Integration of pharmaco and nonpharmaco therapies of psychosomatic disorders

Symposium abstracts / Journal of Psychosomatic Research 58 (2005) S7– S29 for redecision may play an important role in treatment of psychosomatic disorders. A final goal of treatment of stress associated diseases is not merely an improvement of physical condition but also an achievement of quality of life and discovery of new way of happy life. Transactional analysis can be one of the professional psychotherapies suitable for psychosomatic care and contributory for health promotion of mind and body.

31402 — How TA is applied in clinical psychiatry Noma K

S19

adult decision. All this is done prior to contracting for change about a psychosomatic illness. During the contracting, cons are identified while early and present scenes (symptoms) are being revealed. Being the illness and giving voice to the illness will reveal the early decision, at which time a redecision can be facilitated. As a psychotherapist, the issue then becomes anchoring the new decision so that support, celebrations, and practice may occur.

31404 — How TA can be used in terminal care Shirai S

I think, as a clinician, that I would like to use any tool that I can help my clients solve their problem with. And one of most powerful tool is TA theory. I think a therapist needs to be a healthy human being model for a client. I mean, we are honest and direct, do not discount them and ourselves, and do not play games. In other words, we need to be out of our own script. In the process of diagnosis, I can tell, not only from her story but also from her words and body languages, this client’s situation, if her ego states are working, if she discounts, what her drivers are, what her injunctions are, what her adaptations are, and what script that she is struggling with is in a short period. This is very important to build a good rapport between a therapist and a client. By using TA, a therapist can interact with a client and help her activate herself to get through her old script. In treatment, a contract is necessary to avoid transference, and making contract also means that we believe that there is power and autonomy in a client. TA theory tells us clearly what is going on with a client, with a therapist and with between a therapist and a client. I talk about the need of treatment for us as therapists, and supervision.

I have been involved for more than 25 years with terminal care and would like to share how TA can be used in terminal care. The following are some of aspects of TA basic theories applicable to terminal care situations. 1. Use of bEgogramQ for understanding patients: The egogram is a great help for medical staff to understand patients’ way of thinking and behavioral patterns in general. We discovered that the egogram patterns of patients who wanted to know their diagnosis and prognosis and those of patients who did not want to know were different. 2. TA theory of blife script analysisQ: TA’s basic understanding of human life is that, bwe live our life based upon our bLife Script Q rooted in early childhood decisions. This will help medical people predict how and to what extent patients will accept the difficult reality confronting them. It will also make it possible for staff to know how they can assist patients to live the last stage of their life in the most peaceful and fulfilling way. 3. TA’s basic theory of bstrokeQ: All humans have bhunger for stimuli from other people,Q in TA terms, bstroke.Q This concept of bstrokeQ will be of great help for the people working with terminally ill patients who have a great need for bstroke.Q Whether we can spend our last moments of our life in a way we wish depends upon how much we can get positive bstrokeQ from other people.

31403 — Using TA as a psychotherapist Wilson SS

Integration of pharmaco and nonpharmaco therapies of psychosomatic disorders

Identifying Personality Adaptations Closing Escape Hatches Contracting for Change Cons Present scene, early scene Early messages Early Decision Redecision Anchor the Redecision Support, celebrate and practice Objectives for the presentation: Each participant will be presented with: methods of identifying personality adaptations through preferred areas of contact a method of closing the escape hatches of homicide, suicide, and going crazy a method of giving a voice to the psychosomatic symptom such in a manner that healing may occur. This panel presentation will begin with identification of the six basic personality adaptations: schizoid, paranoid, antisocial, passive-aggressive, obsessive compulsive, and histrionic. Identification is done by listening to the clients’ verbal clues and watching for the body language. The colloquial titles of creative daydreamer, brilliant skeptic, charming manipulator, playful resistor, responsible workaholic, and enthusiastic over reactor will be presented using the doorways to therapy— open, target, and trap. Closing escape hatches is based on the OK coral and the four basic life positions. This necessitates the introduction of ego states because this is an

