[in Japanese]

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[in Japanese]

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According to the Japanese National Survey of Health, approximately half of Japanese people perceive psychosocial stress concerning work-, financial-, and health-related problems. While we may be unable to avoid the stressors in our lives, we certainly can limit their impact through the practice of proven mind/body skills. The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress (e.g.decrease in heart rate, blood pressure, and muscle tension). Dr.Herbert Benson is a pioneer in this field, and has been organizing the Mind/Body Medical Institute, Harvard Medical School as the President for more than 10 years, based on the concept of the relaxation response. In this review article, the activities of the institute were introduced from the perspectives of research, education, and clinical activities. Because the institute has offered a variety of stress management programs including training in the relaxation response, cognitive restructuring, exercise, and nutrition to those who complained of mind/body symptoms, the published data of stress management and the relaxation response were summarized from the perspectives of mind/body medicine. For example, the treatment effects of medical symptom reduction program were assessed in the Mind/Body Medicine Clinic, Harvard Medical School (Nakao M, et al : Psychother Psychosom 67 : 43-49, 1998). Participants were 1,312 outpatients attending a 10-week behavioral medicine intervention which included training in the relaxation response, cognitive restructuring, exercise, and nutrition. All of the patients had physical symptoms and were referred to the clinic by their physician. The Medical Symptom Checklist (12 major symptoms), Symptom Checklist 90 Revised (SCL-90 R), Stress Perception Scale, and the Health-Promoting Lifestyle Profile were administered before and after the program. Of the sample, 1,012 patients completed the program, and 911 completed the post-treatment assessment. Self-reported frequency of medical symptoms, degree of discomfort, and interference with daily activities were significantly reduced as a result of the program. Anxiety and other psychological distress as measured by the SCL-90 R and stress perception scales showed significant reductions as well. Furthermore, health-promoting lifestyle functioning significantly improved. Evidence suggests that this stress management is important to prevent from many types of diseases and to maintain our health conditions.

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In recent years, the improvement of professional standards within complementary and alternative medicine (CAM) has been paralleled by increased public interest and patronage. Two identical surveys of unconventional medicine use in the United States by Eisenberg, one done in 1992 and the other in 1997, showed that during that time frame CAM use had increased from 34% to 42%, and Americans spent more out-of-pocket for CAM than they paid out-of-pocket for all hospitalizations. In 1992, the office of alternative medicine (OAM) was founded in the National Institute of Health (NIH) in the U.S. on the 2 milliondollar budget per year. The National Center for Complementary and Alternative Medicine (NCCAM) was established as one of the 27 institutes and centers that make up NIH by Congress in 1998. NCCAM funding appropriated for each fiscal year increased dramatically to 104.6 million dollars in 2002. One of the CAM modalities, "Mind-body medicine" is characterized by a philosophical commitment to whole-person care. Its origins are founded in ancient and holistic healing traditions, which strive for unity of mind, body, and spirit. Integrative medicine is renewing the soul of medicine by combining the advances of science and technology in Western medicine training with the whole person approach of traditional healing systems. Health care system in the West is shifting from "disease oriented" to "health generated", which means the preventive medicine and health promotion with CAM will be regarded in the medical system. In recent years, integrative medicine combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. Historically, "Shinshinigaku" of Japan came from the US as "psychosomatic medicine", and has developed in the Japanese cultural background. But the meaning of the word "psychosomatic medicine" in the U.S has changed. "Mind-body medicine" or "integrative medicine" is more suitable for the translation of "shinshinigaku" than "psychosomatic medicine". I describe in this paper that it is necessary to regard the "shinshinigaku" in the U.S. as a new framework "integrative medicine" or "mind-body medicine".

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[in Japanese]

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The author presented here current conditions and trends of psychosomatic medicine in Germany based on his own experience in Germany. 1. Aspect of clinical practice : Thirty-two out of 37 medical faculties across Germany are equipped with a psychosomatic department. How it is established in the system of the university variously differs. An investigation in Heidelberg University Clinic revealed that 35% of in-patients have psychiatric problems and 5% required psychosomatic consultation service. Group therapies and family therapies are commonly and actively employed in many facilities, where psychologists play an important role. 2. Aspect of pre-and postgraduate education : Medical students voluntarily organize a distinguished group activity "Anamnesegruppe", in which they have much opportunity to go through doctor-patient communication. As to the postgraduate education, the medical association in each country in Germany takes the responsibility for giving life-long educational courses. In Hessen, for instance, an 80-hour course including lectures and case conferences during a year and a half is organized for doctors who do not major in psychosomatic medicine. 3. Aspect of research : The German College of Psychosomatic Medicine, founded in 1974 as a juridical person, aims at investigating psychological, physical and social factors and their interactions in the onset and development of somatic disorders. It possesses currently some 450 members, attempting to improve psychosomatic medicine in the domains of research, apprentice and treatment and intending to foster international contacts in this field.

