Among the fluctuations of various biological systems, the evaluation method for the heart beat fluctuation has been well established, and it is called the heart rate variability (HRV). HRV has been used in fields such as medicine, psychology, nursing, and stress research as an index that reflects physiological functions, especially autonomic functions such as the cardiac vagal function.

In the fields of psychosomatic medicine and psychology, HRV is widely used as an index of stress evaluation and physiological function. Compared to biochemical stress markers such as cortisol, HRV can be measured over time, and has the advantage of being able to easily capture not only static states but also dynamic state changes. On the other hand, it also has the disadvantage of being unstable in time.

As a method for analysis of HRV, time domain analysis, frequency domain analysis and nonlinear analysis are typically used. Each has advantages and disadvantages, and it is necessary to use them properly according to the purpose and the state of measurement data. Conventionally, frequency domain analysis has been often used, but there are limits such as exclusion of components other than periodic fluctuation components, and overconfidence should be avoided.

HRV changes with stress, and tends to differ from that of healthy individuals in pathological conditions such as illness. Certain characteristics have also been found in functional somatic disorders related to psychosomatic medicine, and several meta-analyses have also been reported. Combining the findings of change in HRV due to stress in healthy subjects with the results of meta-analysis in the disease group, it is presumed that while the stress response is observed in the acute phase of stress-related diseases, the decrease in HRV seen under stress load is fixed and can be seen even when stress load is not applied in the chronic phase of the diseases.

Various portable/wearable devices have been developed for heart beat measurement, and large-scale data analysis technology is advancing day by day for HRV analysis. Future development of HRV measure and assessment is expected in the field of psychosomatic medicine.

The Wechsler Adult Intelligence Scale goes beyond simply measuring “Full-scale IQ”. The Japanese version of the WAIS-Ⅳ, released in 2018, would calculate Five composite scores : Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, Processing Speed Index, and Full-Scale IQ as its total. An intelligence test was initially used to identify the presence or absence of intellectual delays, but the WAIS-Ⅳ has been developing as the understanding tool for within-individual differences assessing through its components.

Recently in some clients/patients with a variety of psychosomatic symptoms, The author assume an intelligence discrepancy that leads social adjustment problems, eventually makes physical symptoms worse as a secondary disturbance. Understanding their within-individual differences by WAIS, psychologists/clinicians can provide them with therapeutic intervention, appropriate set of tasks, and direction for social adjustment, also might help to soothe their physical symptoms and develop their coping abilities.

Sandplay therapy is a psychotherapy technique mainly used in education and medical services. M. Lowenfeld originally devised it in 1929 as a psychotherapy approach for children, known as the World Technique. Subsequently, D. M. Kalff, a child therapist approved by C. G. Jung, developed its present form based on a theory of Jungian psychology. In sandplay therapy, it is important to observe sand trays of clients from an overall perspective rather than individually examining the details. Another important point is predicting the progress of counseling. As the therapy encourages clients to create concrete manifestations from their unconscious imagination, it may have destructive action in addition to therapeutic effects. Therefore, it is important for clinicians to use sandplay therapy for clinical practice with a sufficient understanding of its ambivalence. To discuss the applicability of sandplay therapy, this paper refers to coloring shock (refusal/discontinuation of coloring), and the mixture of rivers and streets as phenomena observed at the stage of coloring in therapy using the Landscape Montage Technique, which was developed by Hisao Nakai. A sand tray created by a female in her twenties with obsessive-compulsive neurosis was also analyzed in order to develop insight into manifestations using sand in psychotherapy.

This presents a case where mindfulness approach utilizing a body aiming at a patient with chronic pain. Mindfulness-based meditation enables him to develop psychological posture to observe with acceptive attention to sensation of pain, resulting in alleviating fixation of attention to sensation of pain and catastrophic cognition, so that the patient developed a sense of self-efficacy and explored how he has dealt with pain. The processes leading to improved life styles and awareness to the patient's own personality/tendencies as well as to the background of onset of symptoms have been reviewed. A perspective of interoception is also factored into for discussion.

