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Studies that look to disseminate psychological therapies in different countries often discuss whether and how much cultural adaptation may be required. However, most do not provide sufficient descriptions of how language translation and cultural adaptations were performed, and rarely give examples of specific changes. This makes it hard to understand how much the adapted treatment differs from the original, causing difficulty when comparing studies. This study aimed to describe the translation and cultural adaptation process used to generate a Japanese version of a UK-developed online psychological therapy for social anxiety. It aimed to evaluate the translated and adapted content with a case series of Japanese patients. Following translation and back-translation, incorporating cultural adaptations where appropriate, the new Japanese content was reviewed and a list of adaptations collated and categorised. The Japanese treatment material was then evaluated using a guided self-study approach with six Japanese patients with social anxiety. Four categories of adaptation were identified: Linguistics and Metaphors, Social Systems, Social Behaviours, and Familiarity. Assigning instances of adaptation into these categories showed good interrater reliability (0.78). The Japanese materials showed excellent treatment efficacy (pre-post Hedges’ g = 2.31). Patient feedback highlighted areas of strength, and further suggestions to improve suitability for Japanese settings. The clinical outcomes observed suggest that the translation and adaptation procedures were effective. Ways of further improving the adaptation based on patient feedback were identified. It is hoped that the translation procedure and adaptation categories described in this study may help other clinicians/researchers working to disseminate both online or in-person psychological therapies cross-culturally.

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 Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes. Objective This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation. Methods A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire. Results Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions. Conclusions It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful.

BACKGROUND Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes. OBJECTIVE This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation. METHODS A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire. RESULTS Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions. CONCLUSIONS It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful.

Background: The novel corona virus infection (COVID-19) has immediately become a pandemic. Identifying characteristics of possible “super spreaders,” who are assumed to be a dominant cause of rapid transmission, will help in designing proper prevention strategies. Methods: We conducted a nation-wide online survey to investigate the relationship of understanding and anxiety levels about COVID-19 to possible risk behaviors for spreading the virus in Japan. In total, 4,000 citizens responded to our questionnaire during March 27 and 28, 2020. The questionnaire included several questions covering the level of fear and anxiety about COVID-19, infection preventive behaviors, access to media, level of trust in information about the virus, as well as participants’ demographic characteristics. Findings: In total, 13·7% of participants reported that they have a very low understanding of COVID-19. This study defined those participants as “indifferent individuals.” In addition, 10·6% and 12·2% of them indicated that they have no anxiety of being infected and transmission to others, respectively. We also found that 11·2% showed no worry about symptomatic aggravation, and 8·5% had no concern about spreading the infection. Indifferent individuals were less likely to access information sources than others, and do not trust the information they obtained about the virus. They were less anxious about their own health, and less likely to engage in precautionary behaviors (e.g., washing hands and avoiding crowded spaces) than other participants. Interpretation: The present study suggests it is highly important to educate those who have no concerns about COVID-19, and help them to stop their risk behaviors in order to prevent and control this viral pandemic. Funding Statement: This study was funded by a management grant provided by the Ministry of Education, Culture, Sport, Science and Technology to Chiba University Graduate School of Medicine. Declaration of Interests: The authors declare no conflict of interests regarding this study. Ethics Approval Statement: This study protocol was approved by the Ethics Committee of Chiba University Graduate School of Medicine and the Ethics Committee of the International University of Health and Welfare before implementation. Participants were informed that their participation was voluntary.

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.

The aim of the present study was to examine the affect regulation strategies of college athletes using the novel diagrammatic ‘distance affect regulation mapping’ (DARM) tool. In a mixed-methods approach, 96 college athletes completed and reflected on the DARM and completed questionnaires measuring attachment orientation. The correlation analyses demonstrated that athletes who had secure attachment orientations were more likely to seek proximity to someone they relied on to help soothe stress. Qualitative analysis suggested that college athletes found the DARM helpful in highlighting the effective strategies they used to cope with stress. The DARM is a promising tool for researchers to visually capture a range of strategies, and for college athletes to reflect on, improve, and further develop their affect regulation strategies.

