, and PD has come to be regarded as a brain disease. The studies include those showing brain functional abnormalities at rest, specific responses to the relevant tasks, and brain structural abnormalities. The results indicated the hypofunction and atrophy of prefrontal cortex besides the hyperfunction of amygdala, hippocampus, and periaqueductal grey that are the key structures of the above-mentioned models. On the other hand, PD could be treated successfully by a cognitive behavior therapy without the use of psychotropic drugs in a study, and the brain glucose metabolic changes were found not in amygdala but in bilateral dorsomedial prefrontal corteces related to mindful awareness. This result indicates that the change in mind brings the change in body, which is an important fact presenting a basis of mind/body interaction.

本研究の目的はQuick Environment Exposure Sensitivity Inventory(QEESI)を用いて一般人の中から化学物質過敏症(MCS)の疑いがある人をスクリーニングするための日本独自のカットオフ値を設定すること、また、喫煙などの常時に曝露する化学物質がMCSの発症に及ぼす影響を検討することである。北里研究所病院臨床環境医学センターでMCSと診断された103名とこれらの患者群と年齢性別をマッチングした対照群(健常者)309名に対し、QEESIを用いたアンケート調査を行った。患者群と対照群の自覚症状は、QEESIの4下位尺度40項目得点をロジスティック回帰分析および受信者動作特性曲線(ROC曲線)を用いて比較した。常時曝露化学物質の影響はマスキング尺度10項目のロジスティック回帰分析で検討した。MCSの自覚症状は、化学物質不耐性、症状、日常生活障害の3下位尺度で評価でき、カットオフ値は、それぞれ、40、20、10点と設定された。3下位尺度中いずれか2尺度がカットオフ値以上の人は、患者群では88.4%、健常者群では14.5%であった。そこで、日本では、化学物質不耐性40点以上、症状20点以上、日常生活障害10点以上のいずれか二つに該当する人を"MCSの疑いがある"としてスクリーニングできることが示唆された。常時曝露化学物質10項目のロジスティック回帰分析では、患者群が対照群より得点が高いもの(オッズ比1以上)と、患者群が対照群より得点が低いもの(オッズ比1以下)に明白に分類された。オッズ比15.0の仕事・趣味での化学物質使用とオッズ比4.7の殺虫剤・防虫剤は、日本のMCSの発症要因の一つである可能性が高い。一方、オッズ比1以下の5項目(喫煙、受動喫煙、飲酒、カフェイン摂取、柔軟剤使用)は患者の多くがこれらの要因で症状が悪化するため回避するようになった項目だと考えられる。(著者抄録)

Background: Panic disorder is one of the anxiety disorders, and anxiety is associated with some locomotor activity changes such as "restlessness". However, there have been few studies on locomotor activity in panic disorder using actigraphy, although many studies on other psychiatric disorders have been reported using actigraphy. Therefore, the aim of the present study was to investigate the relationship between panic disorder and locomotor activity pattern using a wrist-worn activity monitor. In addition, an ecological momentary assessment technique was used to record panic attacks in natural settings. Methods: Sixteen patients with panic disorder were asked to wear a watch-type computer as an electronic diary for recording panic attacks for two weeks. In addition, locomotor activity was measured and recorded continuously in an accelerometer equipped in the watch-type computer. Locomotor activity data were analyzed using double cosinor analysis to calculate mesor and the amplitude and acrophase of each of the circadian rhythm and 12-hour harmonic component. Correlations between panic disorder symptoms and locomotor activity were investigated. Results: There were significant positive correlations between the frequency of panic attacks and mesor calculated from double cosinor analysis of locomotor activity (r = 0.55) and between HAM-A scores and mesor calculated from double cosinor analysis of locomotor activity (r = 0.62). Conclusion: Panic disorder patients with more panic attacks and more anxiety have greater objectively assessed locomotor activity, which may reflect the "restlessness" of anxiety disorders. © 2008 Sakamoto et al
licensee BioMed Central Ltd.

Multiple chemical sensitivity (MCS), a syndrome in which multiple symptoms occur with low-level chemical exposure, has not been clarified in detail. The aim of our study was to clarify the clinical characterisitics of physician-diagnosed MCS patients in Japan. We analyzed patient characerisitics based on the medical records of 106 patients diagnosed with MCS according to the 1999 Consensus and the Japanese diagnostic criteria for MCS. We evaluated subjective symptoms using the Quick Environment Exposure Sensitivity Inventory (QEESI) and compared the QEESI scores with those of four MCS patient groups in the US reported by Miller and Prihoda [Miller, C.S., Prihoda, T.J., 1999b. A controlled comparison of symptoms and chemical intolerances reported by Gulf War veterans, implant recipients, and persons with multiple chemical sensitivity. Toxicol Ind Health 15, 386-397].
Female patients accounted for 74.0%. Most male patients were in their 30s, whereas female ages ranged widely from 10 to 65 years. Among estimated onset factors, those seen in males tended to be workplace related, while female patients showed a variety of factors. Co-morbid allergic disease was present in 84.0% of patients. A significant difference in the QEESI score between male and female patients was found in only one item out of 10 in symptom severity and life impact. However, all 10 items in chemical intolerance were significantly higher in females than in males. The mean QEESI score in the patient group in our study was lower than those in any of the four self-reported patient groups in the US. (C) 2007 Elsevier GmbH. All rights reserved.

Aims: Sociocultural factors are thought to be important in the pathogenesis of eating disorders. However, there have been few studies comparing eating behavior among various cultural populations. The aim of the present study is to compare attitudes towards bodyweight and shape, and desire for thinness in Japanese male and female subjects with those in people from other countries and of different ethnic origin.
Methods: The subjects were 411 Japanese, 130 Indian, 135 Omani, 113 Euro-American and 196 Filipino adolescents. The Eating Attitude Test-26 and the Drive for Thinness subscale of the Eating Disorder Inventory-2 were used to assess eating attitudes and fat phobia.
Results: Subjects from India, Oman and the Philippines demonstrated eating attitudes that were similar to or worse than subjects from Western countries and Japan, although their desire for thinness was not as strong. The relationship between body mass index and eating attitudes or fat phobia in Indian, Omani and Filipino subjects differed from that in subjects from Western countries and Japan. In addition, both males and females showed disturbed eating attitudes in the Indian, Omani, and Filipino subjects. Conclusion: There are differences in eating attitudes and the drive for thinness among different cultural groups.

Objective. To investigate the relationship between subtypes of irritable bowel syndrome (IBS) and severity of symptoms associated with panic disorder (PD). Material and methods. The study comprised 178 consecutive new PD outpatients. Sixty-four patients met the Rome-II criteria for IBS (IBS[+]; 29 diarrhea-predominant IBS (IBSD), 14 constipation-predominant IBS (IBSC), 21 other types of IBS). Results. IBSD patients with agoraphobia avoided a greater number of scenes owing to fear of panic attack than did PD patients without IBS (IBS[-]) and with agoraphobia. IBS[+] patients with avoidant behavior due to fear of IBS symptoms had significantly higher Beck Depression Inventory (BDI) scores and avoided a larger number of scenes owing to fear of panic attack than IBS[+] patients with agoraphobia and without avoidant behavior due to fear of IBS symptoms or IBS[-] patients with agoraphobia. Conclusions. The results suggest that the presence of IBSD or avoidant behavior because of fear of IBS symptoms may be associated with a more severe form of agoraphobia, and the latter may also be associated with depression.

本研究の目的は日本の化学物質過敏症(MCS)患者の臨床的特徴を明らかにし、診断に有効な他覚的臨床検査について検討することである。そこで、北里研究所病院臨床環境医学センターの外来患者で、MCSと診断された患者106名のカルテを基に、性別、年齢、発症要因、アレルギー疾患、自覚症状の性差及び他覚臨床検査結果について解析した。患者の74%は女性であった。84%の患者が何らかのアレルギー疾患を有していた。男性は若年者が多く発症要因は職場関連の化学物質曝露が大部分を占めたのに対し、女性は幅広い年齢分布を示し推定発症要因も多彩であった。自覚症状はquick environment exposure sensitivity inventory(QEESI)で評価し、男女の得点を比較した。症状と日常生活障害は男女で有意差がなかったが、化学物質不耐性は全項目で女性が男性より有意に得点が高かった。他覚的臨床検査(滑動性眼球追従運動、視空間周波数特性、瞳孔反応、神経反射)の陽性率は、それぞれ、85.8、69.8、46.7、54.1%であり、これら4つの検査がすべて陰性だった患者はいなかった。神経眼科的検査結果からは、MCS患者の多彩な自覚症状は高位の中枢神経や自律神経系の機能異常に起因することが示唆された。(著者抄録)

Patients with chronic fatigue syndrome (CFS) report substantial symptom worsening after exercise. However, the time course over which this develops has not been explored. Therefore, the objective of this study was to investigate the influence of exercise on subjective symptoms and on cognitive function in CFS patients in natural settings using a computerized ecological momentary assessment method, which allowed us to track the effects of exercise within and across days. Subjects were 9 female patients with CFS and 9 healthy women. A watch-type computer was used to collect real-time data on physical and psychological symptoms and cognitive function for 1 week before and 2weeks after a maximal exercise test. For each variable, we investigated temporal changes after exercise using multilevel modeling. Following exercise, physical symptoms did get worse but not until a five-day delay in CFS patients. Despite this, there was no difference in the temporal pattern of changes in psychological symptoms or in cognitive function after exercise between CFS patients and controls. In conclusion, physical symptoms worsened after several days delay in patients with CFS following exercise while psychological symptoms or cognitive function did not change after exercise. (C) 2007 Elsevier Inc. All rights reserved.

Serotonin (5-hydroxytryptamine; 5-HT) 2C receptors and the downstream melanocortin pathway are suggested to mediate the appetite-suppressing effects of 5-HT drugs such as m-chlorophenylpiperazine (mCPP) and fenfluramine. Here, we report that fluvoxamine (3-30 mg/kg), a selective serotonin reuptake inhibitor (SSRI), in the presence of SB 242084 (1-2 mg/kg), a selective 5-HT(2C) receptor antagonist, exerts appetite-suppressing effects while fluvoxamine or SB 242084 alone has no effect. The appetite-suppressing effects were attenuated in the presence of SB 224289 (5 mg/kg), a selective 5-HT(1B) receptor antagonist. Moreover, CP 94253 (5-10 mg/kg), a selective 5-HT(1B) receptor agonist, exerted appetite-suppressing effects and significantly increased hypothalamic pro-opiomelanocortin (POMC) and cocaine- and amphetamine-regulated transcript (CART) gene expression and decreased hypothalamic orexin gene expression. These results suggest that fluvoxamine and inactivation of 5-HT(2C) receptors exert feeding suppression through activation of 5-HT(1B) receptors, and that 5-HT(1B) receptors up-regulate hypothalamic POMC and CART gene expression and down-regulate hypothalamic orexin gene expression in mice.

Objective: To compare Omani and western teenagers attending schools in Muscat, Sultanate of Oman and Filipino teenagers residing in Manila, Philippines on indices of deliberate food restriction and dieting behavior. Methods: The sample consisted of 444 students who were assessed using the cross-culturally valid measure, Eating Attitude Test-26, a subscale of Eating Disorder Inventory to gauge the presence of the drive for thinness or 'fat phobia' and the Bradford Somatic Inventory to elicit the presence of somatization. Result: Significant differences in attitudes to eating, body image and somatization between the western and non-western teenagers were found. Conclusion: This paper suggests that trajectories of eating disorder, such as body image disturbances as expressed in fat phobia and somatization, tend to vary from culture to culture and underscore the view that some of the health related behavior among adolescents need to be examined within socio-cultural contexts. © 2007 Elsevier Ltd. All rights reserved.

While various VOCs are known to show neurotoxic effects, the detailed mechanisms of VOCs on autonomic nervous system have not been fully understood partly because objective and quantitative measures to indicate neural abnormalities are still under development. Nevertheless, heart rate variability (HRV) has been recently proposed as an indicative measure of the autonomic defect. In this study, we used HRV as an indicative measure of the autonomic defect to relate their values to the personal concentrations of VOCs measured by a real-time VOC monitor. The measurements were conducted to 7 healthy subjects for 24 hours. The results showed HF powers were decreased for 6 subjects when the TVOC concentration changes were high, indicating the suppression of parasympathetic nervous induced by the exposure to VOCs. The present study indicated these real-time monitoring was useful to characterize the trends of VOC exposures and their effects on autonomic nervous system. Application of the present method is expected to lead to diagnosis and cure for the patients such as MCS and sick building syndrome in the future.

Gorman et al. proposed a "fear network" hypothesis as the neuroanatomical mechanism of the panic disorder in the human brain. This "fear network" should be centered in the amygdala and involve its interaction with the hippocampus and medial prefrontal cortex. Projection from the amygdala to hypothalamic and brainstem sites should consecutively lead to a lot of observed signs of conditioned fear responses. We have been studying regional brain glucose metabolism in patients with panic disorder using PET with [18F] fluorodeoxyglucose (FDG). One purpose of this study is to clarify the mechanism of the panic disorder in the human brain and to verify this "fear network" hypothesis. Another purpose is to investigate the effect of the "cognitive-behavioral therapy" on the human brain. In this study, we performed to compare regional brain metabolic rate for glucose in subjects with pre-treatment panic disorder to those in normal controls, and also to investigate the changes produced after successful completion of cognitive-behavioral therapy. The pre-treatment subjects with panic disorder showed significantly higher levels of metabolic activity in the bilateral amygdala, hippocampus and some regions of brainstem and cerebellum as compared with control subjects. After successful cognitive-behavioral therapy, areas of increased regional brain glucose metabolism were shown in the bilateral medial prefrontal regions, whereas areas of decreased metabolism were in the right hippocampus, left cerebellum, pons and so on, but there were no significant change in the amygdala. These results provided the first neuroimaging support in human patients for the "fear network" hypothesis of panic disorder. The results after cognitive-behavioral therapy, also, clearly explained the therapeutic mechanism in the human brain on the basis of this hypothesis.

Objectives: The purpose of this report is to show a key concept of Narrative-Based Medicine (NBM) through qualitative analysis of interactions between the patient, a doctor and a third person. We will now need to consider a plasticity of illness narratives more closely to understand this interactive relationship. Subjects and method: Illness narratives were collected from 20 outpatients at a clinic in Tokyo. From March 2000 to August 2000, we conducted non-structured interviews intensively to examine illness narratives. The subjects of this study were 5 patients who were placed in the 3rd stage of the Four-stage model (Table 1). This study adopted the qualitative research method from an anthropological point of view because it was necessary to mention the influence of researchers upon their subjects. Results: It has been recognized by our research that there is a process to refine illness narrative (Fig. 1). In the 3rd stage of the Four-stage model, patients become an expert of illness experience while medical doctors remain as a specialist of disease. Furthermore, we examined a key concept in NBM. We found that there are 3 aspects of witness in the 3rd stage (Fig. 2); (I) illness narratives of witness, (II) medical doctor as a witness person for their illness narratives, (III) researcher or family member as a second witness person for doctor-patient relationship. Conclusion: We found that each interaction among 3 aspects could be considered indispensable in order to conduct NBM effectively. It is sure that to witness a patient's daily life is one of the most important elements in NBM. Therefore, we named the interaction among 3 aspects Witness-Based Medicine.

