大島 郁葉

Abstract This study investigated the factor structure and determined the reliability and validity of the Camouflaging Autistic Traits Questionnaire–Japanese version (CAT‐Q‐J) among 204 autistic and 410 non‐autistic people. Since a confirmatory factor analysis revealed no factor validity of the CAT‐Q‐J for both autistic and non‐autistic adults, an exploratory factor analysis was conducted to ensure the psychometric properties matched those of the original scale as much as possible. The results showed the CAT‐Q‐J comprised three subscales, a four‐item compensation subscale, a five‐item masking scale, and a five‐item assimilation subscale. The overall CAT‐Q‐J and all three subscales showed sufficient internal consistency and moderate‐to‐good and stable test–retest reliability in both the autistic and non‐autistic samples. Convergent validity was also supported by the correlations found with measures of autistic traits, well‐being, anxiety, and depression. Different from the original CAT‐Q, compensation/masking for the autistic sample was not correlated with mental health or autistic traits. The reliability and the validity of the overall CAT‐Q‐J were confirmed; however, caution should be exercised when interpreting its subscales.

Abstract Background To examine the relationship between social camouflage and mental health in Japanese autistic adults and make an international comparison with a sample from the UK. Methods This study analysed secondary data of participants with a self-reported diagnosis of autism from Japan (N = 210; 123 men and 87 women) and the UK (N = 305; 181 women, 104, men, and 18 nonbinary). The relationships between the quadratic term of the Camouflaging Autistic Traits Questionnaire and mental health scales, including depression and anxiety, were assessed. Results The UK sample showed linear relationships, whereas the Japanese sample showed significant nonlinear relationships. The quadratic terms of the Camouflaging Autistic Traits Questionnaire slightly explained generalised anxiety (β = .168, p = .007), depression (β = .121, p = .045), and well-being (β = − .127, p = .028). However, they did not explain the association between social anxiety and the Camouflaging Autistic Traits Questionnaire. Limitations Participants had self-reported diagnoses, and while the autism-spectrum quotient provides a cut-off value for screening, it does not enable confirming diagnoses. Mean scores of the Japanese version of the Camouflaging Autistic Traits Questionnaire were lower as compared to the original CAT-Q, which implies that the social camouflage strategy types used by autistic people in Japan and the UK could differ. The cross-sectional design limits causal inferences. Conclusion In the UK, more social camouflage was associated with poorer mental health scores, whereas too little or too much social camouflage was associated with a low mental health score in Japan. The Japanese population is seemingly less aware of and educated on autistic characteristics and considers ‘average’ behaviour a good thing. This could influence Japanese autistic people’s social camouflage use, differing from that of autistic people in the UK. The differences in the relationship between social camouflage and mental health between Japan and the UK could be associated with national-level divergence regarding the culture of autism.

<p>Background: Imagery rescripting (IR) is a technique used in cognitive-behavioral therapy and schema therapy, the treatment process of which has not been empirically verified despite being implemented for various mental disorders. This study aims to examine the experiential process of patients who undergo IR.Methods: Schema therapy sessions were video-recorded with the consent of five patients with chronic depression. Two raters adopted the task analysis protocol to analyze the videos of seven IR sessions.Results: The following experiential process common among successful sessions with the patients was revealed: (1) recalling the episode of an adverse childhood experience, (2) expressing anger and dissatisfaction with the behavior of others during the adverse experience, (3) expressing needs that were not met during the adverse experience, (4) expressing hurt feelings due to needs that were not met during the adverse experience, (5) expressing complex emotions due to fulfillment of needs, and (6) having a sense of relief, attachment, or self-compassion. The behavioral markers of each step were identified as well.</p>

本学では、2020年度の前期は新型コロナの影響で入構制限があったため学生健診の実施時期や方法を変更せざるをえなかったが、2021年度は例年どおりの形で健診とWEB問診を行うことができた。今回、新型コロナ流行の影響下で学生が抱えるメンタルヘルスの問題を明らかにするため、流行が拡大する前年の2019年度から、感染拡大が始まってから1年後となる2021年度までのWEB問診データを分析した。WEB問診では、まずスクリーニング目的にWEB上でMINI精神疾患簡易構造化面接法日本語版およびその中のMINIスクリーンを改編した質問項目と、自閉症スペクトラム指数(AQ)の45番目の項目(他の人の考えを理解することは苦手だ)について症状の有無を尋ねた。そして、「症状あり」と回答した学生に、MINI精神疾患簡易構造化面接法を改編した質問項目と、SCOFF、AQ10日本語版、SASS、SDISSを改編した質問項目に加え、「学業に支障をきたす要因」と「コミュニケーションに支障をきたす要因」について回答を求めた。分析の結果、スクリーニング用の質問項目で「症状あり」と回答した学生の割合は、「うつ病エピソード」を除く全ての項目で2019年度に比べて2020年度に低下し、2021年度にはほぼ2019年度のレベルに戻っていた。MINI精神疾患簡易構造化面接法を改編した質問項目、SCOFF、AQ10で基準以上の症状があった学生の割合とSASSスコアには、明らかな経年的変化はみられなかった。