The objective of the present study was to investigate the factor structure, and the reliability and validity of the Japanese version of the Obsessive-Compulsive Inventory-Revised (OCI-R). The participants included 214 university students enrolled at two universities in a metropolitan area. They completed the OCI-R and other related scales, and of these, 38 students answered the OCI-R again two weeks later. Based on a factor analysis, the six-factor structure, the same as the original version, was confirmed. For reliability, internal consistency and test-retest reliability were evaluated and both internal consistency and test-retest reliability were confirmed. For convergent validity, we calculated the correlation coefficient using the Japanese version of the Maudsley Obsessional-Compulsive Inventory, which measures obsessive-compulsive symptoms. For concurrent validity, we calculated the correlation coefficient using the Patient Health Questionnaire-9, which measures depressive symptoms; and the Generalized Anxiety Disorder-7, which measures anxiety symptoms. Overall, the factor structure, the reliability, and the validity of the Japanese version of the OCI-R were all confirmed in this study. In the future, we will investigate whether the same results can be obtained in clinical groups.

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 and objectives The perception of threat and associated feelings of anxiety typically prompt people to seek safety; reassurance seeking is an interpersonal strategy almost universally used to reduce the immediate perception of risk. Excessive Reassurance Seeking (ERS) is considered to be particularly prominent and unequivocally counter-productive in people suffering from anxiety disorders in general and OCD in particular, producing short term relief but a longer term return and worsening of the original anxiety. We evaluated the extent and specificity of the effects of ERS in OCD and mechanisms involved in both anxiety relief and the hypothesized later return of anxiety.. Method Self rated effects of reassurance seeking were investigated in 153 individuals with OCD, 50 with panic disorder, and 52 healthy controls, evaluating reactions to the provision and non-provision of reassurance. Results Reassurance is associated with short term relief then longer term return of both discomfort and the urge to seek further reassurance in both anxious groups; healthy controls do not experience significant resurgence. Greater return of anxiety and urge to seek more reassurance were associated with higher levels of overall reassurance seeking.. Limitations The findings were based on retrospective self-report of naturally occurring episodes of ERS; prospective studies and induced behaviours are now needed. Conclusions Not only is reassurance a quick fix for people experiencing OCD, but in the absence of treatment the only fix! The findings explain why reassurance seeking continues despite advice that it will worsen anxiety problems. Such advice is potentially harmful to patients and their loved ones..

Background The novel corona virus infection (COVID-19) quickly became a pandemic state. Identifying characteristics of “possible super spreaders”, suggested as a dominant cause of rapid spreading transmission, will help us to design proper prevention strategies. Methods We conducted a nation-wide online survey to investigate the relationship of perception and anxiety levels about COVID-19 to the possible risk behaviors for spread of the virus in Japan. We recruited a total of 4,000 citizens, who responded to the questionnaire including several questions regarding the level of fear and anxiety about COVID-19, infection preventive behaviors and access to media with trust level about the virus as well as some demographic and socioeconomic data during March 27th and 28th, 2020. Findings Thirteen-point-three percent of the participants rated “1” on a nine-point Likert with respect to the knowledge about COVID-19. Ten-point-one percent and 11.7% presented no anxiety of being infected and transmission to others. Ten-point-eight percent showed no worry about symptomatic aggravation. Eight-point-one percent had no serious concern about expanding infection. The distribution of these items was highly correlated with each other. Participants with the low level of knowledge about COVID-19 were likely to less frequently access any information sources and neither trust them. They were less anxious about their health status, and less likely to put precautionary behaviors such as washing hands and avoiding crowded spaces, suggested by statistical analyses. Interpretation The present study suggests that it is greatly important to enlighten those have no concerns about this crisis of COVID-19 and modify their risk behavior via various ways, in order to prevent and control this viral pandemic. Funding This study was funded by the management grand provided to Chiba University Graduate School of Medicine and the Japan Society for the Promotion of Science KAKENHI grants., Highlights ● The lack of knowledge about COVID-19 is the core cognitive trait of potential super spreaders who occupy more than 10% of citizens. ● Super spreaders may be in a vicious circle of cognitive indifference, lack of exact information, and recurrent risky behaviors. ● To stop the deterioration of pandemic of COVID-19, we should give proper knowledge to indifferent individuals with any means.

Substance Use Risk Profile Scale (SURPS; Conrod & Woicik, 2002) measures four risk personality dimensions related to substance use; anxiety sensitivity (AS), hopelessness (H), sensation seeking (SS), impulsivity (IMP). The aim of this study is to develop the Japanese version of Substance Use Risk Profile Scale (SURPS-J) and to probe the reliability and validity of this scale to the Japanese context. This study consists of the test of the factor analysis (Study 1; N = 462), the reliability (Study 2; N = 64), and the validity (Study 3; N = 182). Our findings are as below; Study 1 showed the conformed factorial structure of SURPS-J and Study 2 revealed the good test–retest reliability. Additionally, Study 3 demonstrated the adequate validity of SURPS-J and its sensitivity in identifying risky drinking motivations and lifetime tobacco and alcohol use. Results showed that high H individuals are likely to experience smoking under the personal and collective situations, while high SS and IMP individuals are prone to drink alcohol under the collective situation. Additionally, high AS individuals are prone to drink by virtue of negative reinforcement motives and high SS and IMP drink by reason of all drinking reinforcement motives.

