Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

The purpose of this study is to investigate the effects of a program containing a combination of social skills training (SST) and parenting training (PT) for the enrichment of social interaction skills and reduction of parenting stress for children with high-functioning autism spectrum disorder (HFASD) and their parents in Japan. Twenty-two patients with HFASD from second to fourth grade and their parents were assigned to a training group (TG) or treatment as usual (TAU) and compared. The children with HFASD and their parents who were assigned to the TG participated in the manualized program for over a period of five to six months. Subjects provided demographic and medical information and completed teacher and parent-rating scales for social competence (Social Responsiveness Scale-2: SRS-2) and parent-rating of parenting stress (Parental Stress Index: PSI) and mental health (General Health Questionnaire-28: GHQ-28). The participants exhibited some improvements pre-, middle-, and post-treatment, particularly regarding the GHQ, PSI and SRS-2, as reported by parents. However, the social skills improvement reported by teachers was not significant. At the three-month follow-up, parent-rated GHQ and PSI maintained improvement, and SRS-2 achieved the greatest improvement from the baseline rating. Although some findings indicate that a program combination of SST and PT might be useful for enhancing social skills and improving parental stress and mental health, some subscales did not show a sufficient effect. Future research should consider program contents and provide longitudinal follow-up data to test the durability of the treatment.

DOI： 10.1016/j.braindev.2021.04.007

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Expressive suppression (ES) of emotion is considered a moderator that reduces the efficacy of cognitive behavioural therapy (CBT); however, whether and how ES moderates the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders (UP), a version of CBT targeting aversive/avoidant responses to emotions, including ES, remain unclear. We investigated whether and how emotion regulation, especially ES, moderates UP efficacy for anxiety symptoms in patients with anxiety and depressive disorders. METHODS: We conducted a secondary analysis of data from a previous trial. Seventeen patients with anxiety and/or depressive disorders were included. Changes (slope estimates) in the Structured Interview Guide for the Hamilton Anxiety Rating Scale from pre-treatment to post-treatment were measured using a latent growth curve model with empirical Bayesian estimation. Pre-treatment ES, cognitive reappraisal, and depressive symptoms were used as slope factor predictors. RESULTS: Only pre-treatment ES significantly predicted the slope in the latent growth curve model (estimate value = 0.45; standard deviation = 0.21; 95% credible interval = 0.03-0.87, one-tailed p-value = 0.004), and an inverse correlation between pre-treatment ES levels and improvement magnitude of anxiety symptoms was demonstrated. LIMITATIONS: Because the data were obtained from a single-arm trial, this study did not have controls, and most participants received pharmacotherapy in addition to UP. Therefore, generalisability of the present findings might be compromised. CONCLUSIONS: Low ES before UP was an effective predictor of greater improvement in anxiety symptoms after UP. The findings suggest that interventions intended to improve ES may improve UP efficacy.

DOI： 10.1016/j.jad.2020.07.132

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Meta-analyses of several randomized controlled trials have shown that cognitive behavioral therapy (CBT) has comparable efficacy to antidepressant medication, but therapist availability and cost-effectiveness is a problem. OBJECTIVE: This study aimed to evaluate the effectiveness of Web-based CBT blended with face-to-face sessions that reduce therapist time in patients with major depression who were unresponsive to antidepressant medications. METHODS: A 12-week, assessor-masked, parallel-group, waiting- list controlled, randomized trial was conducted at 3 medical institutions in Tokyo. Outpatients aged 20-65 years with a primary diagnosis of major depression who were taking ≥1 antidepressant medications at an adequate dose for ≥6 weeks and had a 17-item GRID-Hamilton Depression Rating Scale (HAMD) score of ≥14 were randomly assigned (1:1) to blended CBT or waiting-list groups using a computer allocation system, stratified by the study site with the minimization method, to balance age and baseline GRID-HAMD score. The CBT intervention was given in a combined format, comprising a Web-based program and 12 45-minute face-to-face sessions. Thus, across 12 weeks, a participant could receive up to 540 minutes of contact with a therapist, which is approximately two-thirds of the therapist contact time provided in the conventional CBT protocol, which typically provides 16 50-minute sessions. The primary outcome was the alleviation of depressive symptoms, as measured by a change in the total GRID-HAMD score from baseline (at randomization) to posttreatment (at 12 weeks). Moreover, in an exploratory analysis, we investigated whether the expected positive effects of the intervention were sustained during follow-up, 3 months after the posttreatment assessment. Analyses were performed on an intention-to-treat basis, and the primary outcome was analyzed using a mixed-effects model for repeated measures. RESULTS: We randomized 40 participants to either blended CBT (n=20) or waiting-list (n=20) groups. All patients completed the 12-week treatment protocol and were included in the intention-to-treat analyses. Participants in the blended CBT group had significantly alleviated depressive symptoms at week 12, as shown by greater least squares mean changes in the GRID-HAMD score, than those in the waiting list group (-8.9 points vs -3.0 points; mean between-group difference=-5.95; 95% CI -9.53 to -2.37; P<.001). The follow-up effects within the blended CBT group, as measured by the GRID-HAMD score, were sustained at the 3-month follow-up (week 24) and posttreatment (week 12): posttreatment, 9.4 (SD 5.2), versus follow-up, 7.2 (SD 5.7); P=.009. CONCLUSIONS: Although our findings warrant confirmation in larger and longer term studies with active controls, these suggest that a combined form of CBT is effective in reducing depressive symptoms in patients with major depression who are unresponsive to antidepressant medications. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry: UMIN000009242; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000010852 (Archived by WebCite at http://www.webcitation. org/729VkpyYL).

