清水 栄司

BACKGROUND: School-based cognitive behavioral therapy (CBT) programs could contribute toward preventing anxiety disorders in children. However, setting aside class time for such programs is difficult. Internet-based CBT (I-CBT) is an efficient way to provide CBT. However, studies on I-CBT for anxiety prevention remain scarce, including I-CBT for school-based universal prevention programs. Therefore, we developed an e-learning version of a school-based anxiety-prevention CBT program, "Journey of the Brave," which was effective in Japan, to make it more flexible and accessible. This study evaluated its feasibility. METHODS: We conducted a single-arm study based on 44 parents and children. Children aged 10-12 years took the e-learning program at home. Parents and children responded to a questionnaire three times: before the learning (Pre), after the learning (Post), and three months later (FU: Follow-up). Feasibility was comprehensively evaluated through dropout rates, satisfaction and learning records, and changes in scores on psychological scales assessing anxiety symptoms, emotion-regulation skills, and children's emotional and behavioral problems. RESULTS: Of the 44 children, 42 started the e-learning, and 32 continued it (dropout rate of 23.8%). Furthermore, 83.9% of the children and 96.8% of the parents responded "agree" or "somewhat agree" regarding overall satisfaction. The parent-rated Spence Children's Anxiety Scale(SCAS) (SCAS-P) showed a significant decrease between Pre and FU (p = 0.014, 95% CI = (-9.22, -0.84)); however, the child-rated SCAS (SCAS-C) reduction was not significant (p = 0.08). The Emotion‑Regulation Skills Questionnaire (ERSQ) also increased significantly between Pre and FU (p = 0.045, 95% CI = (0.18, 18.31)). The Total Difficulties Score of the Strengths and Difficulties Questionnaire(SDQ) decreased significantly from Pre to Post (p = 0.025, 95% CI = (-3.62, -0.19)); however, it was not significantly different between Pre and FU (p = 0.67). CONCLUSION: The e-learning version showed low dropout rates and high satisfaction ratings from parents and children. Moreover, this study did not rule out the possibility that the program reduced children's anxiety and improved their emotional-regulation skills. Therefore, its potential and feasibility were indicated. TRIAL REGISTRATION: UMIN, UMIN000049182, Registered 11 October 2022.

The Parent Overprotection Measure (POM) is a promising scale to measure parent overprotection toward a child from the parent's perspective. However, no Japanese translation of the scale has been developed, and whether the POM can be applied to a Japanese population is unknown. This study translated the POM into Japanese and examined its psychometric properties. Parents of 380 children aged 4 to 7 years (including 190 mothers and 190 fathers) completed online questionnaires. Exploratory and confirmatory factor analyses (CFA) indicated that the Japanese translation of the POM has a bi-factor structure, including one general factor (general overprotection) and two specific factors (care/attention and control/prevention). The measurement invariance of reports from mothers' and fathers' perspectives was confirmed by multiple group CFA. The McDonald's Omega was acceptable for all factors, but the general overprotection factor explained most scale variance. Pearson's correlation coefficients were more than .20 between the control/prevention factor and child anxiety symptoms in both mother and father reports. The correlation between the control/prevention factor and parent anxiety according to fathers' reports also exceeded .20. These results provided the factor structure and supported the reliability of the POM among a Japanese population; however, further investigation of the validity of the scale is needed.

BACKGROUND: Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) are distinguished by whether anxiety is limited to social situations. However, reports on the differences in brain functional networks between GAD and SAD are few. Our objective is to understand the pathogenesis of GAD and SAD by examining the differences in resting brain function between patients with GAD and SAD and healthy controls (HCs). METHODS: This study included 21 patients with SAD, 17 patients with GAD, and 30 HCs. Participants underwent psychological assessments and resting-state functional magnetic resonance imaging (rsfMRI). Whole-brain analyses were performed to compare resting-state functional connectivity (rsFC) among the groups. Additionally, logistic regression analysis was conducted on the rsFC to identify significant differences between GAD and SAD. RESULTS: Patients with SAD and GAD had significantly higher rsFC between the bilateral postcentral gyri and bilateral amygdalae/thalami than HCs. Compared with patients with SAD, those with GAD had significantly higher rsFC between the right nucleus accumbens and bilateral thalami and between the left nucleus accumbens and right thalamus. RsFC between the left nucleus accumbens and right thalamus positively correlated with state anxiety in patients with SAD and GAD, respectively. In addition, logistic regression analysis revealed that the right nucleus accumbens and the right thalamus connectivity could distinguish SAD from GAD. CONCLUSIONS: GAD and SAD were distinguished by the right nucleus accumbens and the right thalamus connectivity. Our findings offer insights into the disease-specific neural basis of SAD and GAD.

BACKGROUND: Studies comparing the brain functions of major depressive disorder (MDD) and social anxiety disorder (SAD) at the regional and network levels remain scarce. This study aimed to elucidate their pathogenesis using neuroimaging techniques and explore biomarkers that can differentiate these disorders. METHODS: Resting-state fMRI data were collected from 48 patients with MDD, 41 patients with SAD, and 82 healthy controls. Differences in the amplitude of low-frequency fluctuations (ALFF) among the three groups were examined to identify regions showing abnormal regional spontaneous activity. A seed-based functional connectivity (FC) analysis was conducted using ALFF results as seeds and different connections were identified between regions showing abnormal local spontaneous activity and other regions. The correlation between abnormal brain function and clinical symptoms was analyzed. RESULTS: Patients with MDD and SAD exhibited similar abnormal ALFF and FC in several brain regions; notably, FC between the right superior frontal gyrus (SFG) and the right posterior supramarginal gyrus (pSMG) in patients with SAD was negatively correlated with depressive symptoms. Furthermore, patients with MDD showed higher ALFF in the right SFG than HCs and those with SAD. LIMITATION: Potential effects of medications, comorbidities, and data type could not be ignored. CONCLUSION: MDD and SAD showed common and distinct aberrant brain function patterns at the regional and network levels. At the regional level, we found that the ALFF in the right SFG was different between patients with MDD and those with SAD. At the network level, we did not find any differences between these disorders.

INTRODUCTION: Insomnia is a common health problem and cognitive-behavioural therapy (CBT) is recommended as a treatment. As there is a critical shortage of CBT-trained therapists, we developed a digital CBT application (IIIP MED: Sleepy Med) as Software as a Medical Device for insomnia. This paper describes the study protocol for an exploratory randomised controlled trial (RCT) to evaluate effectiveness and safety of our developed digital CBT (dCBT) for 5 weeks compared with zolpidem tartrate for patients with insomnia disorder. METHODS AND ANALYSIS: This proposed multicentre exploratory RCT will be conducted at the outpatient clinic of Chiba University Hospital, Akita University Hospital and Yoyogi Sleep Disorder Center, Japan. The study population comprises two parallel groups (dCBT and zolpidem) consisting of 15 participants each (n=30 in total) diagnosed with insomnia disorder who remain symptomatic at 4 weeks after sleep hygiene education. We will evaluate the effectiveness at baseline, week 5 (post-intervention) and week 10 (follow-up). The primary outcome will be the change of subjective sleep onset latency at week 5 from baseline. Secondary outcomes include sleep-related outcomes, such as objective sleep onset latency measured by mobile electroencephalography, functional improvement during the daytime and quality of life. ETHICS AND DISSEMINATION: Ethics approval was granted by the Institutional Review Board of Chiba University Hospital (K2023001). All participants will be required to provide written informed consent. Results will be published in international journals. TRIAL REGISTRATION NUMBER: jRCT2032230353.