Recently, aromatherapy, serving as complementary and alternative medicine (CAM), draws increasing attention from nurses, and many hospitals have employed aromatherapy for nursing care. Aroma massage, characterized by plant-derived mild flavor with soft touching, gives a patient a strong sense of security and comfort. The Palliative Care Unit of our hospital also has actively carried out aroma massages by volunteer staffs and nurses, since opening of the unit. However, what's happening now is that nurses practicing aromatherapy on patients cannot have sufficient time for close communication with the patients because of their busy hospital jobs. Recognizing the need of a system which allows nurses to carry out aromatherapy without being bound to the routine work during business hours, we have started a relaxation nurse system since April 2006. At present, partly due to shortage of nurses, the aromatherapy activity can be conducted only about once a month. In the activity, nurses not only practice aromatherapy in the Palliative Care Unit, but also visit other wards to practice aromatherapy upon request. In addition, to spread accurate knowledge about aromatherapy, we give theoretical and practical lectures to nurses in postgraduate education or alternative medicine training. Therefore, a majority of our nurses have a certain level of knowledge about aromatherapy and ability to practice it. On the aromatherapy day, nurses do not have to spend their time on the routine work, and so they can be devoted to aromatherapy and closely and personally communicate with each individual patient. This would provide large benefit to both nurses and patients.Such a system is still rare nationwide, but we expect that many hospitals will adopt such a system from now on, possibly followed by appearance of relaxation nurses and relaxation clinics which employ the biofeedback therapy.

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Individuals under high stress tend to be in a state of tunnel vision. Especially patients with panic disorder would show this tendency. They focus on their anxiety and prediction of discomfort. Our previous study suggested that individuals under high stress would chose less coping strategies than individuals under low stress and their internal environments differed. In the present study, the process toward accommodation by increasing their coping strategies during cognitive behavioral therapy was investigated. The frame of reference in which we tried to identify such accommodation process by self monitoring aimed to contribute to expand the opportunities of application of biofeedback. Two clinical cases recovering from panic disorder with agoraphobia were instantiated. They showed high level anxiety to ride public transportation. In both cases, they needed to be liberated from the distress of riding in enclosed spaces. At the beginning of therapy, the patients had concentrated on their anxiety. During the progression of the therapy, the patients explored the practicable behaviors more and more and their coping strategies had increased. The cognitive process in the patients circulated as a sort of circuit. We can call the former process the anxiety-amplification circuit, and the latter process the self-regulation- amplification circuit. It is suggested that the patients with the anxiety-amplification circuit need the self-regulation- amplification circuit in their cognition to accommodate external environment. During biofeedback process, the patients moderate their internal environment by monitoring physiological information. In other words, this process is self-regulation. On the other hand, cognitive behavioral therapy lets the patients recognize how to recognize and changes the patients's perspective. Through this meta recognition the internal environment is moderated. Basically both biofeedback and cognitive behavioral therapy can let the patients self-regulate their internal environment by self-monitoring. These two techniques could share the same therapeutic framework.

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Increasing evidence suggests that perceived happiness influences stress responses to mental stress testing. We examined the effects of perceived happiness on heart rate (HR) and subjective responses induced by mental stress tests such as speech and mental arithmetic between high and low happiness groups screened according to levels of perceived happiness among 235 participants. After a 10 minutes pre-task period, 8 high and 8 low happiness participants completed the task period which included 2 minutes preparation for speech, 3 minutes speech and 5 minutes mental arithmetic in front of an observer followed by a 30 minutes post task period. Subjective stress responses were assessed by NASA-TLX. HR was higher in the lower happiness group compared to the higher happiness group during the pre-task and mental arithmetic. Both groups did not differ in subjective stress responses.

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In a previous study, biofeedback (BF) therapy was performed to treat hypertension using direct and indirect techniques, and the effectiveness of these techniques was clarified. In the current study, BF was performed for five months to treat hypertension and then the patients were followed for one year. This treatment group was compared an untreated group in order to examine the sustained effect of BF therapy. Patients with hypertension in the group to undergo BF therapy had slight to moderate hypertension and often had slightly elevated anxiety and depression scale scores. Comparison of these patients before and after BF therapy revealed that they had significant decreases in blood pressure while outpatients and in anxiety and depression scale scores, and this improvement remained even a year later. Comparison of this group to the untreated group revealed significant differences in these three indices. In summary, BF therapy for hypertension was found to stabilize blood pressure and mitigate anxiety and depression. Results clearly indicated that its effects remained even a year later.

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