【目的】対象者の属性を調整した場合,乳がん患者である母親の抑うつ・不安と家族機能が子どものQOLに影響を及ぼすかどうかを検討する.【方法】交絡因子となる対象者の属性別にサブグループに分けて,抑うつ・不安と家族機能を独立変数,子どものQOLの合計得点を従属変数とした2要因分散分析を行った.【結果】各属性のサブグループにおいて,母親の抑うつが高い場合は母親の抑うつが低い場合よりも子どものQOLが有意に低いことが示された.きょうだいの有無のサブグループ,母親の化学療法の受療有無のサブグループにおいて,家族機能による子どものQOLに差異がみられた.【結論】今後,子どもを持つ乳がん患者の家庭を支援する際に,子どものきょうだいの有無や乳がん患者の化学療法の受療有無などといった属性も考慮したうえで,母親の心理状態と家族機能にアプローチする必要があると考えられる.(著者抄録)

PURPOSE: Several studies have explored factors causing depression in cancer survivors, including perceived physical symptoms. Another critical factor in the depression symptomatology of cancer survivors is activity restriction (AR). We investigated how AR mediate the effects of perceived pain and fatigue on depression in cancer survivors. METHODS: Cancer survivors (n = 61; mean age 56.16 years) that were recruited through cancer support groups in Japan participated in this study. Participants completed a battery of questionnaires comprising demographic and clinical information, the Pain Catastrophizing Scale, the Cancer Fatigue Scale, the Activity Restriction Scale for Cancer Patients, and the Hospital Anxiety and Depression Scale. RESULTS: Mediation analysis indicated that AR partially mediates the effect of pain on depression. Direct paths from pain to AR, AR to depression, and pain to depression were significant (P < .005). Moreover, indirect paths from pain to AR, AR to depression, and pain to depression were also significant at the 95% level [0.04-0.13]. However, AR did not mediate the effect of fatigue on depression, and fatigue had a significant direct path to both AR and depression (P < .005). CONCLUSION: This study aimed to explore the mediating effect of AR in the relationships of perceived pain and fatigue and depression in cancer survivors. We found that AR mediates perceived pain to depression, however not for perceived fatigue. In addition, because AR was experienced in the face of any survivorship period, AR may need to be treated as a long-term effect of the cancer diagnosis.

BACKGROUND: Depression has major negative consequences for individuals and society, and psychological assessment tools for early disease detection are needed. The aim of this study was to investigate the reliability and validity of an updated Japanese version of the Children's Depression Inventory (CDI-J) and set a cut-off score for the detection of depression. METHODS: The participants consisted of 465 children and adolescents aged 7-17 years. The control (CON) groups consisted of students recruited from elementary and junior-high school (CONEJ) and children recruited from among hospital staff members (CONRE), while the outpatient clinical (OPC) groups consisted of pediatric psychosomatic outpatients (OPCPD) and adolescent psychiatric outpatients (OPCPS). The CON and OPC CDI-J scores underwent factor analysis using varimax rotation, followed by measurement invariance analysis. The Youth Self-Report (YSR) was administered to assess concurrent validity. The Mini-International Neuropsychiatric Interview was administered to the OPC group to diagnose current depressive symptoms. Receiver operating characteristics (ROC) analysis was conducted to evaluate case-finding performance and to set cut-off points for the detection of depression. RESULTS: The CDI-J was reliable in terms of internal consistency (Cronbach α = 0.86; mean inter-item correlation, 0.16). Re-test reliability was substantial (mean interval 18 days: γ = 0.59, P < 0.05). The four-factor solution exhibited adequate internal consistency (range, 0.52-0.73) and correspondence (Pearson correlation of 0.65 with the YSR) for both the CON and OPC groups. On ROC analysis the optimal cut-off score was 23/24. CONCLUSION: The CDI-J can be used as a reliable and well-validated instrument alongside standard diagnostic procedures.

抗うつ薬による治療に同意しないうつ病の40歳の乳がん患者に行動活性化療法を適応し、奏効した症例を報告した。いつまた再発するのだろうか、いつまで生きられるのだろうかという訴えのあるうつ状態を示していた。外来でエスシタロプラム5mgを処方したが、嘔気と日中の眠気のため患者の自己判断で中止した。抗うつ薬に関する誤解を訂正すべく繰り返し説明を行ったが、意思は変わらず、薬物療法とは異なるアプローチが必要と考えられた。対象患者は再発不安や死への恐怖を反芻し、みずから活動抑制的な生活を送ることで気分が落ち込むという悪循環に陥っていた。計8セッションの行動活性化療法を行い、介入前の中程度のうつ状態から介入後は寛解状態までの改善が認められるようになった。行動活性化療法ががん患者に特に良い適応があること、がん患者のその後の人生を主体的に生きることにもつながる可能性があることが示唆された。

Introduction: Social anxiety disorder (SAD) symptoms are maintained by cognitive biases, which are overestimations of the severity and likelihood of negative social events (cost/probability biases), and by sensitivity to rewards and punishments that are determined according to behavioral inhibition/behavioral activation systems (BIS/BAS). Cost/probability biases might activate the behavioral immune system and exacerbate the avoidance of social events. Earlier studies have proposed that low BIS or high BAS decrease SAD symptoms; BIS/BAS may even change the effects of cognitive biases on SAD symptoms. Hence, the current study investigates the interaction effects of BIS/BAS and cost/probability biases on SAD symptoms. Method: Seventy-six Japanese undergraduate students completed the Japanese version of the Liebowitz Social Anxiety Scale (LSAS), which comprises Fear and Avoidance subscales, the BIS/BAS Scale, and the Social Cost Probability Scale. Results: A multiple regression analysis was performed to examine whether cost/probability biases, BIS/BAS, and their interactions affected SAD symptoms; following this, the main effects of cost bias and BIS were determined for LSAS-Fear (β = 0.64, p < 0.001; β = 0.33, p < 0.01) and LSAS-Avoidance (β = 0.49, p < 0.001; β = 0.35, p < 0.01). The interaction effect between cost bias and BAS was significant for LSAS-Avoidance (β = -0.32, p < 0.05). Simple slope analysis showed that the slope of cost bias was significant for low-BAS individuals (β = 0.77, p < 0.001) but not for high-BAS individuals (β = -0.21, n.s.). The interaction effect between probability bias and BAS was significant for LSAS-Avoidance (β = 0.40, p < 0.01) as well. Further, simple slope analysis revealed that the slope of probability bias was significant for low-BAS individuals (β = -0.53, p < 0.05) but not for high-BAS individuals (β = 0.17, n.s.). Discussion: The study found interesting results with respect to the avoidance of social events. Low-BAS individuals with high cost or low probability biases regarding social events may have a tendency to avoid social events. In contrast, if high-BAS individuals overestimate the cost of social events or underestimate the probability of social events, their anticipation of rewards might prevent them from avoiding social events.

本研究の目的は、認知行動療法(cognitive behavioural therapy;CBT)のトレーニングの基本構成要素と教育方法に関する日本の現状を明らかにすることであった。臨床心理士養成大学院(修士課程)にてCBTの教育に携わる大学専任教員を対象に、CBTのトレーニングの基本構成要素と教育方法を評価する質問紙への回答と、教育構成要素の自由記述を求めた。74名のデータを整理した結果、CBTの基本構成要素に関する教育は、概して十分に実施されているとは言えないことが示唆された。特に、理論や技法の基礎教育は行われている一方で、臨床実践のための教育や訓練が不足していることが示唆された。また、それらの教育の実施の程度は教員間でばらつきも大きく、各教員の裁量に依存して教育が行われている傾向が示唆された。最後に、日本のトレーニングの基本構成要素には、複数の教育項目が新たに必要であることが示されたため、日本の現状を踏まえて、CBTのトレーニング・ガイドラインを整備する必要性がある。(著者抄録)

Background: Behavioral activation therapy (BAT) directly addresses activities that individuals value most highly, and may be easily applicable to cancer patients. However, there is no established evidence of the use of BAT in this population. In this study, we examined the possibility of a BAT program for depression and anxiety in cancer patients. Case presentation: We retrospectively reviewed the medical records of cancer patients with each of the following characteristics: 1) were outpatients or inpatients visiting the psycho-oncology division of the National Cancer Center Hospital in Japan; 2) met criteria for Major Depressive Disorder or Adjustment Disorders; and 3) participated in a BAT program. The primary outcome was the program completion percentage. Secondary outcomes were self-reported depression severity (Patient Health Questionnaire-9 (PHQ-9) score), anxiety disorder status (Generalized Anxiety Disorder-7 (GAD-7) score), and clinical improvement (Clinical Global Impression-Improvement (CGI-I) score) after the program. We analyzed both depression and anxiety by the matched paired t-test. Ten patients participated in the program, and nine completed it. One dropped out due to cognitive impairment secondary to brain metastasis. Both the PHQ-9 scores (pre: 14.4 (SD, 6.1); post: 5.1 (SD, 5.8)) and the GAD-7 scores (pre: 11.9 (SD, 4.9); post: 4.7 (SD, 5.5)) significantly improved after the program (PHQ-9: P = 0.0014; GAD-7: P = 0.0004). CGI-I scores ranged from 1 to 3, and all subjects except the patient who dropped out improved clinically. Among the ten patients, three distinctive cases could be observed as follows. Case 1; a 45-year-old housewife with breast cancer who did not agree to take antidepressants because of concerns about the side effects achieved remission without antidepressants and began to live an active life. Case 4; a 66-year-old housewife was so shocked after endometrial cancer diagnosis that she was absent-minded and her compliance with the assigned homework was poor, therefore, her depression did not improve much. Case 9; a 62-year-old man with laryngeal cancer who had recurrent anxiety. Increased business activity, on which he put great value, gradually allowed him to be able to live his life actively without concerns. Conclusions: This study suggests that BAT would be effective for the depression and anxiety of cancer patients.