The purpose of the present study was to explore the experience of being asked for reassurance from the perspective of carers of obsessive compulsive disorder (OCD) sufferers, and to examine its relationship to sufferers’ reassurance seeking by a direct comparison with data obtained from the person they normally offer reassurance to. Forty-two individuals with OCD and their carers completed alternate versions of the Reassurance Seeking Questionnaire. Result suggest that carers report most commonly providing reassurance when asked to do so, and the frequency of their reassurance provision is associated with how carefully sufferers seek reassurance, rather than their OCD symptom severity. The carer's perspectives on the impact of reassurance provision was accurate; both sufferers and carers perceive that reassurance works only temporarily, but even if the anxiety-relieving effect of reassurance decreases in the medium term, it is likely to be perceived as beneficial because carers accurately perceived that sufferers would feel much worse if they refused to provide reassurance. The present study is the first to quantitatively investigate carer's experiences of reassurance provision, and elucidate why carers feel the need to provide it.

Purpose – The purpose of this paper is to discuss the implementation and evaluation of a cognitive behavioral therapy (CBT) training course for clinicians in Chiba, the sixth-largest province in Japan. Design/methodology/approach – Individual CBT for obsessive-compulsive disorder, bulimia nervosa, or social anxiety disorder was delivered by trainees of the Chiba CBT training course in a single study design. Findings – The results demonstrated that individual CBT delivered by trainees led to statistically significant reductions in symptom severity for all three disorders. Feedback from the trainees indicated that the training course achieved its aims. Research limitations/implications – Barriers to the dissemination of CBT in Japan such as opportunities for training and possible solutions are discussed. Originality/value – This paper evaluates the Chiba CBT training course, which is a Japanese adaptation of the UK Improving Access to Psychological Therapies Project and the first post-qualification CBT training course in Japan.

Background and objectives Mental contamination is the experience of feelings of dirtiness without direct physical contact with a contaminant. Imagining a non-consensual kiss from an immoral man (Dirty Kiss task) can evoke feelings of mental contamination in non-clinical female participants. We investigated whether feelings of mental contamination evoked by the Dirty Kiss task are reduced by washing behaviours. Methods Forty-eight female participants were split into two groups: washing (n=24; asked to wash their hands and mouth after the Dirty Kiss task) and non-washing (n=24; asked to wait without engaging in any behaviour after the Dirty Kiss task). Indices of mental contamination were administered before, immediately after, 5 min after, and 20 min after the task. Results Mental contamination scores did not significantly differ between the groups at any point. However, in both groups, scores immediately after the Dirty Kiss task were significantly higher than those 5 or 20 min later. Limitations The long-term effects of washing behaviour on mental contamination were not clarified. Conclusions Mental contamination can be reduced by washing behaviour, although no more effectively than waiting without washing.

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.

Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behavior that resembles the compulsive behaviors that are typically seen in OCD. ERS can be complex, persistent, extensive, debilitating and may dominate people’s interactions. In addition to resembling compulsive checking in OCD it may also have the effect of transferring responsibility to others. Caregivers are frequently asked to take part in a range of rituals as part of the OCD sufferer’s problem, often seeing it as a way of supporting the sufferer. We are still in the early stages of understanding the factors that elicit and maintain these responses in caregivers. The present investigation considered the interpersonal components of ERS by applying an in-depth analysis using qualitative methods in the context of an interview of caregivers who provide reassurance to OCD sufferers. Ten interviews were conducted and analysed using thematic analysis. Seven overarching themes were identified as important in the experience of being asked for and providing reassurance. These concern factors such as how people seek reassurance, how they process it, why other people give it and so on. A particularly pervasive theme was caregivers’ experience of frustration in the face of ERS. Clinical implications of the findings are discussed.

The cognitive biases associated with perfectionism include a selective attention to failure and the discounting of success. The present study experimentally focused on the relation between self-oriented perfectionism (SOP) and selective attention using the social cognitive paradigm. Forty undergraduate students who were identified as either high or low in SOP were asked to perform modified versions of the Stroop task. The results suggest that participants with high SOP did not take longer to respond to failure words than to neutral words, but their reaction time to failure words was longer than that of participants with low SOP. These findings provided the basis for cognitive behavioral biases for perfectionism.

