Psychotherapy for Somatoform Disorder (신체형 장애의 정신치료)
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- Korean Journal of Psychosomatic Medicine
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- v.4 no.2
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- pp.269-276
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- 1996
A theroretical study was made on the psychodynamism of somatoform disorder. Somatoform disorder is caused by a defense mechanism of somatization. Somatization is the tendency to react to stimuli(drives, defenses, and conflict between them) physically rather than psychically(Moore, 1990). Ford(1983) said it is a way of life, and Dunbar(1954) said it is the shift of psychic energy toward expression in somatic symptoms. As used by Max Shur(1955), somatization links symptom formation to the regression that may occur in response to acute and chronic conflict. In the neurotic individual psychic conflict often provokes regressive phenomena that may include somatic manifestations characteristic of an earlier developmental phase. Schur calls this resomatization. Pain is the most common example of a somatization reaction to conflict. The pain has an unconscious significance derived from childhood experiences. It is used to win love, to punish misdeeds, as well as a means to amend. Among all pains, chest pain has a special meaning. Generally speaking, 'I have pain in my chest' is about the same as 'I have pain in my mind'. The chest represent the mind, and the mind reminds us about the heart. So we have a high tendency to recognize mental pain as cardiac pain. Kellner(1990) said rage and hostility, especially repressed hostility, are important factors in somatization. In 'Psychoanalytic Observation on Cardiac Pain', psychoanalyst Bacon(1953) presented clinical cases of patients who complained of cardiac pain in a psychoanalytic session that spread from the left side of their chests down their left arms. The pain was from rage and fear which came after their desire to be loved was frustrated by the analyet. She said desires related to cardiac pain were dependency needs and aggressions. Empatic relationship and therapeutic alliances are indispensable to psychotherapy in somatoform disorder. The beginning of therapy is to discover a precipitating event from the time their symptoms have started and to help the patient understand a relation between the symptom and precipitating event. Its remedial process is to find and interpret a intrapsychic conflict shown through the symptoms of the patient. Three cases of somatoform disorder patients treated based on this therapeutic method were introduced. The firt patient, Mr. H, had been suffering from hysterical aphasia with repressed rage as ie psychodynamic cause. An interpretation related to the precipitating event was given by written communication, and he recovered from his aphasia after 3 days of the session. The second patient was a dentist in a cardiac neurosis with agitation and hypochondriasis, whose psychodynamism was caused by a fear that he might lose his father's love. His symptom was also interpreted in relation to the precipitating event. It showed the patient a child-within afraid of losing his father's love. His condition improved after getting a didactic interpretation which told him, to be master of himself, The third patient was a lady transferred from the deparment of internal medicine. She had a frequent and violent fit of chest pains, whose psychodynamic cause was separation anxiety and a rage due to the frustration of dependency needs. Her symptom vanished dramatically when she wore a holler EKG monitor and did not occur during monitoring. By this experience she found her symptom was a psychogenic one, and a therapeutic alliance was formed. later in reguar psychotherapy sessions, she was told the relaton between symptoms and precipitating events. Through this she understood that her separation anxiety was connected to the symptom and she became less terrifide when it occurred. Now she can travel abroad and take well part in social activities.
Purpose: This study was planned to determine the characteristics of extremely obese patients during Bariatric surgery and to evaluate how the difference in the number of postsurgical personal nutritional educations they received affected the weight loss. Methods: This is a retrospective study on the basis of the medical records of extremely obese patients for 15 months after receiving gastric banding. A total of 60 people were selected as the study subjects and they were divided into the Less Educated Group and the More Educated Group according to the average number of personal nutritional educations they received. We investigated both groups to determine the general characteristic, health related lifestyle habits, obesity related complications and symptoms in possession, and eating habits before their surgery, the body composition measurement result, obesity determination indices at 1, 3, 6, 9, 12, and 15 months before and after their surgery, and the biochemical parameters at 6 months before and after their surgery. Results: Body fat and weight showed rapid reduction until 6 months after the surgery, but thereafter reduced slowly depending on the result of body composition measurement. Regarding body fat and weight, the More Educated Group, who received nutrition education more often, showed significantly lower levels than the Less Educated Group at 15 months after surgery. Regarding BMI and degree of obesity, the More Educated Group showed significantly lower levels than the Less Educated Group at 15 months after surgery. Here, we were assured that BMI is reversely proportional to the number of personal nutritional educations at 15 months, which is more outstanding after surgery than before surgery. Conclusion: Long-term nutritional education is a key factor for the extremely obese patient in maintaining the effects of Bariatric surgery on weight and body fat reduction onwards. In the next stage, considering the characteristics of the study subjects, adoption of individual nutrition education is recommended for postsurgical prospective arbitration of obesity in order to monitor blood pressure, obesity related complications, symptoms in possession, and how eating habits and health related life habits change, and to judge the actual effect of the nutritional education method at the same time.