本研究の目的は、日本の認知行動療法の実践家を育成するために不可欠と考えられる教育研修内容を明らかにすることであった。まず、国内外の認知行動療法家4名によって、英国認知行動療法学会が認証した大学の35の研究科を対象に、教育内容項目が網羅的に収集された。次に、国内外の認知行動療法家7名によって、英国におけるガイドラインにおける教育カテゴリーと日本での教育制度の状況を参照しながら、収集された580項目の教育内容について、分類・整理が行われた。その結果、最終的に、3カテゴリー、62項目が得られ、日本の認知行動療法の教育内容リストが作成された。今後、本研究を基盤として、教育研修内容を構成することが求められる。(著者抄録)

本研究の目的は、認知行動療法のセラピストを養成する英国の国家政策プロジェクトで作成されたコンピテンスリストの項目について集約化を行い、セラピストがCBTを行う際に必要となるコンピテンスを整理することであった。CBTを専門とする臨床心理士2名と臨床心理学大学教員4名、臨床心理学大学院生1名により分析した結果、45の大項目それらを構成する352の小項目は、45の大項目と108の小項目に集約された。今後は、これらをもとにチェックリストを作成し、妥当性を検討していく必要があるだろう。(著者抄録)

<p>The purpose of the present study was to explore influences of depression and anxiety on self-care behavior in patients with type 2 diabetes. Outpatients with type 2 diabetes (N＝65) were recruited from an endocrinology and metabolism clinic. Hierarchical multiple regression analyses showed that anxiety affected diet therapy and depression affected foot-care, both as components of diabetes-related self-care behavior. On the other hand, depression and anxiety did not significantly affect exercise therapy. Before providing medical-treatment instruction in alimentary therapy or foot care for type 2 diabetes mellitus patients with depression or anxiety, the patients' strategies for coping with the depression and anxiety that may arise when performing self-care behavior should be investigated. For doing that, assessment and intervention by behavior analysis may be effective.</p>

BACKGROUND: Depression is characterized by negative self-cognition. Our previous study (Yoshimura et al. 2014) revealed changes in brain activity after cognitive behavioral therapy (CBT) for depression, but changes in functional connectivity were not assessed. METHOD: This study included 29 depressive patients and 15 healthy control participants. Functional Magnetic Resonance Imaging was used to investigate possible CBT-related functional connectivity changes associated with negative emotional self-referential processing. Depressed and healthy participants (overlapping with our previous study, Yoshimura et al. 2014) were included. We defined a seed region (medial prefrontal cortex) and coupled region (ACC) based on our previous study, and we examined changes in MPFC-ACC functional connectivity from pretreatment to posttreatment. RESULTS: CBT was associated with reduced functional connectivity between the MPFC and ACC. Symptom change with CBT was positively correlated with change in MPFC-ACC functional connectivity. LIMITATIONS: Patients received pharmacotherapy including antidepressant. The present sample size was quite small and more study is needed. Statistical threshold in fMRI analysis was relatively liberal. CONCLUSIONS: CBT for depression may disrupt MPFC-ACC connectivity, with associated improvements in depressive symptoms and dysfunctional cognition.

<p>Effects of brooding, a negative component of cognitive information processing during rumination, and possible effects of depressive symptoms on verbal working memory capacity were investigated. Healthy undergraduate and graduate students (N=37) participated in a test for assessing reading span and recall, and also completed the Japanese version of the Ruminative Responses Scale (RRS), the Japanese version of Center for Epidemiologic Studies Depression Scale (CES-D) and the Stanford Sleepiness Scale. Results of t-tests conducted on recall and reading span scores with high and low brooding as independent variables indicated no significant differences. Moreover, an analysis of variance on recall and reading span scores, with high and low brooding and high and low depressive symptoms as independent variables also indicated no significant differences. These results suggest that characteristics of verbal working memory capacity are not impaired by brooding and rather that brooding might cause impairments of visuospatial working memory capacity.</p>

Objective: Many patients with implantable cardioverter defibrillators experience depressive symptoms. In addition, avoidance behavior is a common problem among patients with implantable cardioverter defibrillators. We examined the association between avoidance behaviors and depressive symptoms in patients with implantable cardioverter defibrillators. Method: We conducted a single-center, cross-sectional study with self-completed questionnaires between May 2010 and March 2011. We measured avoidance behaviors (avoidance of places, avoidance of objects, and avoidance of situations) and depressive symptoms (using the Beck Depression Inventory, Version II) in 119 participants. An avoidance behaviors instrument was developed for this study and we confirmed its internal consistency reliability. Results: Ninety-two (77.3%) patients were aged older than 50 years, and 86 (72.3%) were men. Fifty-one (42.9%) patients reported avoidance of places, 34 (28.6%) reported avoidance of objects, and 63 (52.9%) reported avoidance of activity. Avoidance behavior was associated with increased odds for the presence of depressive symptoms (OR 1.31; 95% CI 1.06-1.62). Conclusions: This was the first study to identify the relationship between avoidance behavior and depressive symptoms among patients with implantable cardioverter defibrillators; however, there are a few methodological limitations. (C) 2016 Asociacion Espanola de Psicologia Conductual. Published by Elsevier Espana, S.L.U.

Fear of cancer recurrence (FOR) is one of major concerns among cancer survivors, and psychological supportis necessary. This study defined that FOR consisted of concerns of cancer recurrence (CR) and coping behavior toward CR, and examined the correlation between concerns of and coping behavior toward CR, anxiety and depression in order to identify the picture of cancer survivors with excessive level of FOR. The cross.sectional study was conducted. The target was breast cancer survivors who aged over 20 and had no recurrence. The questionnaires were distributed to 220 members in breast cancer patient association. The questionnaires were demographic data, concerns about recurrence scale Japanese version (CARS-J), coping behavior to CR which was developed in this study and HADS. Forty six participants were included in analysis. The multiple linear regression analysis showed that years since diagnosis, cognition of CARS-J and filling everyday life with activities were correlated with anxiety; while cognition of CARS-J, filling everyday life with activities and avoiding recurrence risk were correlated with depression. This result may contributed to capture the picture of breast cancer survivors with excessive level of FOR.

Objectives : The purpose of this study was to investigate the predictive power of rejection sensitivity with respect to change in depressive symptoms in outpatients with atypical or other types of depression. Method : Twenty-seven depression patients completed the questionnaire assessing their rejection sensitivity and depressive symptoms twice at 6-month intervals. Results : The results indicated that rejection sensitivity was not only related to simultaneous depressive symptoms, but also led to an increase in depressive symptoms 6 months later. Simultaneous depressive symptoms were related to all factors associated with rejection sensitivity except "unassertive interpersonal behavior due to fear of hurting others." In contrast, increases in depressive symptoms were related to "unassertive interpersonal behavior due to fear of hurting others" as well as "obsequence to others." Conclusion : These results suggest that depressive symptoms at a given point in time are linked to an individual's cognition, implying that the fear of being rejected by others is present, while changes in depressive symptoms are predicted by whether an individual takes specific actions or countermeasures to avoid being rejected.

BACKGROUND: With a large number of children surviving cancer worldwide, numerous investigations have assessed psychological and social adjustment among childhood cancer survivors. According to these studies, it is unclear whether childhood cancer survivors successfully adjust to daily life after being discharged from hospital, especially for adolescent and young adult survivors who have unique needs and concerns. The primary aim of this study was to identify the factors underlying psychosocial difficulties faced by adolescent and young adult survivors in their day-to-day lives after being discharged from hospital. METHODS: Semi-structured interviews were conducted. Twenty-five childhood cancer survivors were recruited from two regional cancer institutions in Japan. Content analysis was applied to the responses. RESULTS: Nineteen attributes were extracted and classified into four categories as follows: physical difficulties, interpersonal difficulties, behavioral difficulties, and uncertainty about the future. The attributes indicated by >50% of the participants were "I am worried about not feeling well," "I have difficulty continuing treatment in daily life," "I have difficulty moving my body," "I have to be absent from school or work because of illness," and "I am left behind academically." CONCLUSIONS: This study identified important factors of psychosocial day-to-day difficulties. Clinically, these results suggest that it is important to watch for these signs and to provide early support to survivors so that their daily life and development are not hindered by the treatment and its side-effects, and to offer long-term support focusing on individual patient characteristics such as sex, age, and cancer history.

