Characteristics of psychosomatic medical therapy are thought to elucidate the psychosomatic interrelation in a patient and to aim recovery from the disease applying various psychosomatic treatments. I propose the meaning of psychosomatic medical therapy is to establish a good patient-doctor relationship, to produce good outcomes, and to alter a patient’s cognition and behavior.

Therapeutic self, advocated by JG Watkins, is defined as a personal nature of a physician which can produce a desirable behavior and/or prompt recovery within a patient through the treatment above knowledge, experience, or technique possessed by a physician. The core concept of therapeutic self is “resonance”. And to understand a patient as a whole, not only “resonance” but also objective estimation of the patient are required of the physician. Though it is possible for us to understand the conceptual framework of “resonance”, it may be hard both to feel “resonance” introspectively and to perform it perfectly. But therapeutic self certainly exists even if a physician has insufficient “resonance”. Therapeutic self plays a very important role in various aspects of psychosomatic medical therapy.

The author mentioned his view about psychosomatic medical therapy, therapeutic self, and the role of the therapeutic self in psychosomatic medical therapy.

The negative effects on children by their parental discord were shown by an evidence-based research by Lee, Wei-Yun, et al. with an introduction of new DSM-5 category of Child Affected by Parental Relationship Distress (V61.29).

This paper focuses on Cognitive Behavioral Therapy as an effective method in the management of chronic pain. First, it gives a multidimensional assessment of pain in Fibromyalgia Syndrome patients and proposes ways of coping with the fluctuating nature of the symptom by accepting it as part of everyday life. Next, it reports on new undertakings based in local communities : group study workshops on Cognitive Behavioral Therapy responding to the needs of ailing patients and their families and focusing on self-help support using the psycho-educational method. We compared the data and evidence in the form of free-style writing and preliminary questionnaires provided by the participants of such experimental workshops in four communities ; these revealed the discrepancy and the often conflicting understanding of the disease between patients and their family members, as well as common patterns of thinking and behavior that could more likely cause pain. From the above, we recognized the crucial importance of creating environments for treatment by taking into account the external and internal circumstances in which pain-triggering behavior mostly likely would occur, and that such measures would greatly reduce the tendency towards such problematic behavior. We concluded with case reports with emphasis on the circumstances before and after the pain occurred, and the assistance provided in each case.

This pilot study investigated the initial efficacy of a work-focused cognitive-behavioral group therapy (WF-CBGT) for workers on sick leave due to depression. WF-CBGT, including behavioral activation therapy, cognitive therapy, and problem solving therapy techniques, was conducted for 8 weekly 150-minute sessions. Participants completed questionnaires on depression and anxiety, social adaptation and Difficulty in Returning to Work Inventory at pre- and post-intervention time points. Rates of reinstatement after the intervention were examined. All scale scores significantly improved after intervention and, except for difficulty in RTW related to physical fitness, all effect sizes were above the moderate classification. One participant dropped out, but 15 participants who completed the intervention succeeded in RTW. Results suggest that WF-CBGT is a feasible and promising intervention for workers on leave due to depression.

Background : Achalasia is a chronic esophageal motility disease. Patients with achalasia experience distressing gastrointestinal symptoms and have a poor quality of life. In current practice, we made an achalasia-associated QOL score named Achalasia Symptom Scale; AchaSyS, and clarified that pneumatic dilation improved both esophageal clearance and QOL in achalasia patients by the use of AchaSyS. But we did not clarify how well physiological measurements of esophageal function correlate with the therapeutic effect.

Objective : The aim of our study was to investigate whether the psychosomatic function improved much more in therapeutically successful patients and how the degree of post-treatment QOL improvement predicted pre-treatment esophageal functional data.

Method : We investigated twenty eight consecutive newly diagnosed achalasia patients in Tohoku University Hospital from October 2007 through December 2012. The outcome of the study was indispensable for the retreatment at the yearly follow-up assessment. Patients were divided into the effective group (24 patients) and the ineffective group (4 patients). Their outcomes were evaluated by analyzing physiological measurements of the height and width at 1 minutes in the timed barium esophagogram column, and the width in the high-resolution manometry (HRM) of LES pressure and high pressure zone. In addition, patients completed quality-of-life questionnaires (AchaSyS, Gastrointestinal Symptom Rating Scale; GSRS, Psychological General Well-being Index; PGWB and 36-Item Short Form Health Survey ; SF-36). We compared pre and post treatment data. Categorical variables were compared with the use of the chi-square test. Continuous variables are presented as means (with 95% confidence intervals) and were compared with the use of Student’s t-test (p<0.05). Statistical analysis was performed using JMP pro12 for Windows.

Results : All physiological data, AchaSyS total score and all subcategories, and some QOL data were improved statistically in the effective group after treatment. Pre-treatment LES resting pressure was correlated to the post-treatment AchaSyS total score (p=0.013, r=−0.46). This means QOL after treatment improves much more so that pre-treatment LES pressure is high.

Conclusion : It was shown statistically that LES resting pressure influenced the treatment effect for achalasia, and it was suggested that QOL improved through the psychosomatic pathway.

Background : It is difficult for female patients with vulvar pain to consult doctors because of their shame, even though the pain has disrupted their daily life. Vulvodynia without organic disorders is often refractory to be treated.

Case : We experienced a case of vulvodynia treated effectively with Kampo medicine and psychological therapy.

Disccusion : We discuss the pathogenesis and treatment of vulvodynia from both perspectives of Kampo and Western medicine. In Kampo medicine, this case has findings of jinkyo (a functional decline with age) and oketsu (blood atasis). There are some reports that hojinzai (medicine for jinkyo) or kuoketsuzai (medicine for oketsu) was effective for vulvodynia. On the other hand, from the perspective of Western medicine, vascular insufficiency and muscle spasms at vulva are considered as vulvodynia. The treatment with Kampo medicine and anti-depressants, anti spasm medicine are sometimes effective for vulvodynia. A psychosomatic approach is also important for vulvodynia patients as shown in this case.