In 46 normal subjects, we examined a) the component of respiratory sinus arrhythmia ( = HF) , b) the component coefficient of variance of HF (CCV-HF) , c) the component of Mayer wave related sinus arrhythmia ( = LF), and d) LF/HF ratio. Both of a) and b) are thought to reflect parasympathetic activity, and both of c) and d) are thought to reflect sympathetic activity. We studied how the heart rate variations are infiuenced by respiratory cycle (CY). At first, we performed the regression analysis between the heart rate variations and CY as an intrasubiect factor using all subjects' data. The square of partial correlation of each dependent variable and log CY was ; for log HF R^2=0.7334 (F(1,191)=526.25,p<0.0001), for log CCV-HF R^2=0.7307 (F(1,190)=515.57,p<0.0001), for log MWSA R^2=0.4568 (F(1,191)=106.37,p< 0.0001) , and for log (LF/HF) R^2=0.6703 (F(1,191) = 388.34,p < 0.0001) . Then we predicted the heart rate variations employing CY as the parameter, and examined the reliability by cross validation. For instance, Pearson correlation between the real value of LF/HF (CY = 15) and the value predicted from the real value of LF/HF (CY =20) for each subject was 0.9866 (p< 0.0001). With this study, we concluded that the heart rate variations could be assessed more accurately, considering the influence of respiratory cycle. The heart rate variations modified by respiratory cycle would be used clinically as a reliable index of autonomic nervous function in the future.

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The purpose of this paper is to discuss the application of the blood pressure (BP) biofeedback system (the direct method) to the treatment of essential hypertension. The subjects of this study were 10 outpatients with essential hypertension (5 men and 5 women) . The ages were ranged from 25 to 65 years (M=52.1) . Three patients had taken anti-hypertensive drugs. It was instructed that self-monitoring of BP at home had been performed three times a day through the baseline period (2 weeks) to the follow-up period (2 weeks) . In the treatment period, 4 sessions of the BP biofeedback training were performed once a week. The average self-monitored BP in the follow-up period reduced compared with those in the baseline period, but there was no significant change. The average systolic and diastolic BP monitored by the Finapres reduced significantly compared with those in the first session and the forth session (*136±15.1-118 ±15.9/*90±9.6→80±9.9 mmHg, *p< 0.05,respectively) . The average systolic and diastolic BP determined professionally reduced significantly compared with the baseline period and the follow・up period (**157 ±11.4→138±8.9/**94±6.9→84±5.5 mmHg, **p< 0.01,respectively) . The BP elevations by the mental stress test in the follow-up period decreased compared with those in the baseline period (21±8.0→14±7.5 mmHg/*14±7.5→8±7.0 mmHg, *p< 0.05) . The BP biofeedback treatment was effective to the patients with hypertension (not severe) and diagnosed as white-coat hypertension. Professionally determined BP and computer-monitored BP more markedly reduced than self-monitored BP. The BP elevation by the mental stress test was suppressed by the treatment. Therefore, it is considered that this BP biofeedback system may suppress the response of BP elevation by the stress. We would like to perform further study for the clinical application of this biofeedback system to the essential hypertension and investigate the relationship among the degree of effect, the patients' characters, periods of illness, and the severity of illness.

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This paper reports nine serious cases of non-ulcer dyspepsia (NUD) treated by systemic family therapy, and also discusses the connection between the patients symptoms and their family dynamics. About 90% of the patients revealed significant improvement by this therapy. This study also discusses the therapist's effective involvement in the therapeutic process. Generally, problems arising due to familial causes have to be viewed at two different levels. The first is that of content. That is, the specific problem as identified by either the patients or their family members. The second is that of context which is the web of interrelationships and other related circumstances within the family which are infiuenced by the belief that there is a problem. Systemic family therapy thus places greater emphasis on changing the dynamics within the family which are influenced by the belief that there is a problem. Systemic family therapy thus places greater emphasis on changing the dynamics within the context. In the representative three cases reported here in the therapist ostensibly addressed the content, each in a different way. In the first case the therapist "denied the existence of the specific family relationship problem identified by the patient and the family members." In the second representative case the therapist "acknowledged the patient's family relationship problem but denied its relation to the patient's symptoms, " In the third case the therapist "acknowledged the patient s famlly relationship problem and also acknowl edged its relation to the patient's symptoms." Thus the therapist adapted three different stances. In each of the representative three cases, however, the therapist actually attempted to change the dynamics within the patient's familial context. The reason for using different therapeutic approaches in the three cases was that in each case the strength of the patients' and/or their family members' belief in the existence of a family relationship problem differed. The therapist, therefore, had to deal with each patient and his/her family members in a different way in order to establish a harmonious optimum therapeutic relationship.

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In order to investigate the changes of coping styles before and after having cancer, and the relationship between coping styles and emotional states among cancer patients, we conducted a study using the Profile of Mood States (POMS) and the Dealing With Illness-Coping Inventory. The coping methods such as active-cognitive, active-behavioral and avoidance and all coping strategies except for avoidance-solitary behaviors were found to be used by sixty breast cancer patients more frequently after having such a disease than before (p<0.001). It was also found that there were positive correlations between active-reliance behaviors and tension-anxiety and depression, between cognitive-passive behaviors and tension-anxiety and lack-of-vigor, between passive-resignation behaviors and depression and confusion, and between avoidancesolitary behaviors and anger-hostility, fatigue and confusion. In conclusion, this study demonstrates that having cancer makes a patient use more frequently avoidance behaviors as well as active coping styles, and the passive/avoidance coping styles are often correlated with negative emotions. These results imply that we should support cancer patients with consideration of their coping styles as well as their emotional states.

