Stiffness in the shoulders and back pain are national diseases of the Japanese people, and there are so many patients. A significant number of these patients have myofascial pain with psychosomatic stress-related illnesses. In recent years it has become known that the concept of the trigger point is not just a point of stiffness but a hypersensitized nociceptor present in the fascia. The active fascia with many trigger points is projected as a thickened, white overlay under ultrasound guidance. This myofascial release, which removes the myofascial membrane with injectable fluid, is highly effective for myofascial pain, and can be applied to cases of hypersensitivity of body sensation in the background of psychosomatic disorders or, conversely, to cases of desensitization. Outline the basic techniques of myofascial release for use in psychosomatic medicine.

Assertiveness is a communication style that is based on mutual respect. This concept was originally proposed in the field of behavior therapy. The concepts of traditional assertiveness are limited in the situations that they can be applied to and are difficult to discriminate from aggressive behavior. Considering these two problems, the use of functional assertiveness as a new concept of assertiveness is proposed. Functional assertiveness is defined as interpersonal communication that occurs when a speaker encounters interpersonal problems that should be resolved or has objectives that should be achieved, and the speaker’s way of conveying themselves is perceived as appropriate by the listener. The features of functional assertiveness and how to enact it are discussed.

It is necessary for physicians to depict not only organic diseases but also actual function of the target organ if patients complain of symptoms originated from the target organ. High-resolution manometry (HRM) has been developed as the esophageal function evaluation tool. HRM enables us to evaluate more accurate esophageal motility than the conventional methods. Based on HRM experience with psychosomatic specialty, we could diagnose various cases from simple motility disorders to psychosomatic diseases. Flexible treatments including reproduction of pathophysiology with the other tests which are easy to understand visually for patients are often useful. Good examples are esophageal fluoroscopy and biofeedback approaches. Once new knowledge and techniques are acquired, it is important to reconsider treatments depending on availability and general techniques.

Doctors of psychosomatic medicine need to consider not only “generality” of human being on which medicine depends but also “individuality” which means that each client has various clinical courses. For dealing with this contradiction, we described not merely general mind-body but also “self-narrative” correlations by which professional doctors could effectively assess clients. We also mentioned “intervention on self-narratives” which fitted traits of each client. Then it was considered that the position of Doctors of psychosomatic medicine included contradiction which other medical workers did not have but embodied holistic care.

This paper articulates some theoretical and practical aspects of human experiencing for physicians in psychosomatic medicine. Based on the works of Eugene Gendlin, an American philosopher and noted psychotherapist who developed Focusing-Oriented Psychotherapy, basic concepts of ‘experiencing’ and ‘Re-experiencing’ are elaborated. Practical suggestions for implementing these philosophical concepts in clinical interviews are discussed. Furthermore, the manner of experiencing, and the Experiencing Scale (EXP Scale) which is used to rate the client’s manner of experiencing is introduced. A recent call for an international collaboration research on psychotherapy outcome using the EXP Checklist, a newer version of the EXP Scale, is introduced. From the manner of experiencing distinguishable with the EXP Scale, some practical suggestions as to what physicians should listen for in clinical interviews are discussed.

More than a half century passed since cognitive behavior therapy (CBT) was born and CBT is a great success in various clinical settings including psychosomatic medicine. Effectiveness of CBT has been revealed through many meta-analyses and CBT became the first choice of treatments for many physical and psychological disorders. As the development and wide spread of CBT, however, misunderstanding and misuse are observed as well. In this article, the importance of several key concepts of CBT such as collaborative empiricism, therapeutic alliance, and principles of behavior modification were pointed out and the clinical tips of CBT were discussed.

Psychiatric knowledge that the doctors specializing in psychosomatic medicine should have is related to its history and relationship to psychiatry in Japan. The knowledge of psychiatry necessary for the practice of psychosomatic medicine is to review mental symptoms systematically, to clarify the role of psychologists and the significance of psychological examinations and to use antidepressants appropriately. In the future it is essential to discuss what practice can be done by psychosomatic medicine specialists.