This study explored the relationship between the neutral and negative interpretation, and explored the influence of the positive, neutral, and negative interpretations in ambiguous events for SAD patients. In this study, 50 SAD patients completed (1) the Japanese version of the Liebowitz Social Anxiety Scale (Asakura et al., 2002); (2) the interpretation measure of ambiguous events. The results of correlation analysis revealed that the negative interpretation did not relate to neutral interpretation but positive interpretation (r=-.48, p<.001) in social events. The regression analysis revealed that the influence of negative interpretation in social events predicted social anxiety symptoms (β=.34, p<.05). The results suggest that to benign negative interpretations of ambiguous events will be decrease social anxiety symptoms by increasing positive interpretation of them.

Background : Effective communication between cancer patients and their doctors is important in alleviating patients&#039; physical and psychological burdens. Hence, there is a growing need to encourage an improvement in patientdoctor communication. Cancer outpatients often hesitate to speak with their doctors even when they have necessary information to provide or questions to ask. This study examines the relationships between patients&#039; hesitation in speaking with their doctors and their communication behaviors. Subjects &amp; Method : The participants were 51 individuals (21 male and 31 female, mean age 62.08±11.38 years) undergoing outpatient treatment with complementary and alternative medicine. They were asked to recall the most recent consultation with their primary doctor, and then completed questionnaires measuring the degree of their hesitation in that particular social exchange. The factors influencing patients&#039; hesitation were analyzed using the maximum likelihood estimation. Subsequently, the relationship between patient characteristics and hesitation was examined using Mann-Whitney U and Kruskal-Wallis tests. Results : The results revealed that indecision regarding the topic of discussion, and the decision to forsake their doctors, are among the prime factors influencing patients&#039; hesitance to engage in effective communication with their primary doctors. A marginally significant difference with respect to age, stage of disease, employment, and recurrence status was observed. In particular, patients with recurrence were more likely to exhibit hesitance in communication compared to patients without recurrence (p=0.05). In addition, patients under 50 years of age were more likely to be indecisive about the topics of discussion, compared to patients in their 60 s (p=0.08). Similarly, patients at stages I-III were more likely to be indecisive than were patients at stage IV (p=0.08). In addition, employed patients were more likely to forsake their doctors than were unemployed patients (p=0.08). However, hesitation did not significantly differ by sex, cancer type, treatment, ECOG performance status, presence or absence of metastasis, residential conditions, or disease duration. Conclusion : To encourage better patient-doctor communication, it is necessary to alleviate patients&#039; hesitation to talk to their primary doctors. Communication skill training programs for patients targeting both the alleviation of patients&#039; hesitation and the amelioration of patients&#039; communication skills may be necessary.

Effective communication between cancer patients and their primary doctors is important in alleviating patients' physical and psychological burdens. However, cancer outpatients often hesitate to speak with their doctors even when they have something to say or questions to ask. This study examines the relationships between patients' hesitance to communicate with their primary doctors and patients' communication behaviors during their medical interviews. The participants were 51 individuals undergoing outpatient treatment in the form of complementary and alternative medicine. They were asked to recall the most recent consultation with their primary doctor, and then completed questionnaires about the degree of their hesitation, their communication behaviors, and their degree of satisfaction with that particular social exchange. In order to examine the relationships between patients' communication behaviors, satisfaction, and hesitation, partial correlation coefficients controlling for patients' age, cancer type, and employment condition were calculated. The results revealed that patients' hesitation was related to some of their communication behaviors: presenting information, asking questions, stating preferences, and checking information. Hesitation is an obstructive factor in the effective communication of patients. Therefore, it is necessary for primary doctors to recognize this hesitation, and to address it by actively engaging in communication with their patients.

The aims of the present study were to compare symptoms and attentional bias of patients with generalized social anxiety disorder (GSAD) to those of patients with non-generalized social anxiety disorder (NGSAD), and of patients with high perceived physiological arousal social anxiety disorder to those of patients with low perceived physiological arousal social anxiety disorder. Participants (n=16) with social anxiety disorder and control participants without social anxiety disorder (NC; n=6) were asked to fill out questionnaires and to perform a modified dot-probe task in which they were presented with negative and positive evaluation words, body-sensation words in 2 separate exposures that involved automatic and strategic processing. ANOVAs of the attentional bias scores, with subtype (GSAD vs. NGSAD vs. NC) and perceived physiological arousal (high vs. low vs. NC) as independent variables, revealed no significant differences. However, t-tests comparing attentional bias scores with 0 indicated that whereas participants with non-generalized social anxiety disorder were vigilant while performing automatic processing with positive evaluation words, patients with high perceived physiological arousal and social anxiety disorder tended to pay more attention to the body-sensation words on the tasks requiring strategic processing. The significance of assessing social anxiety disorder subtypes and possibly appropriate interventions for each subtype were discussed.

The present study aimed to investigate differences between factors related to post-traumatic stress symptoms (PTSS) and social disability in patients with post-traumatic stress disorder. Female patients with post-traumatic stress disorder (N=41) who visited the clinic mainly in the wake of an experience with domestic violence (DV) completed the Event Check List (ECL), the Impact of Event Scale-Revised (IES-R), the Sheehan Disability Scale (SDISS), the Cognitive Appraisal Rating Scale (CARS), the Negative Appraisal for Post-traumatic Stress Symptoms (NAP), and the Tri-Axial Coping Scale-24 (TAC). A partial correlation analysis, performed to determine whether symptoms of post-traumatic stress disorder were related to social disability, revealed a weak correlation between their scores on the Impact of Event Scale-Revised and the SDISS. Moreover, hierarchical multiple regression analysis revealed that the appraisal of threat, negative prediction and implications relating to post-traumatic stress symptoms, and avoidance-like thinking positively influenced post-traumatic stress symptoms. However, appraisal of threat and becoming resigned positively influenced social disability, and negatively influenced positive interpretation and evading one's responsibility. These results suggest that even if the post-traumatic stress disorder condition improves, the degree of social disability may not. Furthermore, the relationship between cognitive behavioral variables and post-traumatic stress symptoms is different from the relationship between cognitive behavioral variables and social disability. Therefore, in addition to conventional treatments for post-traumatic stress disorder, such as cognitive behavior therapy (CBT), an intervention may be required that positively influences social disability.

Social anxiety disorder (SAD) is characterized by strong fear and anxiety during social interactions. Although ventrolateral prefrontal cortex (VLPFC) activity in response to emotional stimuli is related to pathological anxiety, little is known about the relationship between VLPFC activity and social anxiety. This study aimed to investigate whether VLPFC activity was involved in SAD and whether VLPFC activity was related to the level of social anxiety. Twenty-four drug-naïve patients with SAD and 35 healthy controls underwent near-infrared spectroscopy (NIRS) scanning while performing a verbal fluency task (VFT). Results indicated that, compared to the healthy controls, the SAD patients exhibited smaller changes of oxygenated hemoglobin (oxy-Hb) concentrations in the VLPFC during the VFT. Furthermore, the right VLPFC activation was negatively correlated with social avoidance. In contrast to the latter, the healthy controls exhibited a positive correlation between changes of oxy-Hb concentrations in the bilateral VLPFC and social fear. Our findings provide evidence for VLPFC dysfunction in SAD, and indicate that the VLPFC dysfunction may contribute to the difference between normal and abnormal social anxiety.

Background: Anxiety is often present in patients with depression. The aim of this study was to evaluate the impact of clustered depression and anxiety on mortality and rehospitalization in hospitalized patients with heart failure (HF).
Methods: A total of 221 hospitalized patients with HF, who completed the questionnaires, were analyzed in this prospective study (mean age 62 +/- 13 years; 28% female). One-third patients had implanted cardiac devices. Depression was defined as a Zung Self-Rating Depression Scale index score of &gt;= 60 and anxiety was defined as a State-Trait Anxiety Inventory score of &gt;= 40 (male) or &gt;= 42 (female). The primary outcome was the composite of death from any cause or rehospitalization due to worsened HF and refractory arrhythmia.
Results: Of the 221 HF patients, 29(13%) had depression alone, 80(36%) had anxiety alone, and 46 patients (21%) had both depression and anxiety. During an average follow-up of 41 +/- 21 months, patients with depression alone and those with clustered depression and anxiety were at an increased risk of the primary outcome [hazard ratio (HR) 2.24, 95% confidence interval (CI): 1.17-4.28, p = 0.01 and HR 2.75,95% CI: 1.51-4.99, p = 0.01, respectively] compared to patients with no symptoms. Multivariate analysis after adjusting for age, gender, New York Heart Association functional class, B-type natriuretic peptide, device implantation, renal dysfunction, and left ventricular dysfunction showed clustered depression and anxiety, but not depression alone or anxiety alone, was an independent predictor of the primary outcome (HR 1.96,95% CI: 1.00-3.27, p = 0.04).
Conclusions: Our results showed that clustered depression and anxiety were associated with worse outcomes in patients with HF. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

重症社交不安障害(SAD)患者における拒絶に対する過敏性とうつ症状が社交不安症状に与える影響性について検討した。通院中のSAD患者62例を対象にアンケートを実施した。大うつ病の診断は35例であった。大うつ病の診断の有無について検討し、IPSMの関係破綻の不安、社会的自己像と真の自己像の不一致、合計点に有意差を認め、大うつ病の診断を有する群で得点が高かった。IPSMの各尺度間には、おおむね中程度から強い正の相関を認め、なかでもBDI-IIはLSASおよびIPSMのほぼ全ての下位因子および合計得点との間に強い正の相関を認めた。SAD症状の関係は擬相関で、うつ症状は拒絶に対する過敏性とSAD症状を媒介していると考えられた。

The purpose of the present study was to examine generalization and maintenance effects of social skills training (SST) for a fifth-grade boy with autism spectrum disorder (ASD) in a general education classroom. A social skills training program was developed that identifies target skills from a functional assessment, instructs matches for characteristics of autism spectrum disorder, and includes some homework on behavioral rehearsal. The social skills training consisted of 10 sessions, focusing on the following target skills: responding to initiations skills, entry skills, assertive skills, anger management skills, and problem-solving skills. The results were as follows: (a) The teacher's ratings of the boy's social skills improved, and (b) the frequency of his playing with peers after school increased. These results suggest that social skills training for this elementary school child with autism spectrum disorder improved his skills, and that the improvement generalized and was maintained. The discussion suggests that functional assessment of peer, teacher, and parent interactions is necessary for social skills training with individuals with autism spectrum disorder.