31501 — Role of yoga therapies in psychosomatic disorders (WHO Professor) Singh AN Psychosomatic diseases are the pathological expression of biological, psychic, and social parameters of health and illness, whereas Yogic approaches are ways to bind closely the normal interrelationship of above. Thus, the yoga, a mystic way of life, originated 2800 years ago in India and compiled comprehensively by Patanjali in the fourth century, is remarkably vibrant, unique, and successful in the management of psychosomatic diseases. Yoga therapy emphasizes self-regulation by patients and stresses the importance of somatopsychic functioning of the individual. The spiritual itinerary of yoga is discussed and emphasis is given to its use in these psychosomatic diseases, where therapeutic effectiveness can be demonstrated logically and scientifically. Besides reviewing the recent researches of yoga therapy, particular effort is made to discuss its relationship to other therapies of psychosomatic diseases. Yogic approaches have been successfully used in the management of bronchial asthma, essential hypertension, mucous colitis, peptic ulcer, cervical spondylosis, chronic sinusitis, intractable pain, personality disorder, anxiety reaction, anxiety depression, gastritis, and rheumatism.

31502 — Development and evaluation of Balneo–Morita therapy for the treatment of fibromyalgia syndrome Nagata K, Hasegawa T, Okano H, Kiyama K, Tsutsumi T, Hirokado Y, Ohtsuki C, Ohba T Purpose: We applied Balneo–Morita (BM) therapy in the treatment of fibromyalgia syndrome (FMS). Participants and Methods: The participants included 11 patients with FMS. These patients were treated with BM therapy, and the efficacy of the therapy

S20

Symposium abstracts / Journal of Psychosomatic Research 58 (2005) S7– S29

was evaluated both subjectively by use of VAS and objectively through the determination of urinary levels of 17-KS-S (S) and 17-OHCS (OH), and S/OH ratio. BM therapy combines the Balneo with Morita therapy. Results: Ten patients completed the whole treatment course. The average period of stay at the spa in these patients was 4.2F1.2 weeks. VAS decreased from 7.8 to 3.0. After treatment, elevation in S level was seen in one group and decrease in OH level in the other group. At the follow-up check made 6 months after the therapy, relapse was found in only one patient. Discussion: To relieve the substantial tension and to alleviate pain, it is a prerequisite to change the patient’s way of life. BM therapy is an existential therapy utilizing the place of a spa. The patient can obtain physiotherapeutic and chemotherapeutic efficacy through the use of a spa as well as the efficacy from change of air by staying at a spa, using the approach of Morita therapy, which can change the patient’s way life.

31503 — Music therapy of fibromyalgia syndrome Tanamura M, Nagata K, Hasegawa T, Ohtsuki C Purpose: Patients with fibromyalgia syndrome (FMS) were treated by use of music therapy, and the therapeutic results were evaluated psychophysiologically. Participants and Methods: Six patients with FMS were treated with music therapy. The pianist with notion of the patient’s emotion played on the piano the pieces chosen to support and sympathize with the patient’s emotion. The pieces chosen were short pieces of classical music. Music therapy was done for 1 h once a week for a total of six sessions. Before and after the music therapy, the patient’s pain was assessed by VAS, analysis of spectrum of ECG, and measurement of urinary levels of 17-KS-S (S), 17-OHCS (OH), and S/OH ratio. Results: The analysis of the spectrum revealed elevation in LF/HF in all cases. The level of S was low and that of OH was high, with low S/OH ratio. In patients in whom the music therapy was proven to be effective, as shown by decrease in pain demonstrated by VAS, LF/HF decreased and HF increased. Moreover, there was a patient group with increase in S and also a group with decrease in OH. In the group of patients in whom no response was obtained music therapy, these prohomeostatic effects were not seen. Discussion: Music therapy exerts physiological actions and works prohomeostatically when it is effective. It was considered music therapy acts on neuro-endocrinological system. However, the important thing for the introduction of music therapy is whether the patient has an interest in music, and it was indicated that such a patient’s interest may greatly affect the therapeutic efficacy.

