Background: Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. Methods: This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. Results: Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was −40.87 and 0.68, respectively; the between-group difference was −41.55 (−53.68 to −29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. Conclusions: Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.

Purpose: – The purpose of this paper is to discuss the implementation and evaluation of a cognitive behavioral therapy (CBT) training course for clinicians in Chiba, the sixth-largest province in Japan. Design/methodology/approach: – Individual CBT for obsessive-compulsive disorder, bulimia nervosa, or social anxiety disorder was delivered by trainees of the Chiba CBT training course in a single study design. Findings: – The results demonstrated that individual CBT delivered by trainees led to statistically significant reductions in symptom severity for all three disorders. Feedback from the trainees indicated that the training course achieved its aims. Research limitations/implications: – Barriers to the dissemination of CBT in Japan such as opportunities for training and possible solutions are discussed. Originality/value: – This paper evaluates the Chiba CBT training course, which is a Japanese adaptation of the UK Improving Access to Psychological Therapies Project and the first post-qualification CBT training course in Japan.

Aim To evaluate the long‐term effectiveness of modified brief assertiveness training (with cognitive techniques) for nurses. Background Most assertiveness training takes a long time to conduct; thus, briefer training is required for universal on‐the‐job training in the workplace. Methods In this single‐group study, nurses received two 90‐min training sessions with a 1‐month interval between sessions. The degree of assertiveness was assessed by using the Rathus Assertiveness Schedule as the primary outcome, at four time points: pre‐ and post‐training, 3‐month follow‐up and 6‐month follow‐up. Results A total of 33 nurses received the training, and the mean Rathus Assertiveness Schedule score improved from −14.2 (SD = 16.5) pre‐training to −10.5 (SD = 18.0) post‐training (p < .05). These improvements were maintained until the 6‐month follow‐up. The pre–post effect size of 0.22 (indicating small effect) was larger than the effect sizes ranging from −0.56 to 0.17 (no effect) reported in previous studies that used brief training. Conclusions Modified brief assertiveness training seems feasible and may achieve long‐term favourable outcomes in improving assertiveness among nurses. Implications for Nursing Management The ease of implementation of assertiveness training is important because creating an open environment for communication leads to improved job satisfaction, improved nursing care and increased patient safety.

Effective communication has a great impact on nurses’ job satisfaction, team relationships, as well as patient care/safety. Previous studies have highlighted the various beneficial effects of enhancing communication through assertiveness training programs for nurses. However, most programs take a long time to implement; thus, briefer programs are urgently required for universal on-the-job-training in the workplace. The purpose of this feasibility study was to develop and evaluate a modified brief assertiveness training program (with cognitive techniques) for nurses in the workplace. This study was carried out as a single-group, open trial (pre-post comparison without a control group). Registered nurses and assistant nurses, working at two private psychiatric hospitals in Miyazaki Prefecture in Japan, were recruited. After enrolling in the study, participants received a program of two 90-min sessions with a 1-month interval between sessions. The primary outcome was the Rathus Assertiveness Schedule (RAS), with secondary measurements using the Brief Version of the Fear of Negative Evaluation Scale (BFNE) and the Brief Job Stress Questionnaire (BJSQ). Assessments were conducted at baseline and after a 1-month interval (pre- and post-intervention). A total of 22 participants enrolled in the study and completed the program. The mean total score on the primary outcome (RAS) significantly improved from −12.9 (SD = 17.2) to −8.6 (SD = 18.6) (p = 0.01). The within-group effect size at the post-intervention was Cohen’s d = 0.24; this corresponds to the small effect of the program. Regarding secondary outcomes, there were no statistically significant effects on the BFNE or any of the BJSQ subscales (job-stressors, psychological distress, physical distress, worksite support, and satisfaction). This single-group feasibility study demonstrated that our modified brief assertiveness training for nurses seems feasible and may achieve a favorable outcome in improving their assertiveness. Further controlled trials with longer follow-up periods are required in order to address the limitations of this study.

Objectives To clarify the dissemination status of cognitive behavioural therapy (CBT) in Japan under the national health insurance scheme. Design Retrospective observational study. Setting National Database of Health Insurance Claims and Specific Health Checkups of Japan. Participants Patients who received CBT under the national health insurance scheme from fiscal years (FY) 2010 to 2015. Primary and secondary outcome measures We estimated the change rate and the standardised claim ratio (SCR) for the number of patients receiving CBT and analysed the association between the CBT status and several regional factors. Results We found that (a) a total of 60 304 patients received CBT during the study period; (b) the number of patients receiving CBT was highest in the first year (−1.8% from FY2010 to FY2015); (c) the number of patients who received CBT per 100 000 population decreased (or remained at zero) in most prefectures (32 out of 47); (d) there was a maximum 424.7-fold difference between prefectures in the standardised claim ratio for CBT and (e) the number of registered CBT institutions was significantly associated with the number of patients who received CBT. Conclusions The provision of CBT did not increase in the first 6 years (FY2010–2015) after its coverage in Japan’s national health insurance scheme. Further studies including a questionnaire survey of registered CBT institutions are required to get more detailed information on the dissemination of CBT in Japan.