The pharmacological and microbiological studies of Cefoperazone (T-1551, Toyama Chemical Co., Japan) were conducted in vitro and in vivo. The studies included stability and physicochemical characteristics, antimicrobial activity, animal and human pharmacokinetics, animal pharmacodynamics and safety evaluation of Cefoperazone sodium for injection. 1) Stability and physicochemical characteristics. Sodium salt of cefoperazone for injection had a general appearance of white crystalline powder which contained 0.5% water, and of which melting point was
Brand has received much attention from considerable marketing research. When consumers consume product or services, they are exposed to a lot of brand related stimuli. These contain brand personality, brand experience, brand identity, brand communications and so on. A special kind of new crisis occasionally confronting companies' brand management today is the brand related rumor. An important influence on consumers' purchase decision making is the word-of-mouth spread by other consumers and most decisions are influenced by other's recommendations. In light of this influence, firms have reasonable reason to study and understand consumer-to-consumer communication such as brand rumor. The importance of brand rumor to marketers is increasing as the number of internet user and SNS(social network service) site grows. Due to the development of internet technology, people can spread rumors without the limitation of time, space and place. However relatively few studies have been published in marketing journals and little is known about brand rumors in the marketplace. The study of rumor has a long history in all major social science. But very few studies have dealt with the antecedents and consequences of any kind of brand rumor. Rumor has been generally described as a story or statement in general circulation without proper confirmation or certainty as to fact. And it also can be defined as an unconfirmed proposition, passed along from people to people. Rosnow(1991) claimed that rumors were transmitted because people needed to explain ambiguous and uncertain events and talking about them reduced associated anxiety. Especially negative rumors are believed to have the potential to devastate a company's reputation and relations with customers. From the perspective of marketer, negative rumors are considered harmful and extremely difficult to control in general. It is becoming a threat to a company's sustainability and sometimes leads to negative brand image and loss of customers. Thus there is a growing concern that these negative rumors can damage brands' reputations and lead them to financial disaster too. In this study we aimed to distinguish antecedents of brand rumor transmission and investigate the effects of brand rumor characteristics on rumor spread intention. We also found key components in personal acceptance of brand rumor. In contextualist perspective, we tried to unify the traditional psychological and sociological views. In this unified research approach we defined brand rumor's characteristics based on five major variables that had been found to influence the process of rumor spread intention. The five factors of usefulness, source credibility, message credibility, worry, and vividness, encompass multi level elements of brand rumor. We also selected product involvement as a control variable. To perform the empirical research, imaginary Korean 'Kimch' brand and related contamination rumor was created and proposed. Questionnaires were collected from 178 Korean samples. Data were collected from college students who have been experienced the focal product. College students were regarded as good subjects because they have a tendency to express their opinions in detail. PLS(partial least square) method was adopted to analyze the relations between variables in the equation model. The most widely adopted causal modeling method is LISREL. However it is poorly suited to deal with relatively small data samples and can yield not proper solutions in some cases. PLS has been developed to avoid some of these limitations and provide more reliable results. To test the reliability using SPSS 16 s/w, Cronbach alpha was examined and all the values were appropriate showing alpha values between .802 and .953. Subsequently, confirmatory factor analysis was conducted successfully. And structural equation modeling has been used to analyze the research model using smartPLS(ver. 2.0) s/w. Overall, R2 of adoption of rumor is .476 and R2 of intention of rumor transmission is .218. The overall model showed a satisfactory fit. The empirical results can be summarized as follows. According to the results, the variables of brand rumor characteristic such as source credibility, message credibility, worry, and vividness affect argument strength of rumor. And argument strength of rumor also affects rumor intention. On the other hand, the relationship between perceived usefulness and argument strength of rumor is not significant. The moderating effect of product involvement on the relations between argument strength of rumor and rumor W.O.M intention is not supported neither. Consequently this study suggests some managerial and academic implications. We consider some implications for corporate crisis management planning, PR and brand management. This results show marketers that rumor is a critical factor for managing strong brand assets. Also for researchers, brand rumor should become an important thesis of their interests to understand the relationship between consumer and brand. Recently many brand managers and marketers have focused on the short-term view. They just focused on strengthen the positive brand image. According to this study we suggested that effective brand management requires managing negative brand rumors with a long-term view of marketing decisions.
