Prolonged perceived stress predicts fingernail cortisol increase: A longitudinal study.

Cortisol levels in fingernail samples are known to represent cumulative hormone levels. However, findings on the association between fingernail cortisol and perceived stress have been inconsistent. Since the effect of confounding factors cannot be excluded in cross-sectional studies, this study longitudinally examined the effects of perceived stress and negative life events on changes in fingernail cortisol levels over a period of six months. In total, 113 university students rated their perceived stress and negative life events twice, fingernail samples were collected every 15 days during a six-month period. Furthermore, fingernail cortisol levels were quantified according to each stress and negative life event assessment. We conducted longitudinal multilevel analyses to estimate the effects of perceived stress and negative life events in changes within an individual (within-person change) as well as individual differences of them over the study period (between-person level) on changes in fingernail cortisol levels. Within-person increase in perceived stress and negative life events did not significantly predict within-person increase in fingernail cortisol levels. In the between-person level, higher average levels of negative life events did not significantly predict the rate of increase in fingernail cortisol levels than those with lower levels. However, individuals with higher average levels of perceived stress showed a steeper slope of time in fingernail cortisol levels. These findings suggest that prolonged high levels of perceived stress may be associated with fingernail cortisol levels.

Development of a risk assessment tool for Japanese sex offenders: The Japanese Static-99.

In Japan, sexual offending, especially paraphilic sexual offending, has become a major problem, and approximately 3000 people are arrested for frotteuristic and voyeuristic behavior each year. Considering the repetitive nature of such behaviors, determining the recidivism risk is imperative. Globally, Static-99 is one of the most widely used actuarial risk assessment tools to predict recidivism among sex offenders. However, sexual offending is largely influenced by social and cultural backgrounds, and whether risk factors identified in the West are applicable to other countries is unknown. Therefore, we developed a Japanese version of the Static-99 and examined its reliability and validity with 167 Japanese paraphilic sex offenders. The results showed good internal consistency (Cronbach's alpha coefficient = 0.88) and predictive accuracy (area under the curve = 0.76). The results indicate that the Japanese Static-99 can be used with Japanese sex offenders. Moreover, risk factors identified in the Western context are applicable to Japanese sex offenders despite the different nature and manifestations of their offending.

The effect of distraction versus post-event processing on cortisol recovery in individuals with elevated social anxiety.

There are preliminary findings that repetitive thinking on social situations (post-event processing; PEP) is associated with impaired cortisol recovery after experiencing social evaluative stressors. However, no studies have examined the effect of experimental manipulation of PEP on cortisol recovery among socially anxious individuals. The aim of the present study was to examine the effect of distraction on cortisol recovery following a social-evaluative stressor in individuals with subclinical social anxiety symptoms. A total of 40 participants, who scored >30 on the Liebowitz Social Anxiety Scale, completed a standardized stress test (the Trier Social Stress Test; TSST). They were then randomized to complete either a 10-min distraction or PEP induction task. Subjective anxiety and salivary cortisol levels were assessed at -20, -10, 0, +10, +20, +30, +40, and +50 min, with respect to the TSST offset. Contrary to the hypothesis, no difference in cortisol recovery was observed between distraction induction and PEP induction. These findings suggest that short-term distraction induction may not be sufficient to promote cortisol recovery in individuals with elevated social anxiety.

Effects of cortisol on retrieval of extinction memory in individuals with social anxiety.

While exposure-based treatment for social anxiety disorder (SAD) has been shown to be effective, the high relapse rate remains a problem. Although relapse has been understood as the inability to retrieve extinction memory, the factors that influence the extent of retrieval of extinction memory have not been determined. This study aimed to examine whether the cortisol response to acute stressors in socially anxious individuals inhibits the retrieval of extinction memory, focusing on the cortisol response to acute stressors as a factor. Thirty-nine participants who scored 42 or more on the Liebowitz Social Anxiety Scale participated in the experiment for two consecutive days. On the first day, a fear conditioning task aimed at learning fear and extinction memory was administered, and on the second day, a psychosocial stress task (Trier Social Stress Test; TSST) was conducted, followed by an extinction retrieval test. The results indicated that cortisol responsiveness (Responder/Non-responder) was not associated with the retrieval of extinction memory indexed by subjective and physiological measures. However, a supplementary analysis revealed that the total amount of cortisol secretion was associated with attenuated retrieval of extinction memory. These findings suggest that the total cortisol secretions, rather than cortisol responsiveness to the acute stressor, may play a role in relapse.

