This is a case od phobia successfully treated by the application of behavior therapy.The patient was a forty-two year old married woman. Four years previously she had experienced an attack of palpitation and tachycardia upon being injected with streptomycin, and two years preciously she had experienced the same attack upon being injected with narcotics by dentist. After that, palpitation occurred frequently.Owing to a strang fear of death, and that the attack might happen again, she became unable to remain alone at home, eat food or do her daily necessary tasks. She develped a fear of riding in buses, street cars and elevators. That is, the conditioned fear which had been provoked by streptomycin and narcotics had widely been generalized not only to medicines, but also to daily necessaries and foodstuffs which seemed to contain chemicals or smelt of medicines. Consequently, the attack and the behavior disturbances had been reinforced by this.As my efforts in psychotherapy by persuasion and support and the pharmacotherapy by minor tranquilizers proved unsuccessful in her treatment. I decided to use systematic desensitization-a branch of behavior therapy. In the procedure of systematic desensitizatin, I followed Wolpe's method. The desensitization was done partially through having her imagine herself in sensitive situations and partially facing these situations in reality.This desensitization process was carried out for sixty days and she then was able to stay at home by herself, do daily necessary tasks and eat normally.At present three years treatment, shi is quite free from her former symptoms and has not developed symptom substitution.

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[in Japanese]

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This is a case of hyperventilation syndrome which was successfully treated by the application of behavior therapy.The patient was a twenty-seven year old married woman telephone operator, who had been living with her husband's parents for seven years. During this time her thoughts and feelings had been suppressed by these inlaws.While working at her telephone exchange, she had an attack of hyperventilation and palpitation with numbness and rigidity of the extremities. After that, the attack occurred almost every day. Due to a strong fear that the attack might happen again, she became unable to continue her occupation.I used psychotherapy by persuation and support, and pharmacotherapy using a minor tranquilizer, but all in vain. As a result of behavioral analysis, it became clear that her symptoms were conditioned avoidance-responses to anxiety. So I decided to use systematic desensitization and assertive training in accordance with the theory of reciprocal inhibition, following the procedures of Wolpe's method. The systematic desensitization and assertive traiing were carried out for two months.At present, two years after treatment, she is quite free from her former symptoms and has not developed symptom substitution.

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In this study, ten cases of hyperventilation syndrome were divided into 'mild' and 'severe' groups, based on the extent of their clinical attack and on the effectiveness of therapy.In the 'mild' cases, the clinical attack of heperventilation syndrome was provoked by emotional factors such as anger and tension as well as physiological factors including over-strain, fever and disturbance of ventilation in individuals who were physiologically hypersensitive to variationso f the content of gases in the blood.In the 'severe' cases, particular traits such as hysteric and compulsive traits were observed besides the above mentioned somatic predisposing factors. The clinical attacks of the individuals who possessed psychic conflict and psychic trauma were triggered by the psychological situations associated with these factors.In both groups, anxiety and phobia, which give rise at the onset of the clinical attack due to the aggrevating situation, resulted in a cause of induction and/or maintenance of symptoms when confronted with comparable situations.The improvement of the 'mild' cases was achieved by having them breathe CO_2 rich air (breathing into a paper bag), medication with tranquilizers, and instruction concerning the psychosomatic correlative factors to the patient. In the 'severe' cases, the improvement of the symptoms was achieved only by a combined treatment with these therapeutic procedures and a systematic psychoterapy. This combined treatment, including autogenic training, induction of the hyperventilation syndrome by suggersting stress under hypnosis, and desensitization therapy to situations precipitating the symptoms, psychological integration of the psychic conflict was successful even for the most severe cases.

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Biofeedback Techniques were used for lowering the systolic blood pressure of 4 patients with essential hypertension. Digital blood pressure was continuously monitored. The lowering effect on digital systolic blood pressure by true biofeedbach techniques was substantially greater than that of the false biofeedback information techniques. These results show the possibility of the use of biofeedback techniques in the treatment of essential hypertension.