The purposes of this study were to clarify the characteristics of physician-diagnosed MCS patients in Japan. Thus, based on the medical records of 106 patients diagnosed with MCS according to both the 1999 Consensus and the Japanese diagnostic criteria for MCS, we analyzed demographic characteristics (sex and age), onset factors, co-morbid allergic diseases. In addition, subjective symptoms were evaluated using the QEESI®, and we compared the QEESI® scores with those of four MCS patient groups in the U.S. reported by Miller and Prihoda (1999b). Female patients accounted for 74.0%. The peak age in males was 30-34 years, whereas females showed a wide age distribution with three peaks, 30-34, 45-49 and 60-64 years. The most common MCS onset factors included indoor air contaminants by new construction or renovation of home or work place (63.2%), followed by exposure to chemicals in workspace or hobby (26 3%). In addition, co-morbid allergic disease was presented for 84.0%.

Objectives: We introduce "Mobile Nurse" (MN)-an emerging platform for the practice of ubiquitous medicine.
Methods: By implementing in a dynamic setting of daily life the patient care traditionally provided by the clinical nurses on duty, MN aims at integral data collection and shortening the response time to the patient MN is also capable of intelligent interaction with the patient and is able to learn from the patient's behavior and disease sign evaluation for improved personalized treatment.
Results: In this paper, we outline the most essential concepts around the hardware, software and methodological designs of MN. We provide an example of the implementation, and elaborate on the possible future impact on medical practice and biomedical science research.
Conclusions: The main innovation of MN, setting it apart from current tele-medicine systems, is the ability to integrate the patient's signs and symptoms on site, providing medical professionals with powerful tools to elucidate disease mechanisms, to make proper diagnoses and to prescribe treatment.

Recalled evaluation of headache intensity is often affected by several factors. Recently, computerized ecological momentary assessment (EMA) has been developed to avoid such problems as recall bias. Here, we compared recalled headache intensity with momentary headache intensity using EMA in tension-type headache (TTH). Forty patients with TTH wore watch-type computers for 1 week to record momentary headache intensity and also rated their headache intensities by recall. We calculated intraclass correlation coefficients between recalled headache intensity and indices from EMA recordings in the whole study population and in two subgroups divided by variability of momentary headache intensity. The results showed that consistency and agreement of momentary and recalled headache intensity were low, and this was especially marked in the subjects whose headache varied widely. These observations suggested that variability of headache intensity may affect recall of headache intensity and this should be taken into consideration in both clinical and research settings.

Several neuroanatomical hypotheses of panic disorder have been proposed focusing on the significant role of the amygdala and PAG-related "panic neurocircuitry." Although cognitive-behavioral therapy is effective in patients with panic disorder, its therapeutic mechanism of action in the brain remains unclear. The present study was performed to investigate regional brain glucose metabolic changes associated with successful completion of cognitive-behavioral therapy in panic disorder patients. The regional glucose utilization in patients with panic disorder was compared before and after cognitive-behavioral therapy using positron emission tomography with F-18-fluorodeoxyglucose. In 11 of 12 patients who showed improvement after cognitive-behavioral therapy, decreased glucose utilization was detected in the right hippocampus, left anterior cingulate, left cerebellum, and pons, whereas increased glucose utilization was seen in the bilateral medial prefrontal cortices. Significant correlations were found between the percent change relative to the pretreatment value of glucose utilization in the left medial prefrontal cortex and those of anxiety and agoraphobia-related subscale of the Panic Disorder Severity Scale, and between that of the midbrain and that of the number of panic attacks during the 4 weeks before each scan in all 12 patients. The completion of successful cognitive-behavioral therapy involved not only reduction of the baseline hyperactivity in several brain areas but also adaptive metabolic changes of the bilateral medial prefrontal cortices in panic disorder patients. (c) 2006 Elsevier Inc. All rights reserved.

Objective: To find differences in heart rate before and after refeeding and to identify which parameters of autonomic activity and endocrine function are associated with these differences.
Methods: Before and after the start of refeeding, body weight, RR interval (RRI), heart rate variability, endocrine function, and energy expenditure were measured in nine female anorexia nervosa patients.
Results: After short-term refeeding, mean daytime heart rate rose from 54.9 to 69.4 bpm (P &lt; .05). The changes in sympathetic activity were correlated negatively with the changes in RRI (r = -.933, P &lt; .001). Urine C-peptide, IGF-1, and fT3 increased significantly, and norepinephrine tended to increase.
Conclusion: We demonstrated that autonomic nervous activity was relevant to changes in heart rate during refeeding, and it is speculated that the increases in insulin secretion, thyroid function, and IGF-I were responsible for the mechanisms. (c) 2006 Elsevier Inc. All rights reserved.

OBJECTIVE: The objective of this study was to investigate associations between accelerometer measurements of physical activity and psychosocial variables in older people. METHODS: Subjects were 184 Japanese aged 65-85 years. An accelerometer provided step count and physical activity intensity data throughout each 24-hour period for 1 year. At the end of the year, anxiety, depression, and cognitive function were assessed. RESULTS: Controlling for age, the daily number of steps, and the daily duration of moderate-intensity physical activity showed significant negative correlations with depressive mood. CONCLUSION: A depressive mood is associated with the quantity and quality of habitual physical activity.

The authors prospectively assessed the causal relationship between psychosocial factors and glycemic control in 256 Japanese outpatients with Type 2 diabetes. Using structural-equation modeling, they first developed a causal model in which glycosylated hemoglobin (HbA(1c)) at 6 months after assessment was influenced by the baseline psychosocial factors. Then, the reliability of the causal model was investigated with measurement of HbA(1c) at 12 months after baseline. Self-efficacy directly reinforced adherence, and adherence had a direct association with future HbA(1c) Other psychosocial factors, including social support, diabetes-related distress, daily burden, and emotion-focused coping prospectively influenced HbA(1c) indirectly through self-efficacy.

Medical Anthropology is one of the branches of social and cultural anthropology, and it explores the relationship between health-illness and their socio-cultural systems. In this reports, we wish to present in detail methods of qualitative study on psychosomatic research applying the approach of Medical Anthropology, illustrating our original reports such as <1> Socio-Cultural Background of the Clients in Folk Sector Medicine; Qualitative Research by Medical Anthropology Concept (Jpn J Psychosomatic Med 45: 53-62, 2005), <2> Illness Narrative in Psychosomatic Medicine: Qalitative Research in Cultural Anthropology (Jpn J Psychosomatic Med 45: 449-457, 2005), and <3> "Witness-Based Medicine" in Psychosomatic Medicine: Qualitative Research in Cultural Anthropology (2nd report) (Jpn J Psychosomatic Med 45: 907-914, 2005). In clinical medical anthropology, following 3 key concepts are much useful to clarify the socio-cultural interaction of illness experience. 1) Illness behavior in pluralistic health care system: Health care system of a society consists of medical subsystems that exist in cooperative or competitive relationship with one another. A. Kleinman (1980) described it as a local cultural system composed of three overlapping parts: the popular, folk, and professional sectors. It is meaningful to determine a patient's characteristic illness behavior within this pluralistic health care system. 2) Explanatory Model (EM): Doctors and patients view illness-health in very different ways. Doctors regard sickness as 'Disease' objectively in accordance with scientific rationality, while patients look at sickness as 'Illness' subjectively from their individual experiences of agony. In clinical sessions, these two different EM's conflict and assimilate. 3) Illness narrative & Clinical ethnography: Narrative approach aims to understand meanings of illness experiences and describes practical knowledge based on a patient's first-hand experience of illness by multi-vocal story telling. Ethnography approach tries to illustrate through clinical fieldworks the various worlds of patients' individual and local life story or history.

Objectives: The objectives of the study were to find the prevalence of major depressive disorder (MDD) in male climacteric outpatients in Japan, and to determine whether symptoms on the Aging Males' Symptoms (AMS) scale scores differed between patients with and without MDD, with the aim of increasing the specificity of future symptoms scales for partial androgen deficiency of the aging male (PADAM).
Methods: Eighty-three patients aged 40-70 who visited the male-climacteric services as outpatients were assessed using three items: a self-administered questionnaire corresponding to diagnosis for MDD, the Beck Depression Inventory, and the AMS scale.
Results: Almost half the patients had MDD. The total AMS score, the scores on the AMS psychological, somatic and sexual subscales, and the scores for all except three questionnaire symptoms were higher in patients with MDD. There were strong correlations between the AMS scale and the Beck Depression Inventory.
Conclusions: There is a higher prevalence of MDD in male-climacteric outpatients and scores on most items of the AMS scale were higher for patients with MDD. We suggest that only those symptoms whose scores did not differ between patients with and without MDD are used to assess symptoms of PADAM in the presence of MDD, or that the current AMS is used only after diagnosis of MDD and elimination of these patients. Then the relevance of each item of the AMS to testosterone levels should be simultaneously examined in the future study, which will determine the items highly specific to PADAM symptoms. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Objective: Eating disorders (ED) are thought to be risk factors for sudden death, and arrhythmias are one of the major causes of sudden death in ED patients. Late potentials (LPs) are a predictor of arrhythmias and can be measured using signal-averaged electrocardiography (SAECG). We examined arrhythmogecity by LPs in ED patients. Methods: We performed SAECG on 48 female ED patients [21 with anorexia nervosa (AN) and 27 with bulimia nervosa (BN)] and on 20 healthy women. An LP was judged positive if two or more of the following criteria were fulfilled: QRS duration &gt; 120 ms, root-mean-square voltage &lt; 20 mu V, and a high-frequency, low-amplitude duration &gt; 38 ms. We compared the occurrence of LPs among subgroups. Results: Compared with the controls, BN patients with a history of AN had significantly more SAECG abnormalities. Conclusions: BN patients with a history of AN may be prone to ventricular arrhythmias. (c) 2006 Elsevier Inc. All rights reserved.

Resting energy expenditure (REE) increases in anorexia nervosa patients after refeeding; however, the associated mechanisms remain unclear. We hypothesized that changes in autonomic nervous activity are relevant to changes in REE during refeeding. The objectives of this study were (1) to confirm differences in REE during refeeding and (2) to identify the parameters associated with these differences. The subjects were 9 female inpatients with anorexia nervosa receiving cognitive-behavioral therapy. Both before and after the start of refeeding, which was defined as the first increase in food intake of 1675 kj or more per day, body composition, REE, endocrine function, R-R interval, autonomic nervous activity evaluated in terms of heart rate variability, and physical activity were measured and psychological tests completed. The differences in measurements before and after refeeding and specific associations between changes in REE and other factors were assessed. Resting energy expenditure increased significantly by 22.7% from 3190 to 3910 kj/d (P &lt; .01) with the increase in energy intake. Fat-free mass and physical activity did not change. The increase in REE was accompanied by higher insulin-like growth factor-I, free triiodothyronine, and norepinephrine and decreases in parasympathetic activity and R-R interval. Some factors might be responsible for the increases in REE observed with refeeding. No previous study has simultaneously observed multiple variables related to energy metabolism during refeeding. (c) 2005 Elsevier Inc. All rights reserved.

The objective of this double-blind, placebo-controlled randomized withdrawal study was to evaluate the efficacy and safety of sertraline for 8 weeks in treating Japanese patients with DSM-IV panic disorder. Patients (n=394) were initially treated with 8 weeks of open-label sertraline followed by 8 weeks of double-blind treatment with either sertraline (50-100 mg/day) or placebo. Responders during the open-label phase were eligible to be entered into the double-blind phase. Two hundred and forty patients were entered to the double-blind phase and randomly assigned to receive sertraline (n=119) or placebo (n=121). On the primary efficacy measure (relapse), there was no significant difference between the two treatment groups (sertraline 10.1 %; placebo 13.2%). However, the frequency of panic attacks was significantly (P=0.012) lower for sertraline compared to placebo. The proportion of sertraline-treated patients who met response criteria (Clinical Global Impression-Improvement Scale score of 1 or 2) at the end of double-blind phase treatment was also significantly (P=0.003) higher for sertraline (89.9%) compared to placebo (74.4%). Panic Disorder Severity Scale total score was significantly (P=0.012) lower in the sertraline group compared to the placebo group. Adverse events during acute treatment were consistent with the known adverse event profile of sertraline, and the incidence of adverse events during the double-blind phase treatment was not different between sertraline and placebo. Int Clin Psychopharmacol. (c) 2005 Lippincott Williams & Wilkins.

Objective: This semiprospective case-control study was performed to investigate the relationship between harmony-seeking personality and the occurrence of prostate cancer. Methods: Out of 217 consecutive participants admitted to hospital for biopsy, 86 and 81 were classified into the case and control groups, respectively, based on their initial diagnosis and eligibility criteria. The participants answered several questionnaires after admission. The logistic regression model was used for multivariate analyses to assess the association. Results: "Harmony-seeking personality" was selected as the only psychological variable significantly contributing to the model, while "family history of prostate cancer" as the only somatic variable. "Harmony-seeking" maintained a significant contribution to the model, also including "family history" and even to the model adjusted by "patient prediction of cancer diagnosis" and "prostate-specific antigen" (PSA), probably related to the consequences of the disease. Conclusion: The harmony-seeking personality could differentiate between groups of men with and without prostate cancer. (c) 2005 Elsevier Inc. All rights reserved.

The present study was performed to assess cerebral glucose metabolism in patients with panic disorder using positron emission tomography. F-18-fluorodeoxyglucose positron emission tomography with voxel-based analysis was used to compare regional brain glucose utilization in 12 nonmedicated panic disorder patients, without their experiencing panic attacks during positron emission tomography acquisition, with that in 22 healthy controls. Panic disorder patients showed appreciably high state anxiety before scanning, and exhibited significantly higher levels of glucose uptake in the bilateral amygdala, hippocampus, and thalamus, and in the midbrain, caudal pons, medulla, and cerebellum than controls. These results provided the first functional neuroimaging support in human patients for the neuroanatomical hypothesis of panic disorder focusing on the amygdala-based fear network. NeuroReport 16:927-931 (c) 2005 Lippincott Williams & Wilkins.

The present study was performed to examine how intention to learn and explicit knowledge in sequence learning are reflected in event-related potentials. Participants responded to numerals presented in a repeating order, which were replaced infrequently by deviant numerals. The participants were given incidental or intentional learning instructions. Sequence parts for which they acquired explicit knowledge were identified for each participant by post-task memory tests. Reaction times indicated that sequence learning occurred under both types of instruction. The N2 enhancement for deviants was primarily associated with explicit sequence knowledge, and the P3 enhancement showed a weak association. These results suggested that N2 and P3 reflect different aspects of explicit learning. NeuroReport 16:705-708 &COPY; 2005 Lippincott Williams & Wilkins.

QEESI (c) (Miller and Prihoda, 1999a: Toxicology and Industrial Health, 15, 370) was applied to 498 subjects, recruited from the general population of Miyagi prefecture, Japan, who had not been diagnosed previously as having multiple chemical sensitivity (MCS) or sick building syndrome.
Seventeen (3.8%) of 440 subjects who returned valid completed questionnaires were classified as having symptoms 'very suggestive' of MCS using the four-classification system of Miller and Prihoda (1999a). We conducted detailed telephone interviews with these 17 individuals. All were visiting local hospitals on an outpatient basis with diagnoses other than MCS and had either current or previous presumed chemical exposure. Therefore, we recommended they undergo a medical check by MCS medical experts and indoor air quality assessment.
Seven subjects participated in both the medical check and indoor air quality monitoring, six subjects participated in indoor air quality monitoring only and four subjects participated in neither. The seven subjects who participated in both the medical check and monitoring were diagnosed as having MCS by the above expert physicians. In nine houses of 13 subjects who participated in indoor environmental quality (IEQ) survey, acetaldehyde (9/9), formaldehyde (8/9), total volatile compounds (TVOCs) (6/9) and paradichlorobenzene (3/9) levels were above the respective guideline values for indoor air concentrations, outlined by the Ministry of Health, Labor and Welfare of Japan and were presumed to act as factors contributing to the subjects' hypersensitivity and onset or development of symptoms.
These results suggested that there might still be a population of patients not properly diagnosed as having MCS by clinicians in Japan. Therefore, we verified the efficacy of QEESI (Japanese version) for screening of MCS patients.
The results of indoor air quality analysis suggested the manifestation and deterioration of MCS in Japan might be precipitated by indoor air pollutants, such as formaldehyde, acetaldehyde, volatile compounds (VOCs) and paradichlorobenzene.

