Today, family therapy has developed to one of the important clinical fields

of psychotherapy and family support. The membership of JAFT is

approximately 1100, and one third of them are medical doctors, which is

one of the features of family therapy in Japan.

The clinical feature of family therapy is to understand clinical symptoms in

the context of interaction and/or the belief of family members.

The basic epistemological background has been the systems theory for

these several decades. Recently, new paradigm of clinical practice has

appeared, which is known as postmodern approach in the Western world,

whereas it is called as narrative therapy or narrative approach in Japan.

The concepts and methods of family therapy has been gradually applied in

clinical fields working with families, which, e.g., have child or adolescent

problems, marital problems, problems of mental illness or chronic physical

illness including terminal care, psychosomatic problems, and so on.

The author would like to report about the development and the present

situation of family therapy in Japan as the context of family therapy or

family-based approach in the treatment of psychosomatic problems.

30202—The positioning of family therapy in Japanese

psychosomatic medicine

Kojima T

It was in the mid-1980s that family therapy began to catch attention in

Japanese psychosomatic medicine. It began with the introduction of family

therapy for eating disorders by Minuchin, S., and also Palazzoli, M.S. It had

a big impact on the psychosomatic field since it was just when they were

groping for a more effective treatment in coping with the increasing number

of patients with eating disorder. Also in Japan, credit goes to Shimosaka,

K., for his original approach towards the families of such patients. In the

1990s, a full-scale practice of family therapy started at the Department of

Psychosomatic Medicine in Kyushu University Hospital by Hayakawa. H.,

Higashi. Y., and Kojima. T, et. al. An effective outcome was seen not only

in eating disorders, but also in various psychosomatic disorders. The most

significant factor of the above practice is the development of a new medical

family therapy model and the techniques based on it.

30203—Approach of family therapy for psychosomatic diseases in

Japan—presentation of statistical data and concrete cases of family

therapy for psychosomatic patients and the family

Yoshikawa S

In the United States, it is well known that approach of the family therapy for

eating disorder is practiced by the research of Minuchin, S. et al. In Japan,

the approach is practiced for psychosomatic patients too. The above-

mentioned psychosomatic disease intends not only diseases, such as

psychogenic physical irregularity, in a narrow sense. But psychosomatic

medicine in Japan also includes psychosomatic diseases seen in the field of

terminal care, for example. Primarily, as the basic approach for psychoso-

matic disease, the medicine model and psychotherapy are used together.

And the approach of family therapy is effective especially for the patients of

diseases such as chronic pain and terminal care that are not improved by

general psychosomatic treatments.

The speaker practiced the approach of the family therapy for about

140 patients and families of Somatoform Disorders. In this presentation, the

speaker shows summary of some these cases and research after the illness

and shows characteristics and effectiveness of the family therapy in the

psychosomatic medicine.

Bio-psychosocial medicine in disasters—report from Kobe 10 years

after the Great Hanshin-Awaji earthquake

30301—What can medical assistance do for victims in catastrophes?

Nakayama S, Kozawa S, Ukai T, Ishii N

Introduction: Based on lessons from the Great Hanshin Earthquake, 15

key hospitals for disasters were designated in Hyogo prefecture and have

dispatched their medical teams to affected areas.

Results: In domestic disasters, 13 teams were dispatched in flood in Hyogo

and 10 in Niigata Chuetsu Earthquake in 2004 from key hospitals for

disasters and Red Cross hospitals in Hyogo. In overseas disasters, Kobe

University Medical Team was sent for 921 Chi-Chi Earthquake in Taiwan

in 1999 and Gujarat Earthquake in India in 2001. Hyogo Emergency

Medical Center sent doctors and nurses as members of GO (JMTDR) or

NGO (HuMA) team to help victims of Tsunami disaster in Sri Lanka and

Indonesia in 2004 and 2005. Activities of the teams were fact finding and

advice and clinical activities. Most of serious trauma cases had been

transported before their arrival, and assistance teams could take care of

patients with minor injuries and sickness.

Discussion: Prompt medical assistance must be provided in disasters,

taking account of the fact that lack of information is one of the

inevitabilities of catastrophe. Physical treatment was the first priority of

disaster medical management. At the same time, mental supportive care,

which could be given not only by specialists but also by any member of the

teams, looked essential; even victims had difficulties to communicate

with foreigners.

Conclusion: Rapid dispatch of assistance teams is the most important as

well as well timed withdrawal. Any team must be more conscious of its

potential to reduce psychological and mental stress of the victims in

affected areas.

