Low-intensity mindfulness and cognitive-behavioral therapy for social anxiety: a pilot randomized controlled trial.

BACKGROUND: Cognitive-behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive-behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety. METHODS: Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment. RESULTS: A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51-1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention. CONCLUSIONS: These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.

Effect of rejection sensitivity on the development of anxious-depressive attack in Japanese outpatients: The mediating roles of rumination, social anxiety, and depressive symptoms.

Objective: Anxious-depressive attack (ADA) is a cluster of symptoms, including sudden and intense anxiety or depression, intrusive rumination about negative memories or future worries, prominent agitation, impatient behavior, and/or loneliness; in some cases, symptoms include a wide range of violent coping behaviors to manage emotional distress. Four characteristics-rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms-are thought to be associated with the development of ADA. However, the complex relationships among these factors have not been clarified. In this study, we aimed to examine the mechanism by which these four characteristics influence the development of ADA. Methods: We conducted a structured interview about ADA with 332 outpatients, who completed several self-report measures, to assess rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms. Results: A structural equation model showed goodness-of-fit with the data. These findings suggest that rejection sensitivity may demonstrate a direct effect on the occurrence of ADA. Furthermore, rejection sensitivity might affect depressive symptoms through rumination and social anxiety symptoms and consequently contribute to the development of ADA. Conclusion: These results provide preliminary evidence that rejection sensitivity contributes to the development of ADA.

Self-focused attention, cost/probability bias, and avoidance behavior mediate the relationship between trait mindfulness and social anxiety: A cross-sectional study.

Self-focused attention, cost/probability bias, and avoidance behavior are maintaining factors for social anxiety. In particular, cost bias and avoidance behavior predict social anxiety. It has been shown that the enhancement of trait mindfulness improves these maintaining factors. This study examines the relationships among trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety, and clarifies whether they mediate the relationship between trait mindfulness and social anxiety. A cross-sectional design was used to examine the relationships among these variables. Participants were recruited from three universities in Japan (January 2019-December 2019). Undergraduate students (N = 367) completed a set of self-report measures assessing trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Results of path analyses revealed that the hypothesized model's goodness-of-fit indices had high values. Trait mindfulness showed a direct negative association with self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Moreover, trait mindfulness was negatively associated with social anxiety via self-focused attention, cost/probability bias, and avoidance behavior. These findings indicate that mindfulness plays an important role in social anxiety and provide impetus for future research involving clinical studies of mindfulness-based interventions for social anxiety.

A pilot randomized controlled trial of the shogi-assisted cognitive behavioral therapy (S-CBT) preventive stress management program.

BACKGROUND: Shogi is a traditional board game in Japan. A preventive stress management program based on Shogi-assisted cognitive behavioral therapy (S-CBT) was applied in the Japanese municipality of Kakogawa City. The study aimed to develop an S-CBT preventive stress management program for the elderly and determine its efficacy. METHODS: The participants were 67 elderly men with amateur-level Shogi skills. They were randomly assigned to either the S-CBT group (n = 33) or the waiting-list control group (n = 34). The S-CBT program was conducted over six 90-min sessions. The outcome measures were recorded using K6 instrument, the Japanese version of the abbreviated Lubben Social Network Scale, five items on cognitive behavioral functioning, and subjective well-being scale. RESULTS AND CONCLUSIONS: The dropout rates of the S-CBT group and waiting-list control groups were 36.4 and 44.1%, respectively. Effect sizes (Cohen's d) and 95% confidence intervals (CIs) were calculated for each group. Domains that changed immediately after the S-CBT intervention were problem-solving skills, self-reinforcement, and negative automatic thoughts. Future research should promote mental and physical health through the design of intervention programs using familiar materials. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN CTR) UMIN000036003 .

The anxious-depressive attack severity scale: development and initial validation and reliability.

BACKGROUND: Anxious-depressive attack (ADA) is a symptom complex that comprises sudden intense feelings of anxiety or depression, intrusive rumination of regretful memories or future worries, emotional distress due to painful thoughts, and coping behaviors to manage emotional distress. ADA has been observed trans-diagnostically across various psychiatric disorders. Although the importance of ADA treatment has been indicated, a scale to measure the severity of ADA has not been developed. This study aimed to develop an Anxious-Depressive Attack Severity Scale (ADAS) to measure the severity of ADA symptoms and examine its reliability and validity. METHODS: A total of 242 outpatients responded to a questionnaire and participated in an interview, which were designed to measure the severity of ADA, depressive, anxiety, anxious depression, and social anxiety symptoms. Based on the diagnostic criteria for ADA, 54 patients were confirmed to have ADA and were included in the main study analyses. RESULTS: The exploratory factor analysis of the ADAS identified a two factor structure: severity of ADA symptoms and ADA frequency and coping behaviors. McDonald's ωt coefficients were high for the overall scale and the first factor (ωt = .78 and ωt = .83, respectively) but low for the second factor (ωt = .49). The ADAS score was significantly positively correlated with clinical symptoms related to anxiety and depression. CONCLUSION: The present study demonstrated that the ADAS has sufficient reliability and validity; however, internal consistency was insufficient for the second factor. Overall, the ADAS has potential to be a valuable tool for use in clinical trials of ADA.