Feedback negativity is a negative component of the event-related brain potential observed 250-300 ms after feedback stimuli. The present study investigated the effects of value (correct or incorrect) and reward magnitude (no, small or large) on feedback negativity and P300. Feedback negativity was larger after incorrect feedback than after correct feedback, irrespective of reward magnitude. In contrast, P300 amplitude increased with reward magnitude, irrespective of value. The amplitude of feedback negativity was correlated with a trait score of negative affect and not positive affect, whereas P300 amplitude was correlated with positive affect and not negative affect. These results suggest that value and reward magnitude are processed separately in the brain. (c) 2005 Lippincott Williams F Wilkins.

Objective: This study was conducted to confirm the definition of multiple chemical sensitivity (MCS) in actual life: that multiple symptoms are provoked in multiple organs by exposure to, and ameliorated by avoidance of, multiple chemicals at low levels. We used the Ecological Momentary Assessment to monitor everyday symptoms and the active sampling and passive sampling methods to measure environmental chemical exposure. Methods: Eighteen patients with MCS, diagnosed according to the 1999 consensus criteria, and 12 healthy controls participated in this study. Fourteen patients and 12 controls underwent 1-week measurement of physical and psychologic symptoms and of the levels of exposure to various chemicals. Linear mixed models were used to test the hypotheses regarding the symptom profile of MCS patients. Results: Some causative chemicals were detected in 11 of 14 MCS patients. Two other patients did not report any hypersensitivity episodes, whereas passive sampling showed far less exposure to chemicals than control subjects. Another subject reported episodic symptoms but was excluded from the following analyses because no possible chemical was detected. Eleven of the 17 physical symptoms and all four mood subscales examined were significantly aggravated in the interview based on "patient-initiated symptom prompts." On the other hand, there were no differences in physical symptoms or mood subscales between MCS patients and control subjects in the interview based on "random prompts." Conclusions: MCS patients do not have either somatic or psychologic symptoms under chemical-free conditions, and symptoms may be provoked only when exposed to chemicals.

Objective: The aim of this study was to assess the possible interactive effects of age, sex, duration of hemodialysis (HD), educational and income levels, and stress coping mechanisms on depression and anxiety in patients on maintenance HD. Methods: Uremic patients (N = 416), regularly undergoing HD for more than I year, who did not have apparent cerebrovascular disease or serious intellectual impairment, were investigated. The interactive effects of age, sex, duration of HD, and educational and income levels, in relation to stress coping mechanisms, on depression or anxiety were assessed by hierarchical multiple regression analyses. Results: Regression lines illustrating significant (P&LT;.05) interactions were constructed. The decrease in depression accompanying the increase in task-oriented stress coping was greater in highly educated patients than it was in the other patients. Anxiety levels decreased when patients had both high income and demonstrated a range of task-oriented stress coping mechanisms. For patients undergoing HD for tong duration, or with a relatively high income, the decrease of depression and anxiety accompanying a decrease of emotion-oriented stress coping was greater, as compared with other patients. The decrease of depression accompanying an increase of avoidance-oriented stress coping was greater in patients with low income and in older patients than it was in the other patients. Conclusions: These findings may lead to the development of specific and focused interventions for depression or anxiety in maintenance HD patients. &COPY; 2005 Elsevier Inc. All rights reserved.

The aim of this paper is to explain how we will develop psychosomatic medicine in the Department of Psychosomatic Medicine of The University of Tokyo now and in the future, featuring the research methodologies and clinical activities. We will focus on the three research methodologies such as the Ecological Momentary Assessment (EMA), brain functional studies, and neuroendocrinology. The EMA is a method to assess and record biopsycho-socio-ecological data of human subjects in their daily lives, which makes possible the scientific studies on mind-body relationship in natural settings. The major problem to be solved is how to apply or develop relevant data analysis methods to compress huge amount of data and get a concise conclusion. We illustrated one of our studies on multiple chemical sensitivities for indicating the merit of the EMA. Brain functional studies using positron emission tomography, functional magnetic resonance imaging, or eventrelated brain potentials can assess real-time brain functions of human subjects that have been regarded as a black box, which makes possible the studies on 'mind-brain-body' relationship. The relevant issue here is to set parameters of each function of brain, body, and mind and to formulate their relationship. The target of neuroendocrinology is the complex network of various variables of homeostasis control systems including stress hormone, sex hormone, and feeding substances. The relevant issue to be tackled is to include psychobehavioral variables in the above-mentioned network and to investigate the relations among various kinds of variables. The main targets of our clinical activities are psychosomatic diseases, eating disorder, panic disorder, and mild depression. Although the range of our targets naturally overlaps with that of psychiatry, we are much inclined to view patients from the aspects of their body and behavior, and firmly maintain the position that we would see patients under the condition that a patient and a doctor can understand verbally each other. We use pharmacotherapy, lifestyle modification, relaxation, and cognitive behavioral therapies as treatment modalities. Having concrete methodologies of behavior modification and understanding of doctor-patient relationship is one of the major differences between our department and the other departments of internal medicine. We can establish our identity only by living in our own environment day by day. The identity of psychosomatic internal medicine should be also established by exercising what only psychosomaticists can do every day under the request of clinical and research activities and in responding to social demands.

Medical anthropology is one of the branches of social and cultural anthropology, and it investigates the relationship between socio-cultural system and health and/or illness. The objective of this study is to clarify socio-cultural background of the clients in folk sector medicine in Japan, using qualitative research by medical anthropology method. Explanatory model which Kleinman A. defines as 'the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process' was extracted and analyzed from each clients' illness story. The subjects are the clients of one folk sector healer who practice Oriental medicine, Buddhist medicine and Splritualism method. Semi-structured interview and free writing questionnaire were carried out. Characteristic state of diseases easy to use folk sector medicine was evaluated ; the mortal diseases such as cancer for which orthodox medicine has no effective treatments, and the chronic diseases that cannot be controlled completely by orthodox medicine, such as chronic pain and allergic diseases. Characteristic pattern of illness behavior to use folk sector mediclne was also evaluated. The first (75%) : those who use both folk and professional sector medicine. The second (25%) : those who use only folk sector medicine after finding professional sector medicine unsatisfactory. Diverse ideas that regarding life and death were identified by the clients who consult even the same healer. In the illness story, it was founded that each client subjectively selected suitable sector of medicine from the wide range of pluralistic health care systems based on their own sense of values and life stories. By this study, the importance of narrative based medicine (NBM) was indicated.

Objectives:This research attempts to examine illness narrative as health resource in psychosomatic medical treatment. In clinical process, illness narratives in which explanatory models are implicated show considerable plasticity reflecting doctor-patient relationships. We argue for relevance of Narrative-Based Medicine, through detailed analysis of this plasticity in illness narratives. Subjects and Method:Illness narratives were collected from 20 outpatients at a clinic in Tokyo. From March 2000 to August 2000, we conducted non-structured interview in order to examine illness narratives qualitatively from an anthropological point of view. Results:We found that these illness narratives should be considered as health resources for every patient to cope with various stress-factors in their daily life. We hypothesized four-stage model of clinical process according to the observation on transition of doctor-patient relationship and changing contents of a patient's illness narratives. At the beginning of illness symptom, all patients suffer deeply from not being able to express their mind-body discrepancy verbally. At the first stage, they visit medical facility to seek an orthodox explanatory model of medical science. In the second stage, they begin to ask personal explanatory model of the doctor in charge. Finally, they become able to narrate their illness experience fluently, since they have developed a definition of their health conditions while maintaining mind-body discrepancy in certain degree. In the third stage, patients become an expert of "illness experience", while medical doctors remain as a specialist of "disease". Conclusion:It is clear that to continue narrating illness experience has important meaning and function for a patient's health care. In the third stage, some patients become enable to narrate their feelings and sensations particular to their bodily experience. At the same time, medical doctor respects their knowledge of bodily experience and shows proper attitude as audience in their illness narrative.

Hikikomori, a form of acute social withdrawal, is becoming a silent epidemic in Japan. As it has not been reported from other parts of the world, hikikomori fulfills the criteria for "a culture-bound syndrome." We report a case from Oman, in the southern part of Arabia, with all the essential features of hikikomori. We speculate that the social environment of Japanese and Omani society could reinforce behavior akin to hikikomori although this condition may also transcend geography and ethnicity.

Objectives : We argue for a key concept in "Narrative-Based Medicine" through detailed analysis of interactions in illness narratives. The purpose of this research is to illustrate that practical knowledge based on a patient's lived experience of illness has significant meanings and functions for medical treatments that advocate a holistic medical care. Subjects and method : Subjects of this research are 5 patients placed in the 3^<rd> stage of Four-stage model (1^<st> report). This research adopted the qualitative research method from an anthropological point of view, because it was necessary to mention the influence of a researcher upon subjects. An anthropological research for narrative analysis can deal with interactions among patients, a doctor and a researcher as academic agenda. Results : We examined illness narratives for clarification of a key concept in "Narrative-Based Medicine". It was clarified that illness narratives as "witness" were proving the truth of their illness experience. We found there are 3 aspects on dynamics of witness (Fig. 1); (1) illness narratives as witness of subjects in the 3^<rd> stage, (2) a medical doctor as a witness person for their illness narratives, (3) a researcher or a family member as a second witness person. We found that each interaction among these 3 aspects could be considered indispensable conditions in order to conduct medical treatments based on the dynamics of witness. Significance of illness narratives as witness lies in that subjects will be able to live together with chronic illness through interactions among these 3 aspects. Conclusion : In analysis of illness narratives in this research, it was clarified that the dynamics of witness in the above mentioned 3 aspects could generate medical phenomenon that encouraged patients to live together with chronic illness. We regarded the dynamics of witness as one of the key concepts of "Narrative-Based Medicine". Hence we named this medical phenomenon "Witness-Based Medicine".

Objective : High prevalence of irritable bowel syndrome (IBS) in patients with panic disorder (PD) has been reported. PD has a lot in common with IBS on the viewpoints of symptomatology, pharmacotherapy and the brain-gut axis theory. However, precise characteristics of PD patients with IBS are not well understood. Therefore, the purpose of this study is to investigate the clinical characteristics of PD patients with IBS. Method : The participants of this study were 150 PD outpatients (37 males and 113 females, mean age was 33.7±9.5 years old), who met DSM-IVcriteria. PD patients completed Rome II Modular Questionnaire (RMQ), Scale of PD symptoms, and Beck Depression Inventory (BDI). Results : The prevalence of IBS who met Rome II criteria was 36.0% of all participants. The onset of IBS preceded in 38.9%, the onset of PD preceded in 29.6%, and the simultaneous onset was found in 14.8%. The PD patients with IBS (PD[+]/IBS[+]) had significantly higher prevalence of agoraphobia and depression than those without IBS (PD[+]/IBS[-]). PD[+]/IBS[+] was apt to have higher frequency of anticipatory anxiety than PD[+]/IBS[-]. Furthermore, as compared among PD[+]/IBS[+] with agoraphobia (IBS[+]/AP[+]), PD[+]/IBS[+] without agoraphobia (IBS[+]/AP[-]), PD[+]/IBS[-] with agoraphobia (IBS[-]/AP[+]), and PD[+]/IBS[-] without AP (IBS[-]/AP[-]), IBS[+]/AP[+] and IBS[-]/AP[+] had significantly higher degree and frequency of anticipatory anxiety and depression than IBS[-]/AP[-]. Conclusion : High frequency of anticipatory anxiety and depression of PD[+]/IBS[+] may be associated with agoraphobia. However, there was no significant difference between IBS[+]/AP[+] and IBS[+]/AP[-], and between IBS[-]/AP[+] and IBS[+]/AP[-]. Therefore, we should not disregard the relationship between IBS and high score of anticipatory anxiety and depression. Further studies on relationship between IBS and agoraphobia may be required in larger sample.

Error-related negativity (ERN) is a negative deflection in the event-related potential elicited in error trials. To examine the function of ERN, we performed an experiment in which two within-participants factors were manipulated: outcome uncertainty and content of feedback. The ERN was largest when participants expected correct feedback but received error feedback. There were significant positive correlations between the ERN amplitude and the rate of response switching in the subsequent trial, and between the ERN amplitude and the trait version score on negative affect scale. These results suggest that ERN reflects detection of a negative reward prediction error and promotes subsequent response switching, and that individuals with high negative affect are hypersensitive to a negative reward prediction error.

We investigate long-duration time series of human physical activity under three different conditions: healthy individuals in i) a constant routine protocol and ii) in regular daily routine, and iii) individuals diagnosed with multiple chemical sensitivities. We find that in all cases human physical activity displays power law decaying temporal auto-correlations. Moreover, we find that under regular daily routine, time correlations of physical activity are significantly different during diurnal and nocturnal periods but that no difference exists under constant routine conditions. Finally, we find significantly different auto-correlations for diurnal records of patients with multiple chemical sensitivities.

The authors' purpose in this study was to test the hypothesis that laterality and imbalance of muscle stiffness relate to personality. The authors selected 23 healthy volunteers and divided them into two groups based on the predominance of muscle stiffness on the left or right side. Imbalance of muscle stiffness was calculated as the absolute value of the difference of muscle stiffness between the right and left sides. The authors evaluated personality with the Japanese version of the Eysenck Personality Questionnaire. Subjects with left predominant muscle stiffness of the rectal abdominis had significantly higher neuroticism score than those with right predominant muscle stiffness. Subjects with more imbalance of muscle stiffness in the latissimus dorsi and in the trapezius had significantly higher neuroticism and psychoticism scores than those with less imbalance. The findings suggest that laterality and imbalance of muscle stiffness relate to personality.

OBJECTIVES: Irritable bowel syndrome (IBS) is considered to be a transcultural functional bowel disorder with high comorbidity and psychiatric disorders; but well-designed epidemiologic studies have never been performed in Japan. The purpose of this study was to establish the prevalence of IBS, together with the comorbiclity rates of panic disorder (PD) and agoraphobia, employing a large-scale survey based on stratified random sampling.
METHOD: A total of 4,000 subjects aged 20-69 years completed a questionnaire and the results were weighted to ensure representativeness of the Japanese general population. The questionnaire covered key symptoms of IBS, PD, and agoraphobia. The prevalence of IBS and its subtypes was calculated by gender. The comorbidity of PD and agoraphobia with IBS was compared with morbidity in non-IBS subjects; and comorbidity in IBS subjects who had consulted medical practitioners regarding their symptoms and in those who had not was also compared.
RESULTS: The prevalence of IBS was 6.1% in total. It was significantly higher in females than in males. Diarrhea-predominant IBS was more prevalent in males and constipation-predominant IBS in females. The morbidity rates of PD and agoraphobia were significantly higher in IBS than in non-IBS subjects. Comorbidity did not differ between female and male IBS subjects, while morbidity was significantly higher in female than in male non-IBS subjects; and comorbidity did not differ between consulter and nonconsulter subjects.
CONCLUSIONS: The prevalence of IBS and its comorbidity with PD and agoraphobia in Japan were demonstrated to be similar to those reported in Western industrialized countries.

