Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can do access to CBT via the Internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time. Objective: The present study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, and SAD. Methods: A total of 29 Japanese participants (mean age = 35.4 years, SD=9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of therapist using tablet PC (iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety and Working Alliance Inventory (WAI-SF). All primary outcomes were assessed at baseline, and at weeks 1 (baseline), 8 (mid-intervention), and 16 (post-intervention) by face-to-face during therapy. The occurrence of adverse events were observed after each session. For the primary analysis comparing between pre- and post- treatments, the participants’ points and 95% CIs were estimated by the paired t-tests with the change between pre- and post-treatment. Results: A significant reductions in symptom of obsession-compulsion (Y-BOCS; -6.2, Cohen’s d=0.74, 95% CI -9.4 to -3.0, P=.002), panic (PDSS; -5.6, Cohen’s d=0.89, 95% CI –9.83 to –1.37, P=.015), social anxiety (LSAS; -33.56, Cohen’s d=1.10, 95% CI –59.62 to –7.49, P=.018) were observed. In addition, depression (PHQ-9; -1.72, Cohen’s d=0.27, 95% CI –3.26 to –0.19, P=.029) and general anxiety (GAD-7; -3.03, Cohen’s d=0.61, 95% CI –4.57 to -1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336, Cohen’s d=-0.202, 95% CI –0.0198 to 0.00869, P=.208), there were high therapeutic alliance (i.e., WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14, 95% CI 1.24 to 7.04, P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face to face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30). Conclusions: Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable. Clinical Trial: Trial Regsitration system: University Hospital Medical Information Network(UMIN) Center URL: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030495 Trial ID: UMIN000026609 Official scientific title of the study: A single-arm pilot study of videoconference cognitive-behavioral therapy for obsessive-compulsive disorder, social anxiety, and panic disorder

Cultivation of compassion is a useful way to treat mental problems, but some individuals show resistance. Fears of compassion can be an obstacle for clinicians when providing psychotherapy, and for clients when engaging in interpersonal relationships. Despite its importance, a Japanese version of fears of compassion scales (for others, from others, and for self) has not yet been developed. This study developed a Japanese version of the Fears of Compassion Scales and tested its reliability and validity. This study used a cross-sectional design, and a self-report procedure for collecting data. A total of 485 students (121 males and 364 females) answered self-report questionnaires, including the draft Fears of Compassion Scales—Japanese version. There were distinctive factor structures for fear of compassion from others, and for self. The fear of compassion from others scale consisted of concern about compassion from others and avoidance of compassion from others. All scales had good internal consistency, test-retest reliability, face validity, and construct validity. Discrimination and difficulty were also calculated. These results indicate that the Fears of Compassion Scales—Japanese version is a well-constructed and useful measure to assess fears of compassion and the existence of cultural differences in fears of compassion.

Background: The COVID‐19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID‐19 on depression, anxiety and stress, and social safeness.Methods: Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self‐report measures of perceived threat of COVID‐19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness.Results: Perceived threat of COVID‐19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID‐19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID‐19 on social safeness. These effects were consistent across all countries.Conclusions: Fears of compassion have a universal magnifying effect on the damaging impact of the COVID‐19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.

The last few years have seen increasing research on self-report measures of compassion. The Compassionate Engagement and Action Scale (CEAS) is rooted in an evolutionary approach to compassion, which focuses on the competencies of compassion those are engagement with distress or suffering, and taking action to alleviate and prevent it. This study sought to validate the CEAS in a Japanese population using a cross-sectional design. A total of 279 students (82 males, 191 females, 6 unknown) answered self-report questionnaires, including the Japanese version of CEAS. We found single-factor structures for compassion for others scales, compassion from others scales, and compassion for self scales. All scales were found to have acceptable internal consistency, test-retest reliability, content validity, and construct validity. Even though some limitations, these results indicate that the Japanese version of CEAS is an adequately constructed and useful measure to assess compassionate engagement and action toward others, from others, and for the self with Japanese population.

Major depression is one of the most common mental health problems worldwide. More than one-third of patients suffer from treatment-resistant depression (TRD). In this study, we explored the feasibility of group compassion-focused therapy (CFT) for TRD using a randomized controlled trial with two parallel groups. Eighteen participants were randomly allocated to the intervention group (CFT and usual care) and control group (usual care alone) and a participant in each group withdrew. Participants in the intervention group received a 1.5-h session every week for 12 weeks. The effects of the intervention on the participants’ scores were calculated using a linear mixed model. There was a larger reduction in their depressive symptoms and fears of compassion for self and a greater increase in their compassion for self compared to the control group participants. The reliable clinical indices showed that in the CFT (intervention) group, three of nine participants recovered (33%), two improved (22%), two recovered but non-reliably (22%), and the condition of two remained unchanged (22%). These findings indicate adequate feasibility of group CFT for TRD in Japanese clinical settings.Clinical trial registration: [https://clinicaltrials.gov/], identifier [UMIN 000028698].