BACKGROUND: Autistic people demonstrate focused interests, sensitivity to sensory stimulation, and, compared with the general population, differences in social communication and interaction. We examined whether a combination of the Awareness and Care for My Autistic Traits (ACAT) program and treatment-as-usual is more effective than only treatment-as-usual in increasing the understanding of autistic attributes, reducing treatment stigma, and improving mental health and social adaptation among autistic adolescents and their parents/guardians. METHODS: Forty-nine adolescents and their parents/guardians were randomly assigned to either a combination of ACAT and treatment-as-usual or only treatment-as-usual. The combined group received six weekly 100-minute ACAT sessions, while the treatment-as-usual group received no additional intervention. The primary outcome was the change in understanding of autistic attributes (Autism Knowledge Quiz-Child), administered from pre- to post-intervention. The secondary outcomes included the change in Autism Knowledge Quiz-Parent, reduced treatment stigma, and improved mental health and social adaptation among autistic adolescents and their parents/guardians. A primary outcome measure scale was scored by assessors who were blind to the group assignment. RESULTS: The combined group (both autistic adolescents and their parents/guardians) showed an increase in Autism Knowledge Quiz scores compared to those in the treatment-as-usual group. Autistic adolescents in the combined group also demonstrated a decrease in treatment-related stigma and an improvement in general mental health compared to those in the treatment-as-usual group, while there were no group differences in the change in social adaptation. For parents/guardians, there were no group differences in the change in treatment-related stigma, general mental health, adaptive skills, or attitudes toward their children. CONCLUSIONS: The ACAT program could be an effective treatment modality to increase the understanding of autistic attributes among both autistic adolescents and their parents/guardians. The ACAT program positively affects self-understanding, reduces treatment stigma, and stabilizes behavioral issues for autistic adolescents as a part of mental health measures, but it does not effectively reduce treatment barriers or improve mental health for parents/guardians. Further research should consider whether additional support for parents/guardians could be beneficial. TRIAL REGISTRATION: The study was registered in UMIN (UMIN000029851, 06/01/2018).

<p>Purpose: To examine the reliability and validity of the Camouflaging Autistic Traits Questionnaire–Japanese version (CAT-Q-J). Methods: Self-report questionnaires were administered to 204 adults with and 410 adults without autism. Test–retest reliability was confirmed via another survey administered after two weeks.Results: The overall CAT-Q-J showed good reliability, correlating approximately with other scales, supporting its convergent validity. However, a few subscales had insufficient reliability and validity. Exploratory factor analyses showed three factors similar to the original in non-autistic sample (plus a factor comprising reversed items). For the autistic sample, three factors partially differed from the original. Conclusion: Despite acceptable consistency, reliability, and validity at an overall level, the CAT-Q-J should be used with caution.</p>

成人期自閉スペクトラム症(ASD)者に生じる被害的な認知や態度を被害妄想的観念として理解し,成人期ASD者の被害妄想的観念の重症度や,被害妄想的観念と関連する要因を検討することを目的に文献レビューを行った.対象文献8編を分析した結果,ASD者は健常成人よりも被害妄想的観念の重症度が高く,一方で統合失調症患者よりは低い,もしくは同等であることが示された.被害妄想様観念と関連する心理学的要因は,相関分析において心の理論,敵意帰属,被暗示性が,また,回帰分析において私的自己意識が有意な変数であった.今後成人期ASD者を対象とした研究の蓄積が重要であると考えられた.(著者抄録)