Breast cancer is the most common cancer in Japanese women. As patients with breast cancer have a lower level of mental health than healthy individuals, it is most important that they have the support of their partners to adapt to everyday life. However, 3 years after diagnosis the mental health of partners of breast cancer patients is lower than that of the patients. Few studies have examined the difficulties partners may have after their wife has been diagnosed as breast cancer. The aims of this study on partners of breast cancer patients were to investigate (l) the percentage of partners who needed information and advice services, and sympathetic support, (2) difficulties in marital communication regarding the illness, and (3) the relationship between the characteristics and difficulties in marital communication about the illness. The partners completed self-administered questionnaires (n=368). The results showed more than one-half of the partners needed support on information services (67.1 %), advice services (63.9 %), and sympathetic support (56.5%). At the time of diagnosis 66.6% of the partners had trouble grasping what his wife wanted and what he could do for her. These difficulties declined over time, however, 10-30% of partners had continuing problems regarding marital communication about the illness. Difficulties in marital communication about the illness were shown to be associated with recurrence of breast cancer, use of anticancer drug therapy, and a partner's previous experience with cancer. It is therefore necessary to provide partners who have these characteristics with information regarding marital communication about breast cancer.

BACKGROUND: There are few data on clinicians' perspectives regarding support for children who have a parent who has been diagnosed with breast cancer. The purpose of this study was to survey the attitudes of physicians and nurses regarding the care of children who had a parent diagnosed with breast cancer. METHODS: A survey was mailed to 898 physicians and 135 nurses who were members of the Japanese Breast Cancer Society in 2009. They were asked to answer questions about their attitudes toward and current practice regarding care for children who had a parent with breast cancer. RESULTS: A total of 340 surveys (284 physicians and 56 nurses) were used in this analysis. The mean age of the respondents was 47.2 years, and their mean number of years of practice was 21.7 years. While 69.1 % of them reported that they felt it important for people in their roles to provide support for children, 84.4 % felt they could not provide sufficient support. The results also suggested that female gender in practitioners and nurses as opposed to doctor status seemed to be associated with preference for intervention, current practice of intervention, and recognition of difficulty to support. CONCLUSIONS: Physicians and nurses express a variety of opinions with regard to support for children with a parent who has breast cancer. It is important to cooperate with other specialists including physicians, nurses, and psychologists and allocate roles appropriately among them to improve outcomes for these children.

The purpose of this study was to explore the factor structure of the Japanese version of Interpersonal Sensitivity Measure (J-IPSM). The J-IPSM assesses the tendency for being sensitive to rejection (interpersonal rejection sensitivity). This study comprised 301 undergraduate students who completed the J-IPSM. The J-IPSM included 27 items loading on 5 factors - "fear of breakup of a relationship", "unassertive interpersonal behavior due to fear of hurting others", "fear of criticism by others", "discrepancy between social self-image and true self-image", and "obsequence to others". The internal consistency of the scale and each subscale explored by the factor analysis were suffi-ciently high (α=0.78-0.91). Furthermore, among atypical depressive patients, the scores of J-IPSM correlated strongly with the score of the self-reported measures of depressive symptoms. The J-IPSM, therefore, may be highly valid and potential for clinical and research applications. Finally, differences in the results of original IPSM and J-IPSM were discussed from the viewpoint of culture.

Cognitive behavioral therapy (CBT), an effective treatment for depression, targets self-referential processing of emotional stimuli. We examined the effects of CBT on brain functioning during self-referential processing in depressive patients using functional magnetic resonance imaging (fMRI). Depressive patients (n = 23) and healthy participants (n = 15) underwent fMRI scans during a self-referential task using emotional trait words. The depressive patients had fMRI scans before and after completing a total of 12 weekly sessions of group CBT for depression, whereas the healthy participants underwent fMRI scans 12 weeks apart with no intervention. Before undergoing CBT, the depressive patients showed hyperactivity in the medial prefrontal cortex (MPFC) during self-referential processing of negative words. Following CBT, MPFC and ventral anterior cingulate cortex (vACC) activity during self-referential processing among depressive patients was increased for positive stimuli, whereas it was decreased for negative stimuli. Improvements in depressive symptoms were negatively correlated with vACC activity during self-referential processing of negative stimuli. These results suggest that CBT-related improvements in depressive symptoms are associated with changes in MPFC and vACC activation during self-referential processing of emotional stimuli.

The purpose of this study was to investigate the influences of interpersonal rejection sensitivity on depressive symptoms and social anxiety symptoms in social anxiety disorder (SAD) patients. Eighty-one SAD patients completed the questionnaire assessing their rejection sensitivity, depressive symptoms, and social anxiety symptoms. The results indicated that rejection sensitivity led an increase in SAD symptoms through depressive symptoms. In rejection sensitivity, "discrepancy between social self-image and true self-image" and "obsequence to others" in particular are strongly related with depressive symptoms. These results suggest that rejection sensitivity as a possible cause of depressive symptoms in the course of SAD, and were discussed in terms of possibility of approach that focus on rejection sensitivity.

Effects of interpersonal rejection sensitivity and automatic thoughts relating to social phobia, trait anxiety, and depression, in university students in a teacher education course were investigated to determine if these effects differed between pre- and post-practicum students. We administered questionnaires to first year students (n=84; 37 boys and 47 girls) with no practicum experience (no practicum group) and to fourth year students (n=82; 51 boys and 31 girls) with a practicum experience (practicum group). The results showed that in the no practicum group, "Dependence on Evaluation by Others" and "Negative Expectations for the Future" significantly affected interpersonal rejection sensitivity and automatic thoughts related to social phobia, whereas "Negative Expectation for the Future" had a significant effect on these variables in the practicum group. In addition, "Negative Thoughts about the Self" significantly affected trait anxiety. Furthermore, "Fear of Relationship Failure" and "Unassertive Interpersonal Behavior significantly affected the "Fear of Hurting Others" in the no practicum group, whereas there was a significant effect of "Fear of Criticism by Others" on these variables in the practicum group. In both groups, there was a significant effect of "Negative Expectation for the Future" on depression, whereas in the no practicum group, there was a significant effect of "Positive Automatic Thoughts" on depression.

BACKGROUND: Recently, neurobiological studies of the cognitive model of depression have become vastly more important, and a growing number of such studies are being reported. However, the relationship between the proportion of positive and negative automatic thought and activity in the prefrontal and temporal cortices has not yet been explored. We examined the relationship between brain activity and the proportion of positive and negative automatic thought in patients with major depressive disorder (MDD), using multi-channel near-infrared spectroscopy (NIRS). METHODS: We recruited 75 individuals with MDD (36 females; mean age=39.23 ± 12.49). They completed the Hamilton Rating Scale for Depression, Automatic Thoughts Questionnaire-Revised, Japanese version of the National Adult Reading Test, and the State-Trait Anxiety Inventory. Brain activation was measured by 52-channel NIRS. RESULTS: We found that activation in the vicinity of the right superior temporal gyrus is related to a deviation to negative of the proportion of positive and negative thoughts in individuals with MDD. Left dorsolateral prefrontal cortex activity was higher in the group with comparatively frequent positive thought. LIMITATIONS: Our participants were patients taking antidepressant medication, which is known to influence brain activity. Second, the poor spatial resolution of NIRS increases the difficulty of identifying the measurement position. CONCLUSIONS: We found that activation of the prefrontal and temporal cortices is related to the proportion of automatic thoughts in the cognitive model of depression.