Effects of Depressive Symptoms, Feelings, and Interoception on Reward-Based Decision-Making: Investigation Using Reinforcement Learning Model.

BACKGROUND: In this study, we examined the relationships between reward-based decision-making in terms of learning rate, memory rate, exploration rate, and depression-related subjective emotional experience, in terms of interoception and feelings, to understand how reward-based decision-making is impaired in depression. METHODS: In all, 52 university students were randomly assigned to an experimental group and a control group. To manipulate interoception, the participants in the experimental group were instructed to tune their internal somatic sense to the skin-conductance-response waveform presented on a display. The participants in the control group were only instructed to stay relaxed. Before and after the manipulation, the participants completed a probabilistic reversal-learning task to assess reward-based decision-making using reinforcement learning modeling. Similarly, participants completed a probe-detection task, a heartbeat-detection task, and self-rated scales. RESULTS: The experimental manipulation of interoception was not successful. In the baseline testing, reinforcement learning modeling indicated a marginally-significant correlation between the exploration rate and depressive symptoms. However, the exploration rate was significantly associated with lower interoceptive attention and higher depressive feeling. CONCLUSIONS: The findings suggest that situational characteristics may be closely involved in reward exploration and highlight the clinically-meaningful possibility that intervention for affective processes may impact reward-based decision-making in those with depression.

Validity and reliability of the Japanese version of the kleptomania symptom assessment scale: A comparison between individuals with kleptomania and prisoners in Japan.

INTRODUCTION: In Japan, the rate of recidivism among thieves is high, some of which may be caused by kleptomania. The purpose of this study was to translate the Kleptomania Symptom Assessment Scale (K-SAS) into Japanese and validate its psychometric properties in a Japanese sample. A second purpose of the study was to evaluate the validity of K-SAS to discriminate between individuals with kleptomania and shoplifters not affected by the disorder. METHODS: The original K-SAS was translated by researchers. The back-translation of the scale into English was conducted by a professional translator who was fluent in both languages. The items on the Japanese version of K-SAS were deemed appropriate for the Japanese context after being reviewed by a forensic psychiatry specialist. The sample included 22 kleptomania patients, 26 shoplifters, and 47 healthy adults. We tested the scale properties and validity to discriminate between the three groups. RESULTS: The Japanese version of the K-SAS showed adequate reliability and validity. Individuals affected by kleptomania had significantly higher scores than shoplifters and healthy adults. Furthermore, the K-SAS score of kleptomania was not correlated with typical antisocial tendencies. Moreover, the K-SAS score for kleptomania was not correlated with psychometric scales related to obsessive-compulsive disorder and borderline personality disorder. CONCLUSIONS: The Japanese version of the K-SAS is a useful assessment tool for distinguishing between individuals with kleptomania and shoplifters not affected by the disorder in Japan.

Reliability and validity of the Children's Depression Inventory-Japanese version.

BACKGROUND: Depression has major negative consequences for individuals and society, and psychological assessment tools for early disease detection are needed. The aim of this study was to investigate the reliability and validity of an updated Japanese version of the Children's Depression Inventory (CDI-J) and set a cut-off score for the detection of depression. METHODS: The participants consisted of 465 children and adolescents aged 7-17 years. The control (CON) groups consisted of students recruited from elementary and junior-high school (CONEJ) and children recruited from among hospital staff members (CONRE), while the outpatient clinical (OPC) groups consisted of pediatric psychosomatic outpatients (OPCPD) and adolescent psychiatric outpatients (OPCPS). The CON and OPC CDI-J scores underwent factor analysis using varimax rotation, followed by measurement invariance analysis. The Youth Self-Report (YSR) was administered to assess concurrent validity. The Mini-International Neuropsychiatric Interview was administered to the OPC group to diagnose current depressive symptoms. Receiver operating characteristics (ROC) analysis was conducted to evaluate case-finding performance and to set cut-off points for the detection of depression. RESULTS: The CDI-J was reliable in terms of internal consistency (Cronbach α = 0.86; mean inter-item correlation, 0.16). Re-test reliability was substantial (mean interval 18 days: γ = 0.59, P < 0.05). The four-factor solution exhibited adequate internal consistency (range, 0.52-0.73) and correspondence (Pearson correlation of 0.65 with the YSR) for both the CON and OPC groups. On ROC analysis the optimal cut-off score was 23/24. CONCLUSION: The CDI-J can be used as a reliable and well-validated instrument alongside standard diagnostic procedures.