学生の中には大学生活に適応することができず、抑鬱状態になる自閉スペクトラム症(ASD)者が少なからず存在する。このようなケースでは鬱病との鑑別が難しいことがしばしばあり、ASD者への対応をする際には、診断が適切でないと治療的介入を行ったときの効果に影響を及ぼすことがある。そこで今回、鬱病が併存しているASD者と、鬱病の併存がないASD者(ASD者)、定型発達者の違いを明らかにし、治療的介入をしたときに得られる変化との関係について検討した。SASSを用いた社会適応度の比較では、ASD者と鬱病を併存するASD者は定型発達者に比べてスコアが有意に低く、ASD者と鬱病を併存するASD者との間に有意差はなかった。NIRSを用いて前頭側頭部における言語流暢性課題中の脳賦活の大きさを測定すると、ASD者と鬱病を併存するASD者は定型発達者よりも広範な部位で脳賦活の大きさが減少しており、特に鬱病を併存するASD者は併存しないASD者よりも右腹外側前頭前野における脳賦活の大きさが有意に減少していた。このことからNIRSによる脳活動の測定は、ASD者だけでなく、鬱病を併存するASD者を診断するための補助となる可能性が示唆された。

It is a serious problem when people with mental disorders avoid, delay, discontinue, or do not use treatment and support, despite the existence of evidence-based treatment and support methods. In this study, we aimed to clarify the factor structure of BACE v3, a scale to measure barriers to accessing mental health care, and to examine its reliability and validity among Japanese people with mental disorders. An online survey with 268 participants, 20 years old and over, who had received care from mental health services in the past 12 months was conducted. Exploratory and confirmatory factor analysis (EFA and CFA) were used to examine the structure of the BACE v3. Internal consistency and test-retest reliability of all subscales were examined. Convergent validity [correlation of one of the subscales of the BACE v3, the treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH) and with the Internalized Stigma of Mental Illness Scale (ISMI)] was assessed. EFA identified two factors (treatment stigma and non-stigma), and the results suggested that the factor structure of the Japanese version of BACE v3 was similar to the original 2-factor structure. Regarding the CFA result, the goodness-of-fit indices showed marginal fit (root mean square error of approximation = 0.087; Tucker–Lewis index = 0.842; standardized root mean square residual = 0.078; comparative fit index = 0.86). The internal consistency of the treatment stigma subscale was α = 0.90, and the intraclass correlation coefficient was 0.76 (confidence interval: 0.70–0.81). The internal consistency of the non-stigma subscale was α = 0.83, and the intraclass correlation coefficient was 0.64 (confidence interval: 0.56–0.71). The score of the treatment stigma subscale was significantly and positively correlated with the SSRPH and ISMI. Thus, the BACE v3 has acceptable consistency, reliability and validity for the assessment of barriers to accessing mental health care including treatment stigma among people with mental disorders in Japan.

<title>Abstract</title><sec> <title>Objective</title> Psychological problems associated with isolation and mistrust are common among young adults with autism spectrum disorder (ASD). Schema therapy (ST) has recently been shown to be effective against chronic personality problems of various mental disorders, including personality disorders. This pilot clinical trial aimed to explore the feasibility and acceptability of ST in young adults with high-functioning ASD. </sec><sec> <title>Results</title> Following the intervention, a significant reduction in early maladaptive schemas and improvements in quality of life and social adjustment were observed. ST may be feasible and is applicable to young adults with HF-ASD. <italic>Trial registration</italic> UMIN000014535; registered on July 11, 2014 </sec>

本学のメンタルヘルス相談室に2020年7月〜10月に来室した学生のうち、精神障害の診断で継続的なカウンセリングが必要となった20名(障害あり群)と、精神障害の診断基準を満たさず1回のカウンセリングで改善した12名(障害なし群)を対象とし、各種尺度を用いて群間比較を行った。尺度は、「FCV-19S」(新型コロナウイルス感染症に対する恐怖尺度)、「BDI-II」(抑うつ症状の有無と程度の評価尺度)、「YBOCS」(強迫観念と強迫行為の重症度の評価尺度)、「AQ」(自閉症傾向の評価尺度)、「SASS」(社会適応能力の評価尺度)、「SCOFF」(摂食障害スクリーニング)、「大学生活の変化により生じている支障の評価尺度」を用いた。障害あり群はなし群に比べて、AQ下位尺度の「コミュニケーション」とSASS下位尺度の「対人関係」が有意に不良であり、また「メディア授業により生じた支障」の程度が有意に高かった。

