Expressive suppression of emotion is a moderator of anxiety in a unified protocol for transdiagnostic treatment of anxiety and depressive disorders: A secondary analysis.

BACKGROUND: Expressive suppression (ES) of emotion is considered a moderator that reduces the efficacy of cognitive behavioural therapy (CBT); however, whether and how ES moderates the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders (UP), a version of CBT targeting aversive/avoidant responses to emotions, including ES, remain unclear. We investigated whether and how emotion regulation, especially ES, moderates UP efficacy for anxiety symptoms in patients with anxiety and depressive disorders. METHODS: We conducted a secondary analysis of data from a previous trial. Seventeen patients with anxiety and/or depressive disorders were included. Changes (slope estimates) in the Structured Interview Guide for the Hamilton Anxiety Rating Scale from pre-treatment to post-treatment were measured using a latent growth curve model with empirical Bayesian estimation. Pre-treatment ES, cognitive reappraisal, and depressive symptoms were used as slope factor predictors. RESULTS: Only pre-treatment ES significantly predicted the slope in the latent growth curve model (estimate value = 0.45; standard deviation = 0.21; 95% credible interval = 0.03-0.87, one-tailed p-value = 0.004), and an inverse correlation between pre-treatment ES levels and improvement magnitude of anxiety symptoms was demonstrated. LIMITATIONS: Because the data were obtained from a single-arm trial, this study did not have controls, and most participants received pharmacotherapy in addition to UP. Therefore, generalisability of the present findings might be compromised. CONCLUSIONS: Low ES before UP was an effective predictor of greater improvement in anxiety symptoms after UP. The findings suggest that interventions intended to improve ES may improve UP efficacy.

Pilot study of a basic individualized cognitive behavioral therapy program for chronic pain in Japan.

BACKGROUND: Chronic pain is a major health problem, and cognitive behavioral therapy (CBT) is its recommended treatment; however, efforts to develop CBT programs for chronic pain and assess their feasibility are remarkably delayed in Asia. Therefore, we conducted this pilot study to develop a basic individualized CBT for chronic pain (CBT-CP) and assessed its feasibility for use in Japan. METHODS: Our study was an open-labeled before-after trial without a control group conducted cooperatively in five Japanese tertiary care hospitals. Of 24 outpatients, 15, age 20-80, who experienced chronic pain for at least three months were eligible. They underwent an eight-session CBT-CP consisting of relaxation via a breathing method and progressive muscle relaxation, behavioral modification via activity pacing, and cognitive modification via cognitive reconstruction. The EuroQol five-dimensional questionnaire five level (EQ5D-5 L) assessment as the primary outcome and quality of life (QOL), pain severity, disability, catastrophizing, self-efficacy, and depressive symptoms as secondary outcomes were measured using self-administered questionnaires at baseline, post-treatment, and 3-month follow-up. Intention-to-treat analyses were conducted. RESULTS: Effect size for EQ5D-5 L score was medium from baseline to post-treatment (Hedge's g = - 0.72, 90% confidence interval = - 1.38 to - 0.05) and up to the 3-month follow-up (g = - 0.60, CI = - 1.22 to 0.02). Effect sizes for mental and role/social QOL, disability, catastrophizing, self-efficacy, and depressive symptoms were medium to large, although those for pain severity and physical QOL were small. The dropout rate was acceptably low at 14%. No severe adverse events occurred. CONCLUSION: The findings suggest that CBT-CP warrants a randomized controlled trial in Japan. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000020880. Registered on 04 February 2016.

Reliability and validity of the Japanese version of the Emotion Regulation Skills Questionnaire.

BACKGROUND: The Emotion Regulation Skills Questionnaire (ERSQ) comprehensively assesses nine aspects of emotion regulation skills: awareness, clarity, sensation, understanding, compassionate self-support, modification, acceptance, tolerance, and readiness to confront. However, it is unknown about the levels of emotion regulation skills in various mental disorders, and its cross-cultural validity. We developed a Japanese version of the ERSQ, then examined its validity and reliability in clinical and non-clinical populations. METHODS: In an Internet-based survey, 2684 participants (406 with MDD, 198 with PD, 116 with SAD, 66 with OCD, 636 with comorbid MDD and ≥1 anxiety disorder, and 99 with comorbid anxiety disorders; 1163 non-clinical sample) answered the ERSQ, diagnostic status, and measures of mindfulness, emotion regulation, behavioral activation, psychological distress, and life satisfaction. RESULTS: Confirmatory factor analysis (CFA) replicated the theoretical nine-factor structure of the original ERSQ. Higher-order factor analysis model assuming two second-order factors and nine first-order factors also showed adequate fit to the data, suggesting the factorial validity of the scale. Analyses of multi-group CFA indicated the equivalence of factor loadings across clinical and non-clinical subsamples. The levels of internal consistency and time stability were sufficient. Convergent validity of the scale was also confirmed for most of external criteria. Character on the emotion regulation skills for each diagnostic group was depicted. LIMITATIONS: Internet survey of samples with limited disorders, with self-reported diagnoses, may limit generalizability. CONCLUSIONS: The Japanese version of the ERSQ showed adequate reliability and validity.

Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: a randomized controlled trial.

BACKGROUND: Subthreshold depression is highly prevalent in the general population and causes great loss to society especially in the form of reduced productivity while at work (presenteeism). We developed a highly-structured manualized eight-session cognitive-behavioral program with a focus on subthreshold depression in the workplace and to be administered via telephone by trained psychotherapists (tCBT). METHODS: We conducted a parallel-group, non-blinded randomized controlled trial of tCBT in addition to the pre-existing Employee Assistance Program (EAP) versus EAP alone among workers with subthreshold depression at a large manufacturing company in Japan. The primary outcomes were depression severity as measured with Beck Depression Inventory-II (BDI-II) and presenteeism as measured with World Health Organization Health and Work Productivity Questionnaire (HPQ). In the course of the trial the follow-up period was shortened in order to increase acceptability of the study. RESULTS: The planned sample size was 108 per arm but the trial was stopped early due to low accrual. Altogether 118 subjects were randomized to tCBT+EAP (n = 58) and to EAP alone (n = 60). The BDI-II scores fell from the mean of 17.3 at baseline to 11.0 in the intervention group and to 15.7 in the control group after 4 months (p<0.001, Effect size = 0.69, 95%CI: 0.32 to 1.05). However, there was no statistically significant decrease in absolute and relative presenteeism (p = 0.44, ES = 0.15, -0.21 to 0.52, and p = 0.50, ES = 0.02, -0.34 to 0.39, respectively). CONCLUSION: Remote CBT, including tCBT, may provide easy access to quality-assured effective psychotherapy for people in the work force who present with subthreshold depression. Further studies are needed to evaluate the effectiveness of this approach in longer terms. The study was funded by Sekisui Chemicals Co. Ltd. TRIAL REGISTRATION: ClinicalTrials.gov NCT00885014.

[Accepting pessimistic thinking is associated with better mental and physical health in defensive pessimists].

The mental and physical health of defensive pessimists (DPs) is generally worse than that of optimists. However, some DPs who accept their pessimistic thinking style are in good health. This study examined the health of college students who were DPs related to how they accepted their thinking style. In Study 1 (F = 211, M = 131), self-esteem was compared among DPs, strategic optimists (SOs), and depressed persons (DEPs). In Study 2 (F = 376, M = 251, not indicated = 5), the General Health Questionnaire (GHQ28) was compared among these groups. ANOVAs revealed that DPs were healthier than DEPs in self-esteem and on the GHQ28, but worse than SOs in self-esteem. However, ANCOVA examining self-esteem with acceptance of their thinking style as a covariate showed that DPs were better than DEPs and as good as SOs in health. Regarding the acceptance of their thinking style, DPs scored worse than SOs. This study concluded that DPs in better health had better acceptance of their pessimistic thinking style.

[Examination of psychological well-being and subjective well-being in defensive pessimists].

Defensive pessimists (DPs) are considered to be adaptive pessimists because of their high performances, but the well-being of DPs have not been sufficiently studied. Some studies suggested that DPs have lower well-being than optimists, but it is not clear whether their level of well-being is as low as to be considered maladaptive. In this study, well-being was distinguished between psychological well-being including self-improvement, and subjective well-being as in the traditional notion of well-being, and compared well-being among DPs, strategic optimists (SOs) and depressed persons (DEPs) in a sample of 303 college students (F=160, M=143). Results indicated no significant differences in the level of psychological well-being among DPs and SOs, and both of these groups scored higher than DEPs. DPs also scored higher than DEPs in subjective well-being and no differences were found in satisfaction in life between DPs and SOs. Thus, this study concluded that the well-being of DPs were high in some regards and were not maladaptive.

[Defensive pessimists and coping: the goodness of fit hypothesis].

The goodness of fit hypothesis (Lazarus & Folkman, 1984) posits that it is adaptive to use emotion-focused coping and not to use problem-focused coping in uncontrollable situations. This study examines the coping skills that defensive pessimists (DPs) tend to use in uncontrollable situations. The participants were 282 Japanese college students, from which 61 DPs and 64 strategic optimists (SOs) were identified. Based on the controllability they reported about recalled stress situations, they were classified into controllable or uncontrollable subgroups. Eight coping skills, which are concerned with emotion-focused or problem-focused coping, were compared. T-test and analysis of variance (ANOVA) showed that DPs in uncontrollable situations tended not to use emotion-focused coping, which is not consistent with the goodness of fit hypothesis, but they also tended not to use problem-focused coping, which is consistent with the hypothesis. These results imply that DPs can control their behavior adaptively so they do not increase stress more in uncontrollable situations, although they have a vulnerability to feel stress easily because they can not use emotion-focused coping effectively.