Acute cortisol response to a psychosocial stressor is associated with heartbeat perception.

The aim of the present study was to examine the effect of an acute increase in cortisol in response to a psychosocial stressor on heartbeat perception, in a laboratory environment. Thirty-six participants (20 women, 16 men, mean age = 21.7 years, standard deviation = 1.7 years) completed a heartbeat counting task (Schandry paradigm) before and after exposure to an acute psychosocial stressor (Trier Social Stress Test; TSST). Heartbeat counting performance was compared between participants who exhibited strong cortisol responses (>15.5% increase in cortisol from baseline; responders) and those who did not (non-responders). Responders showed increased heartbeat counting accuracy following the TSST, which was not observed in non-responders. The two groups did not differ in their responsivity to subjective anxiety ratings or heart rate. These results indicated that acutely elevated cortisol in response to a psychosocial stressor is associated with increased interoceptive accuracy. The results provide a possible explanation for inconsistent findings on the effect of stress exposure on interoception.

Family Behavioral Repertoires and Family Interaction Influence the Adaptive Behaviors of Individuals With Hikikomori.

Background: Family support is key in the initial stages of psychological support for individuals with hikikomori. However, it remains necessary to confirm the relationship between families' cognitive behavioral factors and the severity of hikikomori to understand ways of improving hikikomori. We examined the influences of family behavioral repertoires for coping with hikikomori and family interaction on the adaptive behaviors of individuals with hikikomori. We employed a control group to examine whether the influence of these adaptive behaviors was unique to families of individuals with hikikomori. Methods: We asked 185 parents of individuals with hikikomori (hikikomori group) and 460 parents of individuals with no experience of hikikomori (control group) to complete the Family Behavioral Repertoire Scale for coping with hikikomori (FBS-H), the Family Interaction Scale for Hikikomori (FIS-H), and the Adaptive Behaviors Scale for Hikikomori (ABS-H). Using the subscales of the ABS-H as the dependent variables, we conducted hierarchical multiple regression analyses wherein family behavioral repertoire was added in Step 1, experience frequency and cognition of contingency were added in Step 2 as control values, family interaction was added in Step 3, and the interaction terms were added in Step 4. Results: The ABS-H total and subscale scores were significantly lower in the hikikomori group than in the control group. The social participation subscale showed the largest difference, while the family subscale showed the smallest. In the hikikomori group, we observed a significant adjusted R 2 for the family and value subscales (Step 1). The ΔR 2 in Step 3 was significant for the interaction and family subscales of the ABS-H. In the control group, significant adjusted R 2 values were found for all ABS-H subscales in Step 1, but the ΔR 2 in Step 3 was not significant for any subscales. Conclusion: Family-related cognitive behavioral factors, such as family behavioral repertoire and family interaction, appear to relate to improvement in hikikomori. Of course, these findings warrant further investigation because we did not examine the longitudinal, causal relations between these variables. In the future, we might also test the effect of family support interventions that target families' behavioral repertoire and family interaction.

Altered Gamma-Band Activity as a Potential Biomarker for the Recurrence of Major Depressive Disorder.

