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Background: Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention ‘decoupling' (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support. Methods: One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50). The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat and completer analyses were conducted. Results: Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial η2 = 0.31) that persisted through 6 months of follow-up. Participants' subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as the intention-to-treat analyses. Conclusions: Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.

Background: The present study aimed to determine the psychophysiological changes induced in subjects by standard autogenic training (AT). Physiological measurements were taken under strict experimental conditions. Methods: Thirty-one healthy students were divided randomly into two groups: the AT group and the control group. In the first session, the physiological variables were measured for all students before and after all were asked to relax in their own way. The AT group were then taught AT for 3 months, after which time the measurements were repeated. In the second session, the AT group practised the standard AT exercise, while the control group repeated their own form of simple relaxation. Electrocardiogram, plethysmogram (PTG) and blood pressure (BP) were measured while the students carried out a breathing rate of 15 cycles/min. The R-R intervals and BP were analysed by an autoregressive model for spectral analysis, and the data were compared by repeated-measures ANOVA. Results: The AT group had a significant increase in the mean R-R interval and a significant decrease in the baseline deflection of the PTG in the second session. There were no significant changes in sympathetic activity except for the change in the PTG, although low frequency amplitude of systolic BP decreased slightly. Conclusions: AT was found to induce significant changes that were independent of respiration in healthy students, although paced breathing might have operated as a mental stress. The increase in mean R-R interval and the decrease in baseline deflection of the PTG were the most robust correlates of AT.

Mental stress and immunological abnormality have recently been listed as causes of alopecia universalis. This disease is difficult to treat with only ordinary pharmacotherapy. Thus, from the standpoint of psychoneuroimmunology, stress was relieved by relaxation and image therapy, and administration of small doses of a strong immunosuppressant was effective, leading to clinically favorable results. In addition, changes were recognized in the subpopulation of peripheral lymphocytes and in beta-endorphin before and after relaxation and image therapy. The treatment of alopecia universalis favorably changed the subpopulations of T cells. A patient suffering from alopecia is always under stress. Alleviating this stress facilitates recovery of immunological competence. Our method was effective in 5 of 6 cases with refractory alopecia universalis.

General and specific anxiety, connected with the fact of myocardial infarction (MI), were investigated in 105 patients before and at the end of posthospitalization rehabilitation. Results as regards general anxiety were compared with data of 63 employed men free of coronary disease and with 34 comparable rheumatic patients. The patients with MI, before the comprehensive rehabilitation, compared with both control groups, have had higher levels of general anxiety in a statistically significant way. At the end of rehabilitation there were no significant differences. There was a significant positive correlation between general and specific anxiety, connected with the fact of MI. During the organized comprehensive posthospitalization rehabilitation, we see that there is a statisticallysignificant decrease of general and specific anxiety.

As practices of altered states of consciousness (ASC) have become more widely used among psychotherapists who have become aware of the limitations of psychoanalytic, educational and behavioral approaches, negative aspects ('Makyo') of ASC have drawn their special attention. For the purpose of controlling or preventing these side-effects, (1) the problem of indication is most important, (2) and evaluation of the patient's personality is indispensable, (3) preparatory education about ASC methods and (4) guidance by experienced leaders are most helpful, (5) appropriate use of tranquilizers and (6) the mere presence of a supportive therapist at the place of practice can also be helpful.

Asthma patients pose special problems as far as the medical supervision, danger of symptoms and the course of the disease are concerned. Some 90 asthma patients were registered for the treatment in the Heidelberg Medical Clinic. 31 patients who were interested in taking part were randomized into 3 groups: two treatment group consisted of the exchange of information, discussion sessions on the illness as well as 'autogenic training' or 'functional relaxation'. The third group was the control group. Before and after treatment the patients were submitted to a thorough examination both of lungs and other internal organs as well as from the psychodiagnostical point of view. The average age of the patients was 43.5 years and the average duration of illness 16.8 years. Nevertheless, the treatment group's sympathomimetics use was significantly reduced by 1 year of treatment (p less than 0.05); the use of steroids decreased as well. The number of visits of the general practitioner also decreased. These results support the conclusion that psychosomatic group therapy can make an important contribution to the treatment of asthma patients. Body therapy practised in 'autogenic training' and 'functional relaxation' seems to be another important healing factor for the treatment in addition to the discussion sessions and the exchange of information.

The psychosomatic aspects of skin disease were studied both clinically and experimentally, from the standpoint of immunology. We found that emotional stress has a great influence on the immune system, as was manifested in skin disease. Skin test in allergic patients significantly improved with autogenic training and relaxation. For clarification of the effects of autogenic training and relaxation, various parameters were simultaneously assessed during the treatment. The serum levels of histamine and dopamine-beta-hydroxylase fluctuated, as determined by the microvibration test. The levels of IgE and findings on the PK test varied only slightly. Before the onset of urticaria, there were changes in the life-style and considerable stress in daily life as well as exposure to an allergen. Using mice subjected to stress, the functions of T cells and macrophages were evaluated. Stress appeared to have a definite influence on the functions of these cells, as related to the important role of the immune system and skin. Thus, the role of stress in clinical disease must always be given consideration.

Body-oriented therapies as relaxation training and certain forms of meditation are gaining popularity in the treatment and prevention of psychosomatic disorders. In this paper, a new method of self-control called self-regulation method (SRM), derived from autogenic training and Zen meditation, is presented. The technique of SRM is introduced. Secondly, physiological studies on SRM using skin temperature, galvanic skin response, and cortical evoked potentials are presented. Thirdly, the results of psychological tests conducted on SRM are presented. These psycho-physiological studies suggest that SRM may elicit a state of ‘relaxed alertness’. Fourthly, clinical applications of SRM are discussed, and 3 cases are presented. Finally, SRM is discussed in relation to the psychology and physiology of ‘relaxed alertness’.

