Hwa-byung Patients Research Articles

Study for revision of Hwa-Byung Scale: The Delphi Method

IntroductionHwa-Byung is a mental syndrome classified as a “cultural-related syndrome” which reflects the cultural characteristics of Korea in DSM-IV. Hwa-Byung is caused by anger, which is characterized by feelings of anger or resent about unreasonable social violence and trauma. Kwon et al (2008) had developed self-report measure to assess severity of Hwa-Byung but it has several limitations to use in current clinical settings. Therefore, we investigated opinions of experts who have professionality in giving treatment of Hwa-Byung patients in the clinical settings.ObjectivesThe present study aimed to reach consent of oriental neuropsychiatrists’ opinions about the direction of revision of the Hwa-Byung scale.Methods The Delphi method is a survey method that induces people to freely present their opinions without face-to-face processes and reaches consent through continuous feedback of survey results while ensuring anonymity. The Consensus Panel consists of 16 experts who are Oriental neuropsychiatrists and have experience in diagnosing patients with Hwa-Byung. A total of four surveys were conducted as consensus was reached on the fourth round. Each questionnaire was distributed by mail to a panel of experts and was asked to submit a response after receiving the questionnaire.ResultsThe results of the study are as follows. First, common factors for Hwa-Byung include anger, resent/blame, modify memory bias and attention bias for anger events. Second, characteristics of young Hwa-Byung patients include stress caused by social factors and excessive immersion in certain things such as drinking or smoking.ConclusionsTherefore, when revising the Hwa-Byung scale, it would be necessary to include these factors.DisclosureNo significant relationships.

Revision and Validation of the Hwa-Byung Scale

IntroductionHwa-Byung is a cultural-related mental syndrome that reflects the cultural characteristics of Korean in DSM-IV. This syndrome is caused by anger or resentment towards unreasonable social violence and trauma.ObjectivesThe purpose of this study is to revise and validate the ’Hwa-Byung scale’, which can be used to diagnose Hwa-Byung and evaluate the severity of its symptoms.Methods To begin with, the factors of the Hwa-Byung scale were set based on the previous studies. Additionally, the respective subfactors were generated by the semi-structured interviews with these patients. Based on these factors and previous studies, a 142-item pool was developed and verified by six Oriental Neuropsychiatrists. A pilot study was conducted on 50 patients with Hwa-Byung and the main study for the validation was conducted on 200 Hwa-Byung patients. Item analysis, internal consistency, and exploratory/confirmatory factor analysis were performed. Lastly, this study analyzed the ROC curve to present the diagnostic cut-off score of the scale.ResultsAs a result of analyzing the content validity of the item pool, we constructed a preliminary scale. We excluded the inadequate questions from the pilot study results. In the main study, The Hwa-Byung scale showed high internal consistency and its items were suitable for the factor structure. Finally, we suggest an optimal cut-off score of the symptoms sub-scale for screening Hwa-Byung.ConclusionsOverall, the results of this study indicated the reliability and validity of the Hwa-Byung Scale. Based on these results, we discussed several values and limitations of this study and provided suggestions for further research.DisclosureNo significant relationships.

A qualitative study on the symptoms and psychological characteristics of young Hwa-Byung patients

Introduction Hwa-Byung is characterized by feelings of anger or resent about unreasonable social violence and trauma. Although Prevalence of Hwa-Byung is high in middle-aged, recently Hwa-Byung is occurred in young people. And it is suggested that young Hwa-Byung patients will show different patterns from middle-aged.ObjectivesThe purpose of present study was to qualitatively analyze young Hwa-Byung patients’ experiences of symptoms and psychological characteristics related to antecedent events of Hwa-Byung.Methods10 women aged 20s were Interviewed using semi-structured questionnaires to in-depth study on their experiences related to Hwa-Byung. The interview data were analyzed using phenomenological approach in order to understand the essence of experiences. In particular, it was analyzed through five steps according to Giorgi (1985). First, by repeatedly reading the material, recurring themes were identified. Second, the meaning units were divided to capture important parts of participants’ statements. Third, similar meaning units were grouped together. Fourth, the determined meaning units were described in psychological term. Finally, research data were integrated and presented according to the described meaning units. Reliability between coders was higher than the minimum reliability coefficient.ResultsIn symptoms, two themes and seven sub-themes were emerged. In psychological characteristics, three components and five sub-themes were derived. In particular, the antecedent events of young Hwa-Byung patients were related to vertical social relationships, suggesting that Hwa-Byung need to be understood under social context which make them angry.ConclusionsPresent study revealed the social context of Hwa-Byung by discussing the differences between young and middle-aged patients, and furthermore, differences between Hwa-Byung and depression, PTSD patients.DisclosureNo significant relationships.