Background: Eating disorders are thought to be risk factors for cardiac sudden death secondary to arrhythmia. Results in previous studies on QT interval and QT dispersion, markers of fatal arrhythmia, have been inconsistent. Methods: We prospectively examined 179 female eating disorder patients, being over 18 years old and diagnosed according to the DSM-IV criteria between January 1995 and December 2002, and 52 healthy women. Patients with abnormal plasma electrolytes or taking medications that might influence the electrocardiogram (ECG) were excluded from the study. QT intervals were corrected for heart rate using Bazett's formula and the nomogram method, which is more reliable at extremely low heart rates than Bazett's formula. QT dispersion was measured as the difference between the longest and shortest QT intervals. QT intervals and QT dispersion in each patient group were compared with those in the control group. Results: The 164 eligible patients consisted of 43 patients with anorexia nervosa restricting type, 35 with anorexia nervosa binge eating/purging type, 63 with bulimia nervosa purging type, and 23 with bulimia nervosa nonpurging type. There was no significant difference in age between eating disorder patients and controls. QT interval and QT dispersion were significantly longer in all eating disorder subtypes than in the control group. QT interval and QT dispersion were significantly correlated with the rate of body weight loss in bulimia nervosa. Conclusions: QT interval and QT dispersion were prolonged in both anorexia nervosa and bulimia nervosa. Examination of ECG in eating disorder patients without extremely low body weight also appears to be clinically important. Copyright (C) 2004 S. Karger AG.

The purpose of this study is to test our hypothesis that muscle relaxation is effective on the psychological well-being of juvenile delinquents. Subjects were 16 juvenile delinquents who had entered a reform school. Subjects were divided into two groups. The muscle relaxation group received muscle relaxation therapy once a week for a total of 4 times. The control group spent an ordinary daily life in the reformatory. Psychological questionnaires used were the Rosenzweig Picture Frustration Study (P-F study), the Psychological Stress Response Scale (PSRS), and the Eysenck Personality Questionnaire (EPQ). There was a significant Group x Time interaction of the Group Conformity Rating (GCR) of the P-F study (F [1, 14] = 10.1, P = 0.007). There were no significant interactions in the other psychological subscales.
Thus, muscle relaxation therapy may improve frustration tolerance among juvenile delinquents.

The purpose of this study was to develop and validate a new scale named the Tokyo University Social Anxiety Scale (TSAS) to select the people with social anxiety disorder. The items of this scale were developed referring to the Liebowitz Social Anxiety Scale and the Brief Social Phobia Scale. The sample consisted of 97 patients with social anxiety disorder (SAD), 37 patients with panic disorder, and 542 healthy controls. Exploratory factor analysis revealed that the scale had 28 items with three factors : "Performance anxiety in front of others and fear of negative evaluation by others", "Physiological symptoms", "Social interaction anxiety", and the item which assesses level of impairment on daily life. Internal consistency of each factor was sufficiently high (Cronbach's alpha=0.84 to 0.92). Results of analysis of variance revealed that patients with SAD showed higher scores than controls in the each subscale and total score, and patients with SAD showed higher scores than patients with panic disorder in "Performance anxiety in front of others and fear of negative evaluation by others", "Physiological symptoms", and total score. Therefore, it was suggested that this scale had high discriminant validity. Correlation analysis for scores of each group indicated that scores of each subscale positively correlated with level of impairment on daily life (Factor 1 : γ=0.30〜0.43 ; Factor 2 : γ=0.35〜0.49 ; Factor 3 : γ=0.34〜0.46). Furthermore, for setting the cut-off point, ROC curve (Receiver operating characteristic curve) was calculated. Results indicated that 35 points had approximately equal sensitivity (88.66%) and specificity (85.84%). Therefore, the point of 35 was adopted as the cut-off point. It was suggested that the Tokyo University Social Anxiety Scale (TSAS) had considerably high discriminant validity and enough potential for the clinical and research application. Finally, it was discussed about the advantage of evaluating fear and avoidance separately.

Objective: The aim of this study was to assess the possible variances of blood urea nitrogen (BUN), serum potassium (SK) and serum phosphorus (SPO4) levels and interdialytic weight gain (IWG) accounted for compliance of uremic patients on hemodialysis (HD). Methods: BUN, SK and SPO4 levels and IWG of uremic patients (n = 310) regularly undergoing three HD sessions per week for more than I year in Japan were assessed. Patients suffering from problems influencing dietary intake and those with malnutrition were excluded. The variances accounted for self-efficacy for health-related behavior and avoidance-oriented coping (AOC) with stress were assessed by hierarchical multiple regression analyses. Results: BUN and SPO4 levels were not significantly (P&lt;.05) associated with self-efficacy or AOC. SK levels and IWG were significantly (P&lt;.05) associated with self-efficacy and/or AOC. The variances of SK levels and IWG accounted for self-efficacy and/or AOC, independent of age, sex, duration of HD and facilities, were 1.6% and 5.0%, respectively. Conclusions: Although the variances of SK levels and IWG accounted for self-efficacy and/or AOC were rather small, the significance of their relationships may suggest that intervention for self-efficacy or AOC could improve compliance and reduce SK levels and IWG of uremic patients on HD. (C) 2003 Elsevier Inc. All rights reserved.

Background: The pathogenesis of restless legs syndrome (RLS) is still unclear. The purpose of this study is to determine relationships of the presence of RLS in uremic patients regularly undergoing hemodialysis (HD) with demographic, clinical, and psychological factors. Methods: In 490 uremic patients on HD therapy in Japan, RLS was diagnosed based on diagnostic criteria established by the International Restless Legs Syndrome Study Group. Data were compared between patients with and without RLS. Results: There were univariately significant (P &lt; 0.05) differences in serum phosphorus levels, anxiety levels determined using the Hospital Anxiety and Depression Scale, and degrees of emotion-oriented and avoidance-oriented coping determined using the Coping Inventory for Stressful Situations. In multivariate, analyses, low hemoglobin levels, high serum phosphorus levels, high anxiety levels, and a great degree of emotion-oriented coping were independently related to the presence of RLS in uremic patients on HD therapy, with statistical significance (P &lt; 0.05). Conclusion : Hyperphosphatemia, anxiety, and a great degree of emotion-oriented coping with stress were independently related to the presence of RLS in uremic patients on HD therapy. The pathogenesis of RLS seems to involve more than one mechanism, which leads to restless legs as the final common pathway. These findings may provide new clues to the pathogenesis of RLS. (C) 2003 by the National Kidney Foundation, Inc.

The purpose of this study was to investigate the effects of coping processes on psychophysiological and psychological responses in stressful settings. In particular, we focused on the effects of a combination of active and avoidant coping processes. Subjects were 40 healthy undergraduate male students (mean = 19.80, S.D. = 0.97) who were randomly divided into four groups: (a) an effort coping group in which a subject faced a controllable stressor mobilizing an effortful and active coping behavior for a reward; (b) a distress coping group in which a subject faced a distressful stressor mobilizing an avoidant coping behavior for threat of punishment; (c) an effort-distress coping group in which a subject faced an ambivalent stressor mobilizing active coping behavior for a reward and avoidant coping behavior for threat of punishment; and (d) a control group. Initially, the effects of effort coping, distress coping, and effort-distress coping on psychophysiological and psychological responses were investigated. It was found that effort coping and effort-distress coping intensified cardiovascular responses, particularly blood pressure, and that distress coping and effort-distress coping intensified skin conductance level (SCL). Secondarily, the relationships between effort coping process, distress coping process, psychophysiological responses, and psychological responses were investigated. As a result of cluster analysis, the changes of heart rate and blood pressure were correlated to the change of the effort score, and the changes of SCL and psychological responses were correlated to the change of the distress score. These findings suggest that active coping processes and avoidant coping processes independently affect different response systems. (C) 2002 Elsevier Science B.V. All rights reserved.

The purpose of this study was to test the hypothesis that, in anorexia nervosa, patients with a low premorbid weight are associated with a low weight at referral and that premorbid weight, referral weight, and weight loss are associated with mood states. The changes of Body Mass Index from premorbid to referral, the duration of illness, and the psychological scores on the Profile of Mood States and the Cornell Medical Index-Health Questionnaire were examined in 49 anorexia nervous patients. Body Mass Index at referral of patients with lower premorbid Body Mass Index was significantly lower than that of patients with higher premorbid level. For patients with a larger relative decrease, scores on depressive mood were lower. These findings suggested that in anorexia nervosa patients, lower premorbid Body Mass Index was associated with lower Body Mass Index at referral, and that the patients with higher relative decrease in Body Mass Index might be satisfied with their weight loss.

The rapid increase of patients with eating disorders in Japan has made necessary the reliable and valid measurement of psychological factors in eating disorders. The purpose of this study was to examine the reliability and validity of the Japanese version of the Eating Disorder Inventory. 766 females without eating disorders and 139 female patients with eating disorders responded to the Eating Attitude Test and the Eating Disorder Inventory. Principal factor extraction with promax rotation isolated 9 interpretable factors with satisfactory internal consistency (Cronbach alpha range = .74-.90). Compared with controls, patients scored significantly higher on all factors after minimizing the influence of Body Mass Index, There were strong correlations among factor scores and scores on the Eating Attitudes Test, particularly among patients. These results indicate the Eating Disorder Inventory as showing psychometrically sound internal consistency and concurrent validity.

うつ病にも軽症群が存在するという考えをもつ臨床家は多いものの,軽症群の概念や特徴を捉えることを目的とした過去の研究は少ない.本研究では,大うつ病と小うつ病の患者(n=34)を対象に,軽症群と中等症以上の群で,うつに関連した扇状の出現率の差異を検討した.「軽症うつ病」(うつ病軽症群)を,大うつ病エピソード(DSM IV)に記載されている9症状のうち6症状以下の該当数にとどまる群と仮定したところ,「憂うつ感・沈んだ気持ち」(p-0.007),「睡眠障害」(p-0.009),「無価値観・罪悪感](p-0.000),「希死念慮](p-0.002)の出現率および現時点での自殺危険性(p-0.031)は,中等症以上の群と比較して有意に低いことが明らかになった.さらに,「憂うつ感・沈んだ気持ち」,「無価値観・罪悪感」の2項目による両群の判別率は85.3%であった.なお,両群間でSDS得点に有意な差は認められなかった.今後は,さらに専門科およびプライマリ・ケア施設での調査を進め,最終的には,治療対象とすべき「軽症うつ病」の見過ごしを避けるため,プライマリ・ケアの現場で使用可能な「軽症うつ病」の概念や診断基準を作成する予定である.

Purpose. The aim of this study was to assess the relationships of compliance with age, sex, and duration of hemodialysis (HD) simultaneously in a large population of uremic patients on HD.
Methods. Uremic patients (n = 484) who were regularly undergoing 3 HD sessions/week in Japan were investigated with regard to age, sex, duration of HD, and compliance measures (i.e., blood urea nitrogen [BUN], serum potassium [SK], and serum phosphorus levels [SPO4] levels and interdialytic weight gain [IDWG]). Associations and interactions among them were assessed by correlations and hierarchical multiple regression analyses.
Results. Older age was significantly associated with low levels of BUN, SPO4, and IDWG (p&lt;0.05), but not with SK levels. Longer duration of HD was significantly associated with high levels of SK, SPO4, and IDWG (p&lt;0.05), but not with BUN levels. The regression lines illustrating significant (p&lt;0.05) interactions predict that in men, the longer the duration of HD, the higher the levels of BUN and SK, and the higher the IDWG; this was not the case in women.
Conclusions. In uremic patients on HD, compliance was likely to be different based on the patient's sex and duration of HD.

The proportion of the population over 65 has been increasing rapidly in industrialized countries. Recently, innovative devices for unconstrained monitoring of health variables at home have been developed. Previous studies focused mainly on the physical aspects, yet mood disturbances are also important in the elderly. To investigate the relationship between subjective symptoms including mood states and behavioral patterns, unconstrained monitoring of the usage of ubiquitous home appliances such as a refrigerator and a television was performed on 100 elderly people for 31 consecutive days. Using inter-event intervals for the use of the appliances, the probability density function (PDF) and cumulative distribution function (CDF) were calculated. The power-law exponents α and β were then obtained as the slopes of the linear regression in log-log plots of the PDF and CDF, respectively. Subjects with higher depression, confusion, fatigue and total mood disturbance scores had significantly smaller α and β. The more fatigued group tended to have a smaller β for the use of the refrigerator. These results suggested that the usage patterns of these ubiquitous appliances could be used to detect changes in mood states in the elderly.

The purpose of this study was to examine the reliability and validity of the General Self-efficacy Scale (GSES: Sakano & Toujyo, 1986) for the patients with panic disorder with agoraphobia. Subjects were 102 outpatients whose primary diagnoses were panic disorder with agoraphobia according to DSM-IV, who were asked to complete the GSES, comprised of 16 items. As a result of factor analysis with varimax rotation, three factors including 15 items were extracted: "Anxiety on failure", "Activeness in behavior", and "Social locus of ability", which were quite similar to that of Shimada et al (1994). Cronbach's a Coefficients revealed that GSES had high reliability when it was conducted for patients with panic disorder with agoraphobia. Furthermore, high concurrent validity was also revealed by the parallel tests using State-Trait Anxiety Inventory Japanese version (Trait form, 20 items), which supported that the higher the self-efficacy was, the lower the anxiety the patients had. Finally, the characteristics of the general self-efficacy were discussed with consideration of the symptoms of panic disorder with agoraphobia.

The authors' purpose in this study was to assess the interactive effects of stressors, coping with stress, and self-efficacy on depression and anxiety in maintenance hemodialysis (HD) patients. Patients (n = 453) undergoing HD for more than 1 year in Japan were investigated. The regression lines illustrating significant (p &lt
.05) interactions predict that itching HD patients with low self-efficacy will be more depressive and anxious than nonitching patients. In HD patients who report a high degree of emotion-oriented coping, itching patients will he more anxious than nonitching patients. These new findings may lead to the development of specific and focused interventions for depression or anxiety in maintenance HD patients. © 2003 Taylor &amp
Francis Group, LLC.

A standardized questionnaire has not been established for screening or diagnostic assessment of patients with multiple chemical sensitivity (MCS) in Japan. In the US, Miller and Prihoda (1999a,b) developed a questionnaire that could be used internationally, the Quick Environment Exposure Sensitivity Inventory (QEESI(C)), to assist researchers and clinicians in evaluating patients and populations for chemical sensitivity. The Japanese version of QEESI(C) was subsequently translated by Ishikawa and Miyata (1999). The present study was performed to investigate the reliability and validity of QEESI(C) ( Japanese version) for research purposes and for evaluation of patients with MCS in Japan.
A total of 498 subjects were recruited from the general population of Miyagi prefecture, Japan. The factor structure in QEESI(C) was analyzed with 40 items on four subscales except for the items in 'Masking' using principal components analysis with Promax rotation. The results showed that 30 items on three subscales, 'Chemical Inhalant Intolerances,' 'Symptom Severity,' and 'Life Impact' except for 'Other Intolerances' were consistent with those reported for the US population by Miller and Prihoda (1999a). Cronbach's alpha reliability coefficient ranged between 0.87 and 0.94 indicating high internal consistency in the 30 items on three subscales.
Next, we compared the mean scores on three subscales of QEESI(C) in two groups: 131 self-reported MCS group who were new outpatients at the Environmental Medical Center in Kitasato Institute Hospital, and 131 members of the general population ( controls) who were matched for both gender and age with the self-reported MCS group. Mean scores on each subscale for the self-reported MCS group were significantly greater than those for controls (P&lt;0.001). Mean scores on all of the 30 items on three subscales for the self-reported MCS group were also significantly greater than for the controls (P&lt;0.001). These findings indicated that the 30 items on three subscales in QEESI(C) can be used for surveys and for diagnostic assessment of patients with MCS as well as for comparative studies between patients in Japan and in other countries.

