Tadashi Funayama

Group cognitive behavior therapy for Japanese patients with social anxiety disorder: preliminary outcomes and their predictors

BackgroundA number of studies have provided strong evidence for the use of cognitive behavior therapy (CBT) in the treatment of social anxiety disorder (SAD). However, all of the previous reports were from Europe and North America and it is unknown whether Western psychological therapies are effective for SAD in non-Western cultures. The present pilot study aimed to evaluate CBT program for SAD which was originally developed for Western patients, among Japanese patients.MethodsFifty-seven outpatients who participated in group CBT for SAD were evaluated using eight self-reported and one clinician-administered questionnaires to measure various aspects of SAD symptomatology at the beginning and at the end of the program. Pre- and post-treatment scores were compared and the magnitude of treatment effect was quantified as well based once on the intention-to-treat (ITT) and once among the completers only. We also examined baseline predictors of the CBT outcomes.ResultsSeven patients (12%) did not complete the program. For the ITT sample, the percentage of reduction was 20% to 30% and the pre to post treatment effect sizes ranged from 0.37 to 1.01. Among the completers, the respective figures were 20% to 33% and 0.41 to 1.19. We found no significant pretreatment predictor of the outcomes.ConclusionGroup CBT for SAD is acceptable and can bring about a similar degree of symptom reduction among Japanese patients with SAD as among Western patients.

Change in quality of life and their predictors in the long-term follow-up after group cognitive behavioral therapy for social anxiety disorder: a prospective cohort study

BackgroundSocial anxiety disorder (SAD) is one of the most common anxiety disorders. The efficacy of cognitive behaviour therapy (CBT) has been examined but to date its effects on Quality of Life (QoL) have not been appropriately evaluated especially in the long term.The study aimed to examine, in the long term, what aspects of Quality of Life (QoL) changed among social anxiety disorder (SAD) patients treated with group cognitive behaviour therapy (CBT) and what predictors at baseline were associated with QoL.MethodsOutpatients diagnosed with SAD were enrolled into group CBT, and assessed at follow-ups for up to 12 months in a typical clinical setting. QoL was evaluated using the Short Form 36. Various aspects of SAD symptomatology were also assessed. Each of the QoL domains and scores on symptomatology were quantified and compared with those at baseline. Baseline predictors of QoL outcomes at follow-up were investigated.ResultsFifty-seven outpatients were enrolled into group CBT for SAD, 48 completed the whole program, and 44 and 40 completed assessments at the 3-month and 12-month follow-ups, respectively. All aspects of SAD symptomatology and psychological subscales of the QoL showed statistically significant improvement throughout follow-ups for up to 12 months. In terms of social functioning, no statistically significant improvement was observed at either follow-up point except for post-treatment. No consistently significant pre-treatment predictors were observed.ConclusionsAfter group CBT, SAD symptomatology and some aspects of QoL improved and this improvement was maintained for up to 12 months, but the social functioning domain did not prove any significant change statistically. Considering the limited effects of CBT on QoL, especially for social functioning, more powerful treatments are needed.

Videotaped experiments to drop safety behaviors and self-focused attention for patients with social anxiety disorder: Do they change subjective and objective evaluations of anxiety and performance?

Safety behavior (SB) and self-focused attention (SFA) have been posited as important maintenance factors in the cognitive model of social anxiety disorder (SAD). The present study reports the results of experiments to drop SB and SFA among clinically diagnosed patients with SAD employing their own idiosyncratic anxiety-provoking situations. The ratings for observable anxiety, belief in feared outcome and overall performance were better for role plays without SB and SFA than for role plays with them. The degree of drop in SFA predicted drop in observable anxiety and belief in feared outcome. Dropping SB and SFA, however, was unable to completely correct the cognitive distortion because the subjective ratings were still significantly worse than the objective ratings.

Cognitive-behavior therapy for Japanese patients with panic disorder: Acute phase and one-year follow-up results

Aim:  The aim of this paper is to report the outcomes and follow‐up data of our cognitive behavioral therapy program for Japanese patients with panic disorder and to examine the baseline predictors of their outcomes.

Interoceptive hypersensitivity as prognostic factor among patients with panic disorder who have received cognitive behavioral therapy

The efficacy of cognitive behavioral therapy (CBT) in the acute-phase treatment of panic disorder is well established. However, there are data to show CBT may not always be able to prevent recurrence after treatment. The central cognitive component of panic disorder psychopathology is thought to be hypersensitivity to physical sensations. The present study reports that some aspects of interoceptive hypersensitivity, gastrointestinal fears in particular, were predictive of the course of panic disorder after end of CBT. Clinically it is suggested that new interoceptive tasks related to gastrointestinal fears are needed.

