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Cited by 6Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan

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Yoshinaga, Naoki, Thew, Graham R, Hayashi, Yuta, Matsuoka, Jun, Tanoue, Hiroki, Takanashi, Rieko, Araki, Mutsumi, Kanai, Yoshihiro +3 more·2023·JMIR Formative Research
DOI 10.2196/45136PMC PMC10199383

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Abstract

Background: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. Objective: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. Methods: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety–related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants’ feedback about their experience with the iCT-SAD. Results: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. Conclusions: Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly.

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  • There is a lack of evidence from clinical trials specifically targeting anxiety disorders in Japan.

    “Although some culturally adapted ICBT programs for mental disorders have begun to emerge in Japan [17-20], there is a lack of evidence of clinical trials that specifically target anxiety disorders [21].”

    From Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial (2024) · cites this paper as [21]

    The Discussion—Conclusions (page not available) calls this Japanese social-anxiety study a pilot trial and recommends a larger randomized controlled trial, supporting a need for stronger evidence. But the paper itself is a clinical trial targeting an anxiety disorder in Japan, and the Introduction—Background cites earlier Japanese trials of face-to-face treatment for social anxiety disorder. It therefore does not support an unqualified lack of clinical-trial evidence for anxiety disorders in Japan. (LLM, conf=0.82)

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  • A subsequent single-arm pilot trial indicated that Japanese iCT-SAD showed good acceptability to clients and preliminary evidence of strong efficacy in Japanese clinical settings.

    “A subsequent single-arm pilot trial indicated that Japanese iCT-SAD showed good acceptability to clients and preliminary evidence of strong efficacy in Japanese clinical settings [14].”

    From Translated and culturally adapted internet-delivered cognitive therapy for social anxiety disorder in Japanese clinical settings: study protocol for a randomised controlled trial (2024) · cites this paper as [14]

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Research works printed but not linked: 3

  1. [7]National Collaborating Centre for Mental Health Social Anxiety Disorder: Recognition, Assessment and Treatment (NICE Clinical Guidelines, No. 159) 2013 Leicester, UK British Psychological Society 25577940
  2. [33]OXCADAT resources: resources for cognitive therapy for PTSD, social anxiety disorder and panic disorder Oxford Centre for Anxiety Disorders and Trauma 2022-11-10 https://oxcadatresources.com/
  3. [45]Yamamoto T Koga Y Sakai M Development of the Japanese version of the work and social adjustment scale and examination of its reliability and validity Seishin Igaku 2019 61 10 1207 14 10.11477/mf.1405205922 · DOI

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Authors
Yoshinaga, N., Thew, G. R., Hayashi, Y., Matsuoka, J., Tanoue, H., Takanashi, R., Araki, M., Kanai, Y., Smith, A., Grant, S. H. L., & Clark, D. M.
Affiliations
  • University of Miyazaki (JP)
  • Oxford Health NHS Foundation Trust (GB)
  • Kobe University (JP)
  • Chiba University (JP)
  • Tohoku Gakuin University (JP)
  • Cardiff University (GB)
  • University of Oxford (GB)
Corresponding author
Yoshinaga, Naoki
ORCID
Venue
JMIR Formative Research
Publisher
JMIR Publications Inc.
Published
2023-05-05
Volume
7
Pages
e45136
ISSN
2561-326X (ISSN-L)
DOI
10.2196/45136
PMC
PMC10199383
OpenAlex
W4372334637
Cited by
6
References
59
Citations by year
2025: 2 · 2024: 4
FWCI
1.55
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JMIR Formative Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Wellcome Trust (200796, 069777)
  • National Institute for Health and Care Research (NIHR-INF-0087)
  • Daiwa Anglo-Japanese Foundation
  • Telecommunications Advancement Foundation
  • Japan Society for the Promotion of Science (13068, 22K11458, 18K13350, 20K23225, 19K19789, 23K20198)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
social anxiety disorder, cultural adaptation, Japanese patients, treatment acceptability, treatment efficacy, taijin kyofusho, depression, generalized anxiety disorder, booster sessions, Liebowitz Social Anxiety Scale, treatment discontinuation, participant feedback, maintenance of treatment effects

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