城月 健太郎

Abstract Background Cognitive–behavioral therapy (CBT) effectively improves the clinical symptoms of social anxiety disorder. However, there are non-responders who cannot decrease their cost/probability bias significantly; hence, their social anxiety symptoms remain unaddressed. Mindfulness training and cognitive–behavioral approaches promote a reduction in cost/probability bias and social anxiety symptoms. This study examines the effectiveness of a four-session program of mindfulness and CBT (M-CBT) in a non-clinical sample of individuals with high social anxiety. Methods Participants were 50 Japanese undergraduate students (37 women and 13 men) randomly allocated to an intervention group (n = 27) and a control group (n = 23). The intervention group underwent a four-session M-CBT program, while the control group did not receive any treatment. Results A group × time analysis of covariances showed significant interactions in the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. M-CBT also produced significant pre-post improvements in the above outcomes with moderate to high effect sizes (ds = .51–1.55). Conversely, there were no interactions in social anxiety symptoms and self-focused attention. Conclusions These results indicate that M-CBT was effective for the negative cognition generated when paying attention to others in probability bias, fear of negative evaluation by others, dispositional mindfulness, depressive symptoms, and subjective happiness. The combination of mindfulness training with cognitive restructuring is proposed as potentially helpful for individuals with probability bias, leading to negative cognition from paying attention to others. Trial registration University Hospital Medical Information Network (UMIN CTR) UMIN000036763. Registered May 16, 2019.

Abstract A four-session program of mindfulness and cognitive behavioral therapy (M-CBT) is a low-intensity treatment module for individuals with high cost/probability bias and social anxiety symptoms. We tested its effectiveness with 23 patients with social anxiety disorder. The patients completed a set of questionnaires that evaluated social anxiety symptoms, cost/probability bias, fear of negative evaluation from others, self-focused attention, trait mindfulness, depressive symptoms, cognitive reappraisal, and suppression at pretreatment, the time before each session of treatment, post-treatment, and follow-up. Linear mixed-effects models showed that the M-CBT was effective for social anxiety symptoms, cost/probability bias, fear of negative evaluation from others, self-focused attention, trait mindfulness, depressive symptoms, and cognitive reappraisal. The M-CBT also produced significant pre-post-improvements in social anxiety symptoms and cost bias with high effect sizes (social anxiety symptoms: d = 1.04–1.06, cost bias: d = 0.82–1.02). These results suggest that M-CBT is effective for treating social anxiety symptoms and cost bias. This study demonstrates that M-CBT is feasible and acceptable for social anxiety disorder. It may comprise a treatment module for those who do not respond to traditional cognitive behavioral therapy. Trial registration number: University Hospital Medical Information Network (UMIN CTR) UMIN000043720, Registered 23 Mar 2021.

BACKGROUND: Recent studies have shown an association between psychological distress and emotion malleability beliefs, meaning mindsets about whether one's emotions are fixed or changeable. However, most studies have not examined the association between these beliefs and sociodemographic factors. METHODS: A nationwide cross-sectional Internet survey of residents of Japan aged 15-79 years was conducted using sampling weights for national estimates to investigate the association between emotion malleability beliefs and sociodemographic factors and between fixed beliefs and severe psychological distress (SPD). SPD was defined as a Kessler 6 Scale score of ≥13. Adjusted odds ratios for SPD were calculated considering potential confounders. Further analyses were stratified by sex, age and presence of any psychiatric disorder. RESULTS: The analysis included 23,142 participants (female, 48.64%). Fixed beliefs were associated with female sex, age < 45 years, and presence of psychiatric disorders. These beliefs were associated with SPD, and additional analysis showed stronger associations with SPD among female respondents, respondents aged 45-59 years, and those aged ≥60 years. CONCLUSION: Results indicate that female sex, age < 45 years, and current mental disorders were associated with fixed emotion malleability beliefs. Associations between fixed emotion malleability beliefs and SPD were particularly strong among female respondents and people aged ≥45 years compared with the general population. Our study extends the association between emotion malleability beliefs and psychological health to the general population. Future studies should explore mechanisms underlying individual differences in emotion beliefs.

Self-focused attention, cost/probability bias, and avoidance behavior are maintaining factors for social anxiety. In particular, cost bias and avoidance behavior predict social anxiety. It has been shown that the enhancement of trait mindfulness improves these maintaining factors. This study examines the relationships among trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety, and clarifies whether they mediate the relationship between trait mindfulness and social anxiety. A cross-sectional design was used to examine the relationships among these variables. Participants were recruited from three universities in Japan (January 2019–December 2019). Undergraduate students (N = 367) completed a set of self-report measures assessing trait mindfulness, self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Results of path analyses revealed that the hypothesized model’s goodness-of-fit indices had high values. Trait mindfulness showed a direct negative association with self-focused attention, cost/probability bias, avoidance behavior, and social anxiety. Moreover, trait mindfulness was negatively associated with social anxiety via self-focused attention, cost/probability bias, and avoidance behavior. These findings indicate that mindfulness plays an important role in social anxiety and provide impetus for future research involving clinical studies of mindfulness-based interventions for social anxiety.