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This study was designed to investigate the causetive factors in the occurrence healing process and recurrence of peptic ulcers, from viewpoint of psychosomatic medicine.The method involved the use of two questionnaires and the interview of patients. In all, 314 gastric and duodenal ulcer cases were analysed.Althouth the frequency of psychologically abnormal persons in our study was fewer than that of other studies, it may be due to the fact that many outpatients and group-examined cases were included in our study.In peptic ulcer patients, psychologically abnormal persons increased as the increment of subjective complaints of the digestive organ. At the time of the occurrence of this disease, external stress acted as a causative factor in 88% of these case. The most frequent kind of stress was the increase of heavy responsibility, next was general anxiety and troubles in personal relations.It was also suggested that the frequency of psychologically abnormal persons was related to the location of the ulcer, as the gastric acid secretion varied by that of ulcer.That a psychologically abnormal personality influenced the healing process of the ulcer, we learned from the result of our study of the difference between the early healed group and the refractory group. But, the recurrence of the ulcer seemed to be influenced more by external stress than that of an abnormal personality.It was also seen that the organ inferiority of the stomach acted as one of the causal factors in the onset of this disease.

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The orthodox medical definition of psychosomatic disease implies a one-way relationship between the dualistic concepts of "psychie" and "soma". THis approach has resulted in the evolution of orthodox psychoterapies which emphasize ego-oriented "psychological" intervention strategies, and which ignore the effect of voluntarily controlled bodily processes such as posture, movement, and breating upon the somatopsychic state of the organism, and which pay little attention to body feeling, defineable as awareness of interoceptive afferent stimulation.In contrast to the orthodox approach, a "somatopsychic" viewpoint ohas recently been evolving, which maintains that psyche and soma are functionally two aspects of a single process, and which emphasizes using the voluntary functions of the body to produce "phychic" changes and to restore homeostatic functioning.Alexander Lowen's "Bioenergetic Analysis" is a recent example of the somatopsychic trend, in which "muscular armour" is penetrated by a variety of techniques in order to restore normal breathing, feeling, and emotional expression. Some of the postures and expressive movement techniques are iluustrated and described in some detail, and their applicability to psychosomatic patients is discussed. It is concluded that the bioenergetic methodology may be particularly applicable to psychosomatic patients, most of whom have histories of repressed emotion.A brief comparison of bioenergetics with the yoga somatopsychic approach is discussed, the former being seen as a "first step" or "acute" treatment methodology compared to the latter.

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In this case, the patient was a thirty year old male office worker. For twelve years, whenever he found himself in the presense of a group of people, he experienced oa couldness in his extremities, sweating, palpitation, nausea and vomiting.The first time he experienced this complaint was when he was at the batter's box in a baseballs game. The second time was when he was speaking on the telephone, and from then on whenever he was asked to speak in front of others at company meetings.Systematic desensitization was applied in his case. A subjective unit of disturbance (SUD) was made, and he was exposed to a minimum of forty SUD points a week. After eitht sessions, systematic desensitization was accomplished and he could imagine his anxious scene of 100 SUD points without become anxious.He has not been bothered with anxiety or palpitation since.

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It is well known that there are some precipitating factors in epileptic seizure occurrence.For example, exhaution, fever, sleeplessness, and tension are mentioned as a precipitating factor by patients themselves.This report is concerned especially with the relaxation from tension state. Recently, we have found 10 patients of temporal lobe epilepsy with such a precipitating factor.The most typical case was reported in detail.Case M.T. 43 yr. FemaleHer seizures began at the age of 31. Since then she has been under anti-epileptic drug therapy. Recently she has seizures of focal sensory type and behavioral automatism. The most interesting is that she has had her seizures almost exclusively at her home, and in the evening.It is around the time when she finishes all the things which should be done as a housewife, she sees her family, and she feels happiest.Once her niece stayed at her home for 2 weeks. During this time she had no seizures at all. We checked the daily fluctuation of serum concentration level of anti-epileptic drugs. No significant differences were found in the samples taken in the morning and evening.The other 9 cases revealed almost the same features.We discussed mainly the difference in our patients from the circadian rhythm as "Feierabend" in grand mal epilepsy. We speculated that this phenomenon might come from the pathophysiological condition which the patients are in refractory course and heavy polypharmaceutical therapy. Such a state may serve to provoke a clinica seizuer at the time of relaxation as one of the precipitating factors.

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We reported here on a case of sixteen year old high school girl who developed dysorexia after the treatment of hyperthyroidism. The dysorexia occured in the remission stage of hyperthyroidism.Her onset was associated with psychological stress which was induced by her English teacher's advice on obesity.We also compared the dysorexia of this case with anorexia nervosa from endocrinological aspects.

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