Cognitive Behavior Therapy (CBT) is a useful method for patients with diabetes and obesity for their life style related diseases as well as for their comorbid mental disorders. A number of obesity patients have various kinds of cognitive distortions related to their eating habits (e.g., "I never eat too much" "I gain weight even after just drinking water"). These cognitive distortions occur in the process of lose-and-gain weight cycles when the patients go on self imposed diets. Therefore it is important for those patients to identify and correct their distortions and to improve their self-efficacy for their exercise and diet. It is useful to evaluate patient's characteristics and personal traits such as all-or-none thinking and overgeneralization. In clinical situations, it is important that the patients notice the relation between their behavior (eating, exercise) and the change of their blood sugar and/or body weight themselves. It is also necessary to support improvement of their self-efficacy and encourage their behavioral change. CBT is very useful to modify patient's cognitive distortions and to enhance their self-efficacy. Therefore all medical staff involved in diabetes and obesity clinics should know the basics of CBT and apply CBT in clinical fields.

View full abstract

The psychopathology of eating disorders has been rapidly changing and expanding since introduction of bulimia nervosa as an ominous variant of anorexia nervosa, three decades ago. The efficacy of cognitive-behavioral therapy for bulimia nervosa (CBT-BN) was first reported by Fairburn et al. (1981). Most guidelines now recommend CBT-BN as a first choice of treatment for bulimia nervosa. Because of the increasing complexity of psychopathology, CBT-enhanced (CBT-E) therapy that addresses mood intolerance, clinical perfectionism, low self-esteem, and interpersonal difficulties in addition to the eating disorder symptoms themselves is being newly proposed. The initial report regarding the efficacy of CBT-E appears to be promising (Fairburn et al. 2009); however eating disorder patients currently being treated at our facility have a considerably greater number of comorbid disorders such as generalized social anxiety disorders, avoidant personality disorders, and multi-impulsivity disorders. For these patients, more specific treatment such as CBT for social anxiety disorder or dialectical behavior therapy should be considered.

View full abstract

Miscarriage can induce psychological distress. When it occurs frequently, other kinds of suffering could result. In the field of gynecology and obstetrics, physicians have executed various novel ideas, such as spending sufficient time for each routine checkup, introducing counseling and providing medical knowledge about recurrent miscarriage (RM) in order to relieve patients with RM and stop excessively increasing sadness and anxiety. These approaches could contribute to improvement of fertility rate, especially for unexplained RM. Verification by a randomized controlled trial (RCT) is needed. On the other hand, we conducted individual sessions of cognitive behavioral therapy (CBT) for RM patients whose depression and anxiety continued even after these efforts. In general, it is evident that CBT for depression or anxiety is effective. Still, we need to implement RCT to show the effectiveness for not only depression and anxiety but also for improved birthrates of RM patients. It is hard to use medication for women who expect to be pregnant in the near future. In Britain, CBT is classified into two levels of intensity; low and high. Low intensity CBT includes a group setting or web site utilization, while high intensity involves individual CBT by skillful therapists. We hope to contribute to the healthy life of women with RM by taking advantage of low and/or high intensity CBT.

View full abstract

The author reviewed the effectiveness of cognitive behavioral therapies (including both strictly-defined, Beckian cognitive behavioral therapies and more widely-defined cognitive behavioral approaches) for physical and psychiatric symptoms of cancer patients. The author also illustrated cognitive a behavioral therapeutic approach which had been developed by Greer JA (2010).

View full abstract

Objectives: The present study aimed to investigate the environment of care and support at the workplace and in the working life of cancer patients and survivors who have returned to work, and to clarify the forms of care and support needed in the workplace. Method: Subjects comprised cancer patients and survivors (N=827) younger than 60 years old who had returned to work within the previous 5 years. Subjects completed self-report questionnaires via the Internet. The questionnaires consisted primarily of subject matter about the subjects’ present situation after returning to work, as well as the psychological care and support that they felt they needed. Results: We found that 22.5% of the subjects received psychological care and support at work, 3.6% needed psychological care and support but did not receive it, and 66.6% did not need psychological care and support and did not receive it. Additionally, 62.3% of the subjects had recovered to a high level of work ability since returning to work, whereas 35.1% had not yet recovered. The forms of psychological care and support needed by subjects in the workplace included financial support, reduction of work hours and burden, and psychological care and support from professionals. Discussion: The present results suggest that psychological care and support in the workplace and medical institutions need to be considered for cancer patients and survivors who have returned to work.

View full abstract

The purpose of this study was to examine the association between trait anxiety and psychological reactions among patients awaiting kidney transplant surgery. Participants included patients awaiting kidney transplant surgery at Kitasato University Hospital between December 2006 and September 2010. A total of 42 participants provided informed consent and underwent an interview with a psychologist. Participants were also asked to complete the STAI-Trait (STAI-T) anxiety scale and Hospital Anxiety Depression Scale (HADS). Based on STAI-T scores, participants were divided into 2 groups based on whether their scores were higher than the median score of 43.5 or lower, and the interview answers were compared between the 2 groups. The HADS score of the high-trait anxiety group was significantly higher than that of the low-trait anxiety group. However, the interview answers were similar regardless of trait anxiety scores. Interview questions related to the degree of distress with respect to dialysis revealed that over 86% of participants experienced distress as a negative psychological reaction. The most frequent reason for feeling negative about dialysis in both groups was related to body constraints imposed by the procedure. Interview questions related to views of life after kidney transplant surgery revealed that over 71% of participants had positive psychological reactions and expected to live a fulfilling life after the surgery. The most frequent reason for feeling positive in both groups was related to liberation from dialysis. These results suggest that trait anxiety may influence the state anxiety and depression of patients awaiting kidney transplant surgery, whereas their interview answers regarding dialysis and views of life after the kidney transplant are independent of trait anxiety. Although anxiety and depression as reflected by STAI-T and HADS scores were higher in the high trait anxiety group, subjects voiced similar reasons for feeling negative about dialysis and were positive about life after kidney transplant surgery. That is, while trait anxiety correlated with differences in state anxiety and depression, it did not correlate with the interview answers. In other words, the findings suggest that for patients awaiting kidney transplantation there are differences in psychological reactions and in actual mental states. From the above results, for medical staff in contact with patients waiting for kidney transplants, it is necessary to perform a more detailed interview to be aware of patient anxiety and depression without the dialysis and transplant of patients.

View full abstract

Amyloidosis covers a group of diseases that result from abnormal deposition of a particular protein, called amyloid, in various tissues of the body. After close examination in our hospital, we diagnosed amyloidosis in a 37-year-old man with variegated body symptoms who had previously been diagnosed with somatoform disorder. Early diagnosis is typically difficult because specific symptoms are scarce, and "over-comprehension" by medical staff delays the diagnosis of amyloidosis. The possibility remains that diseases with difficult definitive diagnosis as shown in this report remain hidden as "suspected somatoform disorder" referrals from primary-care physicians. Keeping in mind that primary care physicians may find some conditions difficult to diagnose, careful attention should paid not to overlook or misunderstand physical symptoms which can strengthen the capabilities of the psychiatrist in liaison psychiatry. In this case, because the patient also displayed a hysterical character and manner of action, physical symptoms from amyloidosis were considered to reinforce the somatoform disorder. Concomitant amyloidosis and somatoform disorder was assumed as the diagnosis in our hospital. In the medical treatment that we provided, definitive diagnosis of the disease was able to be obtained by carefully continuing the diagnostic work even after we had comprehended the characteristics and conflict situation of the patient. This case suggests that correct identification of "comprehension possibility" in psychiatric treatment requires careful attention.

View full abstract