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Cultural Adaptation and Implementation of Cognitive-Behavioral Psychosocial Interventions for Anxiety and Depression in Japanese Youth

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Abstract

The present article reviews the current status of cognitive-behavioral therapy (CBT) interventions for anxiety and depression in Japanese youth. First, a literature review of youth CBT programs for anxiety and depression is provided. Through this process, we identify which program/protocol has been most researched within Japan. Second, through a systematic interview to the authors, the development process of four predominant programs is outlined. The programs included were a family CBT program for anxiety disorders (the Japanese Anxiety Children/Adolescents Cognitive Behavior Therapy program), two school-based prevention programs for anxiety and depression (Journey of the Brave and Phoenix Time), and a transdiagnostic protocol for anxiety and depression (Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents). Third, cultural adaptation and modification of the programs are discussed from the scope of user-centered design principles as described by Lyon and Koerner (Sci Pract 23:180–200, 2016). As a result, changes in program content and material, as represented by the use of culture-friendly program names, acronyms, illustrations, and characters were endorsed in all of the programs. Structured but flexible session formats helped increase learnability and efficiency while keeping the cognitive load of providers and consumers low. A careful selection of providers, as well as quality training and consultation are important factors to maximize competency and ensure appropriate implementation. Application of existing time frames and staff who work in each setting were effective ways to increase scalability. Overall, it was shown that many of the modifications adopted overlap among successful programs; these represent the most basic and essential requirements for a program to be applicable to a wide range of contexts. Implications and further directions are explored.

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Data Availability

The data that support the findings of this study are available from the corresponding author, SI, upon reasonable request.

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Authors and Affiliations

  1. Faculty of Psychology, Doshisha University, 1-3 Tatara Miyakodani, Kyotanabe, Kyoto, 610-0394, Japan

    Shin-ichi Ishikawa & Kohei Matsubara

  2. Japan Society for the Promotion of Science, Tokyo, Japan

    Kohei Kishida

  3. Kwansei Gakuin University, Hyogo, Japan

    Kohei Kishida

  4. University of Miyazaki, Miyazaki, Japan

    Takahito Takahashi

  5. Kansai University, Osaka, Japan

    Hiroko Fujisato

  6. Chiba University, Chiba, Japan

    Yuko Urao

  7. Mejiro University, Tokyo, Japan

    Satoko Sasagawa

Authors
  1. Shin-ichi Ishikawa
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  2. Kohei Kishida
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  3. Takahito Takahashi
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  4. Hiroko Fujisato
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  5. Yuko Urao
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  7. Satoko Sasagawa
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Correspondence to Shin-ichi Ishikawa.

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Conflict of interest

SI, KK, TT, HF, TU, and KM developed the programs which are reviewed in this article, and none of them will receive personal financial benefit from this manuscript. SS declares no conflicts of interest associated with this manuscript.

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Appendices

Appendix 1

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Appendix 2

References for outcome measures included Table 1.

ADIS = Anxiety and Related Disorders Interview Schedule

Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV (ADIS-IV): Child and parent interview schedules. Psychological Corporation.

K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia

Kaufman, J., Birmaher, B., Brent, D., Rao, U. M. A., Flynn, C., Moreci, P., ... & Ryan, N. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980-988. https://doi.org/10.1097/00004583-199707000-00021

SCAS = Spence Children's Anxiety Scale

Spence S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566. https://doi.org/10.1016/s0005-7967(98)00034-5

Ishikawa, S., Sato, H., & Sasagawa, S. (2009). Anxiety disorder symptoms in Japanese children and adolescents. Journal of Anxiety Disorders, 23, 104-111. https://doi.org/10.1016/j.janxdis.2008.04.003

SCAS-P = Parent version of Spence Children's Anxiety Scale

Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent-report measure of children’s anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research and Therapy, 42, 813-839. https://doi.org/10.1016/S0005-7967(03)00200-6

Ishikawa, S., Shimotsu, S., Ono, T., Sasagawa, S., Kondo-Ikemura, K., Sakano, Y., & Spence, S. H. (2014). A parental report of children’s anxiety symptoms in Japan. Child Psychiatry and Human Development, 45, 306-317. https://doi.org/10.1007/s10578-013-0401-y

