Seishin Shinkeigaku Zasshi. 1991 ; 93(8): 645-73.

[A study of psychopathology in phobia and obsessive-compulsive disorder: through the treatment of exposure and response prevention by transcutaneous electrical stimulation]

Yamashita T, Fujimoto K, Aoi K, Shimura E, Kubo K.

Department of Neuropsychiatry, Tokushima University Hospital.

For the treatment of phobia and obsessive-compulsive disorder (OCD), we developed a method of exposure (in vivo or in imagination) and response prevention by transcutaneous electrical stimulation (TES), in which weak electrical stimuli (3-4V, about 5Hz) are applied to the palm ("Rokyu" in acupuncture treatment) or vertex ("Hyakue") of a patient tolerating dysphoria induced in a state of imagination or in real life. TES was very effective in about 80% of 32 patients treated (Seishin Igaku, 1989). Through the treatment of severe cases with TES, several new findings regarding the psychopathology and etiologic mechanism of phobia or OCD were recently obtained. 1) In relatively simple cases treated with TES, anxiety and fear were extinguished within a few minutes by simultaneous close-up normal thoughts. Antagonism may thus possibly be present between a self integration mechanism and pathological mental structure, and TES may discontinuously dysfunctions this antagonism in the manner of a changeover switch. In severe cases, anxiety and fear were not immediately abolished by TES, but strong resistance and fear appeared with increase in TES. Thus, multilevel pathological mental structure are possibly present in severe cases. Moreover, one obsessive-compulsive patient suddenly restored totally free senses after 10 months of TES treatment and stated that he had been found for 10 years by a rule demanding obsessive checking. A certain more decisive principle may then have been present in his pathological mental structure. Based on the above, the pathological mental structure in these phobia and OCD may be concluded to have been dissociated from the self integration mechanism, intensified as the mechanism dealing specifically with anxiety, and finally became resistant to self integration due to the simultaneous close-up of a decisive principle. As for the mechanism of TES action, the following change provides some indication: that is, when TES was applied to the patient under exposure in a state of imagination, strong anxiety was initially induced, and then disappeared after several minutes. This may indicate that TES activates not only a pathological mental structure but also normal mental structure. Thus, while TES may be elevating the energy of anxiety, filling the pathological mental structure, by exposure and response prevention, it is efficiently inducing this anxiety towards the self integration mechanism. 2) On the basis of the above concept, an attempt was made to explain the etiologic mechanism of phobia or OCD. In many cases, the disease is evoked by a trivial provoking trigger after persistent conflict and psychic fatigue.(ABSTRACT TRUNCATED AT 400 WORDS)