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ObjectiveThis study aimed to validate the Sick, Control, One stone, Fat, and Food (SCOFF) questionnaire in relation to the Eating Disorders Examination Questionnaire (EDE-Q) and to examine the appropriateness of a question concerning weight loss among Japanese university students. The psychometric properties of the two Japanese versions were determined among 649 Japanese college students. The original version (SCOFF-O) employed the original item 3, whereas the revised version (SCOFF-2.5) modified the item to “Have you recently lost more than 2.5 kg within three months?” Validity was tested relative to EDE-Q.ResultsThe test–retest reliabilities of SCOFF-O and SCOFF-2.5 were 0.52 and 0.57, while the correlations of SCOFF-O and SCOFF-2.5 with EDE-Q werer = 0.53 andr = 0.56. The sensitivity and specificity of SCOFF-O were 65.2 and 89.7, and those of SCOFF-2.5 were 69.5 and 86.5, respectively. There were significant correlations between the question concerning losing 2.5 kg and the EDE-Q subscales. The Japanese version of SCOFF-2.5 is an appropriate tool for the early screening of eating disorders among Japanese university students.

Background:Homework assignments are generally viewed as an important factor of cognitive behaviour therapy (CBT).Aim:This study examined whether perfectionists procrastinate homework assignments.Method:Thirty-eight university students attended two sessions, 7 days apart from each other. After completing perfectionism scales at the first session, they were asked to complete homework tasks from a self-help wellbeing booklet and return the booklet at session 2.Results:Only maladaptive facets of perfectionism correlated with most of the behavioural measures of procrastination. Moreover, those high in maladaptive perfectionism set and completed fewer planned activities to improve their mood.Conclusions:These findings suggest that perfectionism may affect how clients set their homework, and perfectionism may interfere with the homework assignments of CBT.

Background:It has been proposed that both positive and negative metacognitive beliefs sustain engagement in post-event processing (PEP). However, it is unknown: (1) whether individuals with social anxiety disorder (SAD) actually derive the benefits from PEP that they expect; (2) if this is not the case, how their positive beliefs are maintained; and (3) if they are aware of the counterproductive effects of PEP, why they still perform PEP.Aims:To explore the phenomenology of the processes involved in PEP from the perspective of SADs, in order to address the research questions above.Method:Twenty-one participants suffering from SAD received individual semi-structured interviews. Transcripts were analysed using thematic analysis.Results:Analysis revealed three main themes: (1) ‘Only, safe and useful way to improve myself’: SADs feel the need to improve their social performance, and they believe that PEP is the only, safe, and private way to do so, which is an underlying motive for them to do PEP; (2) ‘It hurts more than helps me’: however, through PEP, they do not seem to obtain the benefit that they expect, or only find a variety of counterproductive outcomes; (3) ‘Better safe than sorry’: they sometimes find makeshift solutions to improve their social performance during PEP, which may maintain their PEP as a form of intermittent reinforcement. They weigh up such costs and benefits, and choose to perform PEP while feeling conflicted about PEP.Conclusions:The results suggest that: (1) SADs rarely obtain the benefits from PEP that they expect; (2) their positive metacognitive beliefs are maintained by solutions they sometimes find during PEP; and (3) SADs choose to perform PEP while feeling conflicted; while PEP ironically maintains and exacerbates negative self-beliefs/images, it is the only safe and useful way to improve their social performance. These findings support and expand on the theories of PEP.

Background: Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. Methods: This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. Results: Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. Conclusions: Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.

The specific phobia of vomiting (also known as emetophobia) is an under-researched area. We present a case report of cognitive therapy treatment for vomit phobia in order to demonstrate the successful implementation of the cognitive techniques proposed by the cognitive models of vomit phobia. The client was a Japanese female living in the UK whose vomit phobia remained after treatment for panic disorder and comorbid depression. The case formulation suggested that the manner in which her fear escalated was similar to the cognitive model of panic disorder. The therapy involved case formulation, attention training, opinion survey and behavioural experiments. These techniques allowed the client to stop her safety-seeking behaviours and adjust her beliefs about vomiting.

Background: One of the most common interpersonal reactions to threat and anxiety is to seek reassurance from a trusted person. The Reassurance Seeking Questionnaire (ReSQ) measures several key aspects of reassurance seeking behaviour, including frequency, trust of sources, intensity, carefulness, and the emotional consequences of reassurance seeking. Aims: The current study compares patterns and consequences of reassurance seeking in obsessive-compulsive disorder (OCD) and depression. Method: ReSQ scores were compared for three groups: 32 individuals with OCD, 17 individuals with depression, and 24 healthy comparison participants. Results: We found that individuals with OCD tended to seek reassurance more intensely and employ self-reassurance more frequently than individuals with depression or healthy participants, and that if reassurance was not provided, they tended to feel a greater urge to seek additional reassurance. Conclusions: This study is the first to quantitatively elucidate differences in reassurance seeking between OCD and depression.