Background : Tumor markers have been used in diagnosis, predicting the extent of disease, monitoring recurrence after therapy and prediction of prognosis. But the utility of markers in lung cancer has been limited by low sensitivity and specificity. TPA-M is recently developed marker using combined monoclonal antibody of Cytokeratin 8, 18, and 19. This study was conducted to evaluate the efficacy of new tumor marker, TPA-M by comparing the estabilished markers SCC, CEA, Cyfra21-1 in lung cancer. Method : An immunoradiometric assay of serum CEA, sec, Cyfra21-1, and TPA-M was performed in 49 pathologically confirmed lung cancer patients who visited Keimyung University Hospital from April 1996 to August 1996, and 29 benign lung diseases. Commercially available kits, Ab bead CEA (Eiken) to CEA, SCC RIA BEAD (DAINABOT) to SCC, CA2H (TFB) to Cyfra2H. and TPA-M (DAIICHI) to TPA-M were used for this study. Results : The mean serum values of lung cancer group and control group were
The study examines how the environmental factors of store influence service brand personality and repurchase intention in the service environment. The service industry has been experiencing the intensified competition with the industry's continuous growth and the influence from rapid technological advancement. Under the circumstances, it has become ever more important for the brand competitiveness to be distinctively recognized against competition. A brand needs to be distinguished and differentiated from competing companies because they are all engaged in the similar environment of the service industry. The differentiation of brand achievement has become increasingly important to highlight certain brand functions to include emotional, self-expressive, and symbolic functions since the importance of such functions has been further emphasized in promoting consumption activities. That is the recent role of brand personality that has been emphasized in the service industry. In other words, customers now freely and actively express their personalities or egos in consumption activities, taking an important role in construction of a brand asset. Hence, the study suggests that it is necessary to disperse the recognition and acknowledgement that the maintenance of the existing customers contributes more to boost repurchase intention when it is compared to the efforts to create new customers, particularly in the service industry. Meanwhile, the store itself can offer a unique environment that may influence the consumer's purchase decision. Consumers interact with store environments in the process of,virtually, all household purchase they make (Sarel 1981). Thus, store environments may encourage customers to purchase. The roles that store environments play are to provide informational cues to customers about the store and goods and communicate messages to stimulate consumers' emotions. The store environments differentiate the store from competing stores and build a unique service brand personality. However, the existing studies related to brand in the service industry mostly concentrated on the relationship between the quality of service and customer satisfaction, and they are mostly generalized while the connective studies focused on brand personality. Such approaches show limitations and are insufficient to investigate on the relationship between store environment and brand personality in the service industry. Accordingly, the study intends to identify the level of contribution to the establishment of brand personality made by the store's physical environments that influence on the specific brand characteristics depending on the type of service. The study also intends to identify what kind of relationships with brand personality exists with brand personality while being influenced by store environments. In addition, the study intends to make meaningful suggestions to better direct marketing efforts by identifying whether a brand personality makes a positive influence to induce an intention for repurchase. For this study, the service industry is classified into four categories based on to the characteristics of service: experimental-emotional service, emotional -credible service, credible-functional service, and functional-experimental service. The type of business with the most frequent customer contact is determined for each service type and the enterprise with the highest brand value in each service sector based on the report made by the Korea Management Association. They are designated as the representative of each category. The selected representatives are a fast-food store (experimental-emotional service), a cinema house (emotional-credible service), a bank (credible-functional service), and discount store (functional-experimental service). The survey was conducted for the four selected brands to represent each service category among consumers who are experienced users of the designated stores in Seoul Metropolitan City and Gyeonggi province via written questionnaires in order to verify the suggested assumptions in the study. In particular, the survey adopted 15 scales, which represent each characteristic factor, among the 42 unique characteristics developed by Jennifer Aaker(1997) to assess the brand personality of each service brand. SPSS for Windows Release 12.0 and LISREL were used in the analysis of data verification. The methodology of the structural equation model was used for the study and the pivotal findings are as follows. 1) The environmental factors ware classified as design factors, ambient factors, and social factors. Therefore, the validity of measurement scale of Baker et al. (1994) was proved. 