At the 59th Congress of the Japanese Society of Psychosomatic Medicine, an international group consisting of Japanese and Korean researchers/practitioners made presentations at a collaborative symposium titled “Clinical Application of Biofeedback/Neurofeedback.” Research and practices concerning the use of biofeedback have been making advances in the field of psychosomatic medicine. However, it is our common vision that further developments in revolutionary form remain possible in this field. In particular, heart rate variability biofeedback has demonstrated clinical utility in the treatment of stress-related mental disorders involving autonomic nervous dysfunction, and in recent years, has developed into a technique of particular interest. On the other hand, knowledge and practice of neurofeedback is not yet widespread in Japan. Nevertheless, the need for clinical neurofeedback use is expected to increase in psychosomatic medicine of the future, primarily on patients/clients with developmental disorders. Moreover, from a global perspective, the Biofeedback Certification International Alliance (BCIA) has come to play an essential role in research and education in clinical applications of biofeedback and neurofeedback. From the above perspectives, Japan is expected to make concrete advances related to biofeedback and neurofeedback in psychosomatic medicine in the foreseeable future.

In order to understand a patient's condition from a psychosomatic perspective, temporal association between physical illness and psychosocial factors needs to be discussed. However, many psychosocial factors such as psychological stress are patient reported outcomes (PROs) and recall biases are inevitable when assessing PROs by using recalled self-reports, which is commonly adapted in clinical settings and even in research settings. Because ecological momentary assessment (EMA) has high ecological validity and an accurate time axis, which is important for temporal analyses, it is thought to be advantageous for evaluating psychosocial correlation, in particular, temporally rather proximal correlation. By using EMA, we have showed associations between tension-type headache exacerbation and psychological stress, tension-type headache and physical activity, and so on. Recently we investigated the relationship between depressive mood and behavioral pattern, and even tried to estimate momentary depressive mood from physical activity data. Ambulatory assessments including EMA will facilitate psychosomatic understanding of patients' pathological condition and will also provide findings which can lead to just-in-time adaptive intervention in the future.

Ecological momentary assessment (EMA) uses electronic devices such as smartphones to examine subjects' momentary psychological state and physical symptoms in daily life. The development of information and communication technology has made it possible to acquire various points of health-related life-log data. In research that employs EMA, a major challenge is determining how to extract useful information from a huge amount of life-log data. This paper discusses our EMA research, which focuses on maternal mental health dynamics during the parenting period, together with our analysis methods. In the future, the health and medical field will utilize health-related data more and more. Across fields, we must study issues such as data processing and analysis, effective behavioral intervention, and ethical and legal security.

The increased prevalence of smartphones and Internet use enables us to implement the innovative intervention approach, namely the ecological momentary intervention (EMI) and just-in-time adaptive intervention (JITAI), which provide the right type/amount of treatment in a patient's natural environment.

We are studying what form of interventions make the most of EMI or JITAI for the treatment of eating disorders (ED) as a new approach to support those suffering from ED.

Our presentation reviewed previous studies that implemented EMI, JITAI or similar forms of interventions for the treatment of ED and outlined forms and characteristics of those interventions. We also discussed when and what type of intervention should be delivered to maximize the therapeutic effect by reviewing the implementation of EMI or JITAI for other medical disorders.

Background : The appropriate choice of sleeping drugs is very important for cancer patients. The previous studies reported the risk of delirium and fall with benzodiazepine hypnotics. However, the detailed factors of other sleeping drugs affecting its risk for cancer patients in hospital are not clear.

Objective : The purpose of this study is to investigate retrospectively the prevalence of delirium and fall with sleeping drugs in cancer patients in hospital.

Methods : This study was conducted from July 2014 to June 2016 at the department of palliative care, medical oncology, gastroenterology and hepatology, Kindai University Faculty of Medicine. The primary endpoint was the onset of delirium and the secondary endpoint was the onset of fall.

Results : The total number of patients was 592 (389 males and 203 females). The median age was 71 years old ranged from 28 to 96. The average (standard deviation) of Performance Status (PS) was 1.7 (±1.2). There were 65 cases of delirium and 25 cases of fall. Brotizolam was prescribed most commonly, and Zolpidem and Eszopiclone were prescribed secondly and thirdly common. The results showed that there were significant correlation between the onset of delirium and PS (p<0.001), and the onset of fall and PS (p＝0.015). Results of analysis without short-term hospitalization showed there were significant correlation between the onset of delirium and PS (p<0.001), age (p＝0.019). There was no significant correlation between the onset of delirium and fall in non-benzodiazepine hypnotics compared with benzodiazepine hypnotics.

Conclusion : In the future, delirium and fall countermeasures of cancer patients during hospitalization were important to try to improve the patient's PS over the type of sleeping drugs uesd.

Background : Advance care planning (ACP) is defined as a process that supports adults in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Although ACP has been increasingly needed for older adults, severe communication problems often make it hard to obtain ACP from older adults themselves. We aimed to collect and analyze the ACP data from the family members of older adults.

Subjects and method : From family members of 100 older adults who live in our long-term care health facility, we collected three ACP data regarding whether or not the family members wish to have 1) do not hospitalize (DNH) orders, 2) do not attempt resuscitation (DNAR) orders, and 3) physician orders for life-sustaining treatment (POLST). We associated these ACP data with the following three data of the older adults : 1) age, 2) revised Hasegawa's dementia scale (HDS-R) score, and 3) the “Needed Support Condition” level.

Results : DNH and DNAR orders were preferred by 61% of the family members in case that 1) elderly persons are over 87 years old, which is about the average life expectancy of Japanese people, 2) their HDS-R scores are lower less than score of eight, and/or 3) their Needed Support Condition levels are over level three. Regarding the POLST when oral food intake becomes impossible, gastric tube feeding or minimum intravenous infusion was preferred by 5% or 88% of the family members, respectively.

Conclusions : In our long-term care health facility, the family members of older adults had three decision making factors for ACP are age, degree of dementia and the Needed Support Condition level.