We examined the relationship of health factors and social support to life satisfaction in older adults dwelling in a rural town. The gender difference in variables related to life satisfaction was also discussed in this study. One hundred and forty-two older adults (86 females and 56 males) who completed a self-administered questionnaire and participated in a health examination in 1998 or 1999 comprised the study participants. The t-test and chi-square test were used to assess the differences between the two genders. Correlation measure and multiple regression analysis were used to assess the relationship between life satisfaction and other health related or socially related factors for each gender. Significant gender differences were observed in living status and several health related factors. According to the results of the multiple regression analyses, life satisfaction was related to mental health and age in females, while it was related to mental health status and social support from others in males. Gender differences in the variables associated with life satisfaction were observed among the community-dwelling older adults. These data suggest the importance of mental health for older adults. When preparing health promotion strategies for older adults, results of gender differences as they related to social support and life satisfaction should be applied in practice.

To examine the relationship between somatosensory amplification and three factors of alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), 48 outpatients attending a Japanese psychosomatic clinic and 33 comparative outpatients completed the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), and other self-rating questionnaires. The scores on the SSAS and the first and second TAS-20 factors were higher (all P&lt;0.001) in the psychosomatic group than in the comparison group. The SSAS was positively associated (both P&lt;0.01) with these two TAS-20 factors, controlling for the effects of age, sex, group, and POMS tension-anxiety and depression. Somatosensory amplification appears to be associated with difficulties identifying and describing feelings, not externally oriented thinking, in Japanese patients.

The purpose of this study was to assess multiaxially school non-attendance students who were hospitalized at the department of psychosomatic medicine. On the basis of the assessment results, sex differences and age differences of psychopathological characteristics were examined. The subjects of the analysis included 67 school non-attendance students, hospitalized at the department of psychosomatic medicine. They were assessed according to the axis 1 (psychiatric disorders), the axis 2 (personality features and disorders), the axis 3 (general medical conditions), and the axis 4 (psychosocial and environmental problems) of DSM-III-R & DSM-IV. These results of the assessment were stratified in each axis after they were classified into one to eight categories. Next, age differences (junior high school group, high school group, and college group) of the number of diagnoses were examined in the axis 1 and the axis 4. Age differences of the existence of any diagnosis were examined in the axis 2 and the axis 3. In addition, sex differences of the number of diagnoses were examined in the axis 1 and the axis 4. Sex differences of the existence of any diagnosis were examined in the axis 2 and the axis 3. In the axis 1, the diagnoses of eating disorders, anxiety disorders, mood disorders were made in many cases (Since adjustment disorders were diagnosed in most of the cases, they were excluded from the analysis). In the axis 2, the diagnosis of immaturity, was found in many cases. In the axis 4, the diagnoses of family-related problems and bullying were made in many cases. In addition, some kind of diagnosis was made in 27 cases (40%) in the axis 2, and 26 cases (39%) in the axis 3. The college group had significantly larger number of diagnoses in the axis 1 than the junior high school group and the high school group (p<0.05, Kruskal-Wallis test. Mann-Whitney U-test following Ryan's procedure for multiple comparison tests). Some kind of diagnosis was given significantly more often in females in the axis 2 than males [p<0.05, χ^2-test (Fisher's exact test)]. Overall, psychopathological characteristics of school non-attendance students are diverse, and the non-attendance behavior cannot be attributed to a single cause. In addition, age difference and sex difference were also found in the results of multiaxial diagnosis. Therefore, school non-attendance students should be assessed multiaxially, and be treated individually.

The present article reports the use of cognitive behavior therapy (CBT) in two psychosomatic and psychiatric primary care settings, based on data from 121 patients visiting either a medical and psychosomatic clinic or a psychiatry and psychosomatic clinic during the past 5.5 years. It was found that although both clinics had many patients with anxiety disorders and adjustment disorders, those patients whose psychological factors affected a medical condition or who had somatoform disorders were more likely to visit the medical and psychosomatic clinic, whereas patients with eating disorders were more likely to visit the psychiatry and psychosomatic clinic. Mood disorders were generally treated by graded task assignment and cognitive behavior counseling; anxiety disorders, by exposure and autogenic training; somatoform disorders, sleep disorders, and psychological factors affecting medical condition, by autogenic training; and adjustment disorders, by cognitive behavior counseling. Patients who had psychological factors affecting a medical condition, adjustment disorders, or anxiety disorders were likely to complete the treatment and recover. These findings suggest that CBT is an efficient treatment for psychosomatic and psychiatric primary care.

The purpose of this study is to examine the relationship between psychological factors, regional brain activity and natural killer cell activity (NTKA). Eight patients with malignant diseases were studied by FDG-PET under a resting condition. NKA and degree of anxiety and depression were measured using Taylor's manifest anxiety scale (MAS) and Zung's self-rating depression scale (SDS). Linear correlation of NKA and psychological measures to the regional brain metabolism in cancer patients was examined using statistical parametric mapping (SPM).
Positive linear correlation between NKA and regional metabolic rate ratios was identified in the visual association cortex, anterior cingulate gyrus (CG) and sensorimotor area, and negative correlation was identified in the inferolateral prefrontal cortex (ILPFC), prefrontal cortex (PFC), orbitofrontal cortex (OFC) and anterior temporal cortex. Positive linear correlation to the MAS score was identified in the visual association cortex, anterior CG, primary sensorimotor area and the posterior parietal cortex, and negative correlation was detected in the ILPFC, PFC, OFC and anterior temporal cortex. The NKA and MAS scores positively correlated with each other (p &lt; 0.001).
The result might serve as supporting data for a hypothesis that psycho-immune interaction is also mediated by the cerebral cortex and limbic system. Copyright (C) 2001 John Wiley & Sons, Ltd.

The purpose of this study is to develop the Beliefs related to Shape and Diet Scale(BSDS), which measures the tendency to have the dysfunctional thinking peculiar to eating disorders. The preliminary study was conducted to examine the items for 512 female students. Then, the BSDS was administered 2861 female students. As a result of factor analysis with varimax rotation, six factors were extracted : Self-esteem, Approval, Diet, Weight, Dependence, Personality and Popularity. Cronbach's α Coefficients and the test-retest reliability revealed high reliability of the BSDS. High concurrent validity of the BSDS was also supported by the parallel tests with the EAT-20, the Binge Eating Scale, and the JIBT-20. As we investigated the relationship between the BSDS and eating disordered tendencies estimated by EAT-20, it was suggested that the more one has the eating disorder tendency, the more she one the dysfunctional thinking related to body-shape and diet.

The purpose of this study was to investigate the cognitive disturbance of eating disorders. Subjects were anorexia nervosa-restricting type(AN-R ; n=52), AN-binge eating purging type(AN-BP ; n=54)bulimia nervosa-purging type(BN-P ; n=39), and normal controls(n=55). As results of one factor ANOVA with Tukey comparison, all subtypes of eating disorders showed higher food preoccupation, more problem avoidance tendency, and more dysfunctional thinking related to diet and weight, and lower selfesteem. However, there were no significant differences between AN-R and normal controls in the scores of variables related to body shape. These cognitive disturbances were most prominent in BN-P, and then AN-BP, AN-R and normal controls. Objective evaluation by three therapists also suggested BN-P and AN-BP showed more severe cognitive dysfunction than AN-R.

Somatosensory amplification refers to the tendency to experience somatic sensation as intense, noxious, and disturbing. It includes an individual's disposition to focus on unpleasant sensations and to consider them as pathological rather than normal. Barsky and his colleagues have reported that the concept of somatosensory amplification is helpful in understanding a variety of clinical conditions characterized by bodily complaints disproportionate to demonstrable medical disease. To examine the reliability and validity of the Japanese Version of Somatosensory Amplification Scale(SSAS), patients attending the psychosomatic medicine clinic and internal medicine clinic were recruited for the study in the university setting. Participants were 48 psychosomatic outpatients(psychosomatic group)and 33 outpatients with general medical problems(control group). All subjects completed four questionnaires : SSAS, Profile of Mood States(POMS), Medical Symptom Checklist, and Self-rated Stress Perception Scale. The SSAS had 10 items to ask the respondent a range of uncomfortable bodily sensations on an ordinal scale from 1 to 5. The POMS consisted of six mood state scales of tension-anxiety, depression, angerhostility, vigor, fatigue, and confusion. The Medical Symptom Checklist was used to assess 16 common somatic symptoms, i.e.headache, visual symptoms, dizziness, ringing in the ears, nausea/vomiting, diarrhea, constipation, abdominal pain, muscle pain, joint pain, back pain, chest pain, palpitation, shortness of breath, insomnia, and fatigue. The Self-rated Stress Perception Scale was to assess degrees of perceived stress to psychosocial situations. In the total sample, the SSAS had item-to-scale correlation of 0.27 to 0.84(all p<0.05)with adequate internal consistency(Cronbach's alpha=0.79). Also, the SSAS scores were positively correlated with the total number of somatic symptoms, degrees of perceived psychosocial stress, and the POMS tension-anxiety, depression, fatigue and confusion scale scores(all p<0.05) ; they were negatively correlated with the POMS vigor scale scores(p<0.0005). The SSAS scores were higher in the psychosomatic group than in the comparison group(p<0.005), and differentiated the psychosomatic group from the comparison group by the multiple logistic regression analysis(p<0.05), controlling for the effects of age(p<0.005), sex, total number of somatic symptoms, degrees of perceived psychosocial stress, and all the POMS scores. It was suggested that the SSAS may be a clinically useful tool to evaluate Japanese psychosomatic patients in terms of experiencing, reporting, and functioning in medical conditions.

The purpose of this study was to develop the Japanese version of "the Nottingham Adjustment Scale(NAS)" which measured psychological adjustment to the visual impairment, and to assess its validity and reliability. The NAS is composed of 7 psychological subscales including anxiety-depression, self-esteem, attitude to disability, locus of control, acceptance of disability, self-efficacy and attributional style. First, we translated the original questionnaire into Japanese after obtaining the author's approval. Next, We translated the Japanese rendering into English again, and asked the author to confirmed it. This Japanese version was called "the NAS-J(the Nottingham Adjustment Scale Japanese version)". The items of the NAS-J were selected through the pretest with sighted people. Then we conducted a survey of visually impaired people who were engaging in vocational training in 5 national rehabilitation centers. A total of 336 persons were asked to fill out the NAS-J and the SF-36(Health-related QOL scale), and primary diseases inducing visual impairment, eyesight, and the number of years since the present sight became stable were also inquired. As a result of factor analysis, 31 items were retained and 7 factors consistent with the original scale were extracted(51.6% of total variance). Each items contributed 0.5 or more loadings to a supposed factor, and contributed 0.5 or less loadings to the other factors. These results showed the sufficient construct validity, convergent validity and discriminant validity. The subscales of anxiety-depression and self-esteem significantly correlated with most subscales of the SF-36 in sighted people, and thus the concurrent validity was shown. The scores of visually impaired people were lower than those of sighted people in 4 subscales such as anxiety-depression, self-esteem, attitude, and locus of control as the earlier study, and the discriminant validity was confirmed. The reliability coefficients of all subscales were more than 0.7 except that of locus of control. Because the number of items of locus of control was rather small, the reliability coefficients of the subscale was permissible. These results showed the sufficient validity and reliability of the NAS-J as the scale which measures the psychological adjustment to visual impairment. We are constructing the structure model of the psychological adjustment and investigating the effects of the adjustment to handicap. We will publish these results on another occasion.

Objective: To examine the effectiveness of Ninjin Yoei To (NYT; Ren-Shen-Yang-Rong-Tang in Chinese medicine; Kotaro Pharmaceutical Co., Ltd., Osaka, Japan), one of the traditional herbal medicines, against lung carcinoma.
Setting: The Nursing Center Himawari
Design, Patient, and Preparation: The regular dosage of NYT (15g/d) was prescribed for 7 weeks to one elderly patient with lung carcinoma. The daily standard dose of NYT is prepared from dried extract obtained from 12 crude natural substances, ginseng, cinnamon bark, Japanese angelica root, astragalus root, peony root, citrus unshiu peel, rehmannia root, polygala root, atractylodes rhizome, schisanda fruit, poria sclerotium, and glycyrrhiza. NYT is certified by the Japanese Ministry of Health and Welfare.
Results: The tumor marker levels (CEA and CA19-9) decreased and the scores of yin-yang and xu-shi inverted from negative and positive during 7 weeks. The patient's cough disappeared and her appetite recovered.
Conclusion: NYT has a positive effect on life expectancy for patients with malignancy. The diagnostic scoring system in yin-yang and xu-shi and prescription of Chinese herb may be available to gain control over a patient's health.

We examined changes in brain waves and blood levels of serum cortisol during yoga exercise in 7 yoga instructors and found that alpha waves increased and serum cortisol decreased. These two measures were negatively correlated (r = -.83). Comparison with a control group of nonpractitioners is desirable.

Objective: To examine the effectiveness of Mao-bushi-saishin-to (Ma-Huang-Fu-Zi-Xi-Xin-Tang in Chinese medicine) (Tochimototenkaido Co, Ltd., Osaka, Japan), one of the traditional herbal medicines, against resistant bacterial infection.
Setting: The Nursing Center Himawari, Izumo, Japan
Design, patient, and preparation: Half of the standard dose of Mao-bushi-saishin-to was prescribed for 7 days to one elderly patient with fever and positive C-reactive protein (CRP) levels suffering from drug resistant Pseudomonas aeruginosa. The daily standard dose of Mao-bushisaishin-to is prepared from 1200 mg of dried extract obtained from three crude drugs, Ephedrae Herba (4 g), Asiasari Radix (3 g), and Aconiti Tuber (1 g). It is certified by the Japanese Ministry of Health and Welfare.
Results: The patient's fever and CRP level returned to normal levels.
Conclusions: In cases in which the fever does not fall in response to antibiotics for at least 3 days, half of the standard dose of Mao-bushi-saishin-to for 7 days might be worth trying to induce remission, especially for elder patients.

Photic Feedback treatment of a patient diagnosed with Miller Fisher syndrome has resulted in the rapid and permanent remission of symptoms. During Photic Feedback treatment, the CD20 appeared to be slighty increased. This map have been associated with changes in humoral immunity. The present clinical observation of a single patient suggests that Photic Feedback treatment should be investigated as a possible adjunct therapy for patients who suffer from polyneuropathies, such as Miller Fisher syndrome. within a carefully controlled clinical trial.

The relationship between psychosocial factors and the occurrence and aggravation of peptic ulcer was studied in elderly people. Thirty-nine (14 male) ulcer patients and 79 (30 male) elderly people aged 65 years and over and living in the community were tested. Information on health status, medication, lifestyle, and psychosocial status was obtained by means of interviews using a questionnaire and from the clinical records of the ulcer patients. The same questionnaire was distributed to the residents. Logistic regression analysis adjusting for age disclosed that peptic ulcer was significantly associated with having an occupation and low exercise practice in men. However, the relationship weakened below statistical significance after adjusting for some physical risk factors besides age Low education was significant but low instrumental support fell short of statistical significance with peptic ulcer in women even after adjustment for several physical risk factors besides age. Thus, the specific psychosocial factors might be independently associated with the occurrence and aggravation of peptic ulcer in at least elderly women.