Cognitive–behavioral therapy modifies the naturalistic course of social anxiety disorder: Findings from an ABA design study in routine clinical practices

While randomized evidence appears to have established efficacy of cognitive–behavioral therapy (CBT) and some pharmacotherapy for social anxiety disorder (SAD), their real‐world effectiveness has been called into question by long‐term naturalistic cohort studies of patients with SAD as they show very low probability of recovery and sustained social dysfunctions despite some drug and psychological therapies.

Case of intrathecal baclofen-induced psychotic symptoms

voxamine, sertraline, paroxetine, milnacipran, mirtazapine) and thyroxine, her mood fluctuated frequently, including nine depressive phases and five hypomanic phases in the 26 months after the first admission, with euthymic periods lasting less than 3 weeks. Several drugs could not be used to sufficient doses due to side-effects; however, most drugs were used to adequate doses and durations. Consequently, she was admitted eight times (total duration: 332 days) due to depressive episodes. On her third and fifth admissions, six bilateral ECT sessions were performed consecutively for acute-phase severe depressive symptoms and moderate improvement was observed. During these two ECT sessions, medications were not changed. In consideration of the outcome of the two previous acute-phase ECT sessions, ambulatory continuationECT was started 26 months after the first admission. Continuation-ECT was administered weekly for the first month and subsequently reduced to biweekly administration. In the subsequent 12 months of C/M-ECT, she did not reach remission; however, her HRSD score decreased to 14 and her YMRS score decreased to 7, indicating reduced severity of depression and decreased hypomanic state. To date, she has not been hospitalized. Antidepressants, particularly tricyclic antidepressants, are reportedly responsible for inducing 20% of RC cases; however, in our patient, most hypomanic phases occurred when she was antidepressant-free. Regarding the C/M-ECT schedule, we could not extend beyond 2-week treatment intervals, which is similar to a report indicating that maintenanceECT could not be extended beyond 3-week treatment intervals for patients with BD. Although she did not achieve complete remission, our experience suggests that C/M-ECT could reduce the likelihood of re-admission by decreasing the severity of RC, thereby providing a cost-effective treatment. Except for one naturalistic study of 14 RC patients, research on the effectiveness of C/M-ECT is limited. In order to evaluate the efficacy of C/M-ECT and establish a standard protocol for BD, further study in a large sample or in a controlled study is needed.

In‐situation safety behaviors among patients with panic disorder: Descriptive and correlational study

In‐situation safety behaviors play an important role in the maintenance of anxiety because they prevent patients from experiencing unambiguous disconfirmation of their unrealistic beliefs about feared catastrophes. Strategies for identifying particular safety behaviors, however, have not been sufficiently investigated. The aims of the present study were to (i) develop a comprehensive list of safety behaviors seen in panic disorder and to examine their frequency; and (ii) correlate the safety behaviors with panic attack symptoms, agoraphobic situations and treatment response.

Behavioral activation: Is it the expectation or achievement, of mastery or pleasure that contributes to improvement in depression?

BACKGROUND Behavioral activation (BA) is receiving renewed interest as a stand-alone or as a component of cognitive-behavior therapy (CBT) for depression. However, few studies have examined which aspects of BA are most contributory to its efficacy. METHODS This is a secondary analysis of a 9-week randomized controlled trial of smartphone CBT for patients with major depression. Depression severity was measured at baseline and at end of treatment by the Patient Health Questionnaire-9. All aspects of behavioral activation tasks that the participants had engaged in, including their expected mastery and pleasure and obtained mastery and pleasure, were recorded in the web server. We examined their contribution to improvement in depression as simple correlations and in stepwise multivariable linear regression. RESULTS Among the 78 patients who completed at least one behavioral experiment, all aspects of expected or achieved mastery or pleasure correlated with change in depression severity. Discrepancy between the expectation and achievement, representing unexpected gain in mastery or pleasure, was not correlated. In stepwise regression, expected mastery and pleasure, especially the maximum level of the latter, emerged as the strongest contributing factors. LIMITATIONS The study is observational and cannot deduce cause-effect relationships. CONCLUSIONS It may be the expected and continued sense of pleasure in planning activities that are most meaningful and rewarding to individuals, and not the simple level or amount of obtained pleasure, that contributes to the efficacy of BA.