International Congress Series 1287 (2006) 334 – 339

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Clinical efficacy of psychotherapy inclusive of Buddhist psychology in female psychosomatic medicine
Takahisa Ushiroyama *
Department of Applied Surgery, Obstetrics and Gynecology Unit, Division of Perinatal/Reproductive Medicine and Endocrinology service, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan

Abstract. Human beings have been asking themselves about the meaning of life and the significance of human life since ancient times. Medical care in cooperation with religion can save human’s mind and body. Being burdened with a lot of social/cultural problems in the modern Japanese society, climacteric women who consult a doctor for symptoms of indefinite complaint have been increasing. One of the teachings of Siddhartha Gautama is bSeeing things as they really areQ (bNyojitsu-chikenQ in Japanese). This means that seeing the reality as it is and is the way of thinking that bit is important to embrace the reality and live positively, instead of trying to do everything as one wants to and turning a blind eye to the reality.Q Psychotherapy inclusive Buddhist psychology was performed in 16 climacteric women with undefined symptoms. Visual analog scale for subjective symptoms decreased significantly after 2–6 months of treatment (25.7 F 10.2) from the baseline value (72.4 F 12.8) ( p b 0.0001). After psychotherapy, no change was observed in plasma cortisol concentration; however, salivary chromogranin A concentration significantly decreased (À61%). Practice of Buddhism is the same as psychotherapy in which suffering people become aware of dself,T find a way of self-fulfillment, and release their minds from suffering. The practice of integrated psychotherapy of acceptance and sympathy, support, and assurance into bNot same individuality, but same humanQ, bSeeing things as they really areQ, and bThere is no such things as permanenceQ as Buddhist psychology is highly expected in the female psychosomatic medicine. D 2005 Elsevier B.V. All rights reserved.
Keywords: Buddhist psychology; Psychosomatic medicine; Climacteric; Self-fulfillment; Enlightenment

* Tel.: +81 72 683 1221; fax: +81 72 681 3723. E-mail address: gyn003@poh.osaka-med.ac.jp. 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.09.178

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1. Introduction The penetration of Buddhism into the western world has especially been enhanced in the past 20 to 30 years. Suzuki introduced Zen Buddhism to the western world with his books dIntroduction of Zen BuddhismT and dThe Training of the Zen MonkT in 1934 for the first time. This movement has accelerated the recent penetration of Buddhism into the western world [1]. In Japan, Buddhism is immediately considered dpure religion,T and people would behave as Buddhists only when they attend funerals. bZen BuddhismQ and bMeditation in BuddhismQ have been known, interested and practiced in Europe and North America. The modern, scientific, and rational world-view seems to be prevalent in today’s societies; however, as a reaction to such dominating worldview, people become more and more interested in dmindT especially in the developed countries. In such trend, people are seeking dpsychotherapyT and dhealingT more than ever before. Growing interest in Buddhism and application of its philosophy in medicine may be phenomena arisen from the particular environment surrounding the modern people. Buddhism is not merely a theory; it is originally a practical scheme based on practice just like the modern clinical psychology. dShitai-Hassho-doT is the basic theoretical scheme of dpsychologyT presented by Siddhartha Gautama. In the context of the modern psychotherapy and behavioral therapy, these acts offer people a chance to reflect on their lifestyles, social and intellectual behaviors, and perception patterns so that they may be able to consciously perform their daily activities such as daily habits, working, playing, eating and sleeping. 2. Incorporation of Buddhism to medicine 2.1. The essence and teachings of Buddhism Human beings have been asking themselves about the meaning of life and the significance of human life since ancient times. The essence of Buddhism is, most of all, to acquire wisdom in way of being, way of living as humans, by looking deep into the human mind. In other words, it is to look deep into the human minds and explore it to gain an insight, to aim for deliverance from many hardships and difficulties (Fig. 1). Japanese are no exception, and especially Buddhism has had a strong influence on daily life as well as spiritual life of Japanese people. Nurturance comes from an earnest and beautiful mind, and Buddhism is to treat all kinds of people and all kinds of things with nurturance [2]. Siddhartha Gautama, the founder of Buddhism, had a deep awareness and understanding of nature (birth, aging, sickness and death). There are three major teachings of Buddhism that will help us understand the philosophy. One of the teachings of Siddhartha Gautama is bSeeing things as they really areQ(bNyojitsu-chikenQ in Japanese). This means that seeing the reality as it is, and is the way of thinking that bit is important to embrace the reality and live positively, instead of trying to do everything as one wants to and turning a blind eye to the reality.Q Next, the teachings of Siddhartha Gautama is dto accept and empathize with hardships of all peopleT. One more teachings of Siddhartha Gautama is dto experience things through one’s body and reach the state of awakening.