Bipolar disorder often develops with depressive symptoms. At first onset, it can not be readily distinguished from unipolar depression. However, whereas the latter is treated with antidepressants, the former typically requires mood stabilizers. Therefore, the concomitant use of antidepressants is ineffective and destabilizing, leading to mood swings. The concept of bipolar spectrum disorder proposed by Ghaemi is useful for differentiating bipolar and unipolar depression. Particularly in cases with a family history of bipolar disorder or hypomania/mania induced by antidepressants, identifying latent bipolar disorder can be facilitated by attention to signs suggesting bipolar disorder (bipolarity) : hyperthymic personality, early age of onset, recurrent major depressive episodes, brief major depressive episodes, atypical depressive symptoms, psychotic major depressive episodes, postpartum depression, attenuated effects of antidepressants, and lack of response to adequate antidepressant trials.

Depression is essentially categorized into one of the psychiatric disorders, however, doctors of psychosomatic medicine often treat this disease. But ten percent of depression patients turn out to be bipolar disorder afterward. So, in treatment of depression, doctors of psychosomatic medicine may be desired to cooperate with psychiatrist. On the other hand, eating disorders are one of the psychosomatic disorders and doctors of psychosomatic medicine are good at physical management of them, however, psychiatrists also treat the eating disorders because psychiatric management are also required. Thus, the disorders treated by doctors of psychosomatic medicine and psychiatrist sometimes overlap, although their education and specialty are respectively different. Depression and eating disorders are referred in this manuscript, and which doctor should treat the disease might depend on the individual conditions of the disease, therefore doctors of psychosomatic medicine and psychiatrist should cooperate with each other regarding each other’s policy.

Background : Laxative abuse is one of the prognostic of poor treatment success for patients with eating disorders (ED).

Subjects : We investigated the effect of an educational program done by pharmacists during inpatient treatment, aimed at reducing the consumption of laxatives and improving the patient’s attitude toward constipation.

Method : By use of medical records and interviews, we also estimated the amount of over-the-counter (OTC) laxatives used. The study was done of 33 patients who abused laxatives, with a one-year follow-up.

Results : 1) There was no significant change in the prescription of laxatives between admission and discharge (p=0.435). However, we speculate that the total amount of laxatives decreased, in consideration of the amount of preadmission OTC abuse. 2) Under the instruction of the chief physician and in collaboration with other members of the medical staff, a pharmacist actively, tenderly, and with understanding educated the patients in the proper use of laxatives, keeping in mind the psychology of ED patients. As a result, the patients were able to change their cognition about laxatives and their strong feelings about their bowel symptoms. 3) Comparison of the amount of laxative abuse before admission and one year after discharge suggested that low preadmission laxative abuse (p=0.000) and intervention of the pharmacist (p=0.029) were factors in reduced OTC laxative abuse after discharge.

Conclusion : We described the role of the pharmacist and the usefulness of a team approach for patients with ED who abuse laxatives. Education by a pharmacist about OTC laxative abuse was useful.

Objectives : Dohsa-hou refers to a nonverbal psychotherapy technique developed in Japan, which combines sensory awareness and emotional experiences through relaxation. The effectiveness of clinically-based approaches has supported the use of Dohsa-hou as a stress management technique. However, the efficacy of Dohsa-hou in community-based approaches remains to be explored. This study was designed to examine the effectiveness of Dohsa-hou as a stress management technique in a child care support community.

Method : Participants (N=36) were randomly assigned to the Dohsa-hou or the Recreation groups (recreation activities included singing with hand activities and recitation of picture books). The psychological stress response scale (SRS- 18) was used to assess stress levels before and after each treatment.

Result : A repeated-measures ANOVA indicated a significant interaction between treatment (Dohsa-hou and Recreation) and time (pre and post treatment) on the total SRS-18 score, as well as on depression/anxiety, sullenness/anger, and lethargy subscale scores (p<.001 in all cases). The Dohsa-hou group showed decreases in the total SRS-18 score, as well as in depression/anxiety, sullenness/anger, and lethargy subscale scores, whereas the Recreation group indicated reductions in the total SRS-18 score and sullenness/anger subscale score.

Conclusion : These results indicate that Dohsa-hou is an effective stress management technique in a child care support community groups. The efficacy of Dohsa-hou as a community-based approach is discussed.