The development, progress, and current status of cognitive behaviour therapy in Japan

Abstract

This article reviewed the development, progress, current status, and future direction of cognitive behaviour therapy (CBT) in Japan. First, the history of CBT in Japan was briefly reviewed, including a description of the development of two major societies and their respective journals: the Japanese Association for Behaviour Therapy (later renamed as the Japanese Association for Behavioural and Cognitive Therapies) and the Japanese Association for Cognitive Therapy. Second, we reported on the existing evidence relating to CBT in Japan, including randomised control trials for depression, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and childhood anxiety disorders. Third, two established training systems for psychologists were outlined: (a) the National Training System for Cognitive Therapists, sponsored by the Ministry of Health, Labour and Welfare; and (b) Behavioural Therapy Specialists, qualified by the Japanese Association for Behavioural and Cognitive Therapies. We also reviewed the pathways to qualification as a clinical psychologist in Japan, undertaken through graduate training courses accredited by the Foundation of the Japanese Certification Board for Clinical Psychologists. Furthermore, we discuss the 2017 launch of the first national qualification standards, which has the potential to instigate dramatic change. Fourth, the impact and role of the national health insurance scheme in relation to psychological qualifications in Japan was described. Finally, future directions for cognitive behaviour therapy in Japan were discussed.

Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review

“…Providing a more detailed account of crucial information, such as the specific training and supervision procedures employed [ 51 , 64 ], can facilitate replication. Detailed reporting can also enable translation or cultural adaptation of interventions to other contexts to circumvent the need to repeat the whole treatment development process [ 62 , 65 ], but the effectiveness of the intervention or its adaptations still needs to be rigorously tested in different contexts [ 66 – 68 ]. Early involvement of partners with experience in dissemination and commercialization can help ensure that important issues are not neglected [ 69 ].…”

“…On the one hand, clinical psychologists and other therapists should be adequately trained in CBT and other EBPTs when graduating [ 45 , 46 , 76 , 117 , 118 ]. On the other hand, training clinicians to deliver CBT when they are already in a clinical position can be invaluable to improve local capacity, especially in primary care or for underserved locations and populations [ 56 , 66 , 68 , 79 , 113 , 119 ]. For active practitioners, mitigating the direct and indirect training costs is crucial to getting them involved [ 83 , 85 ], notably through online training programs [ 91 , 117 – 120 ].…”

“…Mechanisms of access include payment models, as anxiety disorders patients who must pay out-of-pocket may decide to forgo receiving CBT even when it is readily available. Meanwhile, offering CBT at little or no charge has often been suggested to be cost-effective or even profitable from the perspectives of a public healthcare system [ 66 , 76 , 78 , 85 , 113 , 128 , 129 ], public insurers covering private services [ 11 , 69 , 71 , 113 , 127 – 129 ], and private insurers [ 45 , 69 , 94 , 128 ]. Access to CBT for anxiety disorders can also be improved by promoting early detection mechanisms [ 90 , 105 ] and educational efforts to acquaint clinicians with the CBT delivery modalities available in their context [ 62 , 74 , 113 ].…”

“…Regulations on new treatment delivery modalities such as iCBT can also be access-oriented as long as they take their particular nature into account and avoid making them prohibitively expensive to develop or impossible to access between jurisdictions [ 61 , 69 , 94 ]. Standards building capacity for CBT delivery may address psychotherapists’ training and mandate that they have been exposed to CBT for anxiety disorders before graduating [ 45 , 46 , 66 ]. They can also set continuing education criteria to maintain a license to practice specific CBT delivery modalities or CBT in general [ 69 ].…”

“…First, proposed program implementation activities should be coherent with local organizations’ resources and prior practices [ 11 , 78 , 97 , 132 ]. Indeed, taking clinicians’ current skills and practice into account helps reduce the cost and acceptability of implementation [ 60 , 66 , 85 , 129 ]. Program designers should also build-in enough clarity and flexibility to allow program adaptation to local needs without unnecessary administrative burden for clinicians and managers [ 60 , 74 , 121 , 129 , 132 ].…”