Effect of herbal medicine (Huanglian-jie-du granule) for somatic symptoms and insomnia in patients with Hwa-byung: A randomized controlled trial

BackgroundHuanglian-jie-du (HJD) granule, which is composed of representative “heat-clearing” herbs has been used for Hwa-byung. Hwa-byung is a culture-bound syndrome in Korea, characterized by distinct somatic symptoms such as chest congestion and heat sensation resulting from suppressed anger. We investigated the effect of HJD in patients with Hwa-byung. MethodsForty-four patients with Hwa-byung were recruited, and HJD or placebo granules were administered orally three times daily for seven days. The two primary outcomes were somatic symptoms, which were measured by Patient Health Questionnaire of physical symptoms (PHQ-15), and insomnia, which was measured by Insomnia Severity Index (ISI) at post-treatment. ResultsBetween July 10 and October 31, 2017, 44 patients with Hwa-byung (mean age 36.68 years; and 38 female) were randomly assigned to HJD (n = 22) or placebo (n = 22) group. After administration of HJD or placebo granule for seven days, ISI score was lower in the HJD group compared to placebo group at post-treatment (adjusted mean difference -2.56 [95% CI -4.72 to -0.39], p = 0.0208). Meanwhile, there was no difference in PHQ-15 score between HJD group and placebo group at post-treatment (adjusted mean difference -0.50 [95% CI: -3.02–4.02], p = 0.7812). ConclusionsOur results suggest that the administration of HJD granule has a potential to improve insomnia in Hwa-byung patients. Effect of HJD granule for general somatic symptoms in Hwa-byung patients is unclear, and further researches are needed. Trial registrationClinical Research Information Service, KCT0002379.

Effect of the Emotional Freedom Techniques on anger symptoms in Hwabyung patients: A comparison with the progressive muscle relaxation technique in a pilot randomized controlled trial

ContextHwabyung is a psychosomatic disease resulting from the suppression of anger over an extended period. The Emotional Freedom Techniques (EFT) are meridian-based psychotherapy known to cure many psychosomatic diseases, and progressive muscle relaxation (PMR) is a therapeutic method that relieves physical and psychological tension by repeated tensing and relaxation of the muscles. ObjectIn this study, we compared the effects of EFT and PMR in patients with Hwabyung. Design40 patients were enrolled and randomized to receive 4 weeks of group sessions with either EFT (n = 20) or PMR (n = 20). Evaluations were conducted pre- and post-treatment and at 4-week and 24-week follow-ups after session end. Main Outcome MeasuresThe Hwabyung Scale, Visual Analogue Scale of Hwabyung Symptoms (VAS-HS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and State-Trait Anger Expression Inventory (STAXI) were administered as self-report tools. The analysis excluded 8 patients who never attended treatment and 1 patient meeting the exclusion criteria. ResultEFT (n = 15) and PMR (n = 16) improved Hwabyung symptoms (−13.95% and −11.46%, respectively), state anxiety (−12.57% and −12.64%, respectively), and depression (−32.11% and −18.68%, respectively) (p < 0.05 for all). Trait anger improved in EFT group (−13.4%, p = 0.004). There were no significant differences between the groups (p > 0.05) except for trait anger at post-treatment (p = 0.022 for between group). No adverse events were reported during the study.

Role of the Baseline Heart Rate Variability to the Effect of the Huanglian-Jie-Du Granule in Hwa-Byung Patients: Supplementary Analysis from the Randomized Trial Comparing Huanglian-Jie-Du Granule and Placebo for Hwa-Byung

Role of the Baseline Heart Rate Variability to the Effect of the Huanglian-Jie-Du Granule in Hwa-Byung Patients: Supplementary Analysis from the Randomized Trial Comparing Huanglian-Jie-Du Granule and Placebo for Hwa-Byung

The efficacy and safety of a Huanglian-jie-du decoction on Hwa-byung patients: A study protocol for a randomized controlled trial.