DOI： 10.2196/10743

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Background: The Emotion Regulation Skills Questionnaire (ERSQ) comprehensively assesses nine aspects of emotion regulation skills: awareness, clarity, sensation, understanding, compassionate self-support, modification, acceptance, tolerance, and readiness to confront. However, it is unknown about the levels of emotion regulation skills in various mental disorders, and its cross-cultural validity. We developed a Japanese version of the ERSQ, then examined its validity and reliability in clinical and non-clinical populations.
Methods: In an Internet-based survey, 2684 participants (406 with MDD, 198 with PD, 116 with SAD, 66 with OCD, 636 with comorbid MDD and &gt;= 1 anxiety disorder, and 99 with comorbid anxiety disorders; 1163 non clinical sample) answered the ERSQ, diagnostic status, and measures of mindfulness, emotion regulation, behavioral activation, psychological distress, and life satisfaction.
Results: Confirmatory factor analysis (CFA) replicated the theoretical nine-factor structure of the original ERSQ. Higher-order factor analysis model assuming two second-order factors and nine first-order factors also showed adequate fit to the data, suggesting the factorial validity of the scale. Analyses of multi-group CFA indicated the equivalence of factor loadings across clinical and non-clinical subsamples. The levels of internal consistency and time stability were sufficient. Convergent validity of the scale was also confirmed for most of external criteria. Character on the emotion regulation skills for each diagnostic group was depicted.
Limitations: Internet survey of samples with limited disorders, with self-reported diagnoses, may limit generalizability.
Conclusions: The Japanese version of the ERSQ showed adequate reliability and validity.

DOI： 10.1016/j.jad.2016.08.064

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Background: Parker et al. (2006) proposed a new approach to classify specific sub-types of non-melancholic depression caused by various stress factors and premorbid personality styles: the Temperament and Personality Questionnaire (T&P). The current study aim was to develop the Japanese version of the T&P and evaluate its reliability and validity.
Methods: We studied 114 patients with non-melancholic depression. Reliability was assessed using the test-retest method. Convergent validity of the T&P was compared with the clinician ratings of each patient for the eight personality traits. We also assessed the impact of depressive state on the T&P.
Results: The test-retest intraclass correlation coefficients among eight constructs of the T&P ranged from 0.77 to 0.89, indicating good-to-excellent reliability. Anxious Worrying (rho=0.29), Perfectionism (rho=0.17), Personal Reserve (rho=0.18), Irritability (rho=0.38), and Social Avoidance (rho=0.32) showed adequate levels of convergent validity; Rejection Sensitivity (rho=0.16), Self-criticism (rho=0.02), and Self-focus (rho=0.07) showed relatively weak convergent validity. Perfectionism (rho=0.06), Social Avoidance (rho=0.17), Anxious Worrying (rho=0.40), Personal Reserve (rho=0.30), Irritability (rho=0.28), Rejection Sensitivity (rho=0.35), Self-criticism (rho=0.49), and Self-focus (rho=0.24) showed minimal sensitivity to mood state effects.
Limitations: Only one site was used. While a Likert scale was used, the clinician-rated personality trait measure had not been validated.
Conclusions: The J-T&P is a reliable and valid measure for assessing temperament and personality in Japanese patients with non-melancholic depression. (C) 2016 The Authors. Published by Elsevier B.V.

