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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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Correspondence to Shin-ichi Ishikawa.

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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

References Included in the Systematic Review

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*Ishikawa, S., Kishida, K., Oka, T., Saito, A., Shimotsu, S., Watanabe, N., Sasamori, H., & Kamio, Y. (2019). Developing the universal unified prevention program for diverse disorders for school-aged children. Child and Adolescent Psychiatry and Mental Health, 13, 44. https://doi.org/10.1186/s13034-019-0303-2

*Ishikawa, S., Kikuta, K., & Mitamura, T. (2013). Parent-child cognitive behavior therapy for children with anxiety disorders. Journal of Japanese Clinical Psychology, 31, 364-375.

*Ishikawa, S., Kikuta, K., Sakai, M., Mitamura, T., Motomura, N., & Hudson, J. L. (2019). A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders. Behavior Research and Therapy, 120, 103432. https://doi.org/10.1016/j.brat.2019.103432

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*Koseki, S., Shimada, H., & Sasaki, K. (2007). A cognitive and behavioral intervention for depression in fifth grade children. Japanese Journal of Behavior Therapy, 33, 45-57. https://doi.org/10.24468/jjbt.33.1_45

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*Matsubara, K., Fukumitsu, E., Sato, H., Ishikawa, S., & Sato, S. (2017). Maintaining effects of school-based universal depression prevention program: A follow-up study for transition from elementary to junior high school. Japanese Journal of Cognitive Therapy, 10, 181-193.

*Matsubara, K., Sato, H., Ishikawa, S., Takahashi, T., & Sato, S. (2015). Mediation analysis of universal depression prevention for children. Japanese Journal of Cognitive Therapy, 8, 248-257.

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*Nagao, F., & Ishikawa, S. (2018). A case report of cognitive behavioral and psychoeducational intervention for a social anxious girl and staffs in a children's nursing home. Japanese Journal of Cognitive Therapy, 11, 217-226.

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*Nonaka, S., Okajima, J., Miyake, A., Ohara, Y., Ogino, K., Haraguchi, H., Yamaguchi, H., Ishitobi, M., Takahashi, H., Ishikawa, S., & Kamio, Y. (2017). Development of a group cognitive behavior therapy program for anxiety in children with autism spectrum disorder: A preliminary feasibility study. Japanese Journal of Child and Adolescent Psychiatry, 58, 261-277. https://doi.org/10.20615/jscap.58.2_261

*Ohira, I., Urao, Y., Sato, Y., Ohtani, T., & Shimizu, E. (2019). A pilot and feasibility study of a cognitive behavioural therapy-based anxiety prevention programme for junior high school students in Japan: A quasi-experimental study. Child and Adolescent Psychiatry and Mental Health, 13, 40. https://doi.org/10.1186/s13034-019-0300-5

*Okajima, J., Nakamura, M., Ishikawa, A., Higashi, M., Otani, R., & Sakuta, R. (2021). The developments and effects of group cognitive-behavioral therapy programs for anxious children with high-functioning autism spectrum disorder: A Pilot Study. Japanese Journal of Behavioral and Cognitive Therapies, 47, 47-60. https://doi.org/10.24468/jjbct.19-021

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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

Shima, S., Shikano, T., Kitamura, T., Asai, M. (1985). New self-rating scales for depression. Seishin Igaku, 27, 717-723. https://doi.org/10.11477/mf.1405203967

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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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