Mental contamination is the experience of contamination-related feelings of dirtiness despite the absence of direct physical contact with a contaminant. These feelings of dirtiness may be evoked by unwanted thoughts and memories of negative events such as ill treatment or sexual assault. This paper is composed of two related studies. The aim of Study 1 (n = 202 for factor analysis; n = 81 for test–retest reliability) was to develop a Japanese version of the Mental Pollution Questionnaire (MPQ–J), an instrument for measuring mental contamination. The aim of Study 2 (n = 236) was to confirm this instrument’s psychometric properties and to test the hypothesis that cognitions related to responsibility and morality predict feelings of mental contamination. After conducting factor analyses, the final version of the MPQ–J yielded eight items and two subscales. The psychometric properties of the MPQ–J were verified by examining correlations with general psychopathology measures. Hierarchical regression analyses s...

Background Cognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. Individual CBT might be acceptable and effective for patients with SAD even in non-Western cultures; therefore, we conducted a feasibility study of individual CBT for SAD in Japanese clinical settings. We also examined the baseline predictors of outcomes associated with receiving CBT. Methods This single-arm trial employed a 14-week individual CBT intervention. The primary outcome was the self-rated Liebowitz Social Anxiety Scale, with secondary measurements of other social anxiety and depressive severity. Assessments were conducted at baseline, after a waiting period before CBT, during CBT, and after CBT. Results Of the 19 subjects screened, 15 were eligible for the study and completed the outcome measures at all assessment points. Receiving CBT led to significant improvements in primary and secondary SAD severity (ps < .001). The mean total score on the Liebowitz Social Anxiety Scale improved from 91.8 to 51.7 (before CBT to after CBT), and the within-group effect size at the end-point assessment was large (Cohen’s d = 1.71). After CBT, 73% of participants were judged to be treatment responders, and 40% met the criteria for remission. We found no significant baseline predictors of those outcomes. Conclusion Despite several limitations, our treatment—which comprises a 14-week, individual CBT program—seems feasible and may achieve favorable treatment outcomes for SAD in Japanese clinical settings. Further controlled trials are required in order to address the limitations of this study. Trial registration UMIN-CTR UMIN000005897

Introduction Pharmacotherapy and cognitive behavioural therapy (CBT) are consistently effective as first-line treatments for social anxiety disorders (SADs). Nevertheless, pharmacotherapy is often the first choice in clinical practice. In many countries, the first line of pharmacotherapy involves the administration of a selective serotonin reuptake inhibitor (SSRI). Although a significant proportion of patients with SAD fail to respond to the initial SSRI administration, there is no standard approach to the management of SSRI-resistant SAD. This paper describes the study protocol for a randomised controlled trial to evaluate the clinical effectiveness of CBT as a next-step strategy, concomitant with conventional treatment, for patients with SSRI-resistant SAD. Methods and analysis This Prospective Randomized Open Blinded End-point study is designed with two parallel groups, with dynamic allocation at the individual level. The interventions for the two groups are conventional treatment, alone, and CBT combined with conventional treatment, for 16 weeks. The primary end-point of SAD severity will be assessed by an independent assessor using the Liebowitz Social Anxiety Scale, and secondary end-points include severity of other social anxieties, depressive severity and functional impairment. All measures will be assessed at weeks 0 (baseline), 8 (halfway point) and 16 (postintervention) and the outcomes will be analysed based on the intent-to-treat. Statistical analyses are planned for the study design stage so that field materials can be appropriately designed. Ethics and dissemination This study will be conducted at the academic outpatient clinic of Chiba University Hospital. Ethics approval was granted by the Institutional Review Board of Chiba University Hospital. All participants will be required to provide written informed consent. The trial will be implemented and reported in accordance with the recommendations of CONSORT. Clinical Trial Registration Number UMIN000007552.