DOI： 10.1016/j.jad.2016.03.046

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ASSOC ADV BEHAVIOR THERAPY  

Unified protocol (UP) is a transdiagnostic cognitive behavior therapy for emotional disorders. It remains unknown whether UP is applicable for use in non-Western countries and for depressive disorders. We therefore examined its feasibility for a Japanese clinical population using this clinical trial design, which is multicentered, open-labeled, and single-armed (Clinical registry: UMEN000008322). The primary outcome was severity of anxiety symptoms, as assessed using Structured Interview Guide for the Hamilton Anxiety Rating Scale. Secondary outcomes were depressive symptoms, clinical global impression, functioning, quality of life, affectivity, emotion regulation, and adverse events. Of the 28 prospective participants, 17 were eligible and enrolled (depressive disorders = 9, anxiety disorders = 8). Severity of anxiety symptoms, which decreased significantly after the intervention, remained low for 3 months (Hedges' g = 1.29, 95% CI = 0.56-2.06). Similar tendencies were observed for secondary outcome measures. No severe adverse event occurred. Two participants dropped out of the intervention. High treatment adherence and interrater reliability were confirmed. Results suggest the feasibility of UP in the Japanese context sufficient to warrant a larger clinical trial.

DOI： 10.1016/j.beth.2016.02.005

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: The unified protocol for the transdiagnostic treatment of emotional disorders is a promising treatment approach that could be applicable to a broad range of mental disorders, including depressive, anxiety, trauma-related, and obsessive-compulsive disorders. However, no randomized controlled trial has been conducted to verify the efficacy of the unified protocol on the heterogeneous clinical population with depressive and anxiety disorders.
Methods/design: The trial was designed as a single-center, assessor-blinded, randomized, 20-week, parallel-group superiority study in order to compare the efficacy of the combination of unified protocol and treatment-as-usual versus waiting-list with treatment-as-usual for patients with depressive and/or anxiety disorders. The primary outcome was depression at 21 weeks, assessed by the 17-item version of the GRID-Hamilton Rating Scale for Depression. Estimated minimum sample size was 27 participants in each group. We will also examine the treatment mechanisms, treatment processes, and neuropsychological correlates.
Discussion: The results of this study will clarify the efficacy of the unified protocol for depressive and anxiety disorders, and the treatment mechanism, process, and neurological correlates for the effectiveness of the unified protocol. If its efficacy can be confirmed, the unified protocol may be of high clinical value for Japan, a country in which cognitive behavioral treatment has not yet been widely adopted.

DOI： 10.1186/s12888-016-0779-8

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Authorship：Lead author   Language：Japanese   Publisher：日本認知療法学会  

本稿では、Barlowら(2011)が開発した統一プロトコル(Unified Protocol)の中核モジュールの介入内容と理論的背景を概観した。これにより、不安障害やうつ病に対する認知行動療法において、診断横断的に有効な介入要素を明確にすることを目的とした。不安障害とうつ病に対する診断横断的認知行動療法において、感情に気づくスキル、認知的柔軟性、代替行動、身体感覚の忍耐力、そしてそれらの日常での実践を通して、感情に向き合う姿勢に焦点を当てることの重要性が示唆された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Background
The Overall Depression Severity and Impairment Scale (ODSIS) is a brief, five-item measure for assessing the frequency and intensity of depressive symptoms, as well as functional impairments in pleasurable activities, work or school, and interpersonal relationships due to depression. Although this scale is expected to be useful in various psychiatric and mental health settings, the reliability, validity, and interpretability have not yet been fully examined. This study was designed to examine the reliability, factorial, convergent, and discriminant validity of a Japanese version of the ODSIS, as well as its ability to distinguish between individuals with and without a major depressive disorder diagnosis.
Methods
From a pool of registrants at an internet survey company, 2830 non-clinical and clinical participants were selected randomly (619 with major depressive disorder, 619 with panic disorder, 576 with social anxiety disorder, 645 with obsessive-compulsive disorder, and 371 non-clinical panelists). Participants were asked to respond to the ODSIS and conventional measures of depression, functional impairment, anxiety, neuroticism, satisfaction with life, and emotion regulation.
Results
Exploratory and confirmatory factor analysis of three split subsamples indicated the unidimensional factor structure of ODSIS. Multi-group confirmatory factor analysis showed invariance of factor loadings between non-clinical and clinical subsamples. The ODSIS also showed excellent internal consistency and test-retest intraclass correlation coefficients. Convergence and discriminance of the ODSIS with various measures were in line with our expectations. Receiver operating characteristic curve analyses showed that the ODSIS was able to detect a major depressive syndrome accurately.
Conclusions
This study supports the reliability and validity of ODSIS in a non-western population, which can be interpreted as demonstrating cross-cultural validity.