To clarify the effects of ego states on anorexia nervosa (AN) and bulimia nervosa (BN), the questionnaire of the Tokyo University Egogram (TEG) with critical parent, nurturing parent, adult, free child and adapted child scales was administered to 32 female AN patients aged 14 to 32 years (mean age 20 years) and 49 female BN patients aged 14 to 33 years (mean age 23 years). The scores on the critical parent and adapted child scales for AN were significantly lower than those for BN, A multiple logistic regression analysis including all of the TEG scales, age, duration of illness and education showed that the adapted child scale significantly discriminated between AN and BN. The adaptive ego state is suggested for differentiating between the two disorders.

We assessed the changes in regional bone mineral density according to age and examined the relationship between various regional bone mineral densities. The study was conducted in 985 Japanese women divided into &lt; 50-years group (n = 435) and greater than or equal to 50 years group (n=550). The total body bone mineral density and that of the head, arm, leg, thoracic (T)-spine, lumbar (L)-spine, ribs, and pelvis were measured using dual energy x-ray absorptiometry. There was a significant generalized reduction of bone mineral density in all regions after the age of 50 years. The most marked age-related decrease was observed in the L-spine. Bone mineral densities in all regions significantly correlated to each other in both age groups, but the degree of significance varied among regions. The relationship between bone mineral density of the L-spine and that of T-spine regions was the most significant in both groups. In the &lt;50-years group, the correlation between bone mineral density of the pelvis and that of L-spine and T-spine was the highest, followed by that between the pelvis and the leg. On the ether hand, in the greater than or equal to 50-years group, the correlation between bone mineral density of the pelvis and that of the leg was the highest, but not the L-spine of T-spine. Since spine measurements are affected by vertebral deformity and/or aortic calcification, our findings suggest the pelvis may be a useful region for screening measurements of bone mineral density, especially in older women.

We examined the effective amplitudes of alpha waves (using a mean frequency with a range of +/- 0.5 Hz), and activity of natural killer cells in six subjects, before and after a short-distance (43 km, 1 hr.) drive, and after a midnight (am 0:00 similar to am 7:00 to 8:00) long-distance (550 km on average, for 7 to 8 hr.) drive. Following a long-distance drive, the activity of natural killer cells tended to decrease, and the effective amplitudes of alpha waves in the photic feedback period were greater than those observed during the rest period, showing that photic driving had occurred even under physically and mentally stressful conditions. However, after short-distance driving, no photic driving response occurred and activity of natural killer cells tended to increase, possibly related to mental concentration. Avoiding midnight long-distance driving may help prevent excessive stress and preserve high activity in natural killer cells.

Objective: Although psychological stress and smoking have been proposed as factors contributing to Graves' disease, their independent roles in the course of this disease have not been determined. We assessed the association between the course of Graves' disease and psychosocial factors by using multivariate analysis. Methods: We investigated the association between the short-term outcome of Graves' disease (assessed 12 months after the beginning of antithyroid drug therapy) and stressful life events, daily hassles, smoking, drinking habits, coping skills, and social support (before and 6 months after beginning therapy) in 230 patients (182 women and 48 men) with newly diagnosed Graves' disease, using a logistic regression model. Results: After adjustment for smoking, coping skills, and thyroid function, daily hassles scores in women at 6 months after beginning therapy were significantly associated with a hyperthyroid state 12 months after beginning therapy. The relative risk was 3.9 for women with higher daily hassles scores compared with women with lower daily hassles scores (95% confidence interval, 1.1 to 13.2; p &lt;.05). Smoking was not significantly associated with a hyperthyroid state 12 months after beginning therapy in either women or men. Conclusions: Chronic psychological stress is associated with the course of Graves' disease in women.

In order to clarify the differences in mood states between anorexia and bulimia nervosa, the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigour, fatigue and confusion scales was administered to 32 female patients with anorexia nervosa (age range 14 to 32 years, mean age 20 years), 49 female patients with bulimia nervosa (age range 15 to 33 years, mean age 23 years) and 410 &apos;normal&apos; female subjects (age range 14 to 35 years, mean age 23 years). The scores on the depression, fatigue and confusion scales for both anorexia and bulimia nervosa and those on the tension-anxiety and anger-hostility scales for bulimia nervosa were significantly higher tt;an those for the control subjects. The score on the fatigue scale for bulimia nervosa was significantly higher than that for anorexia nervosa. Moreover, the result of the multiple logistic regression analysis including all of the POMS scales indicated that the fatigue scale significantly discriminated between the two disorders, Fatigue mood appears to be a principal indicator for differentiating between the two disorders.

Objective: Although psychological stress and smoking have been proposed as contributing factors to Graves' disease, their independent roles in the pathogenesis of this disease have not been determined. We assessed the association between Graves' disease and psychological stress and smoking by using multivariate analysis. Methods: By a matched case-control method, we investigated the association between Graves' disease and stressful life events, daily hassles, smoking, drinking habits, coping skills, and social support in 228 patients (182 women and 46 men) with newly diagnosed Graves' disease; we used the conditional maximum likelihood method. Results: After data were adjusted for daily hassles, smoking, drinking habits, social support, and coping skills, we found that stressful life events were significantly associated with the risk of Graves' disease in women. The relative risk was 7.7 for women with the highest stress score compared with women with the lowest stress score (95% confidence interval, 2.2 to 27, p for trend &lt;.001). Smoking was also independently associated with the risk of Graves' disease in women. The relative risk for women with the highest number group compared with women with the lowest number group for smoking cigarettes was 5.1 (95% confidence interval, 1.0 to 27; p for trend &lt;.001). These factors were not significantly associated with Graves' disease in men. Conclusions: Psychological stress and smoking were associated with Graves' disease in women, but not in men.

To distinguish the clinical features between psychosomatic illness and neurotic illness, 191 psychosomatic patients (male 39%) and 164 neurotic patients (male 43%) aged 25 to 65 years were diagnosed by the semi-structured interview using the Diagnostic and Statistical Manual of Mental Disorders third edition-revised (DSM-III-R) and these results were recorded in the database. The major diagnoses in the psychosomatic group were somatoform disorder not otherwise specified, bulimia nervosa, and psychological factors affecting physical condition. Similarly, those in the neurotic group were panic disorder with agoraphobia, hypochondriasis, and conversion. The numbers of patients with personality disorders were 33 (17%) in psychosomatic group and 34 (21%) in neurotic group, and the prevalence rates of personality disorder did not differ significantly between the two groups. The psychosocial stress score was lower in the psychosomatic group (none : 19%, mild : 61%, moderate : 17%, and severe- : 3%), compared with the neurotic group (none : 7%, mild : 65%, moderate : 23%, severe- : 5%) . The psychosocial and occupational functioning score was higher in the psychosomatic group (70.2±11.1), compared with the neurotic group (67.8±10.1)(Mean ± S.D.). Although the differences between psychosomatic illness and neurotic illness were clarified by the DSM-iii-R, Iimitations on the DSM-iii-R assessments such as weak correspondence between psychosomatic illness and "psychological factors affecting physical condition" were also found m the present study.

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9-95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview, Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was 'somatoform disorders not otherwise specified', followed by bulimia nervosa,'depressive disorder not otherwise specified', anorexia nervosa, conversion disorder, major depression or depressive disorder,'panic disorder with agoraphobia', and 'psychological factors affecting physical or medical condition'. On axis II, 11-17% of the patients met the criteria for personality disorder. On axis IV, 78-80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.

After administering 15 g/day of Ninjin-Yoei-To (NYT) for one week to healthy people whose NK activity had already been increased by physiological response, a further increase in NK activity was observed after two days. This increased level of NK activity continued during the administration of NYT for a one-week period. The maintaining and reinforcing effect on the immune surveillance system by NYT may be useful for prevention of carcinogenesis.

The aim of the present study was to clarify the mechanism of white coat phenomenon by comparing autonomic nervous functions and psycho-behavioral factors associated with the difference between clinic blood pressure (BP) and day-time mean ambulatory BP and those associated with the mental stress-induced BP elevation.We evaluated 86 untreated patients with mild to moderate essential hypertension who had clinic BP>140 mmHg systolic and/or>90 mmHg diastolic on at least 3 visits. Thirty-three males and 53 females were contained, and their ages ranged from 20 to 75 years. Clinic and 24-hour ambulatory BPs were monitored without medication, and the white coat effect was defined as the difference between clinic BP and day-time (6 : 00-21 : 00) mean ambulatory BP. After sufficient supine rest, BP and RR interval were recorded beat-to-beat at consecutive sessions of 10 minutes of supine rest, 6 minutes of mental stress by backward counting, and 7 minutes of orthostatic stress. Spectral analyses of the BP and RR interval variability were performed for assessing the sympathetic vasomotor tone (SVT) and the baroreflex sensitivity. In addition, various psycho-behavioral factors were assessed by self-administered questionnaires and a semi-structured interview. Then, stepwise multiple regression analyses were performed for systolic and diastolic white coat effects and systolic and diastolic mental stress-induced BP elevations, the independent variables of which were above-mentioned indices of autonomic nervous functions and psycho-behavioral factors.While SVT during mental stress was positively associated with stress-induced BP elevation, SVT during supine rest was negatively associated with white coat effect. While 'Neuroticism', 'Anger' and 'Distorted life style' were positively associated with, and 'Type A behavior pattern' was negatively associated with stress-induced BP evaluation, 'Depression' was positively associated with, and 'Maladaptation' and 'Anger' were negatively associated with white coat effect. Furthermore, there were no significant correlations between white coat effects and mental stress-induced BP elevations.In conclusion, white coat phenomenon was regarded as a quite different condition from mental stress-induced BP elevation based on teh relevant autonomi functions and psycho-behavioral factors.

The purpose of this study was to investigate psychological and psychophysiological responses under an effortful coping condition and an distress coping condition. Efforful coping condition was defined as a condition in which a subject reported high commitment to the task and engaged in active coping. Distress coping condition was defined as a condition in which a subject reported uncontrollability and engaged in passive coping. Subjects were 22 male undergraduate students and were divided into 2 groups : control group and experimental group. All of them underwent both effortful coping condition and distress coping condition.In effortful coping condition, Ss were engaged in 2 mental arithmetic task sessions (low effort tast and high effort task). In the first session, Ss in both groups were requested to perform the low effort tasks under the same condition. In the second session, Ss in the experimental group were engaged in the high effort task session with rewards, and Ss in the control group were engaged in the low effort task session without rewards.In distress coping condition, Ss were engaged in 2 movie sessions(relaxation movie and aversive movie). In the first session, Ss in both groups were requested to watch the relaxation movie under the same condition. In the second session, Ss in the experimental group watched the aversive movie (eye surgery), and Ss in the control group watched the relaxation movie.Heart rate, systolic blood pressure, diastolic blood pressure, skin conductance level and skin temperature were recorded, and effort-distress scores, and psychological responses were measured.Heart rate, blood pressure, and skin temperature were significantly aroused in effortful coping condition and Depression-Anxiety score and skin conductance level were significantly aroused in distress coping condition. The results of ANOVAs revealed that a significant interaction among group, condition, and session was found in systolic blood pressure, diastolic blood pressure, and skin conductance level. These suggest that cardiovascular responses are associated with effort coping, and Depression-Anxiety and skin conductance level are associated with distress coping. Furthermore, the results of regression analyses revealed that the changes of diastolic blood pressure corresponded to the changes of effort score, and that the changes of skin conductance level corresponded to the changes of distress score.Finally, the specific relationship between effort-distress status in stress coping process and psychological-psychopsysiological responses were discussed.

The effect of EEG-driven photic stimulation on stress-related endocrine function was studied. Subjects were 16 healthy males divided into a photic stimulation group (n=8) and a control group (n=8). Electrodermal and emotional lability measures were assessed by nonspecific skin conductance response and the Maudsley Personality Inventory, respectively Plasma cortisol and beta-endorphin concentrations were measured both before and after EEG-driven photic stimulation as well as the resting condition. Subjects with electrodermal, emotional or both lability showed comparable decreases of plasma beta-endorphin on photic stimulation as did the stable subjects. Under resting control conditions, however they showed significant increases of beta-endorphin compared to both stable subjects as well as the photic stimulation condition. In addition, labile subjects showed significant alpha enhancement on photic stimulation compared to stable subjects and to the resting control condition. The data suggest that increases of plasma beta-endorphin in labile control subjects may denote a stress response to the conditions of these experiments, and that any decrease by EEG-driven photic stimulation may indicate a reduction of responsiveness to an acute stress.

For 8 medical students influences of psychological stress or humor on T-cell subset percentages and natural killer cell activity were investigated by measuring these parameters before and after an examination and before and after watching a comedy video. Although T-cell subsets were nor significantly affected by either stimulus and natural killer cell activity was not affected by the examination. the latter was significantly decreased after watching the comedy video.

Although biofeedback has been reported to be efficacious in the treatment of hypertension, the degree of response has varied. :This study investigated the mechanisms of blood pressure reduction by biofeedback. Method: Thirty outpatients with essential hypertension (10 men and 20 women) aged 38 to 65 years were studied. Subjects were randomly assigned to group A or B. Subjects in group A underwent biofeedback treatment once a week for a total of four sessions. Those in group B self-monitored their blood pressure during the sessions as the control period and later underwent the same biofeedback treatment. Results: Blood pressure measured by doctor was reduced by 17 +/- 18/8 +/- 7 (p &lt; .01) and elevation of pressure induced by mental stress testing was suppressed by 8 +/- 9 (p &lt; .05)/4 +/- 8 during the treatment period in group A (mm Hg). In group B, both blood pressure measured by doctor and elevation of pressure by mental stress testing remained unchanged during the control period and they were later suppressed by 20 +/- 15/9 +/- 7 (p &lt; .01) and 11 +/- 10 (p &lt; .05)/5 +/- 9 by the biofeedback treatment. Self-monitored pressure in both groups tended to decrease by the biofeedback treatment. Systolic and diastolic pressures as well as pulse rate decreased, skin temperature increased, and alpha-wave amplitude on electroencephalography increased during the therapy (p &lt; .05). Conclusion: This treatment,Nas effective in suppressing the presser response to stress. Patients whose blood pressure increases with stress may be suited for biofeedback intervention.

To evaluate the reactivity to psychological stress in patients with essential hypertension we investigated hemodynamic and endocrinologic changes during a mental arithmetic task (MAT) and a mirror drawing test (MDT) in 10 hypertensive subjects. Hemodynamic changes were assessed continuously using an ambulatory radionuclide cardiac detector. There were significant increases in systolic blood pressure (Delta SBP: +37.8 +/- 11.1 and +41.0 +/- 9.4 mm Hg during MAT and MDT, respectively, P &lt; .01) and diastolic blood pressure (Delta DBP: +17.5 +/- 3.1 and +21.2 +/- 3.9 mm Hg, P &lt; .01) and in heart rate (Delta HR: +17.1 +/- 5.3 and +12.5 +/- 2.9 beats/min, P &lt; .01) during both tasks in association with an increase in cardiac output (GO). The plasma levels of norepinephrine and epinephrine increased during both the MAT (Delta NE: +0.074 +/- 0.022 ng/mL, P &lt; .01; Delta EP: +0.068 +/- 0.025 ng/mL, P &lt; .01) and the MDT (Delta NE: +0.067 +/- 0.034 ng/mL, P &lt; .01; Delta EP: +0.030 +/- 0.011 ng/mL, .05 &lt; P &lt; .1). Although the Delta NE was similar in response to the MAT and MDT, the Delta EP during the MDT tended to be less than half the Delta EP during the MAT (.05 &lt; P &lt; .10). The Delta EP was positively correlated with the Delta DBP and the Delta CO during both tasks and with the Delta SBP and the Delta HR during the MAT. These findings suggest that MAT- and MDT-induced increases in BP were attributable mainly to an increase in CO, possibly as the result of stimulation of the sympathoadrenomedullary system. However, the sympathoadrenomedullary system appeared to be more closely associated with the hemodynamic responses during the MAT than during the MDT. (C) 1997 American Journal of Hypertension, Ltd.