In clinical settings, autism spectrum disorder (ASD) with comorbid depression is often difficult to diagnose, and should be considered in treatment. However, to our knowledge, no functional imaging study has examined the difference between ASD adolescents with and without comorbid depression. We aimed to compare the characteristics and prefrontal brain function of ASD with and without depression in order to identify a biological marker that can be used to detect the difference. Twenty-eight drug-naïve adolescents with ASD (14 ASD with and 14 ASD without depression) and 14 age- and gender-matched adolescents with typical development were evaluated using several variables. These included intelligence quotient, autism quotient, depression severity using the Beck Depression Inventory 2nd edition (BDI-II), and level of social functioning using the Social Adaptation Self-evaluation Scale (SASS). In addition, frontotemporal hemodynamic responses during a verbal fluency task (VFT) were measured using functional near-infrared spectroscopy (fNIRS). The ASD group, including both of the ASD with and ASD without depression groups, showed smaller hemodynamic responses than the typical development group in portions of the left dorsolateral prefrontal cortex (DLPFC), bilateral ventrolateral prefrontal cortex (VLPFC) and anterior part of the temporal cortex (aTC) during the VFT. Moreover, the smaller hemodynamic responses in the right VLPFC during the VFT in the ASD group were associated with the worse BDI-II and SASS scores. Furthermore, the ASD with depression group showed smaller hemodynamic responses in the right VLPFC during the VFT than the ASD without depression group in a direct comparison. Adolescents with ASD showed reduced activation in broad frontotemporal regions during a cognitive task compared with those with typical development. More specifically, the right VLPFC activation reflected the level of self-estimated depression and social functioning in the ASD subjects, and could be used to discriminate between ASD adolescents with and without depression.

Purpose: In clinical settings, diagnosing comorbid depression in individuals with autism spectrum disorder (ASD) is often difficult. Neuroimaging studies have reported reduced activation of frontal and temporal regions during emotional face recognition task (EFRT) in ASD and depression. However, to the best of our knowledge, no study has examined differences in frontotemporal activation during EFRT between ASD with and without comorbid depression. We aimed to compare the frontotemporal hemodynamic responses to the EFRT in ASD with and without depression and to find clues to help in discriminating the characteristics between them. Patients and Methods: In 24 drug-naïve young adults with ASD (12 with depression [ASD-Dep(+)] and 12 without depression [ASD-Dep(-)]) and 12 with typical development (TD), frontotemporal hemodynamic responses during an EFRT were measured using functional near-infrared spectroscopy (fNIRS). Results: The ASD groups showed reduced activation during EFRT than the TD group in the right ventrolateral prefrontal cortex (VLPFC). Moreover, the ASD-Dep(+) group showed reduced activation during EFRT than the ASD-Dep(-) group in the right anterior temporal cortex (aTC), and reduced activation than the TD group in the left VLPFC. Conclusion: The observed results might reflect reduced regional activation in ASD and ASD with comorbid depression.

<title>Abstract</title> <sec> <title>Background</title> One aim of an autism spectrum disorder (ASD) diagnosis is to obtain special support for the disorder, though this does not guarantee practical support. We developed a psychoeducational program using cognitive-behavioral therapy (CBT) and Aware and Care for my Autistic Traits (ACAT) for Japanese adolescents with high-functioning ASD and their parents. </sec> <sec> <title>Methods</title> This multisite study is a randomized controlled trial. In total, 24 participants will be assigned to the ACAT group and 24 to the treatment-as-usual (TAU) group. The ACAT group will receive a weekly 100-min session for 6 weeks, regular medical care, and one follow-up session. In this ongoing clinical trial, we will compare the scores of the measures recorded in the pre- and post-intervention stages between the ACAT and TAU groups. A total of 41 patients out of a target of 48 have participated in the trial to date. The primary outcome measure is the Autism Knowledge Questionnaire. Secondary outcome measures include Barriers to Access to Care Evaluation 3rd Edition, the Strengths and Difficulties Questionnaire, the Vineland Adaptive Behavior Scales second edition, the Parenting Resilience Elements Questionnaire, the General Health Questionnaire 12, and the Depression Self-Rating Scale for Children assessments, as well as an electroencephalographic recording. </sec> <sec> <title>Discussion</title> It is expected that participants in the ACAT group will significantly increase their self-understanding and awareness of ASD symptoms compared to those in the TAU group. Additionally, the ACAT group is expected to exhibit improved social adaptation and mental health if children and parents are able to better understand the ASD characteristics through sessions. This intervention will contribute to the establishment of an effective evidence-based treatment strategy for adolescents with ASD. </sec> <sec> <title>Trial registration</title> UMIN Register <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000034036">000029851</ext-link>. Registered on January 06, 2018 </sec>