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Fig. 1. Concept and practice of Buddhism.

2.2. Buddhism as psychotherapy Siddhartha Gautama had a logical way of thinking and understanding of medicine. The center of the tenets of Buddhism is dShi-tai (Four Truths)T that consists of dKu-tai (all is hardships),T dShu-tai (the cause of hardships is depletion of love),T dMettai (ideal being, that is, enlightenment),T and dDo-tai (paths to enlightenment: Hassho-do (Noble Eight fold Path)). Among the tenets, dpath to enlightenmentT is called dHasshodoT. It has become popular and used all over the world. Only, meditation originally contains many elements, and practicing meditation in a correct way will lead to denlightenmentT [1]. Gautama describes in dShitai-Hassho-doT what the reasons for the suffering are, what the state of not suffering is, and how to quench the suffering in the Noble Eight Fold Paths (Hassho-do) in an orderly manner. This is called bShi-tai-Hassho-doQ. It is a process to diagnose with correct understanding of suffering as disease, find the cause, identify the ideal condition to cure the disease and an appropriate treatment procedure or method, and lead the patient to a healthy, suffering-free state. In the process, we can see a fairly rational way of thinking equivalent to that in today’s scientific and medical approach. In the medical context, dShitai-Hassho-doT can be applied to dpsychotherapyT in which mental suffering, unstable mental state without peace of mind, or dillness of mindT is treated even though the patient originally suffers from physical illness [2]. 3. Changes in visual analog scale and salivary chromogranin A concentrations during psychotherapy inclusive of Buddhist psychology 3.1. Changes in visual analog scale As previously described, Buddhism psychotherapy may bring about ideal therapeutic efficacy. Recently, we [2] reported that psychotherapy inclusive of Buddhist psychology

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can be applied and effective on improvement symptoms in empty-nest syndrome, mood disorder, and premenstrual dysphoric disorder. Sixteen climacteric patients with undefined symptoms were performed psychotherapy inclusive Buddhist psychology. The most frequent Buddhist concepts used for psychotherapy were bSeeing things as they really areQ (87.5%: 14/16). Other Buddhist concepts used for psychotherapy were bThere is no such thing as permanenceQ (43.8%: 7/16), bNot same individuality, but same humanQ (37.5%: 6/ 16), and bOthers love themselves mostQ (18.8%: 3/16). Visual analog scale for subjective symptoms decreased significantly after 2–6 months treatment (25.7 F 10.2) from the baseline value (72.4 F 12.8) ( p b 0.0001) (Fig. 2). 3.2. Changes in plasma cortisol and salivary chromogranin A concentration I examined the change in plasma cortisol concentration and salivary chromogranin A concentration of the 58 climacteric patients who received 2 sessions of psychotherapy, the first visit and the follow-up visit, provided by incorporating dSeeing things as they really areT, dTo accept and empathize with hardships of all peopleT, and dTo experience things through one’s awakeningT as psychosomatic medical technique based on dMorita psychotherapyT. After 2 psychotherapy sessions (2 weeks later), no change was observed in plasma cortisol concentration; however, salivary chromogranin A concentration significantly decreased (À61%) (Fig. 3). Absence of short-term change in cortisol concentration which is an index for physical stress and the significant decrease in chromogranin A concentration which is an index for mental stress [3] may suggest the

Fig. 2. Changes in visual analog scale during treatment with psychotherapy inclusive of Buddhist psychology in climacteric women with undefined symptoms.