31504 — Prohomeostatic effects of acupuncture Hirokado Y, Shirahata I, Nagata K, Aoyama Y Purpose: For the evaluation of antistress efficacy of acupuncture, urinary levels of 17-KS-S (S) and 17-OHCS (OH) were determined. Participants and Methods: The participants were 37 patients who were divided into two: the group receiving acupuncture (A group) and the control group (C group). In the A group, before receiving acupuncture, urine samples (preurine) were taken. Urine samples (Posturine 1 and 2) were taken after the therapy and early morning on the following day. Results: When levels in preurine and those in Posturine 1 were compared, OH and S levels increased. Comparisons of Preurine and Posturine 2 revealed no differences in all parameters. Comparisons of Posturine 1 and Posturine 2 revealed decreases in OH and S levels and a significant increase in S/OH ratio. Discussion: Because both OH and S levels increased immediately after the acupuncture therapy, it is indicated that acupuncture therapy is a therapy of stimulation, and that stimulation given by acupuncture acts as a stressor to the body and at the same time it stimulates the repairing mechanism of the body. As increase in S level persisted till the next day, it is considered that the acupuncture therapy acts as a stressor immediately after treatment and that the homeostatic efficacy for the body appears a

little later, persisting and gradually accumulating to become a high homeostatic efficacy.

An international psychosomatic research on the mental and physical health of the victims by the Indian ocean tsunami disaster in Sri Lanka 31601 — Trauma intensity and posttraumatic stress disorder in tsunami victims in the matara district in Southern Sri Lanka Dewaraja R , Kawamura N A comprehensive longitudinal investigation was initiated in the Matara district of Sri Lanka, 8 weeks after the Tsunami, with the collaboration of the National Institute of Mental Health in Japan. In the first part of this investigation, a set of questionnaires, The Harvard Trauma Questionnaire (HTQ), the Hopkins Symptoms Checklist (HSC), and the Impact of Events Scale-Revised (IES-R), was administered to adults in a tsunamiaffected area and in a close by nonaffected area. This presentation will present data on the posttraumatic stress disorder level of affected people as measured by the trauma symptoms scale of the HTQ, as a function of the intensity of trauma events that was experienced by them, as measured by the trauma events scale of the HTQ. The main findings of the HSC and the IES-R will also be presented. So far, we have found that there were more than 40% of checklist positive subjects for possible PTSD detected by HTQ at the time point of 2 months after the disaster. The depression score of HSC had strong significant correlation with the HTQ PTSD score. The coefficient for Spearman’s correlation analysis was .700 ( Pb.0001). Thus, depression itself is also a big problem. The implication of our findings for the future care of tsunami-affected people will be discussed.

31602 — Role of WHO for mental health issue in the tsunami-affected countries (Technical Officer) Tsutsumi A Soon after the Indian Ocean tsunami disaster, the World Health Organization (WHO) sent professional mental health officers to Indonesia, Sri Lanka, and the Maldives for talks with government officials at the request of those governments. The WHO has promised to assist tsunami-affected countries with mental health issues as well as other health problems. The WHO has already dispatched four mental health teams consisting of psychiatrists, psychiatric nurses, psychologists, and coordinators to Aceh, Indonesia, with view to establishing long-term monitoring. While the WHO is providing assistance and technical advisors to affected countries at their request in the wake of this tragedy, we do not, in general, conduct direct field interventions. WHO has strengthened the integration of mental health into primary health care and continues to work for policy-level improvements.

31603 — Comparison of house-tree-person test data of tsunami affected and nonaffected children in Sri Lanka Sato H, Dewaraja R, Ogawa T In the first part of an ongoing longitudinal study, we conducted a multi dimensional assessment of the psychological condition of trauma-affected children in the Matara district in southern Sri Lanka. As a part of this assessment, the Synthetic-House-Tree-Person Test and the Revised Children’s Manifest Anxiety Scale (RCMAS) were administered to children (10 –16 years old) studying in a school in an area affected by the tsunami and in a school in a close by area that was not affected. Initial analysis of RCMAS data indicates that there are no significant differences in the overall anxiety scores of children in the two schools. However, the total anxiety scores of male children in the tsunami-affected school were significantly higher than in the nonaffected school. Among the RCMAS subscales, only