Background: The neurophysiological mechanisms of cognitive reactivity, the primary vulnerability factor of major depressive disorder (MDD) recurrence, remain unclear in individuals with recovered MDD (rMDD). Because gamma-band responses (GBRs) can be used to measure cognitive processing, they may also be useful for elucidating the mechanisms underlying cognitive reactivity. Identifying these mechanisms may permit the development of an index for predicting and preempting MDD recurrence. Here, to identify the neurophysiological mechanisms of cognitive reactivity, we examined the characteristics of the GBRs evoked/induced by emotional words in participants with and without rMDD after inducing a negative mood. Methods: Thirty-three healthy control participants and 18 participants with rMDD completed a lexical emotion identification task during electroencephalography along with assessments of cognitive reactivity after negative mood induction. Results: No between-group differences were identified for the task reaction times; however, the rMDD group had significantly higher cognitive reactivity scores than did the control group. Furthermore, the power of late GBRs to positive words was significantly greater in the rMDD group, with the greater power of late GBRs being related to higher cognitive reactivity. Limitations: Considering the population studied, our findings cannot be completely generalized to populations other than adolescents, people with rMDD, and those without a history of co-morbid disorders and early life stress. Conclusions: Our findings indicate that the dysfunction of neural circuits related to higher-order processes like memory and attention might underlie cognitive reactivity. Altered late GBRs to positive information may be persistent biomarkers of the depression recurrence risk.

Post-event Processing Predicts Impaired Cortisol Recovery Following Social Stressor: The Moderating Role of Social Anxiety.

There is growing evidence that individuals with social anxiety show impaired cortisol recovery after experiencing social evaluative stressors. Yet, little is known regarding the cognitive processes underlying such impaired cortisol recovery. The present study examined the effect of post-event processing (PEP), referred to as repetitive thinking about social situations, on cortisol recovery following a social stressor. Forty-two non-clinical university students (23 women, 19 men, mean age = 22.0 ± 2.0 years) completed the Trier Social Stress Test (TSST), followed by a thought sampling procedure which assessed the frequency of PEP reflecting the TSST. A growth curve model showed PEP and social anxiety interactively predicted cortisol recovery. In particular, PEP predicted impaired cortisol recovery in those with low levels of social anxiety but not in those with high levels of social anxiety, which contradicted the initial hypothesis. These findings suggest that PEP is differentially associated with cortisol recovery depending on levels of social anxiety. The possible mechanisms underlying these findings were discussed in terms of protective inhibition framework.

Translation and Initial Validation of the Japanese Version of the Self-Beliefs Related to Social Anxiety Scale.

Cognitive models of social anxiety posit that there are several types of maladaptive beliefs responsible for persistent social anxiety. Although these beliefs are theoretically important, currently there is no validated measure of these beliefs in Japan. In the present study, we translated into Japanese a well-validated measure of these beliefs, the Self-Beliefs Related to Social Anxiety (SBSA) Scale. The psychometric properties of the scale were also examined in two nonclinical samples ( ns = 401 and 30). Using confirmatory factor analysis, the Japanese version of the SBSA was found to have a correlated three-factor structure that consisted of "conditional beliefs," "unconditional beliefs," and "high standard beliefs." In addition, the Japanese version of the SBSA and its subscales demonstrated good internal consistency reliability and test-retest reliability. The Japanese version of the SBSA also demonstrated good convergent and divergent validity. Future applications of the Japanese version of the SBSA are discussed.

Stress-induced cortisol is associated with generation of non-negative interpretations during cognitive reappraisal.

BACKGROUND: Enhanced processing of emotional stimuli after stress exposure is reported to be associated with stress-induced cortisol. Because enhanced emotional information processing could make cognitive emotion regulation more difficult, it was hypothesized that stress-induced cortisol would be associated with non-negative interpretation generation associated with the cognitive reappraisal processes. METHODS: A total of 36 participants (Mean age = 21.3 years, SD = 1.8) watched video clips of depression-related stressful situations before and after the administration of a stress induction task. They were then asked to generate as many non-negative interpretations as possible to reduce the depressive mood. Saliva samples were obtained before and after the stress induction task to measure change in the cortisol level. RESULTS: Participants were allocated post-hoc to either a responder (n = 19) or non-responder group (n = 17) based on the cortisol response to the stress induction task. The number of non-negative interpretations generated following the stress induction task was reduced only in the cortisol responders. The number of post-stress non-negative interpretations was fewer in the responder group when compared by sex, baseline cortisol level, and the number of pre-stress non-negative interpretations, statistically controlled. CONCLUSIONS: Although baseline cortisol and sex may have impacted the results, the results suggest that stress-induced cortisol is associated with difficulty in non-negative interpretation generation during the cognitive reappraisal process.