30302—Participation for disaster relief as a psychiatrist

Fujii S, Kato H

When arguing about the relationship between psychiatry and disaster, we

need to consider two of the same sort but different viewpoints: disaster

psychiatry (medical treatment) and mental health care (psychological

support). When the great Hanshin-Awaji earthquake hit the Kobe area in

January 1995, psychiatric first aid stations and emergency services were

provided for about 3 months against the rapidly increased treatment needs.

Subsequently, 5 months after the strike, the Center for Mental Health Care

was established because of its devastating damage and enormous sufferings.

The center provided psychological support based on the existing local

community health care system, especially for the residents in the temporary

and the permanent housing, until March 2000. With growing general

interests and needs in mental health care, the center reopened in April 2004

as Hyogo Institute for Traumatic Stress, equipped with facilities for

training, study, and a clinic, targeting not only for disaster survivors but also

for victims from crimes and accidents.

Thus, the experience of this huge earthquake urged us to think more about

mental health and to start related programs in the very early stage after

disaster strikes in Japan. Under such conditions, we experienced

unexpected flood by typhoon in Hyogo prefecture, the Niigata Chuetsu

Earthquake in Japan, and finally the Sumatra Earthquake and the Indian

Ocean Tsunami Disaster internationally, all within this 1 year. In the

symposium, we are going to report slightly different ways of participation

as psychiatrists in each disaster, to exchange opinions in medical field and

for the better future cooperation.

30303—The experience as a psychosomatic physician in the disaster

area, Kobe

Murakami N, Ozasa Y, Muramatsu S

The Department of Psychosomatic Internal Medicine in Kobe Red Cross

Hospital was founded in 1996 for the purpose of treating psychosomatic

and psychological problems in patients from the Great Hanshin-Awaji

(Kobe) earthquake on January 17, 1995.

A disaster causes compound stressors. A disaster breeds physical, psycho-

logical, and social distress because of disease, injury, death of family,

homelessness, job loss, and loss of community. Such compound stressors

have a bad effect on body and mind of victims for a long duration.

For example, according to our research on 82 diabetes outpatients in 1996,

those who had suffered from the Great Hanshin-Awaji Earthquake were

Symposium abstracts / Journal of Psychosomatic Research 58 (2005) S7–S29S8

more apt to have worse cases of diabetes. Diabetes represents one of the

psychosomatic diseases. Multiple factors such as diet, exercise, compliance

and coping for illnesses were related to this result.

According to other researches on outpatients of psychosomatic internal

medicine in 2000 and 2005, about 40% of the patients thought that there

was still a correlation between the illnesses and the disaster 10 years after

the earthquake. In fact, some patients came to consult us about their

physical and psychological distress for the very first time.

In our opinion, the victims should be provided physical, psychological, social

and spiritual care over a long period after a disaster. We must provide a

network among the various specialists in case of an event of a disaster.

Brain–body interactions: real daily phenomena of

psychosomatic medicine

30401—Theory of emotional awareness and brain

processing of emotion

Lane RD

Negative affect that is not experienced or expressed may be the most

pathogenic response to environmental stress. The purpose of this paper is to

provide a way of understanding this phenomenon from a psychological and

physiological perspective. A cognitive developmental model of emotional

awareness will be presented that holds that the ability to become consciously

aware of one’s own feelings is a cognitive skill that goes through a

developmental process similar to that which Piaget described for other

cognitive functions. The developmental process consists of the transition

from unconscious (implicit) to conscious (explicit) processing, with explicit

emotional processing having a modulatory effect on implicit processes. A

parallel hierarchical model of the neural substrates of emotional experience

will be presented next supported by recent neuroimaging work. It will be

argued that the neural substrates of implicit and explicit emotional processes

are distinct. The neural substrates of implicit aspects of emotion and three

distinguishable aspects of explicit emotional processing will be presented:

background feelings, focal attention to feelings, and reflective awareness of

feelings. The conscious processing of affective states requires the partic-

ipation of structures that subserve attention andmental representation that are

not unique to emotion. The domain general (i.e., not specific to emotion)

function of these structures may help to explain the vast individual

differences that are observed clinically in the ability that people have to

monitor and report their own emotions. The implications of this psycho-

biological model for behavioral medicine research will be presented.