The Japanese self-focused attention scale: Factor structure, internal consistency, convergent, and discriminant validity.

OBJECTIVE: Self-focused attention is a maintaining factor for social anxiety disorder. It was shown that self-focused attention correlates with trait mindfulness, but not with attention control. This study examined the reliability and validity of the Japanese version of the self-focused attention (J-SFA) scale. METHOD: Students (N = 502) completed a set of questionnaires, measuring self-focused attention, social anxiety symptoms, trait mindfulness, and attention control. RESULTS: A confirmatory factor analysis indicated that the J-SFA scale has a bi-factor structure. The Cronbach's α coefficient was high. Correlation analysis showed that each factor of the J-SFA scale was significantly weakly to moderately correlated with social anxiety symptoms and trait mindfulness, and the J-SFA scale's factors were significantly or non-significantly very weakly correlated with attentional control functions. CONCLUSION: The findings indicate that the J-SFA demonstrated satisfactory reliability and validity for our sample and provide impetus for future research into the measure for clinical and nonclinical samples in Japan.

The effectiveness of intervention with board games: a systematic review.

To examine the effectiveness of board games and programs that use board games, the present study conducted a systematic review using the PsycINFO and PubMed databases with the keywords "board game" AND "trial;" in total, 71 studies were identified. Of these 71 studies, 27 satisfied the inclusion criteria in terms of program content, intervention style, and pre-post comparisons and were subsequently reviewed. These 27 studies were divided into the following three categories regarding the effects of board games and programs that use board games: educational knowledge (11 articles), cognitive functions (11 articles), and other conditions (five articles). The effect sizes between pre- and post-tests or pre-tests and follow-up tests were 0.12-1.81 for educational knowledge, 0.04-2.60 and - 1.14 - - 0.02 for cognitive functions, 0.06-0.65 for physical activity, and - 0.87 - - 0.61 for symptoms of attention-deficit hyperactivity disorder (ADHD). The present findings showed that, as a tool, board games can be expected to improve the understanding of knowledge, enhance interpersonal interactions among participants, and increase the motivation of participants. However, because the number of published studies in this area remains limited, the possibility of using board games as treatment for clinical symptoms requires further discussion.

Correction to: BPSM-D-19-00022R2 Subjective well-being and problem-solving skills for alleviating the stress of elderly men attending a randomized controlled trial of shogi-assisted cognitive behavioral therapy.

[This corrects the article DOI: 10.1186/s13030-019-0153-4.].

BPSM-D-19-00022R2 Subjective well-being and problem-solving skills for alleviating the stress of elderly men attending a randomized controlled trial of shogi-assisted cognitive behavioral therapy.

Shogi is a popular board game in Japan, and shogi-assisted cognitive-behavioral therapy (S-CBT) has been applied in Kakogawa City, a Japanese municipality. The purpose of this study was to clarify the effects of S-CBT on the subjective well-being of elderly men. Participants were 61 elderly men with amateur skill at shogi. They were randomly assigned to either the S-CBT group or a wait list group (control). The S-CBT group participated in a weekly, six-session S-CBT program. The intervention outcomes were scores on the K6, Lubben Social Network Scale, and a five-item cognitive-behavioral functioning scale. The Subjective Well-being Scale was used to assess happiness and satisfaction with life, and all the participants were classified into high- and low-happiness groups using the median score as the cutoff. The results showed that scores on "self-reinforcement" were significantly (P < 0.05) increased for those receiving S-CBT compared with controls, regardless of the participants' happiness scores. In contrast, the scores on "problem solving skills for alleviating stress" were significantly (P < 0.05) increased for those receiving S-CBT compared with controls only among those in the low-happiness group. These results remained significant after controlling for the effects of age and baseline scores on the K6, Social Network Scale, and "problem solving skills for alleviating stress" category. The S-CBT may be especially beneficial when focused on practical advice for the stress management of older people with low subjective well-being. (trial registration: 000036003 [UMIN, Japan]). Trial Registration: Trial registration number: 000036003 [UMIN, Japan].