The aim of this study was to investigate the relationships among type A behavior pattern job stress (defined by Karasek's D-C-S model) and life style, based on the hypothesis that the person with type A behavior pattern has an increased risk of mental and physical illness when they are under high j ob strain. Six hundred and forty-nine employees (442 men and 207 women) from 2 worksites answered "Job Content Questionnaire", "Maeda Type A Behavior Checklist", and questionnaires to answer the distorted life style (lack of exercise, alcohol abuse, smoking habit, and abnormal eating pattern) . The relationship between job stress and type A behavior pattern was examined by t-test and ANOVA. The causal model including demographic variables was tested by path analysis. Favorably, type A behavior score was positively related to activity level, but on the contrary, the score was also positively related to the level of job strain. Both the level of activity and job strain positively correlated with the distortion in life style. They also, however, correlated with the degree of desirable change in life style such as increased amount of exercise. Thus, high activity level and high j ob strain may both be regarded as stressors, and may bring about desirable coping -behavior at the same time. On the other hand, social support seemed to reduce j ob strain and increase the activity level. It was also indicated that social support from the supervisor differentially affected above factors as compared to the support from coworkers.

Psychological indices of 48 adult patients with atopic dermatitis (AD) subjects were compared among the groups classified by its severity, clinical course, differences of family history, and complication. First, the scores of psychological tests in all subjects were evaluated. Adult patients with AD had high anxiety, depressive mood, and neuroticism, consequently. Moreover, they had low self-efficacy and a tendency to overadaptation. Second, the 3 groups classified by its severity (mild, moderate, severe) were compared by using oneway analysis of variance (ANOVA). "A" (adult) score of Tokyo University Egogram (TEG) of the severe group was significantly lower than that of the mild group (p<0.05), so that reality testing of the severe group was more disturbed than that of the mild group. Moreover, the 3 groups classified by its clinical course (child onset type, temporarily remitted but exacerbated type, adult onset type) were also compared by using one way ANOVA "E" (musculoskeletal), "F" (skin), "I" (fatigue) , and "A〜L, total" (physical symptoms, total) scores of CMI (Cornell Medical Index) and state anxiety score of State-Trait Anxiety Inventry (STAl) the temporarily remitted but exacerbated type presented were significantly higher than those the other types did (p< 0.05) . We claimed that the temporarily remitted but exacerbated type has most psychosomatic complaints. On the other hand, the scores of many psychological items of patients accompanied with bronchial asthma (BA) and/or allergic rhinitis (AR) were evaluated. The results show that the scores of many psychological items of patients accompanied with AR were significantly higher than those of patients not accompanied. So that, physical and psychological symptoms patients accompanied with AR presented were greater. We concluded that it's important we take account of its severity, clinical course, and the presense of AR when we study and treat adult patients with AD.

The function of the autonomic nervous system under fasting therapy (FT) was studied in comparison with control subjects. Sympathetic and parasympathetic modulations were inferred from the powers of the low frequency (LF)/high frequency (HF) spectral component ratio (L/H), and HF spectral component respectively. P-P interval variability from plethysmograph of each subject was measured at first. These components were succesively computerized by fast Fourier transform (FFT), one of power spectral analysis. And the relation among autonomic function, mood states, and self -efficacy was also investigated. The results were as follows : 1) There were no significant changes of autonomic modulations under FT. It was assumed this was due to various diagnoses of subjects and various psychosomatic responses under FT. 2) In mental fatigue cases, sympathetic modulation was significantly activated in the mid-stage of fasting phase and diminished to the baseline level at the end-stage of recovery phase. In contrast, less mental fatigue cases showed no significant changes of sympathetic modulation. Mental fatigue level, therefore, influenced autonomic function under FT. 3) There was no significant change of autonomic modulation under FT between the differences of symptomatic improvement after FT.

The purpose of this study was to investigate the actual dieting behavior in terms of eating disorders, and the relationship between dieting behavior and binge eating. Questionnaires on dieting behavior (the Dieting Behavior Scale), the Eating Attitudes Test (EAT), and the Binge Eating Scale were administered to a sample of 2,019 female high school students and 847 female undergraduate students. As a result of factor analysis of the Dieting Behavior Scale, it was revealed that there were two kinds of dieting behavior, one was Structured Diet (e. g., avoiding eating sweet-s and high calorie food) and the other was Extraordinary Diet (e. g., using laxatives to lose weight) . The stronger eating disorder tendency which was estimated by the EAT was, the more frequencies of both dieting behavior were. However, it was prominent that eating disorder group went on Extraordinary Diet more frequently than the high eating disorder tendency group whose subjects were in normal range in the EAT scores. A result of the regression analysis showed that only extraordinary diet affects binge eating, not structured diet.

Forty-eight adult patients with atopic dermatitis (AD) were compared among the groups classified by its severity and course on peripheral blood chemistry, and serological indices. Those indices included eosinophils (Eo), immunogloblin E (IgE), and lactate dehydrogenase (LDH). Moreover, some psychological indices were examined, inluding Cornell Medical Index (CMI), Tokyo University Egogram (TEG), etc. Then the correlation between the scores of psychological indices and Eo, IgE, and LDH values was examined respectively. We also evaluated the correlation within Eo, IgE, LDH values. Peripheral blood, blood chemistry, and serological examination revealed that Eo, IgE, and LDH values were elevated consequently. IgE was especially elevated to 4,285±4.1 IU/ml(mean±SD) in comparison with its standard value (165 IU/ml or less). Three groups classified by its severity (mild, moderate, severe) were compared by using one-way analysis of the variance (ANOVA) on Eo, IgE, and LDH values. As a result, IgE and LDH values of the severe group were both significantly highest (p=0.004,p=0.036). No siginificant results were obtained although the rest of three groups classified by its course (child onset type, temporarily remitted but exacerbated type, adult onset type) were also compared. We also found a significant negative correlation between IgE value and some CMI scores. We explained this reasons as follows ; 1) stress loading could connect with immunosuppression of IgE, 2) it is possible that subjective physical and psychological symptoms that subjects complained of might be reduced because severe AD patients who show elevation of IgE value scratch their skin hard and they can evaporate their stress. On the other hand, we also found a negative correlation between LDH value and "A"score of TEG (r=-0.407,p=0.021). Moreover, we obtained significant positive correlations between IgE value and LDH value (r=0.414,p=0.007), and between Eo and LDH value (r=0.374,p=0.002), respectively.

The photic feedback (PFB) enhances the alpha rhythm of brain waves using photic driving responses in which the brightness of photic signals is modulated by a subject's own alpha rhythm. While there have been some case reports in which depressive neurotic patients were treated successfully by PFB, the mechanism of effectiveness has not yet been sufficiently elucidated. The aim ot the present study was to investigate the effects of repetitive PFB sessions on electroencephalogram (EEG) and mood states of depressive as well as neurotic subjects compared with control subjects. Twenty subjects were selected from 116 healthy students in university or postgraduate school according to a neuroticism scale of the Maudsley Personality Inventory and the Center for Epidemiologic Studies Depression Scale. Ten subjects were randomly selected from students whose scores in both scales indicated more than 0.5 standard deviation over the average (High score group), and another 10 subjects were also randomly selected from the remaining students (Low score group). PFB was performed using PFB-1 (Pioneer Co, Ltd). All subjects experienced 8 PFB sessions, whose effects were compared betweem the 2 groups. EEG and mood states were measured in the 2nd and 8th sessions, and those sessions were composed of 7-minute pre-rest period, 15-minute photic stimulation period and 6-minute post-rest period. while the other sessions were composed of only pre-rest and photic stimulation periods. EEG was monitored from 6 electrodes including F3,F4,P3,P4,O1 and O2 of 10-20 EEG system. The data from pre-rest period (3-5 min), photic stimulation peniod (9-11 min, 14-16 min, 19-21 min) and post-rest period (24-26 min) were used for analysis, and the power and the average coherence were obtained in alpha 1 (8.0-10.0 Hz) and alpha 2 (10.0-13.0Hz) frequency bands based on the results of Fast Fourier Transformation. The Mood Inventory with five subscales including tension and excitement, refredhing mood, fatigue, depressive mood and anxious mood was administered at the beginning and end of each session. After excluding the data of three subjects spoiled by recording errors and thou of 2 subjects regarded as outliers by rejection analysis, those ot 15 subjects were analyzed by repeated-measures ANOVA. High score group showed higher alpha 1 power in O1 and higher alpha 1 coherence in F3-F4 and both groups showed higher alpha 1 coherence in O1-O2 in the 8th session than in the 2nd session. High score group also showed greater reduction of fatigue score in the 8th session than in the 2nd session. Then, there was a positive correlation between the increase of O1-O2 coherence and the increase of the amount of fatigue score reduction in High score group. It was suggested from these results that PFB increases alpha 1 coherence and that such EEG change in turn reduces fatigue in the depressive neurotic subjects.

This study examined the effects of electroencephalographic- (EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject's own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient's depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.

We have been performing various treatment outcome researches as a trial of applying behavior scientific methodologies to the field of psychosomatic medicine. The purpose of this paper is to discuss the impact of such researches, based on the results of our controlled study of cognitive behavior therapy (CBT) for eating disorders and single-case study of photic feedback (PFB) . We have been doing a group outcome research comparing CBT with operant conditioning p]us brief psychotherapy for anorexia nervosa. Fifteen patients have participated in the study and six of them have completed the one-year follow-up for 2 years and 8 months since the start of this study. The following problems have emerged so far : (1) The number of patients introduced to each group was very different. (2) There have been many serious or atypical cases who could not participate in this study. (3) Therefore, much more time and effort will be necessary for the completion of the study, which will produce the problem of cost effectiveness and the deterioration of data quality. Some significance has been also noted : (1) We have learned to assess the seriousness of patients based on a certain criterion. (2) The common understanding about the treatment has been shared thanks to the treatment manual and supervision. (3) Whether the CBT has specific effects on anorexia nervosa will be clarified if the number of participants grows larger. PFB can enhance the alpha rhythm without subjects' own effort. We have applied it to 28 patients of various neuroses, psychosomatic diseases and depression following the single-case experimental designs. The precise case study of a 37-year-old neurotic depressive patient is presented. According to the changes of the MOOD, his depressive mood was clearly improved by this treatment_ Detailed data analyses of various autonomic measures indicated that the alpha enhancement may have produced parasympathetic suppression and sympathetic predominance, which then improved the patient's depressive symptomatology. The problems were as follows : (1) The generalization of one case is not necessarily possible. (2) Much effort was needed for data analyses. The significance was as follows : (1) We have learned to assess the treatment effects more objectively than before. (2) We could know something about the mechanism of action as mentioned above. (3) A means of studying the treatment process itself was obtained, which is a necessary condition for the optimal regulation of patients' mind and body. Thus, although the introduction of treatment outcome researches accompanies many serious problems to be solved, it may bring about the following promising fruits or by-products : the refinement of diagnosis and assessment methods, the common understanding about the treatment, the objective assessment of the treatment efficacy, the suggestion about the mechanism of action, and the establishment of a means of studying the treatment process itself.

There have been some reports on the assessment of mortality rate in eating disorders. The reports in Western countries and Japan have shown the mortality rate of 1-lO%, and studies on many cases revealed the rate was approximately 4%. Of the outpatients who visited our department for the past 23-years, 724 had eating disorders. In this paper, the prognosis, the number of patients who died, and the situation of their death were investigated in these 724 patients. Data were collected from outpatient charts, registers, data bases and questionnaires given to attending physicians in our department. Data were collected from 434 of the 724 patients, and their list was made. We directly asked the attending physician for a summary of each individual patient and the items described later. Death was confirmed in 9 of the 434 patients. All of them were women, and the age at death ranged from 17 to 48 years (mean, 28 years) . The age at the onset ranged from 14 to 21 years (mean, 17 years) . Four patients had anorexia nervosa (AN) alone, and 5 had AN and bulimia nervosa (BN). The body weight at the time of death was 17-66 kg (mean, 35kg) . Hepatopathy has been confirmed in 6,edema in 4,hypokalemia in 5,and hypoglycemic attack in 4. The cause of death was weakness (debility) in 3,suicide by leaping from a high place in 2,heart failure following attempted suicide by taking medicine in 1,sudden death in 2,and cancer in one patient. As psychosocial factors, a desire for emaciation (fear of obesity) was observed in all the patients, and an attempted suicide, personality disorder, child-mother binding (symbiosis) , obsessive character and hysteric tendency were observed in 4,4,6,5 and 3 patients, respectively. The following points were reconsidered from the standpoint of the attending physician : l . Three patients (Cases 1,3 and 9) with AN, who died from weakness. No therapeutic relationship was established or motivation for the treatment was lacking. These points were reflected upon commonly in these three patients. In Case 9,her mother's load was increased because her father worked away from their home. Her mother showed a strong negative transference to the attending physician. This has been considered a therapeutic problem. 2 . Two patients (Case 5 and 8) with AN + BN commited suicide by leaping from a high place. Management of their unstable mental condition was not adequate. No evaluation was made nor countermeasure taken for chronic depression. Prediction of and response to attempted suicide were not adequate. 3 . A patient (Case 6) with AN+BN and a patient (Case 7) with AN died suddenly. No precise evaluation was made regarding her physical condition.

In the University of Tokyo, we have performed the psychosomatic medical education for all medical students since 1987. The purpose of this paper is to discuss the efficacy and the significance of the psychosomatic medical education. In this paper, we would like to emphasize the importance of bedside teaching (BST) in a small group. The aim of BST is the training of psychosomatic methods for diagnosis and treatment by using oneself as the teaching materials. One-week schedule of BST includes the interview training, the presentation of eating disorder patients, the practice of psychological tests, the intake interview of outpatients, the experience of autogenic training and play therapy using a miniature garden, the practice of gestalt therapy, behavior therapy (biofeedback therapy) and transactional analysis and others. Subjects of this study were 675 medical students (619 men and 56 women) for seven years from 1987 to 1993. We summed up and took the statistic of all free-style reports. The results of this study indicated that the experience learning was useful for understanding the psychosomatic medical model, and that many students recognized the needs of the holistic medical approach for any clinical department. The goal of the psychosomatic medical education is to introduce a psychosocial viewpoint in medicine in addition to biological one, and to cultivate the attitude of holistic medical approach including doctorpatient relationship for all medical students. For this purpose, it might be needed to make a guideline of psychosomatic medical education and to establish a psychosomatic medical department in all medical colleges.