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Fig. 3. Changes of salivary chromogranin A concentration of menopausal patients with psychological symptoms in the treatment by psychotherapy with Buddhism (n = 58).

stress-relieving effect of Buddhism psychotherapy that may lead patients to denlightenmentT and dself-fulfillmentT. 4. Psychotherapy and Buddhism in present society In Japan, 10% of postmenopausal women experience difficulties in daily life due to undefined mental and physical symptoms and visit gynecology outpatient clinics to receive treatment. Few women are cured solely by drug therapy; most patients require psychotherapy [4]. The word dhealing mindT has become quite popular in Japan recently. This implies that interest in and aspirations for Buddhism and meditation in psychotherapy may have quietly started to bud in the minds of modern Japanese having been enjoying the western culture for quite a while. At some hospitals in Japan, dmeditationT has been incorporated in treatment for stress reduction lately; however, Zen meditation has been part of the stress reduction programs at hospitals in the U.S. for more than a decade [5]. Studies have been conducted to prove the clinical efficacy of religious or spiritual psychotherapy as scientifically as possible [6,7]. Practice of Buddhism is the same as psychotherapy in which suffering people become aware of dself,T find a way of selffulfillment, and release their minds from suffering [8]. It is an optimal medical approach to the mental care for menopausal women who are indecisive about their dstate of mindT under various mental stress caused by dloss of identity,T dempty nest,T or dparting experienceT. Therefore, we suggest a new method in psychotherapy that combines ordinary psychotherapy with concepts in Buddhism in the treatment of climacteric women with undefined symptoms. Recommended psychotherapy should be performed based on the ordinary psychotherapy with acceptance and sympathy, support, and assurance. Adding to those, the innovation of bNot same individuality, but same humanQ, bSeeing things as they really areQ, and bThere is no such things as permanenceQ which are considered to be well applied to climacteric medicine out of concepts of Buddhist psychology are expected into the female psychosomatic medicine.

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It may be important to pay attention now to the immeasurable value of the traditional practice, dpracticing meditation and road to enlightenmentT handed down from generation to generation for a long time by observing Buddhism and its great teachings, in order to develop a new road ahead of the modern time when science is worshipped so that dmaturity and peace of mindT can be achieved without losing sight of dindividualT. References
[1] D.T. Suzuki, Manual of Zen Buddhism, Grove Press, New York, 1935. [2] T. Ushiroyama, et al., Treatment using psychotherapy involving Buddhist concepts in middle-aged women with psychosomatic diseases possible related to mother–child relationships, J. Jap. Psychosom. Obstet. Gynecol. 10 (2005) 34 – 42. [3] T. Kanno, et al., Salivary secretion of highly concentrated chromogranin A in response to noradrenaline and acetylcholine in isolated and perfused rat submandibular glands, Exp. Physiol. 84 (1999) 1073 – 1083. [4] T. Ushiroyama, Optimal treatment of menopausal disorders based on differential diagnosis from mental disorders, in: T. Aso, T. Yanaihara, S. Fujimoto (Eds.), The Menopause at the Millennium, Parthenon Publishing, New York, London, 2000, pp. 256 – 264. [5] J. Kabat-Zinn, Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders, Am. J. Psychiatry 149 (1992) 936 – 943. [6] J. Kass, et al., Health outcomes and a new index of spiritual experience, J. Sci. Study Relig. 30 (1991) 203 – 211. [7] D.A. Vella-Brodrick, F.C.L. Allen, Development and psychometric validation of the mental, physical, and spiritual well-being scale, Psychol. Rep. 77 (1995) 659 – 674. [8] T. Ushiroyama, Female psychosomatic medicine and Buddhism, J. Psychosom. Obstet. Gynecol. 25 (2004) SY22.

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