The purpose of the present study was to develop and evaluate a self-report Anxious Depression Scale (ADS). The Anxious Depression Scale assesses symptoms of anxious depression, which is a depressive condition comorbid with anxiety disorders. The participants, 114 outpatients having any anxiety disorder with depression, 153 outpatients having any anxiety disorder without depression, 80 outpatients with major depression, and 97 undergraduate students, completed the Anxious Depression Scale and other clinical scales relating to depression and anxiety. Exploratory factor analysis revealed that the Anxious Depression Scale, including 20 items, appropriately fell into 4 factors: "behavioral/emotional symptoms," "physical symptoms," "aggressive emotions (dynamic emotions) ," and "non-aggressive emotions (static emotions)." Internal consistency of the scale and each subscale was sufficiently high (α=0.74-0.87). The results of an analysis of variance showed that the patients with anxious depression had higher scores than the other participants on all subscales and also had a higher sum on the Anxious Depression Scale. Furthermore, the Anxious Depression Scale scores correlated moderately with other self-report measures of depression. The Anxious Depression Scale is able to measure specifically the severity of anxious depression. Differences in depressive symptoms of each type of anxious disorder were discussed.

The purpose of the present study was to examine the correlation between perceived illness experiences and psychosocial adaptation in adolescent childhood cancer survivors. The participants, 21 youth (7 boys, 14 girls; average age 15.8 years, SD 2.1) who were cancer patients attending pediatric outpatient clinics, were asked to participate in a semi-structured interview and complete the Pediatric Quality of Life (QOL) Inventory. The results indicated that psychosocial daily difficulties influenced their illness perception. Although the results were not statistically significant, positive perception might correlate positively with QOL, and negative perception or a despairing attitude might correlate negatively with QOL. Future research should investigate those influences in a quantitative study.

BACKGROUND AND OBJECTIVES: Depression is characterized by low reward sensitivity in behavioral studies applying signal detection theory. We examined deficits in reward-based decision making in depressed participants during a probabilistic learning task, and used a reinforcement learning model to examine learning parameters during the task. METHODS: Thirty-six nonclinical undergraduates completed a probabilistic selection task. Participants were divided into depressed and non-depressed groups based on Center for Epidemiologic Studies-Depression (CES-D) cut scores. We then applied a reinforcement learning model to every participant's behavioral data. RESULTS: Depressed participants showed a reward-based decision making deficit and higher levels of the learning parameter τ, which modulates variability of action selection, as compared to non-depressed participants. Highly variable action selection is more random and characterized by difficulties with selecting a specific course of action. CONCLUSION: These results suggest that depression is characterized by deficits in reward-based decision making as well as high variability in terms of action selection.

The present article reports effects of cognitive behavioral group therapy (CBGT) on adults with depression, using a controlled clinical trial. The cognitive behavioral group therapy consisted of 12 sessions developed by psychologists, consisting of Beck's cognitive therapy and problemsolving therapy. Participants (n=10) received this treatment from a psychologist, including pharmacotherapy (treatment as usual; TAU) combined with the cognitive behavioral group therapy program (TAU+CBGT group). The other participants (n=10) received only pharmacotherapy (TAU group). The Beck Depression Inventory-II (BDI-II) which measures depression was completed by the participants at 3 times (pre-, mid-, and post) during the cognitive behavioral group therapy program. The results revealed that after the therapy, depression in the group receiving cognitive behavioral therapy with pharmacotherapy improved significantly more than in the treatment-as-usual group. These results suggest that for adults with depression, the administration of pharmacotherapy combined with cognitive behavioral group therapy managed by a psychologist may be more effective than treatment with pharmacotherapy only.

The purpose of the present study was to explore the effect of cognitive behavioral group therapy on depression, social functioning, and the difficulties that employees face when returning to work after sick leave taken to obtain treatment for depression. Participants (N=22) were diagnosed as having unipolar depressive disorder, and were on sick leave. The therapy consisted of 10 weekly 90-minute sessions of closed cognitive behavioral group therapy; the therapist, the therapist's assistant, and a supporter in the therapy were all psychologists. Before and after the treatment, the participants completed the Automatic Thoughts Questionnaire-Revised (ATQ-R), the Tri-axial Coping Scale-24 (TAC), Kikuchi's Scale of Social Skills (KISS) , the Beck Depression Inventory-II, the Social Adaptation Self-evaluation Scale (SASS), and the Difficulty in Returning to Work Inventory (DRW). The results revealed that depression and social functioning scores improved significantly after cognitive behavioral group therapy. On the other hand, the employees still had difficulties in returning to work. This suggests that it is necessary to develop and implement more components of treatment or change the timing of the treatment, in order to reduce difficulties employees face when returning to work.

Objectives : Experience of cancer has been linked to post-traumatic stress disorder for childhood cancer survivors. However, it is also an opportunity for personal growth (Jim & Jacobsen., 2008). Evaluating the long-term effects of cancer and its treatment, we have to investigate the impact of cancer in life domains. The purpose of this study was to explore the perception of the cancer experience in Japanese childhood cancer patients. Methods : Subjects were 25 childhood cancer patients attending the pediatric outpatient clinics (8 male and 17 female), median age at survey was 16.8 yrs (13.8-28.8 yrs), median age at diagnosis was 8.0 yrs (2.3-15.0 yrs). Approximately 18 patients had leukemia, 4 suffered from malignant lymphoma and 3 suffered from osteosarcoma, respectively. They were asked to participate in a semi-structured interview regarding the perception of the cancer experience. The data was analyzed with the content analysis, chi-square test and Fisher's exact test. Results: A total of 11 attributes were extracted. The attributes indicated by many of the participants were "having cancer brought my family closer together (n=14)", "I have met various people (n=12)", "cancer has been a precious experience of my life (n=11)", "I wonder why I got cancer (n=9)". Some attributes showed statistically significant differences among age at survey. Conclusion : This study identified the important components of the perceived cancer experience in Japanese childhood cancer patients. Most patients thought that good things have come out of having had cancer. In addition, older patients have more diversified views of cancer than younger patients because they have had many problems and benefits.

:In recent years, quality of life(QOL) has received much attention as a subjective health outcome by which to measure and adopt patient treatment. Few studies, however, have examined how the QOL of cancer patients differs depending on treatment methods, or the effects of immunotherapy on patients' QOL. Thus, this study aimed to reveal: 1) the differences in QOL between patients treated with immunotherapy and other methods, and 2) whether the QOL of cancer patients treated with immunotherapy improves in accordance with the duration of immunotherapy. Thirty-nine cancer patients receiving immunotherapy who completed a Quality of Life Questionnaire for Cancer Patients Treated with Anti-Cancer Drugs(QOL-ACD) were the subjects for statistical analyses. The result indicated that patients treated with immunotherapy exhibited a higher physical conditions score than did patients receiving chemotherapy (p<0.01). Given that the side effects of immunotherapy are fewer than those of chemotherapy, the results suggested that the presence of side effects during cancer treatment plays an important role in determining patients' QOL.

The present study investigated whether a speaker's interpretation bias predicts effects of video feedback on that person's social anxiety. Undergraduate student participants (N=27) in the experiment made 2 speeches, receiving video feedback for the first speech. Subjective anxiety (visual analog scale), speech perception (Speech Perception Questionnaire; evaluation by oneself and others), and heart rate were measured. Interpretation bias was indicated by the standardized residual of scores by oneself and others. The results indicated that the quality of the speeches did not differ in relation to the degree of interpretation bias. On the other hand, the effects of the video feedback on subjective anxiety before and during the speeches differed in relation to the amount of interpretation bias. Participants' heart rate before the speeches was significantly lower before the second speech, regardless of the degree of interpretation bias. These results suggest that video feedback is more effective for those with high interpretation bias in self-evaluation of performance and subjective anxiety. Interpretation bias might be a factor determining effects of video feedback in alleviating social anxiety.

The purposes of the present study were to develop a Difficulties in Returning to Work Inventory (DRW) and to examine characteristics of the inventory. The inventory was developed based on a sample of 34 patients with unipolar depressive disorder. A total of 60 employees who were on sick leave because of unipolar depressive disorder completed the inventory. Exploratory factor analysis revealed that the DRW was constituted of 10 items, centering on 3 factors. Cronbach's α coefficient was sufficiently high (α=.87), and the validity of the inventory was confirmed by content as well as concurrent validity. The results of the present study suggest that the DRW has high reliability and validity. The inventory was used to classify the 60 employees into 4 categories. The results considered the employees' difficulties in returning to work and suggested treatments that could be provided to them.

The present study examined effectiveness of combined cognitive behavioral group therapy (CBGT) and medication for patients with major depression. The cognitive behavioral group therapy program, which consisted of 12 structured sessions including psycho-education, self-monitoring, behavior activation, challenging and restructuring negative thinking, was conducted by clinical psychologists at Hiroshima University Hospital. At baseline, termination of treatment, and 12-month follow-up, patients (N-74) completed the Beck Depression Inventory (BDI) , the Hamilton Rating Scale for Depression (HAM-D) , the Global Assessment of Functioning scale (GAF) , the 36-item Short-Form Health Survey (SF-36) , the Automatic Thought Questionnaire-Revised (ATQ-R) , and the Dysfunctional Attitudes Scale (DAS). The post-treatment scores on the 4 measurement instruments were significantly lower after the treatment. In addition, the scores on the Global Assessment of Functioning scale and 36-item Short-Form Health Survey were significantly higher than the baseline scores. In other words, the patients improved on all measurements of psychosocial functioning and mood symptoms. Their improvement in depressive symptoms, psychosocial functioning, and dysfunctional cognitions were sustained at 12 months following the completion of the group-cognitive behavioral therapy.

