Research In Psychosomatic Medicine Research Articles

Research progress in psychosomatic medicine in 2023: An overview

Psychosomatic medicine focuses on exploring the interactions of biological, psychological, and social factors in regulating the balance between health and disease. Recent shifts in disease spectra and medical models have contributed to the heightened prevalence and burden of psychosomatic diseases, posing new challenges to the contemporary health-care system. Consequently, there has been an imperative drive toward intensified research in psychosomatic medicine. Neuroscience methodologies have been widely applied in the research of psychosomatic diseases, facilitating the exploration of underlying causal mechanisms of psychosomatic diseases and the examination of correlations between brain function, specific organ systems, and clinical manifestations. This article offers a review of the contemporary research developments in 2023 regarding the pathogenesis, diagnosis, treatment, and intervention strategies for psychosomatic diseases, approached from various systemic perspectives. Drawing upon these insights, it offers an outlook on the future of psychosomatic medicine, aiming to enhance the integration of body–mind to clinical practice for the management of psychosomatic diseases.

Psychosomatic medicine research of obesity and TCM countermeasures

Psychosomatic medicine research of obesity and TCM countermeasures

The Good, the Bad, and the Ugly-Chances, Challenges, and Clinical Implications of Avoidance Research in Psychosomatic Medicine.

Avoidance behaviors are shaped by associative learning processes in response to fear of impending threats, particularly physical harm. As part of a defensive repertoire, avoidance is highly adaptive in case of acute danger, serving a potent protective function. However, persistent or excessive fear and maladaptive avoidance are considered key factors in the etiology and pathophysiology of anxiety- and stress-related psychosomatic disorders. In these overlapping conditions, avoidance can increase the risk of mental comorbidities and interfere with the efficacy of cognitive behavioral treatment approaches built on fear extinction. Despite resurging interest in avoidance research also in the context of psychosomatic medicine, especially in conditions associated with pain, disturbed interoception, and disorders of the gut-brain axis, current study designs and their translation into the clinical context face significant challenges limiting both, the investigation of mechanisms involved in avoidance and the development of novel targeted treatment options. We herein selectively review the conceptual framework of learning and memory processes, emphasizing how classical and operant conditioning, fear extinction, and return of fear shape avoidance behaviors. We further discuss pathological avoidance and safety behaviors as hallmark features in psychosomatic diseases, with a focus on anxiety- and stress-related disorders. Aiming to emphasize chances of improved translational knowledge across clinical conditions, we further point out limitations in current experimental avoidance research. Based on these considerations, we propose means to improve existing avoidance paradigms to broaden our understanding of underlying mechanisms, moderators and mediators of avoidance, and to inspire tailored treatments for patients suffering from psychosomatic disorders.

Implicit Affect, Heart Rate Variability, and the Metabolic Syndrome.

Greater negative affect has been associated with an increased risk of the metabolic syndrome (METs). However, all studies to date have examined this association using explicit affect measures based on subjective ratings of emotional experiences. Prior studies suggest that implicit affect, representing the automatic, prereflective appraisal process involved in conscious emotional experiences, is associated with physiological stress responses independent of explicit affect. Furthermore, low resting heart rate variability (HRV) may increase the risk of stress-related diseases. The goals of this study were to evaluate the associations between implicit and explicit affect and METs and to assess whether these associations were amplified by lower HRV. This secondary analysis of a larger study included 217 middle-aged women who completed measures of implicit affect, explicit affect, high-frequency HRV, and the different components of METs. There was a significant interaction between implicit negative affect and HRV predicting METs (odds ratio = 0.57, 95% confidence interval = 0.35-0.92), such that the combination of higher implicit affect and lower HRV was associated with a greater likelihood of METs. Similarly, there was a main effect of implicit negative affect as well as an interaction between implicit negative affect and HRV on the lipid accumulation product (b (standard error) = -0.06 (0.02), 95% confidence interval = -0.11 to -0.02), a combination of waist circumference and triglycerides. Higher implicit negative affect in the context of lower HRV may be related to a greater risk of METs. The present findings highlight the relevance of including implicit affect measures in psychosomatic medicine research.

Mismatch in Spouses' Anger-Coping Response Styles and Risk of Early Mortality: A 32-Year Follow-Up Study.