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.

We reply to Flett and Hewitt’s (2014) commentary on our findings (Stoeber, Kobori, & Brown, 2014) focusing on the multidimensionality of the Perfectionism Cognitions Inventory (PCI) and the question of whether the Multidimensional Perfectionism Cognitions Inventory (MPCI) represents an alternative to the PCI. In addition, we reiterate the importance of considering suppression effects when examining different dimensions of perfectionism and, in concluding, invite researchers to join forces to further advance the assessment of multidimensional perfectionism cognitions.

Social anxiety disorder (SAD) is characterized by significant distress regarding social performance situations. Patients experience strong embarrassment about how they are perceived by others due to increased self-focused attention. This case report presents two cases of SAD and the effects of cognitive behavioural therapy (CBT) on ‘picturing of self’ (e.g. self-picturing and self-projection). The goal was to demonstrate the changes in ‘picturing of self’ using brief video feedback (VF) as a treatment and projective drawing as an assessment method of CBT, especially with SAD. The CBT consisted of psychoeducation and case formulation, cognitive restructuring, and behavioural experiments. In one case VF was used to provide additional means by showing the patient's own actual moving figure, the self-picture. For the other case, the patient was instructed to ‘draw a person’ and the changes in drawing style were assessed. Through the course of CBT, Liebowitz Social Anxiety Scale scores reduced significantly in both cases. ‘Picturing of self’ changed as a result of the use of CBT. Brief VF and projective drawing would be useful for individuals to see the change in themselves.

Past research indicates that Self-Oriented Perfectionism (SOP: P. L. Hewitt & G. L. Flett, 1991) has been linked to psychopathology but can have both positive and negative elements. The purpose of the present study is to examine whether the relationship of SOP to positive and negative affect would be mediated by the presence of specific cognitions regarding “Personal Standards (PS),” and “Concern over Mistakes (CM)” as well as goal motivations. Two mediations involved in SOP were hypothesized: (1) in the presence of approach goals, the cognition of PS emerges from activated SOP and leads to positive affect; and (2) in the presence of avoidant goals, the cognition of CM emerges from activated SOP and leads to negative affect. In Study 1, 358 college students completed the research questionnaire, and structural equation modeling was used to test the mediation model. In Study 2, 60 participants, 30 rated high and 30 rated low in SOP, were presented with either an approach or an avoidant goal for an experimental task, and asked to rate their perfectionism cognitions and affects. The findings provided partial support for the hypotheses.

本研究は，完全主義の認知を「自己志向的完全主義がセルフ・スキーマとして活性化した結果，意識化された思考であり，できごとの解釈や注意に影響を与えるもの」と定義し，その認知を多次元で測定するための尺度（Multidimensional Perfectionism Cognition Inventory: MPCI）を作成した．研究1では，MPCIの因子構造が明らかとなり，高目標設置，ミスへのとらわれ，完全性の追求の下位次元が特定され，これらの下位次元は十分な信頼性を示した．研究2では，MPCIの構成概念妥当性と基準連関妥当性が明らかとなった．

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...

Health anxiety, also known as hypochondriasis, is classifiable as an anxiety disorder. We present a case report on the effects of a brief cognitive-behavioral therapy (CBT) on health anxiety in order to demonstrate the successful implementation of techniques proposed by cognitive-behavioral models of health anxiety. The client was a Japanese male suffering from slight paralysis in his limbs and the left recurrent nerve. The case formulation suggested that he was misinterpreting his health condition, which made him more anxious and fostered a range of safety-seeking behaviors, including reassurance seeking. The intervention involved attention training and preventing reassurance seeking and the provision thereof. In addition, "mastery and pleasure ratings" were used to improve the patient's mood and increase his engagement in activities other than preoccupation with his health condition. These techniques enabled the client to stop his reassurance seeking behavior and rumination about his symptoms. The present study demonstrated the effectiveness of CBT in reducing health anxiety relating to actual medical conditions. Language: en