Depression is the commonest mental disease. In Japan, depression is not a rare disease and 5% of her people suffer it in their life. It is reported recently that among the causes of the suicide, 27.6% are by depression, and about 70% of the employees'suicide are considered due to depression. So our Ministry of Health, Labor and Welfare is promoting preventive measures for depression as the core of suicide prevention. Cognitive-Behavioral Therapy (CBT) for depression has been covered by national health insurance since April, 2010 in Japan. We showed in this study the trend of late years of the CBT for depression as well as its contents and points of application in practice.

Background: Several studies have suggested that depression poses a risk in cardiovascular patients. The aim of the present study was to evaluate the prevalence of depression and its effect on cardiovascular events and mortality in Japanese inpatients with cardiovascular disease.
Methods and Results: A total of 505 patients hospitalized with cardiovascular disease (28% female; mean age, 61 +/- 14 years; 31% ischemic heart disease; 47% New York Heart Association [NYHA] class II-IV; 25% implantation of pacing devices) were enrolled in the present prospective observational study. The Zung Self-Rating Depression Scale (SDS) was used to screen for depression. The primary outcome was the time to death or cardiovascular event, and the secondary outcome was death. In total, 109 patients (22%) were diagnosed with depression (Zung SDS index score 60). NYHA class III/IV, defibrillator implantation, and being unmarried were independently associated with depression. During an average follow-up period of 38 +/- 15 months, 92 patients (18%) reached the primary outcome. There was a higher incidence of the primary outcome in patients with depression than in those who were not depressed (P &lt; 0.01). Depressed patients had a significantly higher rate of mortality than non-depressed patients (P &lt; 0.01). Depression was an independent predictor of the primary outcome (hazard ratio, 2.25; 95% confidence interval: 1.30-3.92, P &lt; 0.01).
Conclusions: Depression was not uncommon in Japanese inpatients with cardiovascular disease and was associated with cardiovascular outcomes. (Circ J 2011; 75: 2465-2473)

The purposes of the present study were to explore long-term effects of a diabetes camp on self-care behavior of Japanese children with type 1 diabetes, as well as relations between the children's self-care behavior and self-efficacy, and the duration of their diabetes. The participants, 20 children with type 1 diabetes, were asked to complete questionnaires at the beginning and end of a diabetes camp. In addition, a follow-up survey was administered 6 months after they left the camp. The results were as follows: (a) the participants' self-care behavior improved after attending the camp, but this effect was not maintained after several months. (b) participants who had had diabetes for a long duration showed less improvement in self-care behavior than those who had recently been diagnosed with diabetes. (c) participants with high self-efficacy exhibited a larger degree of improvement in self-care behavior than those with low self-efficacy. These findings suggest the importance of considering duration of diabetes and self-efficacy in improving self-care behavior of summer camp participants with type 1 diabetes.

The purpose of this study was to investigate the cognitive and behavioral changes through the recovery process of loss. Subjects were eight undergraduate students (mean age=21.88, SD=2.93) who had experienced personal significant loss. Semi-structured interviews were conducted. A modified grounded theory approach was conducted to analyze what they discussed about in their interview. In addition, subjects were requested to complete a set of questionnaires on the levels of grief, Japanese version of the Posttraumatic Cognitive Inventory (JPTCI), Posttraumatic Growth Inventory (PTGI), and Tri-Axial Coping Scale (TAC-24). The results of this study suggested that increasing positive cognition and behavioral activation are important for the adaptive recovery process of loss.

The purposes of the present study were to develop an Automatic Thoughts Questionnaire for Child-Rearing (ATQ-CR) and to investigate the relationship between automatic thoughts and stress responses in mothers rearing young children. The results of exploratory and high- dimensional factor analysis of data from 324 mothers of preschool children supported the validity of 2 factors: a negative factor, which consisted of 29 items, and a positive factor, which consisted of 14 items. Cronbach's a coefficient was sufficiently high (negative factor: α=.90, positive factor: α=.76) , and scores on the negative factor of the Questionnaire correlated significantly with stress response scores (r=.23-.35). These data suggest that the Automatic Thoughts Questionnaire for Child-Rearing has high reliability and validity. In order to investigate the relationship between automatic thoughts and stress responses, scores on the Questionnaire were compared across 3 groups based on their scores on a State of Mind questionnaire. The results of ANOVAs suggested that the Low Positive group had significantly lower stress response scores than the Neutral and Low Negative groups. The data suggest that a balance of negative and positive thinking is related to stress responses, and .that stress management of automatic thoughts would be helpful for mothers rearing young children.

Methods: The study included 90 consecutively hospitalized patients. Patients underlying heart disease was 24% coronary artery disease, 29% idiopathic dilated cardiomyopathy, 24% hypertrophic cardiomyopathy, 13% idiopathic VF/long QT syndrome and miscellaneous conditions 11%. A secondary indication for ICD implantation was present in 20 patients. All patients completed the Zung Self-Rating Depression Scale (SDS) at study baseline and at the their routine follow-up visit 2 years after the baseline questionnaire. Delivery of ICD therapies was tracked throughout the 2 years.
Results: Depression, indicated by a Zung SDS index score exceeding 60, was present in 29 (32%) of patients at study baseline. Depression was present in 11/51 (21%) patients scheduled to undergo ICD implantation, 2/2 (100%) patients whose device was upgraded to a CRT-D, 3/14 (21%) patients who had undergone pulse generator replacement, 7/14 (50%) patients who experienced electrical storm and 6/9 (66%) patients hospitalized with acute decompensated heart failure. NYHA functional class III was significantly associated with depression at baseline (HR 6.7, 95% CI 1.68-27.2, p = 0.0007). No differences were noted for female gender, demographics, beta-blocker use, or LVEF &lt; 35% (p = ns). Depression was present in 25 (28%) of patients at 2 years follow-up, persisting in 21 (72%) of patients whose Zung SDS scores were elevated at baseline. The median time from ICD shock therapy to completion of the 2 year questionnaire was 9 months (range, 1-22). Patients who were depressed (9/25, 36%) experienced more shocks than non-depressed patients (6/65, 9%) after 2 years (p = 0.002).
Conclusions: Depression is not uncommon among patients who meet criteria for ICD implantation and persists over time particularly when functional status is impaired. Depression is associated with a higher incidence shock therapy. (PACE 2010; 33:1455-1461).

Although it is known that the impairment of social functioning, which is a significant aspect of depression, is distinct from depressive symptoms, whether there are any psychological factors that affect depressive symptoms and social functioning has not yet been investigated. The present study examines relations between psychosocial factors and depressive symptoms or social functioning. Patients (N-66) who had been diagnosed with unipolar major depressive disorder completed the Automatic Thoughts Questionnaire-Revised (ATQ-R) , the Tri-Axial Coping Scale (TAC-24) , Kikuchi's Scale of Social Skills (18 items version; Kiss-18) , the Beck Depression Inventory-IT (BDI-II), and the Social Adaptation Self-evaluation Scale (SASS) . The results showed that "self-criticism" was related to depressive symptoms, whereas "positive thoughts" "positive thinking-distraction" and "social skills" were related to social adaptation. Overall, the results of the present study suggest that the evaluation of psychological factors affecting depression is just as important as the evaluation of the extent of impairment of social functioning.

The purposes of the present study were to verify the efficacy of cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) through a meta-analysis of data from recent research, and to deal with issues related to research on posttraumatic stress disorder. The results of the meta-analysis verified the effectiveness of cognitive-behavioral therapy for posttraumatic stress disorder and suggested further potential applications. Tasks set for the future include: (a) examination of intervention methods in relation to patients' symptom profiles and condition. (b) verification of the efficacy of cognitive-behavioral therapy when used in combination with medical treatment. (c) identification and specification of treatment techniqus and factors that influence therapeutic gain, examination of the techniques' efficiency, and identification of appropriate intervention methods. and (d) examination of factors other than treatment techniques that are known to be effective.

BACKGROUND: Depression is characterized by enhanced self-referential processing of negative emotional stimuli. Imaging studies have suggested that activation of both the medial prefrontal (MPFC) and anterior cingulate cortices (ACC) is associated with self-referential processing. However, whether this pattern of activation occurs in depressed individuals during the self-referential processing of the emotional stimuli had not been investigated to date. METHODS: Participants were 13 patients with major depressive disorder and 13 normal controls. We used block-designed functional magnetic resonance imaging (fMRI) to investigate neural activity during the self-referential judgments of positive and negative valenced personality trait words. RESULTS: Compared with the normal controls, the depressed patients showed hyperactivity in the MPFC and the rostral ACC during the self-referential processing of negative words. In addition, the activity of these regions during self-referential processing of the negative stimuli was correlated with the depressive symptom severity. The rostral ACC activity mediated the correlation between the MPFC activity and the depressive symptoms. Functional connectivity analysis revealed positive connectivities between the MPFC, the rostral ACC, and the amygdala. LIMITATION: Small N and antidepressant effect on imaging data limit the stability of reported findings. CONCLUSIONS: The relationships between the MPFC, the rostral ACC, and the amygdala appear to reflect an interaction between the self-referential processing and the negative emotional information processing, and we propose that the strong connection between the MPFC and the rostral ACC is associated with depressive symptoms.