This study systematically evaluated the psychosomatic reactions, especially physical symptoms of the victims living in the temporary shelters after the Great Hanshin Earthquake in January 1995. There are not so many studies which describe the somatic symptoms of victims in detail and reveal the results of blood pressure measurement after a natural disaster. As there has been no research which excludes the confounding factors in order to evaluate the effects of damages, it is a distinctive feature of this study that the multiple logistic regression analysis was performed in it. Physical and mental conditions of eighty victims (mean age=47.2±19.3; males : n=27,females : n= 53) were examined one month after the quake. Subjects were also requested to administer a checklist of psychosomatic symptoms which consisted of DSM-IV diagnostic criteria for ASD and PTSD. Blood pressure of about two hundred victims was measured both two and five weeks after the quake. Subjects of two weeks after the quake were 191 victims (mean age=58.4±13.1; males : n=68,females : n=123), and five weeks after the quake were 217 victims (mean age=60.1±12.1; males : n=77,females : n=140). Victims showed significantly more physical symptoms of insomnia, easy fatigue, anorexia, headache, palpitation, chest pain than non-victims as a control group. It was also found that three factors of victims, i.e. morbidity of chronic disease, death of close relatives, and complete destruction of houses had influence upon prevalence of psychosomatic symptoms. More symptoms of common cold, anorexia, easy fatigue, depressive feeling were found in victims with chronic diseases. Victims whose close relatives were killed by the quake showed significantly more symptoms of easy fatigue and less symptoms of common cold and anorexia. Victims whose houses were completely destroyed showed more symptoms of insomnia and depressive feeling. Forty-one to forty-six percent of victims who had not suffered from hypertension before the quake showed hypertensive status. Therefore, neurological, cardiovascular, and general symptoms were the most common reactions after exposure to the stressors due to disaster. Furthermore, these symptoms were affected by the severity of the damages in the disaster. These results suggest that somatic symptoms are important components of the reaction after a natural disaster. They also suggest the importance of proper care from both physical and mental perspectives, i.e. psychosomatic or holistic perspective.

In 46 normal subjects, we examined a) the component of respiratory sinus arrhythmia ( = HF) , b) the component coefficient of variance of HF (CCV-HF) , c) the component of Mayer wave related sinus arrhythmia ( = LF), and d) LF/HF ratio. Both of a) and b) are thought to reflect parasympathetic activity, and both of c) and d) are thought to reflect sympathetic activity. We studied how the heart rate variations are infiuenced by respiratory cycle (CY). At first, we performed the regression analysis between the heart rate variations and CY as an intrasubiect factor using all subjects' data. The square of partial correlation of each dependent variable and log CY was ; for log HF R^2=0.7334 (F(1,191)=526.25,p<0.0001), for log CCV-HF R^2=0.7307 (F(1,190)=515.57,p<0.0001), for log MWSA R^2=0.4568 (F(1,191)=106.37,p< 0.0001) , and for log (LF/HF) R^2=0.6703 (F(1,191) = 388.34,p < 0.0001) . Then we predicted the heart rate variations employing CY as the parameter, and examined the reliability by cross validation. For instance, Pearson correlation between the real value of LF/HF (CY = 15) and the value predicted from the real value of LF/HF (CY =20) for each subject was 0.9866 (p< 0.0001). With this study, we concluded that the heart rate variations could be assessed more accurately, considering the influence of respiratory cycle. The heart rate variations modified by respiratory cycle would be used clinically as a reliable index of autonomic nervous function in the future.

Exercise intolerance is commonly complained by panic disorder patients. In the present study, exercise capacity was evaluated in panic disorder patients by the anaerobic threshold (AT) which can be measured at submaximum workload and is hardly influenced by subjects' motivation. The subjects were ten (8 male and 2 female) panic disorder patients and seventeen male sedentary control subjects. Each of them underwent a respiratory gas analysis during a treadmill exercise test. Each of oxygen uptake (V^^・_<O_2>)' heart rate (HR) and ventilatory equivalent for oxygen uptake (V^^・_E/V^^・_<O_2>) at rest, at AT and at peak workload were obtained. Covariance analyses in which age was used as a covariate were utilized for some of the indices because they correlated with age and patients were generally younger than controls (31.0±9.0 vs. 55.8±8.2 ; mean±SD) , and the comparison was made only in male subjects. We also examined the presence of mitral valve prolapse (MVP) because it had been reported that MVP was related to impaired working capacity in anxiety disorder patients. In addition, we meaured the level of experienced anxiety during exercise to clarify the relationship between subjective anxiety and exercise intolerance. Oxygen uptake at AT (V^^・_<O_2>-AT ; F(1,21)=0.12,p=0.7359) as well as at peak oxygen uptake (V^^・_<O_2>-peak ; F(1,21)=0.52,p=0.4771) were very similar in the two groups, but patients showed significantly higher HR at rest (t(23)=2.60,p=0.0162) and at AT (t(22)=4.65,p=0.001). Patients without MVP experienced the highest anxiety before starting exercise (p=0.0351). Thus, objective exercise intolerance was not present in view of normal V^^・_<O_2>-AT and V^^・_<O_2>peak, but hyperresponsiveness of HR and/or anticipatory anxiety against exercise could be related to subjective exercise intolerance in panic disorder patients. This study was only preliminary, and larger numbers of panic disorder patients and age and sex matched sedentary control subjects should be included in future studies.

Diabetes is challenging because of its chronicity and high demands for daily monitoring and care. Diabetic patients must modify their daily lives to comply with diet, exercise, medication taking and glucose testing. Although numerous clinical studies have emphasized the importance of behavioral and emotional influences on glycemic control among diabetic patients, relatively few studies have reported about noninsulin-dependent (NIDDM) adult diabetic patients in longitudinal studies. The present study was designed to predict change in glycemic control during 6 months based on demographic and psychosocial factors among middle-aged and older patients with NIDDM. Subjects were 61 outpatients with NIDDM who completed both the initial and the 6-month follow-up assessments (out of 74 at the beginning) at the Asahi Life Foundation Institute for diabetic care and research. Forty-five were male, sixteen were female and subjects' ages ranged from 36 to 80 years, with a mean of 58.0 years. Patients were requested to fill out diabetic checklist and several psychological questionnaires, from which 9 demographic and 10 psychosocial variables were selected as predictor variables. Level of glycemic control was assessed by glycosylated hemoglobin (HbA_1c) assays at the beginning of the study (pre-HbA_1c) and at the 6-month follow-up (post-HbA_1c) . '% change of HbA_1c' = { (post-HbA_1,c-pre-HbA_1c) /pre-HbA_1c} x 100 was then used as a criterion variable. Multivariate statistical analysis, the Quantification type I method, was conducted in order to take account of potential influence between each of predictor variables and to utilize categorical types of predictor variables. Mean % change of HbA_1c was 0.20% (range : -22.0% to 33.3%) . It was revealed that the combination of egogram pattern, treatment regimen and diabetic education could most accurately predict % change of HbA_1c (R-squared=0.344. F= 5.76,p=0.0002) . The egogram pattern based on transactional analysis which indicating the ways of interpersonal relationships was the best predictable factor. It was indicated that patients with NP dominant pattern had deteriorated the most and those with reverse 'N' pattern had improved the most. It is concluded that useful information to predict % change of level of glycemic control may be obtained from the longitudinal study using the combination of certain psychosocial factors. Future research should refine the measurement to evaluate diabetic self-care behavior, and increase the number of subjects from other institutes.

In recent years, cognitive-behavioral therapy has become prevalent not only in Western coun. tries but also in Japan. There are some reasons for this. First, cognitive-behavioral methods are directly concerned with thoughts and feeling that are imporatnt in psychiatric and psychosomatic disorders. Secondly, these methods have scientific basing and are more amenable to evaluation in clinical trials. Thirdly, cognitive-behavioral therapy is comparatively easy to use. It can be applied to depressive disorders, anxiety and obsessive disorders, eating disorders, and certain somatic problems, etc. Our research group made a manual of cognitive-behavioral therapy for anorexia nervosa supported by the Ministry of Health and Welfare in 1991. We also revised a manual for clinical study of anorexia nervosa in 1992. The aim of this study is to compare cognitive-behavioral therapy with an operant conditioning treatment with brief psychotherapy. This is a multi-center study that was begun in October, 1992. In this paper, we will outline our manual of cognitive-behavioral therapy, and the revised one for clinical study, and make an interium report of the study in our department.

The photic feedback therapy is a kind of therapy used for inducing a relaxation state in a subject. In this therapy, the electrcencephalogram (EEG) records of the subject are converted into photic stimuli, which are applied to his visual sensory system to activate EEG. The principle is based on a combination of the photic driving of EEG and biofeedback theory. The characteristic of this therapy is in that the subject can control the amplitude and freqliency of his EEG with no intentional efforts. We applied this therapy to our outpatients with various psychosomatic diseases and neuroses according to the prescribed protocol and assessed the effectiveness using the psychological and physiological measures. Ten outpatients (8 males and 2 females) aged 21 to 77 (average of 32.2) in our department of psychosomatic medicine participated in this study. Five therapeutic sessions and 2 baseline sessions each before and after the therapeutic sessions were performed once weekly. The extent of improvement of symptoms and the changes of psychological and physiological measures between pre- and post-therapeutic baseline sessions were recorded. The improvement rating showed marked improvement in 3 patients, mild improvement in 4,and no change in 3. The psychological examinations in all subjects revealed a significant decrease (p<0.05) in Self-rating Depression Scale (SDS) score, a tendency of increase (p<0.1) in A score (eye symptom) of the Cornell Medical Index (CMI) and tendencies of decreases (p<0.O1) in T score (extroverted thinking) of the Yatabe-Guilford personality test (Y-G) and NP score (nurturing parent) of the Egogram (TEG). The evaluation in the improved subjects (n=7) revealed a significant decrease (p<0.02) in T score of Y-G and tendencies of increases (p<0.1) in A and M (maladaptation) scores of CMI. The physiological examination using coefiicient of component variance of low frequency (CCV・LF), that of high frequency (CCV・HF), and L/H ratio showed no significant difference. The fact that marked improvement in 3 patients and signifcant changes in some psychological measure were achieved after this short-term therapy suggested that this therapy is suitable as psychosomatic therapy. We guess that these psychological changes resulted from the relaxation state induced by this therapy, which made patients to pay attention to and become aware of their body sensation and their feelings.

The purpose of this study was to develop and validate an instrument to measure the individual's mood state. After the selection of items which state the individual's temporary mood, and their factor analysis with 404 male and female subjects, scale development resulted in a 40-items Mood Inventory with five factors : tension and excitement, refreshing mood, fatigue, depressive mood, and anxious mood. Psychometric evaluation by test-retest method, odd-even method, and parallel test method suggested that the Mood Inventory is internally consistent and has well enough high reliability and validity. A comparative study among patients with psychosomatic diseases, patients with physical illness, and healthy subjects, revealed that patients with psychosomatic diseases showed signifcantly higher scores of tension and excitement, fatigue, depressive mood, and anxious mood than healthy subjects, and that the healthy subjects showed significantly higher refreshing mood score than other clinical subjects. It was suggested that the Mood Inventory has considerably high discriminant validity and enough potential for the clinical and research application.

The purpose of this study is to evaluate psychological and physiological effects of photic feedback system (αFB) which had been developed in order to facilitate relaxation response comparing with autogenic traming (AT). The subjects were 13 healthy individuals (8 AT practiced and 5 unpracticed). All subjects experienced αFB session and AT session in turn with their eyes closed. Each αFB session consisted of a sweep period of 3 min, a rest period of 7 min, an αFB period of 10 min, a rest period of 10 min. Each AT session consisted of a rest period of 10 min, an AT period of 10 min, a rest period of 10 min. Physiological monitoring of blood pressure, heart rate (HR) and respiratory rate (RR) was performed during the sessions. As psychological measures, State trait anxiety inventoryState form (STAI-S) and Profile of mood states (POMS) were administered before and after the sessions, and post-trial subjective feeling-state reports were requested after them. The mean value and the standard deviation (SD) of systolic blood pressure (SBP), diastolic blood pressure (DBP). HR, RR and the coefficient of variance of R-R interval (CVR-R) were calculated on each of three following periods ; 7〜9 min (pre), 17〜19 min (mid), 27〜29 min (post). The data were statistically analyzed with analyses of variance by General Linear Models (GLM) procedure of Statistical Analysis System (SAS). The results were as follows ; 1) According to the results of psychological measures, almost all measures were significantly decreased, and αFB was equally effective for calming mood as AT. 2) SBP-mean and CVR-R Significantly increased, HR-mean significantly decreased. 3) SBP-SD and DBP-SD significantly increased during αFB and AT period. 4) CVR-R increased in the αFB sessions more than in the AT sessions. It is concluded that αFB was equally effective for calming mood as AT and that αFB was prone to increase parasympathetic measures such as CVR-R more than AT.

A case is presented who has recovered from depressive neurosis by the photic feedback (PFB) therapy. The PFB system was developed in order to make body and mind relaxed by enhancing alpha waves of electroencephalogram (EEG) utilizing light signals made from subjects' own EEG. The patient was a 61-year-old male who had developed depressive neurotic symptomatology including insomnia, depressed mood, irritability and gastralgia five years before the first visit under stressful situations accompanying an annexation of his company and suicide of its president. His symptoms had persisted since then because he had been experiencing various distressful life events such as his wife's suffering from subarachnoidal hemorrhage, his symptoms including chest discomfort and palpitations diagnosed as 'angina pectoris', and death of his father and one of his classmates. We have treated this case by using PFB system following the A-B-A-B single-case experimental design. A questionnaire was used as psychological indices measuring depressive mood, cognitive and perceived physiological aspects of anxiety and irritability. Various physiological measures were also monitored such as EEG, skin surface temperature (SST), skin conductance level (GSR), plethysmogram (PLE), the coefficient of variance of the component of respiratory related sinus arrythmia (CCV-HF) and Mayer wave related sinus arrythmia (CCV-LF). Scores of psychological indices, especially depressive mood, decreased within each session until the middle period of the whole treatment. Increases of SST and CCV-HF were also observed, and these psychological and physiological changes were consistent with the state of relaxation. Sleep disturbance such as talking and roaring out during his sleep was improved after one session. and depressive mood was also improved in the first half of the treatment. However, depressive mood was again aggravated and intense anxiety about cardiac illness also appeared in the latter half of it because his close relatives and friends died one after another then. His conditions began to get better after we added cognitive interventions and extended feedback time of the therapy against this situation. We terminated the PFB therapy in the 41 st week. It is hypothesized that the efficacy of the PFB therapy is derived from relaxation induced by alpha wave enhancement. However, how alpha wave enhancement induces relaxation or what relaxation really is still remains to be elucidated. What kind of illnesses can be effectively treated by the PFB therapy should also be made clearer in the future.

Although psychosocia_1 stressors have long been felt to affect diabetes, prior research in this area had been hampered by methodologic difficulties. This study was designed in order to study the relationship between psychosocial factors and metabolic control of diabetes mellitus. Seventy-four middle or old aged outpatients with non-insulin dependent diabetes mellitus (NIDDM) were studied at the Asahi Life Foundation Institute for Diabetes Care and Research. The authors developed a "Diabetic Checklist" self-report questionnaire that measured psychosocial factors and demographic data. Results from this questionnaire and several psychological tests were compared to measurements of glycosylated hemoglobin (HbAic). Multivariate statistical analysis, the Quantification Type I method, was done in order to minimize the methodologic problems found in prior studies. This analysis revealed that the combination of six items (egogram, occupation, body weight, therapy method, diabetic education and eating behavior) could most accurately estimate diabetic control (R-squared=0.576). The egogram pattern based on transactional analysis which indicates the pattern of personal relationships, was felt to be the most useful measurement. The authors conclude that useful information to evaluate diabetic control may be observed from the study of certain psychosocial factors and are planning for the prospective study in this area.