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This study was conducted to describe the self-image of hospitalized children with school refusal accompanied with various physical complaints. 81 children with school refusal (12 to 18 years of age) were asked to answer 42 items concerning mental stress, interpersonal relations, self-reliance and personal interests. Control groups consisted of 491 junior high school students, 492 senior high school students and 377 college students. As a result of factor analysis based on all of 1,440 subjects' data, three factors were extracted : emotional instability, sympathy and self-reliance. According to mean factor scores and mean rating values, the following findings were obtained : 1. Subjects in the control groups became more self-reliant, though their emotional instability became slightly stronger as they grew up, in that they increased their ability to calm unstable emotions. 2. Children with school refusal were emotionally more unstable than the controls, and moreover, their emotional instability was resembled that of patients with psychosomatic diseases or neurosis. Because they generally lacked self-reliance, they seemed too immature to control their unstable emotions, unlike the control groups. Lack of self-reliance was more salient in females than in males. Females with school refusal also showed more sympathy than males in any control group, but they actually were incapable of sharing feelings with others as they wished. 3. The self-image of children with school refusal seemed to have an imbalance with these three factors. Therefore, in order to improve their self-image, it is necessary to assist them toward engaging in proper interpersonal relations and to let them experience on coping with trivial troubles by themselves in their daily lives.

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Diabetes is challenging because of its chronicity and high demands for daily monitoring and care. Diabetic patients must modify their daily lives to comply with diet, exercise, medication taking and glucose testing. Although numerous clinical studies have emphasized the importance of behavioral and emotional influences on glycemic control among diabetic patients, relatively few studies have reported about noninsulin-dependent (NIDDM) adult diabetic patients in longitudinal studies. The present study was designed to predict change in glycemic control during 6 months based on demographic and psychosocial factors among middle-aged and older patients with NIDDM. Subjects were 61 outpatients with NIDDM who completed both the initial and the 6-month follow-up assessments (out of 74 at the beginning) at the Asahi Life Foundation Institute for diabetic care and research. Forty-five were male, sixteen were female and subjects' ages ranged from 36 to 80 years, with a mean of 58.0 years. Patients were requested to fill out diabetic checklist and several psychological questionnaires, from which 9 demographic and 10 psychosocial variables were selected as predictor variables. Level of glycemic control was assessed by glycosylated hemoglobin (HbA_1c) assays at the beginning of the study (pre-HbA_1c) and at the 6-month follow-up (post-HbA_1c) . '% change of HbA_1c' = { (post-HbA_1,c-pre-HbA_1c) /pre-HbA_1c} x 100 was then used as a criterion variable. Multivariate statistical analysis, the Quantification type I method, was conducted in order to take account of potential influence between each of predictor variables and to utilize categorical types of predictor variables. Mean % change of HbA_1c was 0.20% (range : -22.0% to 33.3%) . It was revealed that the combination of egogram pattern, treatment regimen and diabetic education could most accurately predict % change of HbA_1c (R-squared=0.344. F= 5.76,p=0.0002) . The egogram pattern based on transactional analysis which indicating the ways of interpersonal relationships was the best predictable factor. It was indicated that patients with NP dominant pattern had deteriorated the most and those with reverse 'N' pattern had improved the most. It is concluded that useful information to predict % change of level of glycemic control may be obtained from the longitudinal study using the combination of certain psychosocial factors. Future research should refine the measurement to evaluate diabetic self-care behavior, and increase the number of subjects from other institutes.

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The interview was conducted with 25 bereaved family members on their real feelings about medical treatment and nursing care provided in hospital and the existence of health problems. The results were examined in two periods, that is, during hospitalization of patients and after patients' death. The results were summarized as follows : 1. Six subjects (24%) were informed of patients' diagnoses and their health conditions. 2. Twelve subiects (48%) had pains during their hospitalization, and 3 (25%) recognized the effectiveness of pain control. 3. Twenty-two subjects (88%) participated in the moment of patients' death in the hospital. 4. Sixteen subjects (64%) felt regret about their care for patients. 5. Eight subjects (32%) were dissatisfied with care provided by nurses, and 15 (60%) were dissatisfied with medical treatment offered by doctors. 48% and 40% requested nothing from nurses and good explanation on patients' health condition from doctors respectively. 6. Twenty-two subjects (88%) depended on folk remedy to decide their coping behavior for patients and asked Okinawan Yuta, a kind of shaman, what to do. 7. Eight subjects (32%) had health problems during the hospitalization of patients and 9 (36%) after patients' death. Two subjects had the return of their previous illness.

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Untreated seventeen patients with anorexia nervosa who met DSM-III-R criteria were examined using simplified Kampo medicine (traditional medicine in Japan based on ancient Chinese medicine) , and were initially treated by Kampo han fang chun ji (5g of Liu jun zi tang daily for 4 weeks) along with cognitive behavior therapy. These patients had been further treated by cognitive behavior therapy up to maximum 2 years. Fourteen of the all patients were met the criteria of xu (asthenia) according to total Kampo score. There was no patient who met the criteria of shi (robust). Liu jun zi tang reduced a lot of digestive and psychiatric complaints of these patients. However, the quantity or relief of complaints by Liu jun zi tang did not correlate with the outcome at 2 years after the initial visiting ; 1 died, 2 dropped-out (6 mon. and l yr.) , 7 continuative, 7 finished. There were no patients dropped out less than early 6 months of the therapy. The medication of Liu jun zi tang can be a mean of not only improving complaints but also preventing dropped-outs from the therapy.

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