BACKGROUND: Although patients with Treatment Resistant Depression (TRD) often have impaired social functioning, few studies have investigated the effectiveness of psychosocial treatment for these patients. We examined whether adding group cognitive behavioral therapy (group-CBT) to medication would improve both the depressive symptoms and the social functioning of patient with mild TRD, and whether any improvements would be maintained over one year. METHODS: Forty-three patients with TRD were treated with 12 weekly sessions of group-CBT. Patients were assessed with the Global Assessment of Functioning scale (GAF), the 36-item Short-Form Health Survey (SF-36), the Hamilton Rating Scale for Depression (HRSD), the Dysfunctional Attitudes Scale (DAS), and the Automatic Thought Questionnaire-Revised (ATQ-R) at baseline, at the termination of treatment, and at the 12-month follow-up. RESULTS: Thirty-eight patients completed treatment; five dropped out. For the patients who completed treatment, post-treatment scores on the GAF and SF-36 were significantly higher than baseline scores. Scores on the HRSD, DAS, and ATQ-R were significantly lower after the treatment. Thus patients improved on all measurements of psychosocial functioning and mood symptoms. Twenty patients participated in the 12-month follow-up. Their improvements for psychosocial functioning, depressive symptoms, and dysfunctional cognitions were sustained at 12 months following the completion of group-CBT. CONCLUSIONS: These findings suggest a positive effect that the addition of cognitive behavioural group therapy to medication on depressive symptoms and social functioning of mildly depressed patients, showing treatment resistance.

The purpose of the present study was to examine effects of classroom-based social skills training (C-SST) on first grade elementary school students. The participants were 30 first-grade elementary school students (16 boys, 14 girls; 6-7 years old) in one class. The target skill was selected in cooperation with the teacher in charge of the class. We developed a classroom-based social skills training program that the students could work with easily and be readily motivated by. Classroom-based social skills training was done 2 times. Effects of the training were evaluated using teacher-reported target skill behavior scores, social skill scores, self-reported target skill behavior scores, and classroom satisfaction scores. The results suggest that the classroom-based social skills training improved the target skill behavior, social skills, and sociability.

Although it is known that the impairment of social functioning, which is a significant aspect of depression, is distinct from depressive symptoms, whether there are any psychological factors that affect depressive symptoms and social functioning has not yet been investigated. The present study examines relations between psychosocial factors and depressive symptoms or social functioning. Patients (N-66) who had been diagnosed with unipolar major depressive disorder completed the Automatic Thoughts Questionnaire-Revised (ATQ-R) , the Tri-Axial Coping Scale (TAC-24) , Kikuchi's Scale of Social Skills (18 items version; Kiss-18) , the Beck Depression Inventory-IT (BDI-II), and the Social Adaptation Self-evaluation Scale (SASS) . The results showed that "self-criticism" was related to depressive symptoms, whereas "positive thoughts" "positive thinking-distraction" and "social skills" were related to social adaptation. Overall, the results of the present study suggest that the evaluation of psychological factors affecting depression is just as important as the evaluation of the extent of impairment of social functioning.

This study involved the classification of temporary employees into distinct types based on expectancy fulfillment, with the aim of examining the characteristics of each type of employee. Items describing the viewpoints of 91 temporary employees (mean age±SD: 30.64±4.94) regarding their expectancy fulfillment were collected. A factor analysis was conducted, and a measure comprising 20 items and 3 factors was prepared. Using this measure, 61 temporary female employees (mean age±SD: 31.36±5.00) were classified into three types: the unsatisfied expectancy type of occupational skills, the unsatisfied expectancy type of job, and the unsatisfied expectancy type of work-life balance. Regarding the differences among the three types of temporary employees, the "depression anxiety" score (F(2, 58) ＝3.31, p＜.05) and the "helplessness" score (F(2, 58) ＝4.84, p＜.01) as a subscale of stress responses were significant in the unsatisfied expectancy type of work-life balance/the unsatisfied expectancy type of occupational skills. These results provided suggestions regarding the type of career counseling to be provided to temporary employees, considering their expectancy fulfillment.

Neural activity associated with self-referential processing of emotional stimuli was investigated using whole brain functional magnetic resonance imaging (fMRI). Fifteen healthy subjects underwent fMRI scanning while making judgments about positive and negative trait words in four conditions (self-reference, other-reference, semantic processing, and letter processing). Significant activity was observed in the right ventral anterior cingulate gyrus and the right amygdala in the negative-word/self-reference condition, and in the left amygdala in the positive-word/self-reference condition. Compared with the semantic-processing condition, the self-reference conditions showed significantly more activity in the medial prefrontal and temporal gyri, posterior cingulate gyrus, and precuneus. These results suggest that the medial prefrontal gyrus, posterior cingulate gyrus, and precuneus are associated with a self-referential processing, and the ventral anterior cingulate gyrus is involved in self-referential processing of negative emotional stimuli. The results also suggest that the amygdala is associated with self-referential processing of both positive and negative emotional stimuli.

The purpose of the present study was to investigate effects on mental and physical health of structured disclosure of trauma. Participants (25 undergraduate students) were randomly assigned to one of the following groups: (a) structured disclosure of trauma (S) , (b) free disclosure of trauma (F) , and (c) a control group (C) . Over a 3-day period, all participants completed daily written reports in 20-30 minute sessions. To promote cognitive reappraisal, the structured disclosure group was required to follow detailed instructions when describing a trauma. The free disclosure group was asked to describe a trauma freely, as they remembered it. The control group was asked to write about a neutral topic. The findings suggested that endocrine functions in the structured and free recall groups were maintained to improvement. Furthermore, the results for cognitive functions showed a significant tendency for the structured recall group to get higher working-memory scores, compared to the control group.

The purposes of the present study were to develop a Cognitions Inventory of Non-lethal Trauma (CINT), and to investigate the reliability and validity of that inventory. After the inventory was developed on a sample of 302 undergraduate students, 902 undergraduates completed the resulting inventory. Exploratory factor analysis revealed that the Cognitions Inventory of Non-lethal Trauma consisted of 19 items loading on 4 factors. Cronbach's a coefficient was sufficiently high (a= .85), and the validity of the inventory was confirmed by content validity and criterion-referenced validity, concurrent validity. The present results suggest that the Cognitions Inventory of Non-lethal Trauma has high reliability and validity. The clinical availability of the Cognitions Inventory of Non-lethal Trauma was discussed.

The present study was conducted in order to examine how summer camps for children with type 1 diabetes would affect the children's self-control abilities. The self-efficacy of 28 children with type 1 diabetes (average age 10.36 years) in the areas of self-control, knowledge about type 1 diabetes, stress responses, and HbAlc were examined before and after a summer-camp experience. After the camp experience, the children's self-efficacy increased and their stress responses decreased, compared to before they had gone to the camp. In addition, their increased self-efficacy in self-injection, diet control, and self-control of insulin dosage resulted in an improvement in their stress responses and HbAlc. The discussion suggested that summer camps for children with type 1 diabetes could be effective in improving children's self-efficacy in self-control and their knowledge about diabetes.

The purpose of the present study was to examine effects of classroom-based social skills training for elementary school children. Elementary school children (n=18 boys, 24 girls; 9-10 years old) were divided into training and wait-list groups. All the children participated in a 4-week classroom-based social skills training program (C-SST). The effects of training were evaluated through self-reported social skills scores, social self-efficacy scores, and scores on satisfaction with school life. The results suggested that classroom-based social skills training improved social skills and social self-efficacy, and decreased negative feelings. Next, the participants were divided into 3 social skills groups (high, moderate, and low) based on their pretreatment scores, and group differences in each score category were analyzed. The results of this analysis indicated that classroom-based social skills training was especially effective in improving the social skills of the moderately skilled children.

Yoga and Cognitive Behavior Therapy were applied to a patient with type 1 diabetes mellitus and eating disorder. At the beginning of intervention, the patient's motivation towards therapy was uncertain and she was alexithymic. To help the patient identify and express her emotions, thought records were chronicled during sessions. At the same time, yoga was introduced to control her emotions. Behavioral planning enabled the patient to substitute binge-purging with other activities. From the thought records, it was inferred that the patient's lack of confidence in job ability was found to trigger binge eating. Clarification of the areas in which she lacked confidence and then taking small steps to overcome these through the application of cognitive techniques was found to be effective. In addition, her mother's excessive worrying was found to be a major factor in lowering the patient's self-confidence. Therefore, the mother was advised to pay extra attention and give positive feedback in regards to the patient's adaptive behaviors. Our intervention to motivate the patient to actively participate in therapy using cognitive techniques in addition to yoga as a mindfulness technique were found to be effective in controlling eating disorder in a patient with type 1 diabetes mellitus.

