It was indicated that habitual high tension deserved more attention as one of the emotional characteristics of patients with psychosomatic disorders. Its clinical importance was also demonstrated through the data of our fieldworks on chronic headache as well as the clinical findings of three patients, one with muscle contraction headache and two with tension tremor. The author's advocation in this report is that a person who meets following three conditions should be labelled "Tense Person" as a clinical index for the accurate diagnosis of habitual high tension. l) Excessive muscular contraction or tenderness is detectable in the cervical and cranial muscles. 2) The person forms a peculiar psycho-physical "readiness" as is observed on what-is-it reflexes for the objects that obviously need not worry him. 3) The person manifests perfectionistic traits in every day life. We may reasonably suppose that most of the "Tense Persons" must be anxious, yet we are not always able to find any indication regarding the existence of anxiety in them. Recently, it has been pointed out that an important distinguishing feature of the patients with psychosomatic disorders is that they are little aware of their own physical conditions. The "Tense Person" is typrcal in this regard. He never recognizes either excessive muscular contractions or the peculiar psycho-physical "creadiness" as essential factors of his disorder. It is therefore indispensable to let the patients be aware of their exact physical conditions as well as the mechanisms of the symptom formation in the treatment of habitual high tension.

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At present, antianxiety drugs are widely prescribed for a number of different indications. They are mainly used to relieve neurotic anxiety and to induce tranquilization in patients suffering from anxiety disorders. In this paper, the following three points are discussed from our recent psychopharmacologic studies in healthy human volunteers. 1) In subjects with high trait anxiety, the antianxiety activity of benzodiazepine derivatives such as diazepam can be evaluated behaviorally in an experimentally induced stress situation. The antianxiety activity of drugs can be detected using such kind of model, differentiating from their sedative effects. 2) The relationship between plasma diazepam levels and sedative effects is demonstrated in single, but not multiple, dose studies. Both the absorption rate of drugs and the phenomenon of acute tolerance (single dose tolerance) are important to evaluate the relationship. 3) The absorption rate of diazepam from the gastrointestinal tract is influenced by personality trait such as neuroticism level of a subject. Experimentally induced stress also influences the absorption rate of diazepam in highly neurotic subjects. The gastric emptying time seems to cause these pharmacokinetic findings.

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The following investigation was undertaken in order to examine the possible role of anxiety in the development of psychosomatic circulatory diseases. Among such diseases, two groups of essential hypertension with both high and low anxiety levels and NCA were selected. Pressor responses and associated psychophysiological reactions via Mirror Drawing Test (MDT) of these groups were compared with controls. Secondly, beta-blocking agents were administered to determine whether or not these phenomena could be suppressed. In hypertensives, the pressor response tended to be significantly higher than in the controls, suggesting the presence of an organselective factor. Although the stress-induced elevation of blood pressure did not differ in the two age- and sex-matched groups of hypertensives with different anxiety levels, the high anxiety group showed a significant increase in heart rate and serum FFA. In some types of NCA, a significant correlation was seen in an increase in Katz's indices between MDT and an Isoproterenol loading test. This group of NCA, "somatic type"appeared to have a close interrelation between psyche and soma. Accordingly, the hyperdynamic beta-adrenergic circulatory state proposed by Frohlich was considered to be included in this group. However, the pressor response in NCA was lower than that in hypertension, whereas, the heart rate increase was much greater in NCA. On the other hand, resting plasma noradrenaline concentrations were quite similar in both groups. Under stressed situations via MDT however, increment of plasma noradrenaline was greater in hypertensives. Moreover, some hypertensives with higher anxiety levels even showed plasma adrenaline increase after MDT, although the mental stress failed to increase significantly the average adrenaline levels in all cases. A beta-adrenoreceptor blockade significantly suppressed the various psychophysiological responses after MDT in both hypertensives and patients with NCA. An attempt was, therefore, made to use combined treatment with an anxiolytic drug and a beta-blocking agent. The therapeutic effect was especially prominent in the somatic type of NCA. Analysis of the check list suggested a possible anxiolytic effect in the beta-blockers in comparison with the placebos. A vicious circle was thought to be established occasionally between anxiety (primary and secondary) and somatic symptoms. Consequently, psychosomatic approaches are required to break this vicious circle.

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It is said that in anxiety neurosis morbid anxiety emerges as somatic symtoms with no defense mechanism and is experienced as anxiety itself. Anxiety neurosis is not a psychosomatic disease in a narrow sense, but this disorder helps us to consider the relationship between anxiety and psychosomatic disease. The author's definion of anxiety neurosis includes the followings : 1) Sudden onset of anxiety attack 2) Anxiety in intermittent phases 3) Anticipation anxiety-which sometimes culminate in subattacks 4) Phobic avoidance i.e. secondary agoraphobia The subjects consisted of 42 anxiety neurotics (22 males, 20 females) who visited our clinics. In 34 of them (81%) their onset was in their young adult age (20-35 years). The author investigated the situations at the time of onset as well as the premorbid personality features of these 34 cases (19 males and 15 females. 14 males and 13 females were married). As to situations at onset, overwork by overestimating their bodily strength was seen in 7 male cases. Four female patients were not satisfied with their husbands who were said not to meet their dependency needs. With regard to premorbid character, a contradictory self-profile was delineated, i.e. strongminded and bold on the surface but dependent and neurotic inside. It seems that they want to live more freely than those who later suffer from depression. Thus we can assume that these patients have a dependence-independence conflict, and that they had enjoyed "freedom"which was depended on their parents or bodily strength in premorbid days. It seems that taking responsibility or playing the role as adults and being unable to depend on others or their own strength no longer, precipitate the onset. Thus anxiety neurosis has a basic conflict, anticipation anxiety and secondary phobic defense which are considered the characteristics of neurosis. At this point it differs from PSD which is characterized by the defense mechanisms of denial of anxiety, or somatization. But the first anxiety attack manifests itself as a somatic symptom without the patient's anticipation and therefore it can not be regarded as pure anxiety. It is assumed that anxiety neurosis may also have similar mechanisms to those of depression (as Mendels says, 1974) or PSD.