Effect of prolonged stress on the adrenal hormones of individuals with irritable bowel syndrome.

BACKGROUND: The purpose of this study was to investigate the effect of prolonged stress on the salivary adrenal hormones (cortisol, dehydroepiandrosterone [DHEA], DHEA-sulfate [DHEA-S]) of individuals with irritable bowel syndrome (IBS). METHODS: The participants were female college students, including 10 with IBS and 16 without IBS (control group), who were scheduled for a 2-week teaching practice at a kindergarten. Participants were asked to collect saliva for determining adrenal hormones immediately and 30 min after awakening and before sleep, 2 weeks before the practice, the first week of the practice, the second week of the practice, and a few days after the practice. RESULTS: Regarding cortisol/DHEA ratio, significantly increased levels were found during the first week of the practice, and a significant interaction between group and time was found; the ratio at 30 min after awakening in the IBS group was higher than that in the control group. For the other adrenal hormone indexes, no significant differences due to the presence of IBS were found. CONCLUSIONS: Individuals with IBS showed an elevated cortisol/DHEA ratio after awakening compared with individuals without IBS, and the elevated ratio peaked under the prolonged stress. The present study suggests that the cortisol effect is dominant in individuals with IBS under prolonged stress.

[The specificity of cognitive reactivity in recurrent major depressive episodes].

The present study examined cognitive vulnerability to relapses of depression by clarifying the characteristics of "cognitive reactivity" in people with recurrent major depressive episodes. Study 1-1 and 1-2 developed a Japanese version of the Leiden Index of Depression Sensitivity-Revised (LEIDS-R), which assessed cognitive reactivity, and evaluated the reliability and validity of the scale. Study 2 examined the characteristics of cognitive reactivity which differentiate people with recurrent major depressive episodes from people with a single episode or none. The Japanese version of the LEIDS-R was shown to have reasonable reliability and validity. Participants with recurrent major depressive episodes showed more repetitive thoughts about negative issues and avoidance from internal and external aversive events when depressive mood was induced, compared to participants with only a single episode of depression. These results suggest that the characteristics of cognitive reactivity are important considerations for preventing relapse of depression.

Sociocultural beliefs, as well as goodness of fit, influence the effectiveness of coping in Japanese workers.

BACKGROUND: Although the goodness-of-fit hypothesis (GOFH) is one of the most important theories in research about the effect of coping on distress related to different stressful situations, there has been a mixed response to it in the literature. PURPOSE: The present study examined whether the effect of the sociocultural context in stressful situations is consistent with the GOFH. The study investigated sociocultural beliefs about the appropriateness of different coping strategies in a given group as the sociocultural context. METHOD: Japanese employees (N = 1,156) of an information technology company reported their appraisal of stressors' controllability, the coping strategies they employed for the stressors, their sociocultural beliefs about coping strategies, and their psychological distress in response to the stressors. RESULTS: The GOFH was supported only for problem-focused coping with task stressors and not for interpersonal stressors. The applicability of the GOFH differed by sociocultural beliefs about coping, namely an appraisal of what coworkers might think about the appropriateness of the coping method. CONCLUSION: These results suggest that it is important for managing stress to consider the sociocultural context as well as the GOFH.

Effects of distraction on negative behaviors and salivary α-amylase under mildly stressful medical procedures for brief inpatient children.

Inconsistent results have been reported on the effects of distraction on negative emotions during medical procedures in infants. These differing results may be attributable to the fact that the effects are apparent under a mildly stressful medical procedure. A total of 17 infants, 18 preschoolers, and 15 school-aged children who were hospitalized were administered, monitoring for vital signs, a mildly stressful medical procedure, by a nurse in a uniform with attractive character designs as a distractor. Consistent with the hypothesis, participating infants showed fewer negative behaviors and lower salivary α-amylase levels when distracted. The results support the efficacy of distraction in infants under a mildly stressful medical procedure.