Perfectionism cognitions capture automatic perfectionistic thoughts and have explained variance in psychological adjustment and maladjustment beyond trait perfectionism. The aim of the present research was to investigate whether a multidimensional assessment of perfectionism cognitions has advantages over a unidimensional assessment. To this aim, we examined in a sample of 324 university students how the Perfectionism Cognitions Inventory (PCI) and the Multidimensional Perfectionism Cognitions Inventory (MPCI) explained variance in positive affect, negative affect, and depressive symptoms when factor or subscale scores were used as predictors compared to total scores. Results showed that a multidimensional assessment (PCI factor scores, MPCI subscale scores) explained more variance than a unidimensional assessment (PCI and MPCI total scores) because, when the different dimensions were entered simultaneously as predictors, perfectionistic strivings cognitions and perfectionistic concerns cognitions acted as mutual suppressors thereby increasing each others’ predictive validity. With this, the present findings provide evidence that—regardless of whether the PCI or the MPCI is used—a multidimensional assessment of perfectionism cognitions has advantages over a unidimensional assessment in explaining variance in psychological adjustment and maladjustment.

Obsessive–compulsive disorder (OCD) affects roughly 2.5% of the general population [1]. An anxiety–based disorder, OCD is characterized by persistent, intrusive, and distressing obsessions (thoughts, impulses, or images) or compulsions (repetitive, excessive behaviours or mental acts) [1]. Similar to the U.S., nationwide prevalence of OCD in Japan is approximately 2% [2]. In one study, researchers administered the Yale–Brown Obsessive Compulsive Scale (Y–BOCS) symptom checklist [3] to 343 Japanese patients with OCD to examine whether symptom dimensions were stable across cultures. They found that the OCD symptom structure has substantial transcultural stability across Western and Eastern cultures [4]. Fear of contamination features prominently in approximately half of all cases of OCD [5] e.g., ‘I avoid using public toilets because I am afraid of disease or contamination’). In generally, these feelings of dirtiness may be evoked by contact with a contaminant or dirt. However, there is also another type of contamination that may be experienced without physical contact with a contaminant [6,7]. This phenomenon, first identified by Rachman [8], is called mental contamination

Aim: Health anxiety, also known as hypochondriasis, is classifiable as an anxiety disorder. The aim of this study was to examine the relationship between health anxiety and healthcare costs. Method: Participants – 100 Japanese individuals from the general population with chronic health problems and 100 without chronic health problems – were recruited via the Internet. They completed self-report scales measuring health anxiety, state anxiety, depression, obsessionality, and a scale specifically developed for this study that measured the use of healthcare services and the personal costs of respondents' healthcare. Results: Health anxiety was associated with more incidents of inpatient care and greater healthcare expenditure. These associations remained significant even after controlling for state anxiety, depression, obsessionality, and the presence of chronic health problems. Conclusion: We conclude that health anxiety is related to personal as well as social costs in Japan.

The prevention and treatment of substance use for youth are important issues in Japan. Substance use have significant risks of adverse psychological, social and physical health consequences. Personality factors in order to understand individual differences for substance use and misuse particularly were the much promise, and several personality factors have been demonstrated to be associated with risk for substance use. Conrod and Woicik (2002) developed Substance Use Risk Profile Scale (SURPS) that measures four substance use risk personalities: anxiety sensitivity, hopelessness, sensation-seeking, impulsivity being closely relevant to substance use/misuse and abuse. There are only a few studies focusing the relationship between personality factors and substance use among Japanese adolescents. Thus, this paper aimed to review the previous studies on these issues, and introduce studies regarding SURPS including our studies.

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.

Cognitive behaviour therapy (CBT) is widely regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. The theoretical orientations underlying CBT models and treatment interventions developed in Western cultures were typically constrained by Western conceptualizations of SAD. This case study reports on the use of CBT for Japanese SAD, demonstrating the successful implementation of cognitive techniques grounded in the Clark & Wells model. The patient was a Japanese female with excessively high standards for workplace social performance. Therapy mainly comprised case formulation, behavioural experiments, and opinion surveying based on the Clark & Wells model. These techniques allowed the patient to reduce the strength of maladaptive cognitions and lower her excessively high standards for social performance. CBT treatment using the Clark & Wells model was effective and suitable for Japanese SAD, at least in the present case. We also discuss the cross-cultural differences of SAD and adaptation of CBT.

Regarding self–conscious emotions, studies have shown that different forms of perfectionism show different relationships with pride, shame, and embarrassment depending on success and failure. What is unknown is whether these relationships also show cultural variations. Therefore, we conducted a study investigating how self–oriented and socially prescribed perfectionism predicted pride and embarrassment after success and failure by comparing 363 British and 352 Japanese students. Students were asked to respond to a set of scenarios where they imagined achieving either perfect (success) or flawed (failure) results. In both British and Japanese students, self–oriented perfectionism positively predicted pride after success and embarrassment after failure, whereas socially prescribed perfectionism predicted embarrassment after success and failure. Moreover, in Japanese students, socially prescribed perfectionism positively predicted pride after success and self–oriented perfectionism negatively predicted pride after failure. The findings have implications for our understanding of perfectionism, indicating that the perfectionism–pride relationship not only varies between perfectionism dimensions but may also show cultural variations. Copyright © 2012 John Wiley & Sons, Ltd.