A number of studies and case histories involving the use of biofeedback and behavioral approaches throughout Japan have been selected from Japanese journals and summarized. Areas of biofeedback research covered are experimental, clinical and psychological/educational. The behavioral approaches mentioned have been limited to those currently being used in Japan in conjunction with various biofeedback modalities. A brief explanation of a new biofeedback-monitored multi-modal psychosomatic therapy approach developed in Japan, termed cybernation therapy, is also presented along with current Japanese thought on the use of biofeedback in pyschotherapy.

Experiments were conducted to investigate the psychophysiological effects of self-regulation method (SRM), a newly developed method of self-control, using EEG frequency analysis and contingent negative variations (CNV). The results of the EEG frequency analysis showed that there is a significant increase in the percentage (power) of the theta-band and a significant decrease in the percentage (power) of the beta-band during SRM. Moreover, the results of an identical experiment conducted on subjects in a drowsy state showed that the changes in EEG frequencies during SRM can be differentiated from those of a drowsy state. Furthermore, experiments using CNV showed that there is a significant reduction of CNV amplitude during SRM. Despite the reduced amplitude during SRM, the number of errors in a task to evoke the CNV was reduced significantly without significant delay of reaction time. When an identical experiment was conducted in a drowsy state, CNV amplitude was reduced significantly, but reaction time and errors increased. From these experiments, the state of vigilance during SRM was discussed as a state of 'relaxed alertness'.

Body-oriented therapies as relaxation training and certain forms of meditation are gaining popularity in the treatment and prevention of psychosomatic disorders. In this paper, a new method of self-control called self-regulation method (SRM), derived from autogenic training and Zen meditation, is presented. The technique of SRM is introduced. Secondly, physiological studies on SRM using skin temperature, galvanic skin response, and cortical evoked potentials are presented. Thirdly, the results of psychological tests conducted on SRM are presented. These psycho-physiological studies suggest that SRM may elicit a state of 'relaxed alertness'. Fourthly, clinical applications of SRM are discussed, and 3 cases are presented. Finally, SRM is discussed in relation to the psychology and physiology of 'relaxed alertness'.

Physiological parameters were studied over 4.5 months in normal high-school girls. One group frequently practised autogenic training (AT) whereas the other (control) did not. After 4.5 months the physiology of the AT, but not the control group had changed to some extent. The mean increase in finger skin temperature in the final session was significantly greater in the AT group than in the control group, especially in subjects who experienced hand warmth during AT. No significant differenced between groups were apparent for finger blood flow, but within the AT group the girls who experienced hand warmth showed a significantly greater blood flow than those who did not experience hand warmth. The electroencephalogram (EEG) of the AT group showed significantly more 'slow' (delta and theta) and less fast (alpha and beta) activity than at the beginning of the project. Microvibration (MV) of the thumb did not differ significantly in any comparisons. Both in the AT and control group means there were no significant differences between the periods before, during and after AT although significant changes did occur in some individuals of the AT group in the final session. In particular, in 3 of 14 AT subjects respiration rate decreases markedly even though weekly training had not included any breathing exercies. The results suggest that the effects of AT are predominantly long-term, resulting in gradual physiological changes that are maintained to some extent between practice periods.

The authors reports on psychotherapeutic observations and experience with 18 leukemic patients who had been treated temporally in a germ-free environment ('life island'). 14 patients were under psychotherapeutic treatment during which a supporting psychotherapy with additional learning of autogenous training was carried out. The results are discussed and the problems of the therapeutic team of a hematologic intensive-care unit are pointed out.

The changes in surface temperatures of the hands, and the permeation of warmth in the hands during self-regulation method (SRM), a new method of self-control, were studied in 5 trained subjects and in 5 beginners. Temperature changes were measured by thermography. Results indicated that both beginners and trained subjects showed similar significant increases in maximum hand temperatures during SRM, however, trained subjects showed significant increases during the control period as well. Further, both groups showed significant increases in the area of warmth permeation during SRM, however, trained subjects also showed a significant increase during the control period. There was a statistical difference between the two groups for the area of warmth permeation at both the end of the control period and the end of SRM. Thus, in SRM, although beginners seem to be able to raise their hand temperatures in a similar degree to trained subjects, the area of warmth permeation is significantly greater in trained subjects than in beginners. These results indicate that SRM is relatively easy to master for beginners. From these results, the technique of SRM, psychophysiological aspects of SRM and methods of self-control in general, and some issues regarding their clinical applications are discussed.

In defining psychotherapy, the central importance of person-related understanding and of the therapist–patient relationship are emphasized. When psychotherapeutic methods are applied in psychosomatic

Experiences of the past decades have shown us that, especially with psychosomatic illnesses classified as ‘somatic neuroses’, it is not enough to treat merely one member of the family through combined organic and psychiatric therapy, coupled with exercises in relaxation. If a patient who has been brought back to health is sent home to an unchanged pathological family situation, either the patient suffers a relapse or another member of the family becomes ill. The family presents its ‘sick one’ as a standard-bearer for a disturbed family structure in which very often a somatically healthy family member acts as the real psychotoxin. The attention of psychosomatic research has recently been highly concentrated on the relationship between the condition of the family circle and the psychosomatic illness of a member of that family and, therefore, on family therapy.