DOI： 10.1371/journal.pone.0122969

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Background: The Overall Anxiety Severity and Impairment Scale is a brief generic measure for anxiety that encompasses frequency and intensity as well as behavioral and functional aspects of anxiety. This study was conducted to elucidate aspects of reliability, validity, and interpretability, such as equivalence of factor loadings across non-clinical and clinical populations, convergence and discriminance of related variables, and performance of detecting diagnostic and medical status of anxiety disorders.
Methods: Non-clinical and clinical Japanese populations were taken from a panelist pool registered with an interact survey company (total n=2830; 619 panic disorder, 576 for social anxiety disorder, 645 for obsessive-compulsive disorder, a 619 for major depressive disorder, and 371 for non-disorder panelists). Conventional measures of anxiety, depression, mental health and measures for discriminant validity were administered in addition to OASIS.
Results: Exploratory and confirmatory factor analyses indicated good fit to data for the one-factor model of OASIS. Multi-group confirmatory factor analysis showed the equivalence of the factor loadings between those of non-clinical and clinical subsamples. The OASIS reliability was confirmed by internal consistency and test-retest coefficients. Receiver operating characteristic curve analyses showed that OASIS and conventional anxiety measures have fair performance for detecting diagnostic and medical status as anxiety disorders.
Limitations.: Participants were limited to a Japanese population of people who had registered themselves at an interact survey company.
Conclusions: Along with useful information to interpret OASIS, the results suggest the reliability and validity of OASIS in Japanese populations. These results also suggest cross-cultural validity. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jad.2014.08.045

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: A growing body of evidence shows that reducing the duration of untreated illness (DUI) correlates with improved clinical outcome and course of depression. However, the factors involved in delaying treatment contact after the first onset of lifetime depression are not fully understood. This cross-sectional study aims to identify the characteristics that may predict the delay in initial treatment contact after the first onset of lifetime depression by comparing the socio-demographics and clinical characteristics between those with longer and shorter DUI in a well-characterized Japanese clinical sample.
Methods: Ninety-five patients with depression with longer (&gt;12 months) and shorter DUI (&lt;= 12 months) at three Japanese outpatient clinics were studied. Subjects received a comprehensive evaluation, including semi-structured clinical interviews and assessment battery, and their clinical charts were reviewed.
Results: Of the total sample, the median of DUI was 4 months (interquartile range (IQR) 25th-75th percentile, 2-13). We found that 72.6% of patients seek treatment contact within the first year of depression onset. Multivariate logistic regression analysis showed that longer DUI in patients was associated with marital status (never married). Further, the DSM-IV melancholic features approached significance.
Conclusions: Our findings suggest that most Japanese patients with depression are likely to seek treatment within 1 year of onset, and that marital status and melancholia may be potential predictors of the delay in the initial treatment contact after the first onset of lifetime depression.

DOI： 10.1186/1752-4458-8-50

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Language：Japanese   Publisher：(一社)日本小児心身医学会  

本研究では、自閉症スペクトラム障害(ASD)児とその親を対象に親訓練(PT)と社会的スキル訓練(SST)から構成される「獨協なかまプログラム」を開発し効果について検討した。小学2〜5年生のASD児とその親7組をプログラム介入群、6組を通常治療群(TAU群)とした。1回90分のセッションを13回(導入1回、SST6回、PT6回)、6ヵ月間実施し、事前、中間、事後に評価を行った。介入群ではプログラムを完遂した6組、TAU群6組が解析の対象とされた。TAU群と比較して介入群は、親評定のストレス反応、子どもの対人的コミュニケーションにおいて有意な改善が認められた。教師評定においては有意な改善が認められなかった。本プログラムは、ASD児の行動特徴の改善、親のストレス軽減に有効であると考えられたが、今後は、学校連携などを含めた内容にすることやサンプル数を増やして検討する必要があると思われた。(著者抄録)

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Language：Japanese   Publisher：(株)医学書院  

不安障害とうつ病性障害を対象とした認知行動療法(CBT)について、疾患特異的CBTの発展と限界を述べた後、不安障害・うつ病性障害の共通性および診断横断的CBTの可能性を説明した。次に診断横断的CBTの分類を概説すると共に、特定の疾患群に対する限定型診断横断的CBTを対象別(個人、集団)に詳述し、精神疾患全般に渡る包括型診断横断的CBTについても解説した。さらに限定型診断横断的CBTと包括型診断横断的CBTの共通点、不安障害・うつ病性障害に対する診断横断的CBTの三つの課題にも言及した。