Short CAS = Short version of Spence Children's Anxiety Scale

Spence, S. H., Sawyer, M. G., Sheffield, J., Patton, G., Bond, L., Graetz, B., & Kay, D. (2014). Does the absence of a supportive family environment influence the outcome of a universal intervention for the prevention of depression? International Journal of Environmental Research and Public Health, 11, 5113-5132. https://doi.org/10.3390/ijerph110505113

Ishikawa, S., Ishi, R., Fukuzumi, N., Maruyama, K., Ohtani, K., Sakaki, M., Suzuki, T., & Tanaka, A. (2018). Development, reliability, and validity of the Japanese Short Version of the Spence Children’s Anxiety Scale for Adolescents. Anxiety Disorder Research, 10, 64-73. https://doi.org/10.14389/jsad.10.1_64

SPAI-C = Social Phobia and Anxiety Inventory for Children

Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children. Psychological Assessment, 7, 73. https://doi.org/10.1037/1040-3590.7.1.73

Ishikawa, S., Miwa, K., Sasagawa, S., Sato, H., Okayasu, T., & Sakano, Y. (2008). Development of the Social Phobia and Anxiety Inventory for Children Japanese Version. Japanese Journal of Behavior Therapy, 34, 17-31. https://doi.org/10.14389/jsad.10.1_64

STAI = State-Trait Anxiety Inventory

Spielberger, C. D., Gonzalez-Reigosa, F., Martinez-Urrutia, A., Natalicio, L. F., & Natalicio, D. S. (1971). The state-trait anxiety inventory. Interamerican Journal of Psychology, 5. https://doi.org/10.30849/rip/ijp.v5i3%20&%204.620

Shimizu, H., & Imabari, K. (1981). The Japanese version of State-Trait Anxiety Inventory. Japanese Journal of Educational Psychology, 29, 348-353. https://doi.org/10.5926/jjep1953.29.4_348

DSRS = Depression Self-Rating Scale for Children

Birleson, P., Hudson, I., Buchanan, D. G., & Wolff, S. (1987). Clinical evaluation of a self‐rating scale for depressive disorder in childhood (Depression Self‐Rating Scale). Journal of Child Psychology and Psychiatry, 28, 43-60. https://doi.org/10.1111/j.1469-7610.1987.tb00651.x

Denda, K., Kako, Y., Kitagawa, N., & Koyama, T. (2006). Assessment of depressive symptoms in Japanese school children and adolescents using the Birleson Depression Self-Rating Scale. International Journal of Psychiatry in Medicine, 36, 231-241. https://doi.org/10.2190/3YCX-H0MT-49DK-C61

DPRS = Depression Parent-Rating Scale for Children

Kishida, K., Tsuda, M., & Ishikawa, S. (2021). Depressive symptoms in children and adolescents based on a parent-rating scale. Doshisha Clinical Psychology: Therapy and Research, 11, 25-35. http://doi.org/10.14988/00028695

CDI = Children's Depression Inventory

Kovacs, M. (1985). The Children’s Depression, Inventory (CDI). Psychopharmacology Bulletin, 21, 995-998.

Ozono, S., Nagamitsu, S., Matsuishi, T., Yamashita, Y., Ogata, A., Suzuki, S., ... & Yamawaki, S. (2019). Reliability and validity of the Children's Depression Inventory–Japanese version. Pediatrics International, 61, 1159-1167. https://doi.org/10.1111/ped.13984

SDS = Self-rating Depression Scale

Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12, 63-70. https://doi.org/10.1001/archpsyc.1965.01720310065008

Fukuda, K., & Kobayashi, S. (1973). Self-rating Depression Scale. Psychiatria et Neurologia Japonica, 75, 673-679.

CES-D = Center for Epidemiologic Studies Depression Scale

Radloff, L. S. (1991). The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults. Journal of Youth and Adolescence, 20, 149-166. https://doi.org/10.1007/BF01537606

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Ishikawa, Si., Kishida, K., Takahashi, T. et al. Cultural Adaptation and Implementation of Cognitive-Behavioral Psychosocial Interventions for Anxiety and Depression in Japanese Youth. Clin Child Fam Psychol Rev 26, 727–750 (2023). https://doi.org/10.1007/s10567-023-00446-3

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