Background: Imagery rescripting (IR) for early aversive memories in patients with social anxiety disorder (SAD) has shown promising results, but no study has investigated the reactions and perspectives of patients who received IR. Aims: This study aimed to gain understanding of patients' experiences/perspectives on IR as an adjunct to cognitive behavioural therapy (CBT) for SAD. Method: Twenty-five individuals with SAD received one or two sessions of IR over 16 CBT sessions. Contents of recurrent images and linked memories were identified during IR. Outcome measures included social anxiety, image and memory distress and vividness, and encapsulated belief. Patients completed a questionnaire about their perspectives of IR after the session. Thematic analysis was used to analyse the qualitative data. Results: IR resulted in significant within-session improvement in most outcome measures. Linked memories to negative recurrent images in social situations were categorized into nine groups. Common memories were 'Being criticized by others', 'Being made fun of', 'Failing or not doing something well' and 'Being left out in a group'. Most patients (82%) experienced IR as impressive, and more than half of patients (59%) found IR effective. Themes of reasons of impressiveness and effectiveness were categorized as 'Results of IR session' and 'Processes of IR session'. The theme 'Results of IR session' included six subthemes, and the theme 'Processes of the IR session' included five subthemes. Conclusions: Regarding patients' perspectives, although they may experience negative emotions in the process of an IR session, our results suggest that many patients with SAD found IR sessions effective.

© 2017, Springer Science+Business Media, LLC, part of Springer Nature. 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.

© 2018 Kuno, Hirano, Nakagawa, Asano, Oshima, Nagaoka, Matsumoto, Masuda, Iyo and Shimizu. Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders. Comorbid autism spectrum disorder (ASD) or autistic traits may impair treatment response in OCD. To identify possible neurostructural deficits underlying autistic traits, we performed white matter tractography on diffusion tensor images (DTI) and assessed autistic trait severity using the Autism-Spectrum Quotient (AQ) in 33 OCD patients. Correlations between AQ and the DTI parameters, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were examined in major white matter tracts that were suggested to be altered in previous OCD studies. We found a negative correlation between AQ and FA and positive correlations between AQ and MD, AD and RD in the left uncinate fasciculus using age, Beck Depression Inventory, Yale-Brown Obsessive-Compulsive Scale, intelligence quotient and medication as covariates. However, we could not detect the significant results between AQ and all DTI parameters when adding gender as a covariate. In addition, in the ASD comorbid group, FA in the left uncinate fasciculus was significantly lower than in the non-ASD comorbid group and MD and RD were significantly higher than in the non-ASD group. These results did not survive correction for multiple comparisons. In ASD, the socio-emotional dysfunction is suggested to be related to the alteration of white matter microstructure in uncinate fasciculus. Our results suggest that variations in white matter features of the left uncinate fasciculus might be partly explained by autistic traits encountered in OCD patients.

成人期まで未診断の高機能自閉スペクトラム症はこれまでの社会的軋轢から、精神合併症やパーソナリティの問題を有していることが多い。本論文では著者が実践している成人期に診断を受けた高機能の自閉スペクトラム症者に対するスキーマ療法の実践について報告する。そのうえで成人期の高機能自閉スペクトラム症者に対する統合的な治療法の意義について考察する。(著者抄録)

© 2018 AAC. The Young Schema Questionnaire-Short Form (YSQ-SF) is one of the most widely used measures of individual early maladaptive schemas in schema therapy, and this study examined the factor structure and reliability of its Japanese version (YSQ-SF-J). We created a subsample to ensure the samples' mutual independence (N= 248, mean age= 19.75; 121 females). Then, Japanese participants (N= 800) completed the Japanese-translated YSQ-SF. Participants were divided into 2 samples: Sample 1 (n= 700, mean age= 23.05; 350 females); and Sample 2 (n= 100, mean age= 20.27; 50 females) for test-retest reliability. Exploratory and confirmatory factor analyses revealed that the YSQ-SF-J's item-factor structure was identical to the English version. Moreover, the scale showed good internal consistency and test-retest reliability. Results revealed the scale's adequate psychometric properties. Thus, this study provided the first examples of empirical support for the YSQ-SF-J.

© 2018 Japan Brain Science Society. All rights reserved. Schema Therapy (ST) approaches to high-functioning autism spectrum disorder (HF-ASD) in young people have yet to demonstrate differential effectiveness, and there is little evidence that young people with HF-ASD adapt ST. We conducted a pilot study and case series for HF-ASD in adolescents. We first included patients with HF-ASD (N = 8) into a 4-week baseline phase; this phase functioned as a no-treatment control condition. Then patients began a 5-20-week exploration phase during which symptoms and underlying schemas were explored; this phase functioned as a dysfunctional emotional and behavioural control condition. Next, the treatment phase, the patients received up to 25 sessions of individual ST. In this four-case series, all four participants reported severe maladjustment at baseline and achieved remission by the end of treatment. Conclusions: ST shows promise as a treatment for young adults with HF-ASD.