The purpose of this study was to explore the cognitive process in selection of stress coping behavior. Subjects were 182 undergraduate students, who were asked to answer the questionnaire about their own stress experience and coping behavior. Factor analysis showed that the cognitive process in selection of coping behavior included four factors: "Expectation of positive outcome", "Expectation of emotion regulation", "Selection of habitual coping", "Selection in the elimination". Regression analysis showed that the score of "Expectation of positive outcome" was negatively correlated with stress response, the score of "Selection in the elimination" was positively correlated with stress response. Furthermore, interaction between the individual differences of cognitive process and coping behavior was found. People who engaged in emotion-focused coping style with elimination thinking felt more stressful than the others.

The purpose of this study was to investigate negative bias on self-referent processing in depression, focused on the emotion congruent effects in a depressed trait and an experimentally induced depressed mood state based on integration approach. Self-relevant ratings of personality trait words were examined among a depressed trait group, non-depressed trait group and average depressed trait group. Results indicated that the emotion congruent effect was found on each group. The effect of trait on emotion and self-relevant information processing was strong.

The purpose of this study was to validate the three dimensional model of classifying coping behavior. The three are: Encounter-Avoidance, Problem-Emotion, Behavior-Cognition Dimension. A set of questionnaires on coping behavior and psychological stress responses were administered, and 1 604 undergraduates and 1 296 adults completed them. Analyses of covariance structure were performed, and results indicated that the three dimensional model, with eight coping style, showed the highest goodness-of-fit statistics. Multiple regression analyses also indicated that Problem-Emotion and Behavior-Cognition dimensions were useful for predicting the coping effects on psychological stress responses. Therefore, the two dimensional model of Problem-Emotion and Behavior-Cognition, with four coping style, would be helpful for further investigation of coping behavior that would buffer psychological stress responses.

The purpose of this study was to investigate the feature of the psychosocial aspects of patients with atrial fibrillation and to explore the influences of the subjective symptoms of attack, perceived psychosocial inducers of attack, and anxiety on the quality of life (QOL). The participants were 240 patients with paroxysmal atrial fibrillation (57.89 +/- 13.78 years old), who were requested to complete questionnaires on the subjective symptoms of attack, perceived psychosocial inducers of attack, anxiety symptoms, and QOL. The results of this study showed that 29.5% patients met the criteria of agoraphobia of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994). This percentage of prevalence was higher than the general prevalence of DSM-IV data. The subjective symptoms of attack (frequency, duration, and distress of attack) intensify their fear of attack and agoraphobic symptoms, which worsen their QOL. Psychological stress is the main perceived inducer in daily life, and a attack induced by psychological stress affects their anxiety symptoms and QOL.

The purpose of this study was to investigate the effects of coping processes on psychophysiological and psychological responses in stressful settings. In particular, we focused on the effects of a combination of active and avoidant coping processes. Subjects were 40 healthy undergraduate male students (mean=19.80, S.D.=0.97) who were randomly divided into four groups: (a) an effort coping group in which a subject faced a controllable stressor mobilizing an effortful and active coping behavior for a reward; (b) a distress coping group in which a subject faced a distressful stressor mobilizing an avoidant coping behavior for threat of punishment; (c) an effort-distress coping group in which a subject faced an ambivalent stressor mobilizing active coping behavior for a reward and avoidant coping behavior for threat of punishment; and (d) a control group. Initially, the effects of effort coping, distress coping, and effort-distress coping on psychophysiological and psychological responses were investigated. It was found that effort coping and effort-distress coping intensified cardiovascular responses, particularly blood pressure, and that distress coping and effort-distress coping intensified skin conductance level (SCL). Secondarily, the relationships between effort coping process, distress coping process, psychophysiological responses, and psychological responses were investigated. As a result of cluster analysis, the changes of heart rate and blood pressure were correlated to the change of the effort score, and the changes of SCL and psychological responses were correlated to the change of the distress score. These findings suggest that active coping processes and avoidant coping processes independently affect different response systems.

The purpose of this study was to examine the reliability and validity of the General Self-efficacy Scale (GSES: Sakano & Toujyo, 1986) for the patients with panic disorder with agoraphobia. Subjects were 102 outpatients whose primary diagnoses were panic disorder with agoraphobia according to DSM-IV, who were asked to complete the GSES, comprised of 16 items. As a result of factor analysis with varimax rotation, three factors including 15 items were extracted: "Anxiety on failure", "Activeness in behavior", and "Social locus of ability", which were quite similar to that of Shimada et al (1994). Cronbach's a Coefficients revealed that GSES had high reliability when it was conducted for patients with panic disorder with agoraphobia. Furthermore, high concurrent validity was also revealed by the parallel tests using State-Trait Anxiety Inventory Japanese version (Trait form, 20 items), which supported that the higher the self-efficacy was, the lower the anxiety the patients had. Finally, the characteristics of the general self-efficacy were discussed with consideration of the symptoms of panic disorder with agoraphobia.

The purposes of this study were to explore the inducers of atrial fibrillation attack, and to investigate the effects of inducers on fear of attack, agoraphobic symptoms, and quality of life(QOL)in patients with paroxysmal atrial fibrillation. Subjects were 180 patients(119 males and 61 females), who were requested to perform a set of questionnaires on inducer of attack, fear of attack, agoraphobic symptoms, and QOL. Result of factor analysis revealed that atrial fibrillation attacks were induced by the factors of "Psychological", "Tension reduction" and "Exercise". Results of comparing the frequency of each factor indicated that "Psychological stres" was most frequent in their daily lives. Furthermore, results of regression analyses revealed that "Psychological stress" intensified their anxiety symptoms, and degraded their somatic QOL.

The purposes of this study were to explore the individual differences in inducing pattern of arrhythmia attack,and to investigate those effects on fear of attack,agoraphobic symptoms,and quality of life (QOL) in patients with paroxysmal atrial fibrillation. Subjects were 180 patients (119males and 61 females),who were requested to perform a set of questionnaries on inducer of attack,subjective symptoms of attack,fear of attack,agoraphobic symptoms,and QOL.First, the individual differences in inducing patterns of arrhythmia attack were investigated.Result of cluster analysis,four clusters were found: "low frequency pattern(LF)","high frequency pattern(HF)" ,"high frequency on stress pattern(HFS)",and"high frequency on exercise pattern(HFE)". Second,the relationship among inducing pattern,anxiety symptoms,and QOL wasinvestigated. Results of ANOVAs revealed that agoraphobic symptoms score of HFS patients were higher than that of other groups,and that QOL score of HF,HFS,and HFE patients were lower than that of LF patients.

The purpose of this study was to investigate the effect of self-efficacy on quality of life and psychologi cal stress responses in heart failure patients. Subjects were 30 (17 males and 13 females) heart failure patients and 30 (17 males and 13 females) matched non-clinical adults. Results of comparison of self-efficacy and psychological stress responses between heart failure patients and non-clinical adults revealed that heart failure patients felt lower self-efficacy and higher helplessness than non-clinical adults. Results of investigation of the relationship among NYHA classification of cardiac functioning, quality of life, and psychological stress responses suggested that quality of life and psychological stress responses were not associated with symptoms of cardiac functioning. Furthermore, the results of investigation of the effect of self-efficacy on quality of life and psychological stress responses revealed that patients whose "Posrtrveness m behavror" score and "Socral locus of ability" score were high and "Anxiety concerning failure" ecore was low felt high quality of life and low psychological stress responses. Finally, the effectiveness of self-efficacy on improving the quality of life and alleviating psychological stress responses in heart failure patient in clinical settings were discussed,

The purpose of this study was to investigate psychological and psychophysiological responses under an effortful coping condition and an distress coping condition. Efforful coping condition was defined as a condition in which a subject reported high commitment to the task and engaged in active coping. Distress coping condition was defined as a condition in which a subject reported uncontrollability and engaged in passive coping. Subjects were 22 male undergraduate students and were divided into 2 groups : control group and experimental group. All of them underwent both effortful coping condition and distress coping condition.In effortful coping condition, Ss were engaged in 2 mental arithmetic task sessions (low effort tast and high effort task). In the first session, Ss in both groups were requested to perform the low effort tasks under the same condition. In the second session, Ss in the experimental group were engaged in the high effort task session with rewards, and Ss in the control group were engaged in the low effort task session without rewards.In distress coping condition, Ss were engaged in 2 movie sessions(relaxation movie and aversive movie). In the first session, Ss in both groups were requested to watch the relaxation movie under the same condition. In the second session, Ss in the experimental group watched the aversive movie (eye surgery), and Ss in the control group watched the relaxation movie.Heart rate, systolic blood pressure, diastolic blood pressure, skin conductance level and skin temperature were recorded, and effort-distress scores, and psychological responses were measured.Heart rate, blood pressure, and skin temperature were significantly aroused in effortful coping condition and Depression-Anxiety score and skin conductance level were significantly aroused in distress coping condition. The results of ANOVAs revealed that a significant interaction among group, condition, and session was found in systolic blood pressure, diastolic blood pressure, and skin conductance level. These suggest that cardiovascular responses are associated with effort coping, and Depression-Anxiety and skin conductance level are associated with distress coping. Furthermore, the results of regression analyses revealed that the changes of diastolic blood pressure corresponded to the changes of effort score, and that the changes of skin conductance level corresponded to the changes of distress score.Finally, the specific relationship between effort-distress status in stress coping process and psychological-psychopsysiological responses were discussed.