Research in psychosomatic medicine includes a long history of studying how responses to anger-provoking situations are associated with health. In the context of a marriage, spouses may differ in their anger-coping response style. Where one person may express anger in response to unfair, aggressive interpersonal interactions, his/her partner may instead suppress anger. Discordant response styles within couples may lead to increased relational conflict, which, in turn, may undermine long-term health. The current study sought to examine the association between spouses' anger-coping response styles and mortality status 32 years later. The present study used data from a subsample of married couples (N = 192) drawn from the Life Change Event Study to create an actor-partner interdependence model. Neither husbands' nor wives' response styles predicted their own or their partners' mortality. Wives' anger-coping response style, however, significantly moderated the association of husbands' response style on mortality risk 32 years later, β = -0.18, -0.35 to -0.01, p = .039. Similarly, husbands' response style significantly moderated the association of wives' response style and their later mortality, β = -0.24, -0.38 to -0.10, p < .001. These effects were such that the greater the mismatch between spouses' anger-coping response style, the greater the risk of early death. For a three-decade follow-up, husbands and wives were at greater risk of early death when their anger-coping response styles differed. Degree of mismatch between spouses' response styles may be an important long-term predictor of spouses' early mortality risk.

Psychosomatic Medicine Research: a Bridge Between Physical and Psychological Therapy

Psychosomatic Medicine Research: a Bridge Between Physical and Psychological Therapy

Worsening Depression in a Patient with a Granulosa Cell Tumor

Increased estrogen levels are likely to play a role in depression. The steroid hormone estrogen can modulate turnover of neurotransmitters by enhancing serotonin and noradrenaline levels. Estrogen is also involved in the regulation of serotonin receptor number and function. 1 Oscillating estrogen levels during the postmenopausal period or caused by an estrogen-producing tumor may herald a recurrence or a worsening of the depressive episode in a woman with a previous diagnosis of depression. Both high and low levels of estrogen have been associated with the occurrence of depressive symptoms, and the variability in estrogen may cause depression. 2,3 This suggests that exploring the hypothalamicpituitary-gonadal axis in depression may yield areas of research in psychosomatic medicine and psychooncology. At present, evidence-based pharmacologic options are being studied for treating estrogen-sensitive depression. This article offers information on the pharmacological treatment and characteristics of depression in a woman with a previous diagnosis of major depression who is experiencing extreme fluctuations of estrogen levels.

Multilevel Modeling in Psychosomatic Medicine Research

The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.

Mediation Analysis in Psychosomatic Medicine Research

This article presents an overview of statistical mediation analysis and its application to psychosomatic medicine research. The article begins with a description of the major approaches to mediation analysis and an evaluation of the strengths and limits of each. Emphasis is placed on longitudinal mediation models, and an application using latent growth modeling is presented. The article concludes with a description of recent developments in mediation analysis and suggestions for the use of mediation for future work in psychosomatic medicine research.

The Rebirth of Neuroscience in Psychosomatic Medicine, Part II: Clinical Applications and Implications for Research

During the second half of the last century, biopsychosocial research in psychosomatic medicine largely ignored the brain. Neuroscience has started to make a comeback in psychosomatic medicine research and promises to advance the field in important ways. In this paper we briefly review select brain imaging research findings in psychosomatic medicine in four key areas: cardiovascular regulation, visceral pain in the context of functional gastrointestinal disorders, acute and chronic somatic pain and placebo. In each area, there is a growing literature that is beginning to define a network of brain areas that participate in the functions in question. Evidence to date suggests that cortical and subcortical areas that are involved in emotion and emotion regulation play an important role in each domain. Neuroscientific research is therefore validating findings from previous psychosomatic research and has the potential to extend knowledge by delineating the biological mechanisms that link mind and body more completely and with greater specificity. We conclude with a discussion of the implications of this work for how research in psychosomatic medicine is conducted, the ways in which neuroscientific advances can lead to new clinical applications in psychosomatic contexts, the implications of this work for the field of medicine more generally, and the priorities for research in the next 5 to 10 years.

The Rebirth of Neuroscience in Psychosomatic Medicine, Part I: Historical Context, Methods, and Relevant Basic Science

Neuroscience was an integral part of psychosomatic medicine at its inception in the early 20th century. Since the mid-20th century, however, psychosomatic research has largely ignored the brain. The field of neuroscience has burgeoned in recent years largely because a variety of powerful new methods have become available. Many of these methods allow for the noninvasive study of the living human brain and thus are potentially available for integration into psychosomatic medicine research at this time. In this first paper we examine various methods available for human neuroscientific investigation and discuss their relative strengths and weaknesses. We next review some basic functional neuroanatomy involving structures that are increasingly being identified as relevant for psychosomatic processes. We then discuss, and provide examples of, how the brain influences end organs through "information transfer systems," including the autonomic, neuroendocrine, and immune systems. The evidence currently available suggests that neuroscience holds great promise for advancing the goal of understanding the mechanisms by which psychosocial variables influence physical disease outcomes. An increased focus on such mechanistic research in psychosomatic medicine is needed to further its acceptance into the field of medicine.