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It is generally conceded that anxiety plays an important role in the onset and the course of bronchial asthma. We selected as our subjects 30 asthmatic patients who were examined more than twice by using the State-Trait Anxiety Inventory (abbreviated as STAI) at Kyushu University Hospital. The results are summarized as follows : l) Asthmatics had significantly higher STAI scores than healthy subjects. 2) Asthmatics whose onset age was lower than 19 years old had higher STAI scores than asthmatics who had their first attack after the age 40. 3) Asthmatics who had had parent-child problems in childhood revealed significantly higher STAI (A-trait) scores than asthamtics who had scarecely any parent-child problems in childhood. 4) There were discrepancies between the scores of STAI given at the first visit and those under its repeated examination with retrospective instructions at the 3 rd step or the 4 th step of psychosomatic treatment. The results suggested that most of asthmatics were not aware of their emotional states, especially anxiety. 5) The scores of STAI of asthmatics whose psychosomatic treatment had reached at the 4 th or 5 th step were significantly lower than those of asthmatics whose psychosomatic treatment just started. It was shown by these results that the psychosomatic treatment was of value in reducing the asthmatic patients' anxiety.

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1. From the view point of the roles and manifestations of anxiety in psychosomatic disorders, there seems to exist two types of disorders. The one is the disorder in which signs and symptoms of the disease can be understood predominantly as the direct neurophysiological manifestions of anxiety itself. The other is the disorder in which signs and symptoms of the disease can be understood mainly as the manifestations of avoidance response from the anxiety-provoking lifesituations. 2. From the behavioral point of view, the treatment of the former type of disorders can be usually successfully carried out by using the procedures based on the principle of reciprocal inhibition or systematic desensitization. For the treatment of the latter type of disorders, on the other hand, the principles of operant procedures and social skill training should be the main therapeutic strategy. 3. In this paper, some illustrative cases of these types of psychosomatic disorders were presented to verify the above-mentioned basic principles of the methods for behavioral understanding and treatment of psychosomatic disorders in general.

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Anorexia nervosa, characterized by refusal to eat resulting in marked cachexia and amenorrhea, has been recognized as having hypothalamic-pituitary dysfunctions and psychological manifestations. In order to investigate the pathophysiologic mechanism of anorexia nervosa, we studied various endocrinological functions, especially hypothalamic-pituitary functions and psychological or psychiatric aspects in 34 patients with this disease and also introduced some current topics in the pathogenesis and the treatment of this disease. Elevated serum GH, decreased serum LH and FSH in a fasting state were observed in 67,57 and 36 percent, respectively of 34 patients with anorexia nervosa when severely underweight. Basal serum TSH and PRL were almost normal in all patients. The LH and FSH response to LH-RH were low in 76 and 36 percent, respectively of the patients. Interestingly enough, menses stopped with the refusal to eat or prior to weight loss in almost all patients. The serum TSH response to TRH was low or absent in 38 percent and delayed in 90 percent of the patients. The serum PRL responses to TRH were exaggerated in 75 percent of the patients. An abnormal serum GH increase by TRH as shown in acromegaly was found in 38 percent. A Iow serum GH response to insulin-induced hypoglycemia, arginine or 1-dopa was found in 58 percent of the patients. These hypothalamic-pituitary dysfunctions in anorexia nervosa returned to normal after weight restoration. These findings suggest that hypothalamic dysfunctions in anorexia nervosa are resulted from primary but functional change and independent of the malnutritional state. An analysis of the psychological characteristics in our patients with anorexia nervosa revealed a desire to thinness in 83 percent, dependency on her mother in 71 percent, denial of illness with weight loss in 61 percent, hyperactivity in 50 percent, self-induced vomiting in 44 percent, use of a purgative in 39 percent, a depressive state in 22 percent, and episodes of bulimia in 22 percent of 34 patients. Recently, anorexia nervosa with bulimia has been recognized as a subgroup of this disease. In summary, anorexia nervosa is considered to have psychological or psychiatric manifestations and primary hypothalamic dysfunctions but their relationship remains still obscure.

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A psychological strategy with which we can control our internal responses voluntarily is called biofeedback (BF) training. It consists of two components. The first is cognition or knowledge of internal responses and the second is learning control of these responses. These two are based on the operant conditioning in principle. Generally, we do not use rewards or punishments when we apply the biofeedback training to clinical treatment, because it is considered that the release from their symptoms in itself brings a reward for patients. But this concept is not always right and can be one of reasons that BF training brings us unsteady clinical effects, It is desirable that internal responses as a target for the BF procedure satisfy the next four conditions i. e. objectivity, quantitativeness, controllability and pathogenecity. Some of the problems in clinical applications of BF training are as follows : 1) a specific parameter or visceral response for a disease 2) clinical effective dose of these responses which are obtained by BF training 3) correlation of each response 4) individual differences (i. e, personality, motivation, reward, use of voluntary responses and psychological strategy, etc.) 5) transfer of BF efficacy into the daily life We consider that making these problems clear leads to solving the psychosomatic correlation by an objective method of BF training.

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