Irritable bowel syndrome, its cognition, anxiety sensitivity, and anticipatory anxiety in panic disorder patients.

AIM: The present study examined the effect of irritable bowel syndrome (IBS), cognitive appraisal of IBS, and anxiety sensitivity on anticipatory anxiety (AA) and agoraphobia (AG) in patients with panic disorder (PD). METHODS: We examined 244 PD patients who completed a set of questionnaires that included the Rome II Modular Questionnaire to assess the presence of IBS, the Anxiety Sensitivity Index (ASI), the Cognitive Appraisal Rating Scale (CARS; assessing the cognitive appraisal of abdominal symptoms in four dimensions: commitment, appraisal of effect, appraisal of threat, and controllability), and items about the severity of AA and AG. The Mini International Neuropsychiatric Interview was used to diagnose AG and PD. RESULTS: After excluding individuals with possible organic gastrointestinal diseases by using 'red flag items,' valid data were obtained from 174 participants, including 110 PD patients without IBS (PD/IBS[-]) and 64 with IBS (PD/IBS[+]). The PD/IBS[+] group had higher AA and higher comorbidity with AG than the PD/IBS[-] group. In the PD/IBS[+] group, the controllability score of CARS was significantly correlated with AA and ASI. Multiple regression analysis showed a significant effect of ASI but not of controllability on AA in PD/IBS[+] subjects. CONCLUSION: This study suggested that the presence of IBS may be related to agoraphobia and anticipatory anxiety in PD patients. Cognitive appraisal could be partly related to anticipatory anxiety in PD patients with IBS with anxiety sensitivity mediating this correlation.

Adrenal hormone response and psychophysiological correlates under psychosocial stress in individuals with irritable bowel syndrome.

OBJECTIVE: In this study, we investigated levels and relative ratios of adrenal hormones (including cortisol, dehydroepiandrosterone [DHEA], and DHEA-sulfate [DHEA-S]) and their psychophysiological correlates under acute psychosocial stress in individuals with irritable bowel syndrome (IBS). METHODS: Fifty-three college students participated in the study (male: 42, female: 11; mean age: 22.64years), including 13 individuals with IBS (IBS group) and 40 individuals without IBS (control group). The participants were exposed to a standardized laboratory stressor, which included delivering a speech and performing a mental arithmetic task. We measured subjective stress levels and salivary cortisol, DHEA, and DHEA-S levels at relevant time points before, during, and after the tasks. RESULTS: DHEA-S level and the DHEA-S/DHEA ratio in the IBS group were significantly lower than those in the control group, and the cortisol/DHEA-S ratio in the IBS group was higher than that in the control group throughout the experiment. In the IBS group, the appraisal of a threat was positively correlated with cortisol levels (r=0.61), and the appraisal of controllability was negatively correlated with cortisol levels (r=-0.64) and with the cortisol/DHEA ratio (r=-0.71). The control group showed a significant positive correlation between the appraisal of threat and cortisol levels (r=0.32). CONCLUSION: The present study indicates that individuals with IBS had lower DHEA-S levels, and that their stressful cognitive appraisals under acute psychosocial stress caused the effects of cortisol to dominate. This adrenal hormone response may be involved in exacerbating abdominal symptoms in individuals with IBS.

Cognitive dysfunctions after recovery from major depressive episodes.

Although recent studies have indicated that cognitive dysfunctions may persist after recovery from a major depressive episode (MDE), the claim remains controversial. To clarify this clinically important issue, we investigated the cognitive functions of people who had experienced one or more MDE, after controlling for several confounding variables: differences in (a) medications, (b) age ranges, and (c) disorder characteristics. Neuropsychological tests for memory, attention, and executive function were employed to compare 12 recovered depressed participants who had fully met the criteria for MDE to 30 participants who had partially met the criteria or had not met them at all. The recovered depressed participants were impaired on tasks of verbal learning and memory and selective or divided attention in contrast to others. After an alpha correction was applied, the deficits in divided attention remained significant. These cognitive shortfalls also distinguished people who had experienced an MDE from those who had partially experienced them or had not experienced them at all. We suggest that the experience of an MDE may have a persistent negative influence on cognitive functions, particularly on their higher levels, such as divided attention.