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.

The musk-melon is usually evaluated or estimated by the maturity and the configuration of nets on the rind of the fruit by consumers as well as producers. In this paper, the growth of the melon, the distribution and the expansion of the nets were investigated, and their characteristics and relationship were analyzed from the view point of the information engineering. The results are as follows:1. The longitudinal crack first broke out near the equator. The number of nets derived from longitudinal cracks of matured fruits was proportional to the radius on the latitude where the net broke out. The density of longitudinal nets did not change with tce latitude. The width of the nets was inversely proportional to the radius where the net broke out.2. The density of nets derived from latitudinal cracks was higher than that derived from longitudinal cracks. The density of nets derived from latitudinal cracks on the circumpolar zone, near the peduncle or the stylar scar, was higher than that near the equator. The density of nets derived from latitudinal cracks is proportional to the distance from the center to the position where the net broke out. The distribution of nets was entropy-like while the growth of the difference between the growth of the pericarp and the growth of the rind tissue. The cracks broke out on the place where the velocity of stretching of the rind was higher. The greater part of the growth of the fruit after breaking out the cracks is attributed to the growth of the cracks.

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.

Reassurance seeking is a common problem in clinically anxious populations, and is particularly obvious in obsessive–compulsive disorder (OCD). This study seeks to examine the way individuals with OCD try to seek reassurance and the perceived consequences of such reassurance seeking using a qualitative analysis of the perspectives of individuals with OCD who seek reassurance from other people. A semi-structured interview was employed to ask individuals with OCD to reflect on occasions when they sought reassurance, and its impact on themselves and others. Ten interviews were conducted, transcribed, and analysed in detail using thematic analysis. Four overarching themes were identified in terms of reassurance seeking; interrogating feelings to achieve a sense of certainty, ceaseless and careful effort, reluctance to seek reassurance, and interpersonal concern. A thematic map was produced to understand the relationship between themes and sub-themes.

The Multidimensional Perfectionism Cognitions Inventory (MPCI; Kobori & Tanno, 2004) is a promising new instrument developed in Japan to assess perfectionism cognitions regarding personal standards, pursuit of perfection, and concern over mistakes. In this study, we examined reliability and validity of the English version of the MPCI, the MPCI-E (Kobori, 2006), in a sample of 371 native English speakers. A confirmatory factor analysis confirmed the MPCI-E's 3-factorial oblique structure. Moreover, correlations with measures of dispositional perfectionism and past-week positive and negative affect provided initial evidence of the MPCI-E's convergent and differential validity. Finally, hierarchical multiple regressions indicated that the MPCI-E showed incremental validity in explaining variance in positive and negative affect above variance explained by dispositional perfectionism. Overall, the findings provide initial evidence for the reliability and validity of the MPCI-E as a multidimensional measure of perfectionism cognitions that has the potential to further the understanding of positive and negative cognitions in perfectionism.

Setting high standards is one of the core aspects of perfectionism. Shafran, Cooper, and Fairburn (2002) proposed that individuals with self-imposed perfectionism raise their standards after they successfully meet them. This study examines whether individuals with self-imposed perfectionism raise their goal after the feedback of success. Fifty-three college students, whose self-oriented perfectionism (SOP; Hewitt & Flett, 1991) was assessed, performed a task with a goal, and received feedback of success. Following the feedback, they were asked to choose (a) the same goal or (b) a more difficult goal for the next task. The logistic regression analysis revealed that the greater the SOP, the more likely the participants were to choose the difficult goal. The theoretical and clinical implications for the standard setting of perfectionism were discussed.

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.

Individuals with Obsessive-Compulsive Disorder (OCD) need additional information before making a decision. The present study examines information-gathering behaviour and its relationship with perfectionism, one of the risk factors for OCD. Thirty-three participants, 17 rated high and 16 rated low on Self-Oriented Perfectionism (SOP: Hewitt & Flett, 1991), performed a probability inference task. The participants were required to make a decision while gathering information. The results suggest that although the high-SOP group needed additional information before making a decision compared to the low-SOP group, there was no difference in the task completion time between the two groups.

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).