The dynamic psychotherapy for irritable bowel syndrome (IBS) assumes that interpersonal conflict is the cause of the symptoms and aims to gain insight from its relationship with affect and abdominal symptoms. Various effect measurements and practical studies have been conducted to date, and while these indicate that if the treatment is successful, not only will the symptoms improve, but it could also have a positive impact on overall daily living and the person's life, there are such issues as this is highly individualistic, the treatment takes a long time, and the reproducibility is poor. In addition, a certain amount of evidence has already been generated by a variety of techniques for stress management and this is being utilized in daily clinical practice. Assessments are being conducted based on psychological stress models with the aim of modifying the factors that can buffer stress. Specifically, correction of cognitive distortion specific to IBS, expanding the coping repertory, and relaxation techniques are applied matching the characteristics of the patients. In addition, when necessary, these should be combined with lifestyle habit improvement, social support activities, dietary guidance, etc.

As one of the psychotherapies for refractory irritable bowel syndrome (IBS), the effectiveness of cognitive behavioral therapy (CBT) has been shown in the Cochrane review. We introduce Cognitive-Behavioral Therapy with Interoceptive Exposure (CBT-IE) for IBS, its components, and the trend of clinical research on CBT-IE, which has been conducted in Japan in recent years.

It is well established that stress is involved in the development and exacerbation of irritable bowel syndrome (IBS). The proportional relationship between the severity of psychological problems and the severity of IBS suggests the need to use psychotherapy in IBS patients according to disease severity. Diagnostic and treatment guidelines for IBS recommend the use of brief psychotherapy in the second stage and specialized psychotherapy in the third stage. Autogenic training (AT) is a systematized psychophysiological treatment method that uses passive attention to formulas and self-hypnosis to bring the body and mind into a parasympathetic state and thereby achieve homeostatic equilibrium. In many cases of IBS, AT can suppress excessive activity of the vagus nerve innervating the digestive tract. Its effectiveness in increasing the patient's feelings of self-efficacy and providing the feeling of “getting better” can also be demonstrated by brain imaging. It is likely that more practice of AT activates cortical functions related to emotion. Fewer randomized controlled trials have been reported on AT for IBS than on hypnotherapy and cognitive behavioral therapy, suggesting the need to conduct further studies based on a uniform protocol.

Mindfulness-based therapy (MBT) is one of mind-body therapies. There is increasing evidence for MBT in the world. Several studies have shown that meditation in which MBT has originated ameliorates abnormal stress responses or pain behaviors. MBT is also considered to be the most effective treatments for irritable bowel syndrome (IBS) because it may help to improve pain catastrophizing and/or gastrointestinal specific anxiety, which are specific ways of cognition observed in IBS patients. However, very few studies have reported that MBT is effective for IBS. Further studies are warranted to confirm the findings. This article outlines the definition, practices and neurophysiological mechanism on mindfulness meditation, the effects of MBT for IBS, and adverse events of meditation.

The guideline for treating irritable bowel syndrome (IBS) recommends psychotherapy in the third stage, after the failure of other standard treatments, and hypnotherapy is listed as one of the evidence-based psychotherapies. However, the efficacy of hypnotherapy for IBS is not well known in Japan, and patients' accessibility to hypnotherapy is low. This paper describes specific evidence and underlying mechanisms and introduces components of hypnotherapy protocols commonly used in past intervention studies. Also, specific innovations in applying hypnotherapy for IBS are described, and challenges and prospects for hypnotherapy in Japan are discussed.

Background : The Eating Disorder Diagnostic Screen (EDDS ; Stice et al., 2000) is a widely used self-report questionnaire originally based on DSM. The EDDS can be used to diagnose eating disorders. The purposes of this study were to develop a Japanese version of the EDDS-DSM-5 version and examine the reliability and validity of this screener.

Methods : Japanese college students (N=1006, mean age=19.6±1.4 years, 69% female) answered the Japanese version of the EDDS-DSM-5 version. Sixty-eight participants (mean age=20.0±1.0 years, 63% female) answered the Eating Attitude Test-26 (EAT-26 ; Baba & Tsuboi, 1993) and Three-Factor Eating Questionnaire (TFEQ ; Adachi et al., 1992) in addition to the EDDS.

Results : The Japanese version of the EDDS-DSM-5 version exhibited internal consistency (α=.86) and test-retest reliability (r=.81, p<.001). The EDDS correlated positively with EAT-26 and TFEQ, providing evidence of convergent validity. Estimated prevalence rates were 2.8% for anorexia nervosa, 2.4% for bulimia nervosa, 2.4% for binge eating disorder, 3% for atypical AN, 0.5% for low frequency BN, 0.9% for low frequency BED, 0% for purging disorder, and 2.8% for night eating syndrome.

Conclusion : The Japanese version of the EDDS-DSM-5 version showed good reliability and validity. It may be useful in clinical and research applications.

Background : Functional dizziness is affected by psychological factors such as depressive mood. However, the mechanism is not fully understood, and there is no established drug treatment. In this preliminary study, we evaluate the efficacy of antidepressants for treatment of patients with functional dizziness with depressive mood in a randomized controlled trial.

Subjects : Patients with functional dizziness with depressive mood between ages 20 and 74 who presented at our institution between March 2018 to December 2019 were included in the study. Cases with mental illness such as severe depression and schizophrenia were excluded.

Method : Escitalopram group and milnacipran group were randomly assigned as treatments, and the course of clinical symptoms was compared. Furthermore, subjects were selected randomly, and given for 4 weeks waiting period as a control group. The primary endpoint was assessed using Clinical Global Impressions (CGI), and secondary endpoints were assessed Dizziness Handicap Inventory (DHI) and Vertigo Symptom Scale-short form (VSS-sf).

Results : Thirteen patients participated in this study, and 10 were included in the final analysis. There were no significant differences in age, gender, comorbidities, or clinical indicators between the groups. At 4 weeks, escitalopram group had improved CGI and VSS-sf. On the other hands, other groups had no change significantly.

Conclusion : The results suggest that SSRI, such as escitalopram, is a promising initial treatment for functional dizziness. Further multi-institutional trials with access to a larger patient population are warranted to verify these preliminary results.

In patients with psychosomatic disorders, it is often difficult to aware the psychosomatic correlation due to alexithymia. Process-oriented psychology (POP) intervenes from various channels to promote awareness of psychosomatic correlation. [Case] Female in the 30s, health center staff. After treatment of cervical cancer in June X−1, slight fever, general pain, irritability, tremor, malaise persisted. In October X, she visited A Thyroid Clinic and was diagnosed with painless thyroiditis. In December, she suffered from hypothyroidism and was started LT4 compensation. In April X＋1 combined use of counseling was started. Through the channels of physical illness, nightmares, habits, etc., the secondary process “dependency, emotional” is suppressed by the deep consciousness of the primary process “perfect principle, the rational good child” in ego consciousness. In November, she took a large amount of LT4 for suicide. The author stopped the LT4 suspension and then took a leave of absence. After that, the patient gradually became able to accept the impatience and imperfection, and transferred to the NPO for welfare for persons with disabilities in November X+2. Thyroid function is also maintained as normal. Conclusion : POP seems to be effective for psychosomatic disorder patients with alexithymia.