ObjectiveHwa-byung is one of the cultural concept of distress in Korea resulted from chronic accumulated anger. It is characterized by various symptoms like stuffy in the chest, hot or heat sensation, something pushing up in the chest, feeling of mortification, and a flush of anger. This protocol aims to explore the efficacy and safety of Huanglian-jie-du decoction on various somatic symptoms and insomnia in patients with Hwa-byung.MethodsThis is study protocol for a randomized, double-blind, placebo-controlled trial. A total of 44 patients will be randomly assigned to the experimental group or the placebo group in a 1:1 ratio. All medications will be taken orally 3 times per day for 7 consecutive days. The primary outcomes are the mean changes in Patient Health Questionnaire of physical symptoms (PHQ-15) and Insomnia Severity Index (ISI) after the 7 days of administration. The secondary outcomes include the scales to assess stress response, symptoms of Hwa-byung, and state anger.ConclusionThe results of this study will provide high quality and explorative evidence to investigate the effect of Huanglian-jie-du decoction on Hwa-byung.

Korean medicine for Hwa-byung: a systematic and meta-analysis

To assess the effectiveness of Korean medicine as complementary therapy for Hwa-byung from randomized controlled trials (RCTs). Five electronic databases, including English and Korean, were systematically searched up until August 2015. All RCTs involving Korean medicine in combination with conventional therapy for Hwa-byung were included. Five RCTs involving 323 Hwa-byung patients were systematically reviewed. Among them three studies of 139 patients reported a significant improvement in STAXI-E-in and BDI than control group in the treatment group while no significant improvement in STAXI-S, STAXI-T, STAXI-E-con and STAXI-E-out. The four studies of 189 patients reported a significant improvement in STAI in the treatment group. The results of the included studies suggest that Korean medicine is efficacious for Hwa-byung patients in some specific scale. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues.

화병군과 비화병군의 의사소통 유형 및 스트레스 대처 방식 비교 연구

Objectives: Interpersonal stress is a major cause and aggravating factor of Hwabyung. The purpose of this study was to compare communication type and stress coping style between the Hwabyung pa-tients group and non-Hwabyung patients group.Methods: The total number of study participants was 101. Based on the Hwabyung symptom scale, the study participants were divided into Hwabyung patients group (30 patients) and non-Hwabyung pa-tients group (43 patients; control group), and the others were excluded from the study . All included patients were administered the Virginia Satir's communication type questionnaire and stress coping scale based on Folkman & Lazarus's theory. The independent t-test was used to determine the stat-istical significance between the features of communication types and stress coping styles in each group. In addition, Spearman correlation analysis was used to identify the relationship between com-munication types and stress coping styles.Results and Conclusions: 1. Communication types differed significantly between the Hwabyung pa-tients group and non-Hwabyung patients group. 2. Hwabyung patients scored significantly higher in each dysfunctional communication type than functional communication type. Scores of placating stance and super-reasonable stance, which were subtypes of dysfunctional communication type, were high in the Hwabyung patients group. The non-Hwabyung patients group scored the highest in Congruent stance, classified as functional communication type. 3. Stress coping style was not sig-nificantly different between the two groups.Key Words: Hwabyung, Satir, Communication type, Stress coping.

Anxiety and Anger Symptoms in Hwabyung Patients Improved More following 4 Weeks of the Emotional Freedom Technique Program Compared to the Progressive Muscle Relaxation Program: A Randomized Controlled Trial

Background. The Emotional Freedom Technique (EFT) is a meridian-based psychological therapy. The present clinical trial investigates the effectiveness of EFT as a new treatment option for Hwabyung (HB) patients experiencing anger and compares the efficacy to the Progressive Muscle Relaxation (PMR), the conventional meditation technique. Methods. The EFT and progressive muscle relaxation (PMR) methods were performed on 27 HB patients, and their capacities to alleviate anxiety, anger, and emotional status were compared. After a 4-week program, a survey was conducted; patients then completed a self-training program for 4 weeks, followed by a second survey. Results. During the initial 4 weeks, the EFT group experienced a significant decrease in the HB symptom scale, anger state, and paranoia ideation (p < 0.05). Over the entire 9-week interval, there were significant decreases in the HB symptom scale, anxiety state, anger state, anger trait, somatization, anxiety, hostility, and so on in EFT group (p < 0.05). Conclusion. The EFT group showed improved psychological symptoms and physical symptoms greater than those observed in the PMR group. EFT more effectively alleviated HB symptoms compared to PMR. EFT group showed better maintenance during self-training, suggesting good model of self-control treatment in HB patients.

