BackgroundCognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time.ObjectivesThis study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD.MethodsA total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants’ points and 95% CIs were estimated by the paired t tests with the change between pre- and posttreatment.ResultsA significant reduction in symptom of obsession-compulsion (Y-BOCS=−6.2; Cohen d=0.74; 95% CI −9.4 to −3.0, P=.002), panic (PDSS=−5.6; Cohen d=0.89; 95% CI −9.83 to −1.37; P=.02), social anxiety (LSAS=−33.6; Cohen d=1.10; 95% CI −59.62 to −7.49, P=.02) were observed. In addition, depression (PHQ-9=−1.72; Cohen d=0.27; 95% CI −3.26 to −0.19; P=.03) and general anxiety (GAD-7=−3.03; Cohen d=0.61; 95% CI −4.57 to −1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95% CI −0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95% CI 1.24 to 7.04; P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30).ConclusionsVideoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable.

BackgroundAs children’s mental health problems become more complex, more effective prevention is needed. Though various anxiety and depression prevention programmes based on cognitive behavioural therapy (CBT) were developed and evaluated in Europe, North America, and Australia recently, there are no programmes in Japan. This study developed a CBT programme for Japanese children and tried to verify its effectiveness in reducing anxiety.MethodsA CBT-based anxiety prevention programme, ‘Journey of the Brave’, was developed to prevent anxiety disorders for Japanese children. Children from 4th through 6th grades (9–12 years old) in Japanese elementary schools and their parents (13 sample pairs) were the intervention group. For comparison purposes, 16 pairs were the control group. Ten weekly programme sessions and two follow-ups were conducted. Children’s anxiety levels in both groups were evaluated by child and parent self-reports using the spence children anxiety scale (SCAS) three times: pre-programme (baseline), post-programme, and 3 months following the end of the programme.ResultsAt 3-month follow-up, no significant difference was shown between the intervention and control groups on children’s SCAS scores in changes from baseline by using mixed-effects model for repeated measures analysis (SCAS-C: −8.92 (95 % CI = −14.12 to −3.72) and −3.17 (95 % CI = −8.02 to 1.66) respectively; the between group difference was 5.747 (95 % CI = −1.355 to −12.85, p = 0.062). On the other hand, significant reduction was shown in the intervention group on parents’ SCAS (SCAS-P) scores in change from baseline −9.554 (95 % CI = −12.91 to −6.19) and 0.154 (95 % CI = −2.88 to 3.19) respectively; the between group difference was 9.709 (95 % CI = 5.179 to 14.23, p = 0.0001).ConclusionThese preliminary results suggest this anxiety prevention programme for Japanese children was partially effective from parents’ evaluations. However, it is important to note that this study was conducted on a small sample with unbalanced groups at pre-intervention with no randomization. The positive results may require discounting due to the research limitations. A larger-scale study of the programme in elementary school classes to verify its effectiveness with a more rigorous research design is necessary.Trial registration: UMIN-CTR UMIN000009021

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.

BackgroundThe efficacy of cognitive behavioural therapy (CBT) for anxiety related problems in children is empirically supported. In addition, universal anxiety prevention programmes based on CBT have been demonstrated in recent years. The purpose of this study was to verify the effectiveness of a CBT based original programme ‘Journey of the Brave,’ aiming to prevent anxiety disorders and anxiety-related problems for Japanese children aged 10–12 years old.MethodsIntervention groups from two classes of 5th grade elementary students (n = 41) received ten 45-min programme sessions. The control group was drawn from one class of 5th grade children (n = 31) from a nearby school. All participants completed the Spence Children’s Anxiety Scale (SCAS) at pre, post, and 3 months follow-up. Mixed-effects model for repeated measures analysis was conducted.ResultsThe mean anxiety score on the SCAS for the intervention group was significantly reduced at both post intervention and 3 months follow-up compared with the control group. The group differences on the SCAS from baseline to post-test were − 5.321 (95% CI − 10.12 to − 0.523, p = 0.030), and at the 3-month follow-up were − 7.104 (95% CI − 11.90 to − 2.306, p = 0.004).ConclusionsThe effectiveness of the anxiety prevention programme ‘Journey of the Brave’ was verified though this study using a quasi-experimental design on a small sample.Trial registration: UMIN000009021