2) The service brand personalities were subdivided as sincerity, excitement, competence, sophistication, and ruggedness, which makes the use of the brand personality scales by Jennifer Aaker(1997) appropriate in the service industry as well. 3) One-way ANOVA analysis on the scales of store environment and service brand personality showed that there exist statistically significant differences in each service category. For example, the social factors were highest in discount stores, while the ambient factors and design factors were highest in fast-food stores. The discount stores were highest in the sincerity and excitement, while the highest point for banks was in the competence and ruggedness, and the highest point for fast-food stores was in the sophistication, The consumers will make a different respond to the physical environment of stores and service brand personality that are inherent to the corresponding service interface. Hence, the customers will make a different decision-making when dealing with different service categories. In this aspect, the relationships of variables in the proposed hypothesis appear to work in a different way depending on the exposed service category. 4) The store environment factors influenced on service brand personalities differently by category of service. The factors of store's physical environment are transferred to a brand and were verified to strengthen service brand personalities. In particular, the level of influence on the service brand personality by physical environment differs depending on service category or dimension, which indicates that there is a need to apply a different style of management to a different service category or dimension. It signifies that there needs to be a brand strategy established in order to positively influence the relationship with consumers by utilizing an appropriate brand personality factor depending on different characteristics by service category or dimension. 5) The service brand personalities influenced on the repurchase intention. Especially, the largest influence was made in the sophistication dimension of service brand personality scale; the unique and characteristically appropriate arrangement of physical environment will make customers stay in the service environment for a long time and will lead to give a positive influence on the repurchase intention. 6) The store environment factors influenced on the repurchase intention. Particularly, the largest influence was made on the social factors of store environment. The most intriguing finding is that the service factor among all other environment factors gives the biggest influence to the repurchase intention in most of all service types except fast-food stores. Such result indicates that the customers pay attention to how much the employees try to provide a quality service when they make an evaluation on the service brand. At the same time, it also indicates that the personal factor is directly transmitted to the construction of brand personality. The employees' attitude and behavior are the determinants to establish a service brand personality in the process of enhancing service interface. Hence, there should be a reinforced search for a method to efficiently manage the service staff who has a direct contact with customers in order to make an affirmative improvement of the customers' brand evaluation at the service interface. The findings suggest several managerial implications. 1) Results from the empirical study indicated that store environment factors have a strong positive impact on a service brand personality. To increase customers' repurchase intention of a service brand, the management is required to effectively manage store environment factors and create a friendly brand personality based on the corresponding service environment. 2) Mangers and researchers must understand and recognize that the store environment elements are important marketing tools, and that brand personality influences on consumers' repurchase intention. Based on such result of the study, a service brand could be utilized as an efficient measure to achieve a differentiation by enforcing the elements that are most influential among all other store environments for each service category. Therefore, brand personality established involving various store environments will further reinforce the relationship with customers through the elevated brand identification of which utilization to induce repurchase decision can be used as an entry barrier. 3) The study identified the store environment as a component of service brand personality for the store's effective communication with consumers. For this, all communication channels should be maintained with consistency and an integrated marketing communication should be executed to efficiently approach to a larger number of customers. Mangers and researchers must find strategies for aligning decisions about store environment elements with the retailers' marketing and store personality objectives. All ambient, design, and social factors need to be orchestrated so that consumers can take an appropriate store personality. In this study, the induced results from the previous studies were extended to the service industry so as to identify the customers' decision making process that leads to repurchase intention and a result similar to those of the previous studies. The findings suggested several theoretical and managerial implications. However, the situation that only one service brand served as the subject of analysis for each service category, and the situation that correlations among store environment elements were not identified, as well as the problem of representation in selection of samples should be considered and supplemented in the future when further studies are conducted. In addition, various antecedents and consequences of brand personality must be looked at in the aspect of the service environment for further research.