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Yoshiyuki Hirakawa,1 Akira Fujiwara,2 Ryota Imai,3,4 Yuki Hiraga,1,5 Shu Morioka4,6 1Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka City, Fukuoka, Japan; 2Department of Orthopedics, Fukuoka Reha Orthopedic Clinic, Fukuoka City, Fukuoka, Japan; 3School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka City, Osaka, Japan; 4Department of Occupational Therapy, International Univesrity of Health and Welfare, Okawa,Fukuoka, Japan; 5Neurorehabilitation Research Centre, Kio University, Nara, City, Nara, Japan; 6Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara City, Nara, JapanCorrespondence: Yoshiyuki HirakawaDepartment of Rehabilitation, Fukuoka Rehabilitation Hospital, 7-770 Nokata, Nishi-ku, Fukuoka City 819-8551, Fukuoka, JapanTel +81 92 812-1555Fax +81 92 811-0330Email yutsuki0903@yahoo.co.jpAbstract: A woman in her thirties developed complex regional pain syndrome in her left shoulder due to a traffic accident. She demonstrated autonomic nervous symptoms (swelling, sweating, and skin color asymmetry) in her left hand, severe allodynia, neglect-like symptoms (NLS), impaired body image associated with impaired body awareness, and functional impairment of the left shoulder and elbow. She also reported physical self-disgust toward her affected limb, describing it as “reptilian,” as well as aversion to touching others; this body awareness exacerbated her pain and NLS. We therefore conducted stepwise interventions using body shadows. The intervention did not trigger physical self-disgust, enabling formation of body ownership and a body image unaccompanied by pain. Consequently, the patient showed improvements in pain, NLS, and autonomic nervous symptoms.Keywords: pain, neglect-like symptoms, physical self-disgust, body shadow intervention, body image

Keiko Ino,1 Sei Ogawa,1 Masaki Kondo,1 Risa Imai,1 Toshitaka Ii,1 Toshi A Furukawa,2 Tatsuo Akechi1 1Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, 2Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan Background: Panic disorder (PD) is a common disease and presents with broad dimensions of psychopathology. Cognitive behavioral therapy (CBT) is known to improve these broad dimensions of psychopathology in addition to PD symptoms. However, little is known about the predictors of treatment response in comorbid psychiatric symptoms after CBT for PD. Recent studies suggest that anxiety sensitivity (AS) may be a key vulnerability for PD. This study aimed to examine AS as a predictor of broad dimensions of psychopathology after CBT for PD. Materials and methods: In total, 118 patients with PD were treated with manualized group CBT. We used multiple regression analysis to examine the associations between 3 Anxiety Sensitivity Index (ASI) factors (physical concerns, mental incapacitation concerns, and social concerns) at baseline and the subscales of the Symptom Checklist-90 Revised (SCL-90-R) at endpoint. Results: Low levels of social concerns at baseline predicted low levels on 5 SCL-90-R subscales after CBT: interpersonal sensitivity, depression, hostility, paranoid ideation, and psychosis. High levels of mental incapacitation concerns significantly predicted low levels on 3 SCL-90-R subscales after treatment: interpersonal sensitivity, hostility, and paranoid ideation. Physical concerns at baseline did not predict broad dimensions of psychopathology. Conclusion: This study suggested that the social concerns and mental incapacitation concerns subscales of the ASI at baseline predicted several dimensions of psychopathology after CBT for PD. To improve comorbid psychopathology, it may be useful to direct more attention to these ASI subscales. Keywords: panic disorder, anxiety sensitivity, comorbid psychopathology, predictor, cognitive behavioral therapy