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[in Japanese]

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In recent years, it is considered that various psychosocial factors influence the prevention of eating disorders. Psychosocial factors that proceding studies pointed out are self-efficacy, assertion, social support, stress coping strategy, irrational belief and so on. Many researchers have studied relation between these psychosocial factors and eating disorders. But they haven't studied how psychosocial factors can predict eating disorders. In this study, we investigated 1,524 female high school students on to what extent such psychosocial factors and dieting behaviors can predict eating disorders after 3 months. A covariance structural analysis was applied to the model derived from the data of the results which had been obtained by multiple regression analysis, path analysis and factor analysis. The results indicated that 'transfer responsibility' coping strategy, irrational beliefs about self-expectation and about dependence have direct influence on eating disorders. Furthermore, the results also indicated that self-efficacy in eating behavior has indirect influence on eating disorders through dieting behaviors. The results also indicated that both extraordinary diet and structured diet have direct influence on eating disorders. According to the model derived from this study, it is considerd to be effective to intervene in thinking style, self-efficacy, dieting behaviors from various points of view in the preventive intervention in eating disorder. The intervention in thinking style and self-efficacy includes rational behavioral cognitive therapy, stress inoculation training and the rise of self-efficacy etc. The intervention in dieting behaviors includes the regulation of the environment and cognitive intervention for deeply rooted fear of fat, etc. Moreover, in the intervention which stresses importance of the relation of cause and effect 'self-efficacy → dieting behaviors', it is supposed that a combination of the rise of self-efficacy and the regulation of the environment is effective. In this study, the results on the basis of the data derived from the survey indicate the possibility of predictive study on eating disorders by modeling the relation between psychosocial factors and eating disorders.

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The purpose of this study was to investigate the influence of female magazine exposure on eating disorder tendencies. MAGINFO scale, MODEL scale, Body Dissatisfaction scale, Drive for Thinness scale, Dieting Behavior scale and EAT 20 were administered to 933 healthy volunteer female students. As a result, it was fourd that most subjects read female magazines routinely. ANOVA revealed that they were more susceptible to female magazines and had higher thin-ideal internalization and eating disorder tendencies as compared with people who didn't read female magazines. The study also found that the susceptibility to female magazines played a significant role in deciding the magnitude of the influence on thin-ideal internalization and eating disorder tendencies regardless of subscription habit of female magazines. Furthermore, it was shown that susceptibility to female magazines, thin-ideal internalization, body dissatisfaction and drive for thinness led to diet behaviors by using CSM. Finally, the importance of media control in prevention and treatment of eating disorders was discussed.

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We administrated four kinds of psychological testing to a post radical mastectomy patient who received physiotherapy. The tests were administrated during each phase of the rehabilitation process ; pre-operation, post-operation, pre-discharge and follow up at four months. The tests were : Egogram check list : Egogram, State Trait Anxiety Inventory : STAI, Self-rating Depression Scale : SDS and Cornel Medical Index : CMI. Egogram and STAI demonstrated big and clear changes on each phase. However, changes in SDS and CMI were relatively small. It is possible for medical staff in breast cancer rehabilitation to grasp patient's precise changes of psychological status with the use of simple tests.

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We gave the term "Equivalent symptom" to cases in which the motive for consultation has to do with the parents themselves taking the role of the patient through their child. We then examined the traits and medical courses in those cases. Within our cases, 2 of 12 parents were diagnosed with factitious disorder by proxy. Their children's symptoms included various physical symptoms and problematic behavior. In their family background, nine cases were found to have intergenerational transmission in which the parents maltreated their child, and the parents themselves had also been maltreated in their own childhood. Nine cases had family dysfunction, such as single-parent families or marital discord. By visiting pediatricians, parents with Equivalent indirectly seek care for themselves. Pediatricians are responsible for recognizing equivalent symptoms, receiving these visits warmly, and supporting those affected in cooperation with all concerned institutions.

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