Writer's cramp is considered to be a psychosomatic disorder of the nervous system. It is not infrequently encountered in the clinical setting of psychosomatic internal medicine, but its causes are unclear, and a treatment method has not been established. We have used electromyogram biofeedback method (abbreviated below as EMG-BF) as a method of treating writer's cramp. In this report, we will present the results for patients treated with EM-BF at this Department. The subjects were 20 patients treated with EMG-BF at this Department from April 1986 to March 1990. 15 of the subjects were men, and 15 of them developed the disorder in their 40s and 50s. The average period of illness was 7.2 years, and the clinical types were as follows : 11 cases of the stiffness type, 8 of the trembling type, and 1 of dystonia. The subjects with trembling-type writer's cramp included 3 subjects with phobic tendencies. BF treatment was carried out once weekly for a total of 10 sessions, with feedback being carried out using the myogenic potential of the forearm muscle. The results showed that 65% of the patients reported improvement in subjective symptoms. Improvement rates according to the clinical type were 63.6% for stiffness and 75% for trembling, but excluding the results for the subjects with phobic tendencies, who had a favorable prognosis, the improvement rate for the trembling type was 60%, virtually the same as the rate for the stiffness type. In an objective observation of writing ability after treatment, 85% of the subjects were able to carry out routine writing, and deviation was observed compared to the patients' subjective symptoms. Moreover, the prognosis for the sujects who showed a decrease in myogenic potential due to BF treatment was favorable. Based on these findings, one can conclude that EMG-BF is a method which should be used in treatment of writer's cramp having a mild, chronic course, and it can be considered particularly effective in subjects having phobic tendencies.

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We have previously reported the major results of the questionnaire survey on the practice of psychosomatic medicine which was carried out to doctor members of the Japanese Society of Psychosomatic Medicine. The present study reports the results of analyses concerning biofeedback therapy (BF). The questionnaire was mailed to 961 doctors who satisfied a prescribed set of criteria. The average age of the 568 respondents, whose answers were considered valid, was 51. 6 years old. One hundred and fifty-eight doctors had used BF, which comprised the seventh largest group. The average age of the BF group was 48.5 years old, significantly younger than that of doctors who did not use BF. The doctors specializing in psychosomatic medicine accounted for a higher percentage in the BF group. The doctors in the BF group emphasized items concerning 'stress and lifestyle' and 'disease history' as clues to judge whether a patient has a psychosomatic disorder or not. Also frequently employed by the same doctors were such therapies as the brief psychotherapy, autogenic training, muscle relaxation, behavior therapy, and transactional analysis. These results are examined to demonstrate that BF is used mainly by relatively young doctors specializing in psychosomatic medicine.

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In regard to alpha activity enhancement using auditory alpha feedback, we took notice of two principal problems : (1) the feedback techniques to transmit the subjects' alpha activities, (2) the subjects' emotional changes when they received the feedback signals. As for the feedback techniques, binary, integrated or improving integrated (integrate for 5 sec. period) feedback methods have been used previously. When the subjects' alpha amplitude is lower than the set threshold, and so feedback signals are not given, they feel uneasy or impatient. In this study, in order to maintain the subject's mental stability during the feedback training, we designed the following two experiments. [Experiment I] Even if the subject's alpha amplitude is lower than the set threshold, he can be given proportional feed-back signal (scoring imformation) every 1 sec. [Experiment II] The subject can be given the feedback signal not proportionaly but derivativelly . To find his own qualititative alpha activity every time strengthens his self-persuasion and increases his intention to attain his emotional stability. To grasp the aspect of his differential alpha changes during feedback training accelerates the nervous-control response, and so modifies the self-control ability. In these experiments, both feedback techniques above mentioned were found effective in enhancing alpha activities. especially for the subjuct whose basic alpha amplitude is extremely small or whose percentage time alpha is comparatively low (up to 20%). And the results of the experiments suggested that the subject's self-persuasion when he received the feedback signals played an important role in al ha activity enhancement.

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Present study was performed to examine the effects of instructions designed to encourage the awareness of the internal control process on the acquisition of voluntary control of a novel muscular activity. The m. auricularis posterior(the muscle which draws an auricle backward) was selected as the object of the experiment. Twenty-four undergraduate and graduate students who could not move their auricles were required to activate their left m. auricularis posterior and underwent rest, pretest, training, and posttest sessions. They were assigned to one of three groups, i. e., a group BF who were provided with electromyograph (EMG) feedback signals from the left m. auricularis posterior on all training trials, a group NF who were provided with no such information on any training trials, and a group SBF who, in order to encourage their awareness of the experiencing, were provided with EMG feedback at their request on each training trial and asked some questionsabout ways and feelings of striving to activate the left m , auricularis posterior, a bodily feeling brought about by striving, and how to use the feedback signal on every three training trials. Main results were as follows : (1) Mean percentage increase of integrated EMG in the left m. auricularis posterior from pretest to posttest were almost significantly greater for the group SBF than for the gorup BF, and for the group BF than for the group NF. (2) The number of subjects who could learn to move their auricles in the group SBF was also more than that in the other two groups. (3) Only for the group SBF, all subjects knew correctly whether they could move their aurilcles after the experiment. These results provided evidence supporting the hypothesis of the present study that subjects could aquire voluntary control of a novel muscular activity more effectively by being encouraged in their awareness of the internal control process.

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We have developed a new system of brain wave feedback to alleviate mental stress. The system picks up alpha waves of a subject using a bandpass filter, smooths the brain wave envelope and invigorates the alpha waves by stimulating the subject with a light whose intensity is modulated by the amplitude of the processed alpha waves. The system can also lowers the frequency of the alpha waves as well as reinforcing them. Favorable results were observed in the experiments.

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We applied the photic feedback system, which we had previously developed, for the medical treatment of patients with neurosis, depressive disorders and psychosomatic disorders. We evaluated the system's effects to verify it's efficiency in promoting relaxation. The measurement of the physiological index of the autonomic nervous system for the patients with neurosis indicated greater relaxation according to the nervous index of electromyogram and skin conductance level than the control group using simple rest with eyes closed. The index of the cardiovascular system indicated conversely a tendency toward activation. In the psychological test, the photic feedback group's mood became more relaxed than the control group. We assume that photic feedback leads people to a kind of altered state of consciousness and psycho-physiological reaction which differs from ordinary rest with eyes closed, and therefore is efficient for relaxation. Moreover, according to medical diagnosis, the photic feedback treatment was significantly effective for patients with depressive disorders and eating disorders who are normally difficult to treat. It appears that photic feedback is efficient for rhythm disorders peculiar to these illness. However, we don't know yet how the mechanism works.

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