Scientific Evidence for Korean Medicine and Its Integrative Medical Research

Scientific Evidence for Korean Medicine and Its Integrative Medical Research

Qualitative Analysis of the Hwa-byung Recovery Process and Influencing Factors

Objectives: To describe the progress and influencing factors of Hwa-byung. Methods: Data were collected from semi-structured interviews. The progress of and recovery from Hwa-byung were examined using the collected experiences of eight middle-aged women who suffered from Hwa-byung. For analysis of the data collected, a Consensual Qualitative Research (CQR) methodology was used. Results: Of the eight participants who thought they had Hwa-byung, six were actually Hwa-byung patients and two were non-Hwa-byung patients. Four years later, four of the six Hwa-byung patients recovered, while the Hwa-byung of one patient persisted, and the remaining patient had circular Hwa-byung. Over time, the symptoms of Hwa-byung declined substantially. However, the patients recognized that their disease continuously persisted. Moreover, they thought their symptoms had worsened. Many types of changes were observed during the recovery period, including environmental, physical, cognitive, and emotional changes, as well as changes in attitudes toward others. Recovery factors included the reduction of stimuli, social support, exercise, treatment, control of rumination, and some cognitive changes. Conclusions: To recover from Hwa-byung, it is necessary for patients to experience changes in environment, cognition, and emotion, and to employ self-management in everyday life.

화병환자의 불면증 침치료가 인체의 자율신경계에 미치는 영향

Received: August 21, 2014 Revised: September 17, 2014 Accepted: September 25, 2014 Objectives: The purpose of this research is to examine effects of acupuncture treatment on the autonomic nervous systems of Hwa-byung patients with insomnia. Methods: The study was performed through a patient-assessor blind, randomized, placebo-controlled trial in which the volunteers, data collectors, and analysts were unaware of which individuals were receiving the treatment. A total of thirty-seven volunteers were divided into 2 groups. Eighteen subjects were placed into a trial group and 19 subjects into a control group using a randomization table. The trial group was treated with bilateral Shigu, Ahnmyun, B62 (Shinmaek), and K6 (Chohae), while the control group was not given any other treatment. The ISI (Insomnia Severity Scale) was measured as the first evaluative instrument, and then a comparative analysis was conducted by comparing the results with those measured by ANS (BVP/HR, respiration rate, peripheral temperature, skin conductance, EMG). Results: In the BVP/HR, statistically significant decreases were found in those from the trial group compared to those of the control group. Skin conductance was found to be significantly increased in the trial group, as compared to the control group. However, there were no significant differences between the groups with respect to peripheral temperature, respiration rate, and EMG. Conclusions: The results suggest that acupuncture treatment is effective in the treatment of hwa-byung patients who suffer from insomnia due to their autonomic nervous systems.

EFT 집단치료 프로그램이 화병환자에게 미치는 영향에 대한 질적분석

Objectives: The objective of this study is to examine the effects of Emotion Freedom Techniques (EFT) group treatment program for Hwa-byung patients. Methods: Thirteen Hwa-byung patients have participated in the four weeks program of EFT group treatment and the program was executed once a week, for about one hour. After every session, the participants performed EFT by themselves in order to control their symptoms. Four weeks after the program ended, we interviewed the participants by using the semi-structured interview method to observe changes of Hwa-byung. All the data collected was summarized through the qualitative analysis method. Results: Results showed effects of the EFT group treatment program, with regards to the physical, cognitive and emotional aspects. Most of the participants experienced reliefs of Hwa-byung symptoms like chest tightness, hot flashes, insomnia and so on. Their ability to cope with stress improved and their re-experiences of past memories decreased. And their distorted self-images were also restored. Lastly, there was a decrease in negative emotions and an increase in positive emotions experienced by the participants. The participants could control their symptoms by performing self-enforcement. In addition, regarding the form of group therapy, the treatment was effective as it helped the participants to feel solidarity and social support. Conclusions: The EFT group treatment program can relieve the physical, cognitive and emotional symptoms of Hwa-byung. This program can be applied to the psychotherapy of Hwa-byung.