Interoception in alexithymia is of growing interest in the research for the pathogenesis of psychosomatic disorders and in understanding the fundamental processes of emotion-body interaction in human. Empirical studies have shown inconsistent results, which were increased or decreased interoception in alexithymia, due to differences in the quality of the interoception targeted and the methodological differences of the investigations. Individuals with alexithymia demonstrated less accuracy in the heartbeat detection task. The visceral threshold in colonic distention was higher in the irritable bowel syndrome patients with alexithymia. These may indicate that alexithymia may decrease interoceptive ability to detect signals from the internal body. On the other hand, subjective assessment of bodily sensation and bodily symptoms such as with questionnaires exhibited hypersensitivity in healthy people and psychosomatic patients with alexithymia. Subjective belief in the internal bodily state may be amplified in alexithymia. Colonic distention and injection of corticotropin-releasing hormone induced excessive neuroendocrine response in alexithymia. During colonic distention, stronger brain activities in the insula, which is the visceral sensory cortex, was observed associated with higher alexithymia. This suggests the altered interoception and physiological reaction and their functional interaction may be dysregulated in alexithymia.

Our modern society, known as an advanced information society, is transforming our lives at an accelerating pace, and we are required to reevaluate our identity as individuals and develop a psychological container that allows us to be part of and hold a variety of selves within the individual. At its core is interoception that connects the external and internal worlds and tries to maintain a certain coherence as a human being. Interoception can be related to a certain extent through conscious awareness, and at the same time, it is positioned as a contact point between mind and body that obeys physiological and material laws.

Although pathology model of a central nerve sensitization can be postulated for eating disorders and psychosomatic disorders, there is no standardized treatment strategy. There is a need to equalize the level of evidence-based treatment. The Ministry of Health, Labour and Welfare (MHLW) policy research project aims to elucidate the pathophysiology of central sensitization and improve patient care in collaboration with other related projects. Specifically, we will implement treatment programs that have been proven to be effective for these diseases and examine the modification of cross-disease central nervous system hyper-responsiveness and desensitization that underlie the improvement in clinical symptoms. Through this investigation, we aim to generate neuroscientific evidence for therapeutic structures and improve patient care with a focus on central nervous system sensitization.

In the first half of this paper, we proposed a central nerve sensitization pathological model as a mechanism of psychosomatic illness. In the second half of the paper, we proposed an attempt to build a brain imaging database of the eating disorder is presented.

Many patients complain of symptoms which cannot be attributed to any conventionally defined medical diseases. Such symptoms are called medical unexplained symptoms, and physical symptoms are called functional somatic syndromes. Recently, central sensitization syndromes have been proposed as a concept similar to functional somatic syndromes. Central sensitization is associated with pain, headache, abdominal pain, malaise, and insomnia.

In our study, we found that irritable bowel syndrome and migraine had a higher degree of central sensitization.

Many patients with chronic pain visit Department of Pychosomatic Medicine or allied organization in the university hospitals, general hospitals, or clinics. Patients with chronic somatic pain are classified into chronic pain syndrome, migraine, tension-type headache, glossodynia, temporomandibular joint disorder, cervicobrachial syndrome, low back pain, chronic pelvic pain, and fibromyalgia. Patients with chronic visceral pain are identified as irritable bowel syndrome, centrally-mediated abdominal pain syndrome, narcotic bowel syndrome, epigastric pain syndrome, functional chest pain, functional gallbladder disorder, functional biliary sphincter of Oddi disorder, functional pancreatic sphincter of Oddi disorder, levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax. Among them, visceral pain can be replicated with clinical examination simultaneously with measuring pain threshold. Research on visceral pain has been developed by the effort searching pathophysiology and pathogenesis of irritable bowel syndrome. Research on irritable bowel syndrome is a prototype of investigation not only on functional gastrointestinal disorders but also on chronic visceral pain. Irritable bowel syndrome overlaps with many chronic pain disorders as well as anxiety disorders, depressive disorders, and somatic symptom and related disorders. Much effort has been paid attention to seek intracerebral mechanism of sensitization of neurons which code pain. Further research is warranted to alleviate pain in patients with chronic pain.

Object : The purpose of this study was to examine the mediating effect of attachment styles on the effects of Adverse Childhood Experiences (ACEs) on the burden of physical symptoms. Besides, the effects of ACEs on Functional Somatic Syndromes (FSS) and Somatic Symptom and Related Disorders (SSRD) were examined preliminarily.

Methods : A questionnaire survey including ACEs, attachment styles, and the burden of physical symptoms was conducted on 996 adults on the Web.

Results : As a result of the analysis, ACEs exacerbated the burden of physical symptoms directly and indirectly through attachment styles. Furthermore, ACEs significantly increased the morbidity of FSS and SSRD.

Conclusion : The results of this study suggest that ACEs may be associated with an unstable attachment style in the background of exacerbating the burden of physical symptoms.