DOI： 10.11477/mf.1405102612

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00749&link_issn=&doc_id=20131227050003&doc_link_id=10.11477%2Fmf.1405102612&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1405102612&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本小児心身医学会  

自己評定式中学生版自閉症スペクトラム指数(self-rating autism spectrum quotient for junior high school students:SR-AQJ)を作成し、信頼性と妥当性を検討することを目的とした。中学生279名を対象に、質問紙への回答を求め、GP分析と探索的因子分析により、項目の精査を行った。その結果、25項目3因子構造の質問紙が作成された。因子は、&quot;社交性&quot;&quot;コミュニケーション&quot;&quot;想像力&quot;と解釈した。各因子と尺度全体において、Cronbachのα係数を算出したところ、一定の値が得られ、信頼性が確認されたが、妥当性には課題が残った。今後は、臨床活用に向け、妥当性を確認し、さらなる検討を加えていきたい。(著者抄録)

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Language：Japanese   Publisher：先端医学社  

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Language：Japanese   Publisher：診断と治療社  

＜Headline＞1 厚生労働省「労働者の心の健康の保持増進のための指針」には、メンタルヘルスケアにおいては4つのケアによる、4つの取り組みの実践が効果的であることが示されている。2 現状の対策を補うために、うつ病休職から職場復帰した労働者や、ストレスチェック制度において高ストレスに該当した労働者を対象とした一次・三次予防のための簡易型認知行動療法によるセルフケア教育プログラムを開発し、本稿ではその概要を示した。3 このプログラムにより、セルフケアの推進だけでなく、4つのケアの連携の強化、産業保健スタッフの啓発、自殺等の予防としての高リスクの労働者と産業保健スタッフとのコミュニケーションの促進が期待される。(著者抄録)

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Language：Japanese   Publisher：日本認知療法・認知行動療法学会  

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DOI： 10.11477/mf.1405205380

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00749&link_issn=&doc_id=20170608060007&doc_link_id=10.11477%2Fmf.1405205380&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1405205380&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：日本産業ストレス学会  

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Other Link： http://search.jamas.or.jp/link/ui/2016400423

Language：Japanese   Publisher：日本認知療法・認知行動療法学会  

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Other Link： http://search.jamas.or.jp/link/ui/2016355067

Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：日本認知療法・認知行動療法学会  

併存疾患を有する心的外傷後ストレス障害(PTSD)の20代会社員の女性患者に、統一プロトコル(Barlow et al、2004)を実施した事例を報告した。統一プロトコル導入の3年前に、自転車に乗って道路を横断中、自動車に衝突される交通事故に遭い、骨盤骨折のため2ヵ月入院した。この事故の補償をめぐり加害者とトラブルになり、その後PTSDを発症した。統一プロトコルとして、毎週60分から90分のセッションを6ヵ月間に計20回実施した。当初、統一プロトコルに含まれる曝露の手続きに対象患者は強い不安を示していた。統一プロトコルの心理教育として、様々なスキルを身につけて準備をした上で徐々に曝露をすると説明して、開始の同意を得た。統一プロトコルによって曝露を含む介入が可能となり、その結果、症状の改善が見られた。統一プロトコルは曝露導入に抵抗を示す事例や、併存疾患のあるPTSD事例において、治療選択の一つとなり得ると考えられた。

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：医歯薬出版(株)  

本稿では、認知行動療法のなかでももっとも新しい試みのひとつである診断横断的アプローチに焦点をあて、その一例としてボストン大学のBarlow教授らが開発した統一プロトコルについて紹介する。診断横断的アプローチとは、単一の精神疾患を越えて複数の疾患に対して共通の病理・治療メカニズムを想定し、それに基づき、1つの介入により複数の疾患への治療を試みるアプローチである。こうしたアプローチに基づく認知行動療法のなかでも、統一プロトコルは科学研究による検証がもっとも着実に進められている。統一プロトコルは感情科学などの基礎研究の知見をもとにして、既存のさまざまな認知行動的介入や原則をひとつの治療として体系化したものである。対象疾患は不安障害やうつ病性障害といった感情調整の不全を特徴とする感情障害(emotional disorders;「サイドメモ」参照)であり、今後の効果検証が期待されている。(著者抄録)

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