Objective: The objective of this study was to investigate a conceptual model of an individual's mature spirituality using the terms, Will, Joy and Sense, with relation to SOC (sense of coherence) which is related to Salutogenesis. Methods: A multi-site, cross-sectional survey was conducted among university students in the Tokyo metropolitan area (n=201,m=98,f=103,Age 20.4±1.70 years old). The SBAS-TEST and the scale of SOC were administered. The SBAS-TEST is an originally developed spirituality scale which was made after the result of the exploratory factor analysis on Psychosynthesis Questionnaire. The instrument reliability of the SBAS-TEST was confirmed. The three domains of spirituality (Will, Joy, Sense) construct the SBAS-TEST. Will is a trait to decide and conduct to select a positive direction. Will works according to the fulfillment of the individual's maximum function not only for himself but at the same time also for the others and for the whole surroundings and the community. Joy is not subjective happiness but the joyful and thankful attitude spontaneously emerged from within independently from outside events. Sense is explained as the sensitivity for the non local consciousness which may be called God, something great, universe, cosmos, oneness etc. The correlations between the two scales and the correlations among the subdomains of the scales (Will, Joy and Sense in SBAS-TEST; Manageability, Comprehensibility and Meaningfulness in SOC) were calculated. Based on the result, a model of the spirituality which plays a part in Salutogenesis was constructed. Results: SBAS-TEST (spirituality) showed the significant correlations with SOC (r=0.47, p<0.01). The correlations between Will, Joy and SOC were r=0.49 (p<0.01) and r=0.57, (p<0.01), respectively. However there was no significant correlation between Sense and SOC (r=0.04). The only significant correlation shown among subdomains of SBAS-TEST and SOC was between Will, Joy and Comprehensibility (r=0.28, p<0.05 and r=0.39, p<0.01), and between Will and Manageability (r=0.19, p<0.05). Discussion: Because SOC was determined to be an important concept of Salutogenesis, Will and Joy which showed the correlation with SOC may be also identified as the health related concepts, however sensitivity itself may not be considered to contribute to health directly. The correlation between Joy, Will and Comprehensibility suggests that the health related spirituality may be associated with cognitive domain rather than emotion which takes place naturally. The joy within may come from Comprehensibility, such as recognizing what is happening in the real world, but not from unrealistic optimistic attitude which is often observed as a defense mechanism. This hypothesis has accordance with the concept of SOC. Conclusion: Spirituality determined by Will and Joy plays a part in Salutogenesis. The spirituality which contributes to the health is associated with recognizing one's own world but not experiencing the transcendental world itself.

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Objectives: Excessive benzodiazepine (BZP) use is a great issue from both clinical and public-health perspectives. Although Japan is the world's leading country for the number of benzodiazepine (BZP) prescriptions, no hospital-based report has documented this phenomenon exactly. Thus the purpose of this study was to evaluate the frequency of BZP prescriptions in comparison to selective serotonin reuptake inhibitors (SSRI) and serotonin and noradrenaline reuptake inhibitors (SNRI) in a single Japanese hospital throughout a year. Subjects: Annual BZP prescriptions were assessed with anti-depressants including SSRI and SNRI by using an electronic database of medical records for outpatients in a Japanese university hospital, which is a tertiary care hospital affiliated with a private university with approximately 600,000 visits of outpatients annually. Method: The analysis was separately performed according to the department groups (i.e. internal medicine, surgery, neurology, psychiatry and others). Diagnostic information was not obtained in the present study. For the possible indicator of excessive BZP prescriptions, a B/S ratio was defined as the ratio of the number of anxiolytic BZP prescribed (excluding hypnotic BZP) relative to SSRI and SNRI prescriptions. Results: Among the 644,444 hospital prescriptions, 11.9% were for BZP, 1.6% for SSRI/SNRI, and 2.3% for other anti-depressants. Of the BZP prescriptions, 26.8% were written by the internal medicine group. The B/S ratio was the highest in the department group of internal medicine (ratio=13.0), followed by the surgery (7.6), neurology (4.8), and psychiatry (2.5) groups. When the psychiatry group was regarded as reference, the tendency of prescriptions of anxiolytic BZP rather than SSRI or SNRI was statistically significant in the remaining four department groups, after controlling for the effects of patients' age and sex by a multiple logistic regression analysis. Conclusions: BZP prescriptions in the Japanese hospital were far more prevalent than prescriptions for SSRI and SNRI, especially in the internal medicine group. Pharmacological treatment should be carefully considered using evidence-based clinical guidelines; alternatively, physicians might refer patients to psychiatrists or specialists in mental health. The results of this study suggest that a good strategy to prevent the excessive prescription of BZP in Japan would be to distribute medical knowledge about the use of SSRI and SNRI to internists and primary care physicians. And researchers could play a significant role in such types of prescriptions by alerting physicians to appropriate use of BZP and SSRI/SNRI. This suggestion is supported by the present findings of the internal medicine group's share of BZP prescriptions in the hospital. Future studies are needed to precisely determine the causes of frequent BZP prescriptions in Japanese hospitals.

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Objective: Some patients in our outpatient's clinic have difficulty in communicating or expressing their emotions by the use of language. Such physical symptoms of patients who have psychosomatic disease may function as an expression of their emotions, as it is difficult for them to verbalize, or they are not yet aware of their illness. Unless patients are conscious of their emotions and can express their feelings, their physical symptoms continue and the treatment of their illnesses is difficult by a common medical approach. In these cases, we try to employ group art therapy for those alexithymic patients. Subjects and methods: We selected the appropriate patients for group art therapy by the HTP test and personal interview. Group art therapy consists of six sessions. Each session is one and a half hours long and is held everyother week. Patients report their recent events and changes in their life at the beginning of each session They stretch their bodies and extremities for relaxation. They then start drawing a picture of various themes in each session. At the end of the session they share their personal picture with all the participants. Results: We've completed 9 therapy groups at this time. The total number of participation is 33. Most of the participants can't communicate using their pictures at all. Therefore the therapist has to lead them much of the time. However, the participants gradually begin to talk about their pictures in an informal atmosphere without the therapist's instruction. Furthermore, they mention their own ideas or are aware of their own feelings through their drawings. The communication pattern of the participants changes from two-person therapist-participant communication to multi-person inter-participant communication. In the course of time, the participants become able to share the experience with each other without the therapist. For example, Ms S who felt dizzy, stiff with fear of going out, had been under drug treatment. She wanted to reduce her medication but couldn't because of her anxiety. Then she participated in the group art therapy to be aware of her real emotion. Gradually she became aware of her own real emotion, a conflict with her mother and the signs coming from her body. As a result, she began to express her anger towards her mother and ignore her physical symptoms. She finally returned to work. In addition to Ms S, nearly all participants achieved a good balance between their emotion and thinking. They also showed more natural mood and relaxation of their body. Conclusion: Group art therapy is one of the most useful methods for the treatment of to psychosomatic patients who have difficulty in communicating or expressing their emotion.

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