Neural Substrates of Implicit and Explicit Emotional Processes: A Unifying Framework for Psychosomatic Medicine

There are two broad themes in psychosomatic medicine research that relate emotions to physical disease outcomes. Theme 1 holds that self-reported negative affect has deleterious effects and self-reported positive affect has salubrious effects on health. Theme 2 holds that interference with the experience or expression of negative affect has adverse health consequences. From the perspective of self-report these two traditions appear contradictory. A key thesis of this paper is that the foundational distinction in cognitive neuroscience between explicit (conscious) and implicit (unconscious) processes, corresponding to Themes 1 and 2, respectively, provides a unifying framework that makes empirical research on unconscious emotional processes more tractable. A psychological model called "levels of emotional awareness" is presented first that places implicit and explicit emotional processes on a cognitive-developmental continuum. This model 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. Empirical findings using the Levels of Emotional Awareness Scale are presented. A parallel hierarchical model of the neural substrates of emotional awareness is presented next supported by recent neuroimaging and lesion work. The evidence presented in this review suggests that the neural substrates of implicit and explicit emotional processes are distinct, that the latter have a modulatory effect on the former, and that at the neural level Theme 1 and Theme 2 phenomena share critical similarities. The implications of this psychobiological model for research in psychosomatic medicine are discussed.

Funded research in psychosomatic medicine, medical psychology, and psychotherapy

This paper, summarizing the activities of the research task force of the German College of Psychosomatic Medicine (DKPM), reviews how research in psychosomatic medicine, medical psychology and psychotherapy has been funded by different institutions. The review reveals that psychosocial research has received considerable grants especially by the German Research Council and the Federal Ministry of Education and Research but also from other funding institutions. Besides an overview of potential sources for funding in the psychosocial disciplines, recommendations are formulated that might be helpful for raising research funds in the future.

Psychosomatic research in primary health care--ideal concept and reality

The cooperation between research institutions and primary care doctors can be seen as a possible model for practical research in psychosomatic medicine. Cooperation experience with a study in the field of sexual medicine are reported as well as recommendations regarding the planning and implementation of similar studies are given. 7455 Swiss physicians specialized in psychiatry, internal or general medicine were asked to fill out a survey on "sexual dysfunction and anti-depressants". They were also asked if they were willing to interview their patients on the same issue. 1100 physicians agreed to answer the doctors survey and 62 were interested in interviewing their patients. However, only 12 physicians actually did. In 55 telephone interviews doctors mentioned as their main reasons for not participating: lack of time and their hesitation to discuss sexual issues with depressive patients. The collaboration in research projects means a considerable effort on the side of primary care doctors. Therefore, their cooperation should be rewarded appropriately, e.g. time could be counted as further training.

Psychological stress, neuroimmunomodulation, and susceptibility to infectious diseases in animals and man: a review.

This article reviews research on the role of psychological stress, personality, social support and other psychosocial factors in bacterial, viral and parasitic infections. After 100 years of research on man and animals, psychological stress is considered as a potential cofactor in the pathogenesis of infectious disease. Psychological stress seems able to alter the susceptibility of animals and man to infectious agents, influencing the onset, course and outcome of certain infectious pathologies. Many experiments have identified in neuroimmunomodulation the principal mediator of the alterations associated with conditions of stress. The development of psychoneuroimmunology has fostered in-depth study of the complex relationship between psychosocial factors, the central nervous system, the immune system and infectious disease. Although antimicrobial drugs have certainly remained the basis of all anti-infective therapy, this type of study has already led some authors to propose and experiment protocols of psychological intervention or psychoimmunotherapy in pathologies such as tuberculosis, or herpes simplex virus or human immunodeficiency virus infections. The psychoneuroimmunological approach to infectious diseases will probably grow in importance in the future not only in the setting of research in psychosomatic medicine but also in that of clinical microbiology.

Consultation-liaison psychiatry in Australia

Consultation-liaison (C-L) psychiatry as a service entity has developed slowly and to a variable extent in Australia despite the presence of factors conducive to its development. These include a compulsory national health insurance system and a favorable disposition to the biopsychosocial model and to psychoanalytic ideas. C-L psychiatry, however, does enjoy a high profile in many undergraduate medical and postgraduate psychiatry teaching programs. Research on C-L psychiatry is emerging, complementing a strong history of research in psychosomatic medicine. An Australian and New Zealand C-L psychiatry interest group is being formed. Collaboration with the MICRO-CARES Consortium and the European Consultation-Liaison Workgroup is proving to be a great stimulus.