© 2017 Tsuchiyagaito, Hirano, Asano, Oshima, Nagaoka, Takebayashi, Matsumoto, Masuda, Iyo, Shimizu and Nakagawa. Cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) and is also applicable to patients with both OCD and autism spectrum disorder (ASD). However, previous studies have reported that CBT for patients with both OCD and ASD might be less effective than for patients with OCD alone. In addition, there is no evidence as to why autistic traits might be risk factors. Therefore, we investigated whether comorbidity between ASD and OCD may significantly affect treatment outcome and discovered predictors of CBT outcomes using structural magnetic resonance imaging (MRI) data. A total of 39 patients, who were diagnosed with OCD, were enrolled in this study. Of these, except for 2 dropout cases, 15 patients were diagnosed with ASD, and 22 patients were diagnosed with OCD without ASD. Both groups took CBT for 11–20 sessions. First, to examine the effectiveness of CBT for OCD patients with and without ASD, we compared CBT outcomes between the two groups. Second, to investigate how the structural abnormality profile of the brain at pretreatment influenced CBT outcomes, we performed a structural MRI comparison focusing on the gray matter volume of the whole brain in both patients with only OCD, and those with both OCD and ASD. In order to discover neurostructural predictors of CBT outcomes besides autistic traits, we divided our samples again into two groups of those who did and those who did not remit after CBT, and repeated the analysis taking autistic traits into account. The results showed that OCD patients with ASD responded significantly less well to CBT. The OCD patients with ASD had much less gray matter volume in the left occipital lobe than OCD patients without ASD. The non-remission group had a significantly smaller volume of gray matter in the left dorsolateral prefrontal cortex (DLPFC) compared with the remission group, after having partialed out autistic traits. These results indicate that the abnormalities in DLPFC negatively affect the CBT outcome, regardless of the severity of the autistic traits.

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 &lt 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p &lt 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.

© 2015, ASCR Press. All rights reserved. This study investigated the differences in early maladaptive schemas between adult outpatients with high-functioning autism spectrum disorder (n = 48) and a non-clinical controls (n = 86). Both groups completed the Young Schema Questionnaire. There were significant differences between the groups in all the early maladaptive schemas, except self-sacrifice and approval/recognition seeking. Logistic regression analysis revealed that early maladaptive schemas such as insufficient self-control, emotional deprivation, and vulnerability to harm and illness significantly discriminated between the groups, suggesting that some early maladaptive schemas are more important than others for depicting the characteristics of adults with autism spectrum disorder.

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 &lt .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 (Cohens 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. © 2013 Yoshinaga et al. licensee BioMed Central Ltd.

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 endpoint 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.

大うつ病エピソードのある外来患者を対象に、患者と治療者が同一であるクローズドグループ(CG)、患者と治療者が別のセミオープングループ(SOG)の2形態で集団認知行動療法(CBGT)を計12回実施した。CBGT施行前、中間、後に日本語版BDI-IIとSTAI、自動思考質問紙、推論の誤り尺度を実施した。その結果、2形態による差はなく、両形態ともうつや不安、ネガティブな思考に対する効果があった。また、CBGTの効果は抑うつの重症度にかかわらず認められた。以上より、CBGTはその形態や抑うつの重症度に関わりなく、大うつ病エピソードを有する外来患者に有効であることが示された。

目的:青年期男女の摂食障害と関連する認知反応傾向の性差をそれぞれ明らかにし,さらに摂食態度における心理社会的側面の影響を包括的にとらえるため,因果モデル仮説を男女別に比較・検討することを目的とした.対象・方法:大学生男女262人(男性80名,女性182名)を対象とした.使用した質問紙は,身体刺激像,競争心尺度,性役割スケール,EAT-20であった.統計手法はt検定および共分散構造分析のパス解析を用いた.結果:ボディイメージ,女性役割観,摂食態度に性差が認められた.因果モデル仮説においては男女で適合する因果モデルが異なり,男女間で摂食態度の認知反応に基本的な違いがあることが示唆された.したがって,単独の認知の性差のみならず,包括的な因果モデルにも差があると考えられた(著者抄録)