화병 임상진료지침 II. (화병의 실태)

Objectives : The Hwabyung Research Center of The Korean Society Of Oriental Neuropsychiatry attempted to produce clinical guidelines for doctors of Korean medicine for treatment of Hwabyung. Methods : A standard guideline development process was followed. Relevant literature was identified by a review of bibliographies. The operational criteria were used to rate quality of scientific evidence, and line of treatment recommendations included a consensus clinical opinion. This section of the status of Hwabyung in Korea is 2 out of 5 articles drafted and reviewed by clinicians. Results : Hwabyung is changed depending on time and have a risk of relapse. Like previous studies, Female and lower socio-economic and educational level people suffers Hwabyung frequently. But recently number of Male Hwabyung patients increases. Recovery of Hwabyung is involved in depression, anxiety, stress. Hwabyung is related to Major depressive disorder, generalized anxiety disorder, somatoform disorder and diseases of digestive system. Conclusions : This study was observed for progression of Hwabyung. Hwabyung is a long-term disease associated with depression, anxiety and stress. Hwabyung is accompanied by physical and psychological symptoms and degrades quality of life.

기질 및 성격검사(TCI)에 나타난 한방신경정신과 환자의 전반적 특성 및 화병 환자의 특성

Objectives : The purpose of this study is to examine the general personality profiles of patients who visited an oriental neuropsychiatric clinic and to investigate the specific profiles of patients diagnosed with Hwa-byung. Methods : We analyzed the profiles of 122 patients who completed TCI-RS questionnaire for the purpose of counseling. Patients were divided by sex, age and diagnosis related groups. Scales and subscales of each group were compared by an independent t-test and ANCOVA with SPSS windows 16.0. Types of temperament and character were classified by percentile ranks of the total patients and diagnosis related groups. Results : 1. Total patients were classified as the high harm avoidance type of temperament and of low self-directedness type of character. 2. Male patients showed significantly higher scores on NS, all subscales of NS, P2 and P3 than female patients. HA4 and C5 scores were significantly higher in the female group. Younger patients showed significantly higher scores on NS, all subscales of NS, HA1 and P3. However, older patients had significantly higher scores on SD4, SD5, ST2 and ST3. 3. Between diagnosis related groups, Hwa-byung group had significantly higher scores on RD, ST, SD3 and ST2. However P3 score of non-hwa-byung patients was higher than hwa-byung patients. In typical classification, both hwa-byung and non-hwa-byung groups were classified as the same types as total patients. Conclusions : This study showed that the patients visited an oriental neuropsychiatric clinic and had similar personality with that of general psychiatric disorders. Hwa-byung patients exhibited higher RD and ST scores than other disorders, but they had no typical differences.

화병에 대한 산림치유프로그램의 치료 효과

Objectives : The purpose of this study is to examine the effects of a 3 day Hwa-Byung forests healing program, which consists of helpful contents of Korean medicine. Methods : This study examined the effects of forests healing for Hwa-Byung patients, visited Korean medicine hospital neuropsychiatry clinic for outpatients. The Hwa-Byung forests healing program was run with 20 participants; 4 of them quit in the middle of the program and excluded in data analysis. The Hwa-Byung forests healing program consisted of 3 day helpful Korean medicine contents. The primary outcome measurement was Hwa-Byung symptom score, which measured various symptoms of Hwa-Byung. Results : The results of this study showed that Hwa-Byung symptoms were significantly alleviated. General psychological states, including depression, anxiety, and anger, were significantly improved. Quality of life was also enhanced after 3 day program. These results indicate that the 3 day Hwa-Byung forests healing program was effective for the overall improvements of Hwa-Byung patients. Conclusions : The 3 day Hwa-Byung forests healing program were shown to be an effective intervention in improving the overall aspects of Hwa-Byung patients, including symptoms, depression, anxiety, anger, and Quality of life.

