We have been performing various treatment outcome researches as a trial of applying behavior scientific methodologies to the field of psychosomatic medicine. The purpose of this paper is to discuss the impact of such researches, based on the results of our controlled study of cognitive behavior therapy (CBT) for eating disorders and single case study of photic feedback (PFB). We have been doing a group outcome research comparing CBT with operant conditioning plus brief psychotherapy for anorexia nervosa. Fifteen patients have participated in the study and six of them have completed the one-year follow-up for 2 years and 8 months since the start of this study. The following problems have emerged so far: (1) The number of patients introduced to each groups was very different ('2) There have been many serious or atypical cases who could not participate in this study (3) Therefore, much more time and effort will be necessary for the completion of the study, which will produce the problem of cost effectiveness and the deterioration of data quality. Some significance has been also noted: (1) We have learned to assess the seriousness of patients based on a certain criterion. (2) The common understanding about the treatment has been shared thanks to the treatment manual and supervision. (3) Whether the CBT has specific effects on anorexia nervosa will be clarified if the number of participants grows larger. PFB can enhance the alpha rhythm without subjects' own effort. We have applied it to 28 patients of various neuroses, psychosomatic diseases and depression following the single case experimental designs The precise case study of a 37-year-old neurotic depressive patient is presented according to the changes of the MOOD, his depressive mood was clearly improved by this treatment. Detailed data analyses of various autonomic measures indicated that the alpha enhancement may have produced parasympathetic suppression and sympathetic predominance, which then improved the patient's depressive symptomatology The problems were as follows: (1) The generalization of one case is not necessarily possible. (2) Much effort was needed for data analyses. The significance was as follows: (1) We have learned to assess the treatment effects more objectively than before. (2) We could know something about the mechanism of action as mentioned above. (3) A means of studying the treatment process itself was obtained, which is a necessary condition for the optimal regulation of patients' mind and body. Thus, although the introduction of treatment outcome researches accompanies many serious problems to be solved, it may bring about the following promising fruits or by products: the refinement of diagnosis and assessment methods, the common understanding about the treatment, the objective assessment of the treatment efficacy, the suggestion about the mechanism of action, and the establishment of a means of studying the treatment process itself.
|ジャーナル||Japanese Journal of Psychosomatic Medicine|
|出版ステータス||Published - 1996 1 1|
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