Background: Mental contamination is a psychological sense of contamination that involves an internal, emotional feeling of dirtiness that may be evoked by unwanted thoughts and images, such as sexual assaults. Aims: This study aimed to investigate which types of unwanted sexual experiences evoke the strongest mental contamination, and to test the hypothesis that cognitive appraisals of an unwanted sexual experience predict indices of mental contamination (i.e. feeling of dirtiness, urge to wash, internal negative emotions, and external negative emotions). Method: 148 female participants were asked to recall their most distressing unwanted sexual experiences. Indices of mental contamination and cognitive appraisals of the experience were then assessed. Results: Our findings indicated that individuals recalling experiences related to rape felt more intense feelings of dirtiness than individuals recalling other types of unwanted sexual experience, such as verbal sexual assault, visual sexual assault, and forcible touching/frottage. In addition, hierarchical regression analyses demonstrated that a cognitive appraisal of perceived violation predicted all of the indices of mental contamination after controlling anxiety, depression, and fear of contact contamination. Conclusions: The present study demonstrated that an individual is at greatest risk of mental contamination if she has experienced rape/attempted rape, and if she makes a cognitive appraisal of violation regarding the incident.

This case study reveals the effectiveness of a cognitive behavioural therapy (CBT) intervention based on a functional model of interruption of pain and a hypothetical model of functional somatic syndromes in a case of adolescent somatoform pain disorder. Yu was a junior high school student in Japan who was diagnosed with somatoform pain disorder. He was initially opposed to the diagnosis of such a disorder, but the therapist and client worked together towards a realization that CBT was useful through exercise without forcing ‘psychosocial’ explanations on him. The CBT intervention mainly included four types of techniques: self-monitoring, behavioural experimentation, behavioural activation, and distraction. These interventions enabled Yu to reduce his avoidance of activities.

Background: Reassurance seeking is particularly prominent in obsessive-compulsive disorder (OCD) and may be important in OCD maintenance. Aims: This study used a new self-report questionnaire to measure the range of manifestations of reassurance-seeking behaviours, describing their sources from which they seek, frequency, process (how they seek), and consequences (as opposed to triggers and motivations). This study also attempts to identify the degree to which reassurance is specific to OCD as opposed to panic disorder. Method: Reassurance Seeking Questionnaire (ReSQ) was administered to 153 individuals with OCD, 50 individuals with panic disorder with/without agoraphobia, and 52 healthy controls. The reliability and validity of the measure was evaluated and found to be satisfactory. Results: Reassurance seeking was found to be more frequent in both anxiety disorders relative to healthy controls. Individuals diagnosed with OCD were found to seek reassurance more intensely and carefully, and were more likely to employ “self-reassurance” than the other two groups. Conclusions: Further investigation of reassurance will enable better understanding of its role in the maintenance of anxiety disorders in general and OCD in particular.

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of patients with schizophrenia. Although several studies have investigated the comorbidity associated with OCS in schizophrenia, few case studies are available regarding cognitive behavioural therapy (CBT) for the treatment of OCS of patients within this group. This paper describes a case report in which OCS emerged gradually after the remission of positive symptoms of schizophrenia. The CBT involved psycho education and case formulation, cognitive restructuring, exposure and response prevention (EPR), and behavioural experiments. Improvement in the compulsive behaviours led to a greater insight regarding the relationship between OCS and past experience of positive symptoms (e.g. hallucinations). The cognitive characteristics of the patient were discussed in light of current cognitive models of OCD.

This case study introduces brief cognitive behavioral therapy (CBT) for a student athlete with focal dystonia and describes the development of an idiosyncratic cognitive model of the symptom. In order to aid case formulation of the idiosyncratic dystonic symptom, the therapist adapted and applied an existing cognitive model, which emphasizes the interactions between cognition, anxiety, and bodily sensation (e.g. Clark, 1986; Salkovskis and Warwick, 2001).

Background The Obsessive-Compulsive Inventory (OCI) was designed to evaluate the severity of obsessive-compulsive symptoms in both clinical and non-clinical samples. The aim of the study was to develop a Japanese version of this scale (OCI-J) and validate it in both non-clinical and clinical Japanese samples. Findings In Study 1, the OCI-J, the Maudsley Obsessional Compulsive Inventory (MOCI), and measures of anxiety and depression were administered to 150 undergraduate students (non-clinical sample) in order to investigate the internal consistency and convergent validity of the OCI-J. Furthermore, 118 non-clinical participants completed the OCI-J after a 2-week interval to determine the test-retest reliability. In Study 2, OCD participants (n = 35), anxiety control participants with panic disorder (n = 22), and healthy control participants (n = 37) completed the OCI-J in order to test its clinical discrimination ability. Correlational analysis indicated moderate to high correlations between the subscales and total scores of the OCI-J and MOCI. In addition, the OCI-J and its subscales demonstrated satisfactory test-retest reliabilities. Finally, the OCI-J showed good clinical discrimination for patients with OCD from healthy and anxiety controls. Conclusions The OCI-J is a valid and reliable instrument for measuring OCD symptoms in both clinical and non-clinical samples of Japanese.