화병환자의 마음챙김에 기초한 스트레스 감소 프로그램(Mindfulness-based Stress Reduction:MBSR)경험에 관한 질적 연구

Objectives : The objective of the study is to examine what effects the Mindfulness-based stress reduction program can have on Hwa-byung patients. Methods : Ten Hwa-byung patients have participated in this 8-week Mindfulness-based stress reduction program for Hwa-byung. In addition, participants were interviewed regarding the experiences from the changes during meditation or everyday life. Data were collected though a consumer panel and individual interviews. Responses were coded using Consensual Qualitative Research (CQR) methodology. Results : The experiences were categorized into 7 domains and divided to 23 categories. Results showed the psychotherapeutic effects of Mindfulness-based stress reduction program, specifically, positive cognitive changes, emotional stability, and changes in attitude. Also, all participants reported improvement of anger management skill and feeling of tranquility. This means that the Mindfulness-based stress reduction program can relieve the symptoms of Hwa-byung. Conclusions : Mindfulness-based stress reduction program makes changes about emotion, physical symptoms, cognition and personal relationship. This program can be applied to psychotherapy for Hwa-byung.

화병환자의 불면증상에 대한 침치료 유효성 평가연구: 환자-평가자 눈가림, 무작위배정, 일반대조군 임상시험

AbstractObjectives:The purpose of this research is to examine the effects of acupuncture treatment on Hwa-byung patient's insomnia. Methods:The study was performed through a patient-assessor blind, rando mized, placebo-controlled trial in which the volunteers, data collectors and analysts were unaware of indivi duals who were receiving the treatment. A total of thirty-seven volunteers were divided into 2 groups. 18 subjects were placed into a trial group and 19 subjects into a control group by a randomization table. The trial group was t reated on bilateral Shigu, Ahnmyun, B62 (Shinmaek), and K6 (Chohae), while the control group was not gi ven any other treatment. The ISI(Insomnia Severity Scale) was measured as the 1st evaluative instrument, and then a comparative analysis was conducted by comparing the results with those measured by a Likert scale for major symptoms of Hwa-byung, PSQI, Hwa-byung scale, BDI, STAI, and STAXI. Results:In the ISI, PSQI, and the Likert scale regarding major symptoms of Hwa-byung, Hwa-byung scale, BDI, and STAI, more significant decreases were found in those concerning the trial group compared to those of the control group from a statistical perspective. However, in the STAXI, regardin g the trial group, there was no significant decrease compared to the control group. Conclusions:The results suggest that acupuncture treatment is effective in the treatment regarding Hwa-byung patients who suffer from insomnia. Keywords :Hwa-byung, insomnia, acupuncture treatment

Differences in temperament and character dimensions of personality between patients with Hwa-byung, an anger syndrome, and patients with major depressive disorder

This study examined differences in temperament and character dimensions of personality between patients with Hwa-byung (HB) and those with major depressive disorder (MDD). Of 144 participants, 96 completed the Korean version of the Temperament and Character Inventory-Revised Short (TCI-RS) and the Hwa-byung Scale. We diagnosed participants according to the DSM-IV and the Research Diagnostic Criteria for Hwa-byung. We compared TCI scores between the HB group (with or without MDD; N=55) and the MDD-only group (N=41) and correlated them with the total scores on six HB-specific symptoms (global HB severity) on the Hwa-byung Scale. Compared to patients with only MDD, patients with HB with or without MDD exhibited significantly higher scores on Impulsiveness; Harm Avoidance (HA) and its subscales of Anticipatory Worry; and Self-Transcendence (ST), with its subscale of Self-Forgetfulness. However, HB patients had lower scores on Self-Directedness, with its subscales of Responsibility, and Self-Acceptance; and Acceptance. Moreover, Global HB Severity had significant, positive correlations with ST, its subscale Self-Forgetfulness, and Anticipatory Worry but negative correlations with Attachment and Compassion. Our data are cross-sectional and self-reported, so they are subject to personal perceptual bias. The number of participants may be too low for us to generalize the results. These results suggest that HB is a different clinical entity from MDD in relation to personality traits, and that symptoms unique to HB are closely correlated with ST.