Revising the Seriousness of Illness Rating Scale: Modernization and Re-Standardization

The burgeoning research in psychosomatic medicine requires quantitative measures reflecting important biological, psychological, and social variables. The Seriousness of Illness Rating Scale (SIRS), although twenty years old, is currently utilized in psychosomatic research as an index of illness seriousness. In light of medical advances during the past two decades, an expansion and re-standardization of the SIRS appeared warranted. Forty-six medical students, residents, and faculty rated the seriousness of 137 disease items. High inter-rater reliability was demonstrated by a concordance coefficient of 0.716 and overwhelming agreement on relative disease item rankings between the three medical groups. Thus, the Seriousness of Illness Rating Scale-Revised (SIRS-R) is an ordinal level scale which reliably measures current views on illness seriousness and can be easily employed in multivariate psychosomatic research.

International trends of therapy and research in psychosomatic medicine.

Against the background of the holistic concept of illness trends of psychosomatic therapy and research are identified in major countries. Different countries tend to concentrate on different aspects of research or praxis based largely on their compatibility with cultural or social assumptions of illness. The psychotherapies, behavioral medicine, social therapies and biological approaches are underscored in a given country and even within the same country competing therapies strive for hegemony. Problems and limitations of the reductionistic versus the holistic approaches in psychosomatic research are highlighted.

Book reviews

Book reviewed in this article:Human Sexuality and its Problems. By J. Bancroft.Empirical Studies of Psychoanalytic Theories, vol. 1. Edited by Joseph Masling.Crisis Intervention: Therapy for Psychological Emergencies. By D. Aguilera &amp; J. Messick. St LouisBirth Order: Its Influence on Personality. By Cecile Ernst &amp; Jules Angst.Handbook of Clinical Psychobiology and Pathology, vols 1 &amp; 2. By S. Cohen &amp; R. Ross. WashingtonQuestions and Answers in the Practice of Family Therapy. Edited by A. Gurman.Psychotherapy and the Practice of Child Psychiatry: Malcolm Millar Lecture. By F. Stone.Techniques of Brief Psychotherapy. By W. Flegenheimer.Psychiatric Administration. Edited by J. A. Talbot &amp; S. R. Kaplan.Themes in Cultural Psychiatry: An Annotated Bibliography 1975–1980. By A. R. Favazza &amp; A. D. Faheem.Encyclopedic Handbook of Alcoholism. Edited by E. M. Pattison &amp; E. Kaufman.Physique and Delinquent Behavior. A Thirty‐Year Follow‐Up of William H. Sheldon's Varieties of Delinquent Youth. By E. M. Hartl, E. P. Monnelly &amp; R. D. Elderkin.Mental Illness: Changes and Trends. Edited by P. Bean.The Psychotic Process. By John Frosch.Psychiatry and General Practice. Edited by A. W. Clarke &amp; M. Lader.The Evolution of Group Analysis. Edited by Malcolm Pines.Clinical Research in Psychosomatic Medicine. By J. J. Groen. AssenThe Counselling Relationship. By Susan Oldfield.Stress Reduction and Prevention. Edited by Donald Meichenbaum &amp; Matt E. Jeremko.Medical Applications of the Behavioral Sciences. Edited by J. J. Braunstein &amp; R. P. Toister.Interpersonal Issues in Health Care. Edited by H. Friedman &amp; M. DiMatteo.An Introduction to Health Psychology. By Robert J. Gatchel &amp; Andrew Baum.The Psychology of Physical Symptoms. By J. W. Pennebaker.

Maternal-Infant Bonding

Physicians have become increasingly aware that promoting good health often requires more than the physical care of the patient. Research in psychosomatic medicine has shown clearly the intimate ties between psychological and physiological functioning. Practitioners are increasingly aware that for the cure of many disorders, changes are required in the patient's behavioral world as well as his medical one. Involvement in the psychological well-being of the patient has been a growing concern of pediatricians as evidence has mounted that early disturbances in family relations can have serious effects on the care and outcome for children even in early infancy. Marshall Klaus and John Kennell, the authors of this book, have had key roles in bringing these ideas to the attention of the field, and in so doing may have established a new subarea in pediatrics: the psychological care of the newborn. In brief, their position is that the initial emotional