30402—Neurovisceral integration, emotions, and health

Thayer JF

A comprehensive model of emotions and health must attempt to account for

the complex mix of cognitive, affective, behavioral, and physiological

concomitants of normal and pathological affective states and dispositions,

and how these might impact upon health. We present the outlines of a

model that integrates some of these components into a functional and

structural network that may help to guide us in our understanding of

emotion and health. Functionally, this network involves autonomic

regulation, affective regulation, and cognitive regulation. Structurally, this

network includes reciprocal, inhibitory circuits between prefrontal cortex

and subcortical evolutionarily primitive motivational structures that can be

indexed by rhythmic activity of the cardiovascular system. We will briefly

review some of the work that we have done to uncover the functional

aspects of this reciprocal, inhibitory circuit with respect to autonomic,

affective, and cognitive regulation. We will emphasize the relationships

among autonomic, affective, and cognitive regulation in organism health

and propose a group of underlying physiological systems that serve to

integrate these functions in the service of self regulation and adaptability of

the organism. We will attempt to place this network in the context of

dynamical system models that involve feedback and feedforward circuits,

with special attention to negative feedback mechanisms and inhibitory

processes. Importantly, we will show that the negative behavioral states and

dispositions associated with a relative autonomic imbalance toward

sympathetic dominance represent a disinhibition of positive feedback

circuits that are normally under tonic inhibitory control.

30403—Brain–gut interactions and emotion

Fukudo S

Clarifying functional module of the brain in response to visceral stimulation

is one of keys to understand the mechanism of emotion because the brain is

thought to form primitive emotion by integration of interoceptional signal.

Antonio Damasio has suggested that when we think about the potential

consequences of a behavior, the memory of our emotional state (visceral

experiences) in similar circumstances may provide useful information for

evaluating the behavior. Therefore, research on gut feeling is important not

only for clarifying pathegenesis of irritable bowel syndrome (IBS) but also

for understanding the mechanism of emotion. In studies of positron emission

tomography (PET) with injection of H2[15O], colonic distention pressure

dependently induced visceral perception, and anxiety, which significantly

correlated with activation of specific regions of the brain including the

prefrontal, anterior cingulate, parietal cortices, insula, pons, and the

cerebellum. Specific triphasic cerebral evoked potential of N1, P1, and N2

was obtained with the rectal electrical stimulation. Colonic distention

induced a significant decrease in the alpha power and a significant increase in

the beta power of electroencephalogram (EEG). Some molecules which

modifies brain–gut interactions were identified. They were at least cortico-

tropin releasing hpormone, histamine, and serotonin. These data suggest that

the functional module of the brain in response to the visceral perception is

present. Besides, the abnormal consequence of stimulation evoked arousal

and emotion may relate to pathophysiology of IBS. Further research on

brain–gut interactions will provide clinically useful information and basic

knowledge of psychosomatic medicine.

30404—Brain–body interactions as the psychosomatic pathway to

essential hypertension?

Deter HC, Richter S, Buchholz K, Rudat M, Weber C

Introduction: Salt-sensitive normotensive men (SS) are an interesting model

for studying the development of essential hypertension (EH). These

participants exhibit also an enhanced pressor (BP) and heart rate (HR) response

to mental stress. The high stress-induced HR and BP acceleration is also a EH

risk factor and may result from sympathetic activation or vagal withdrawal.

This seems interesting to study brain cardiovascular interactions.

Methods: To understand the importance of autonomic dysbalance for the

increased stress responsiveness, we studied cardiovascular reactivity to mental

challenge in 17 SS healthy Caucasian male and 56 SR control participants.

Salt sensitivity was determined by a 2-week dietary protocol (20 vs. 240 mmol

Na/day). Mental stress was induced by a computerized information processing

task. ECG and BP (Finapres) were registered continuously to determine HR

and interbeat–interval length (IBI). Spectral power of heart rate variability

(HRV) was calculated to estimate vagal cardiac control, and diastolic blood

pressure reactivity was assessed to estimate peripheral sympathetic effects. We

studied also startle modulation in these participants, who viewed a series of

42 pictures of the International Affective Picture System varying in pleasure

and arousal, while acoustic startle probes (95 db) were administered randomly

and EMG of the orbicular eye muscle, HR, and BPwere continously recorded.

Startle modulation was calculated as the difference between startle responses

under negative and positive affective stimuli.

Results: Stress-induced increase in HR was higher in SS than SR

participants. SS in comparison with SR showed significantly reduced

respiratory related HRV during baseline and mental stress conditions

( P b.01). The increase in DBP during mental challenge was significantly

greater in SS ( P b.05). SS showed an enhanced affective startle modulation

Symposium abstracts / Journal of Psychosomatic Research 58 (2005) S7–S29 S9