BACKGROUND: The Cognitive Scale for Functional Bowel Disorders (CS-FBD) and Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ) are a useful measures to assess cognitive-behavioral aspects in individuals with IBS. This study aimed to confirm the reliability and validity of the Japanese versions of the CS-FBD (CS-FBD-J) and IBS-BRQ (IBS-BRQ-J). METHODS: Participants comprised 192 students and 22 outpatients diagnosed with irritable bowel syndrome (IBS). There were 76 students who met the diagnostic criteria for IBS and two students who received treatment for IBS. Participants completed questionnaires containing the CS-FBD-J, IBS Severity Index (IBS-SI), Visceral Sensitivity Index (VSI), 24-item Dysfunctional Attitudes Scale (DAS-24), Hospital Anxiety and Depression Scale (HADS), and Social Adaptation Self-evaluation Scale (SASS). RESULTS: Our exploratory factor analysis revealed that the CS-FBD-J had a unidimensional factor structure and that the factor loadings for two of the 25 items were less than 0.4. The IBS-BRQ-J had a two-factor structure, and the factor loadings for eight of the 26 items were less than 0.4. The confirmatory factor analysis for the 18-item version of IBS-BRQ-J showed that the model fit indices were not sufficient. The CS-FBD-J and IBS-BRQ-J had significant, moderate correlations with the IBS-SI and VSI in the IBS and control groups. Correlation between the DAS-24 and the CS-FBD-J was not significant. The CS-FBD-J and IBS-BRQ-J were significantly correlated to the HADS and SASS (IBS-BRQ-J) only in the IBS group. The scores of CS-FBD-J and IBS-BRQ-J showed significant group differences between the IBS patient group, non-patient IBS group, and control group. The internal consistencies of the CS-FBD-J and IBS-BRQ-J were high. The item-total correlation analysis for the CS-FBD-J and IBS-BRQ-J showed that the correlations between each item and the total score were significant. CONCLUSION: This study confirmed the reliability and validity of the 23-item version of the CS-FBS-J and the 18-item version of the IBS-BRQ-J with the deletion of items with low factor loadings. Regarding the IBS-BRQ-J, two factor structures were confirmed (factor 1: behavior obsessed with abdominal symptoms, factor 2: avoidance of abdominal symptoms and associated difficulties) although the model fit of the structure needs further study.

BACKGROUND: COVID-19 continues to have a global impact and has yet to converge. Behavioral restrictions in daily life are widespread, forcing changes to the behavioral patterns of people. Significant changes have also occurred in children's lives, raising concerns about mental health. The same is true for anxiety symptoms. RESEARCH: In this paper, we described the COVID-19 pandemic effects on mental health, summarized Internet-based cognitive behavioral therapy (ICBT) as an applicability of cognitive behavioral therapy (CBT) for COVID-19, and summarized ICBT's current state as a response for anxiety. An overview of previous intervention studies, including randomized controlled trials (RCTs) on ICBT, showed that many studies were highly effective against anxiety symptoms. Furthermore, regarding the follow-up of ICBT's intervention effect, long-term effect maintenance was also clarified. It was likewise pointed out that ICBT may be used in the future since it is beneficial for children's anxiety symptoms in telemedicine. CONCLUSIONS: Based on these results from previous studies, we discuss ICBT's applicability during the COVID-19 pandemic. Additionally, future measures and prospects for children's mental health during the pandemic are discussed in this study.

OBJECTIVE: Self-focused attention is a maintaining factor for social anxiety disorder. It was shown that self-focused attention correlates with trait mindfulness, but not with attention control. This study examined the reliability and validity of the Japanese version of the self-focused attention (J-SFA) scale. METHOD: Students (N = 502) completed a set of questionnaires, measuring self-focused attention, social anxiety symptoms, trait mindfulness, and attention control. RESULTS: A confirmatory factor analysis indicated that the J-SFA scale has a bi-factor structure. The Cronbach's α coefficient was high. Correlation analysis showed that each factor of the J-SFA scale was significantly weakly to moderately correlated with social anxiety symptoms and trait mindfulness, and the J-SFA scale's factors were significantly or non-significantly very weakly correlated with attentional control functions. CONCLUSION: The findings indicate that the J-SFA demonstrated satisfactory reliability and validity for our sample and provide impetus for future research into the measure for clinical and nonclinical samples in Japan.

Several studies have focused on the cortisol levels in fingernail samples as a possible index of cumulative hormone production; however, the biological validity of fingernail cortisol has not been fully established. We investigated the association between cortisol levels in fingernail samples and other biological specimens, including hair and saliva samples, in healthy young adults to determine whether fingernail cortisol was associated with past cumulative hormone production. Participants were 23 adults (14 men and 9 women; mean age = 22.7 ± 2.8 years). Saliva samples were collected three times per day for 30 days, and hair samples (1 cm) from participants' scalps were obtained. Fingernail samples were repeatedly collected for 8 months, considering growth rate of fingernail and time lag for fingernails to fully extend from the nail matrix. Cortisol levels in hair samples were significantly associated with the levels in fingernail samples that were obtained 3 months after hair collection (r = .48, p < .05). The 30-day integrated area under the curve, based on salivary cortisol levels at awakening and bedtime, were significantly associated with cortisol levels in fingernail samples that were collected 2-5 months after saliva collection. This finding was especially significant after adjusting for the awakening time when the saliva was collected. This study provided evidence that fingernail cortisol was associated with cumulative hormone levels measured several months before but not those in the present. The samples may be useful for endocrinological evaluation in the investigation of chronic stress, cortisol levels, and health; moreover, the use of fingernail samples would permit larger-scale studies.

<p>Relationships among social anxiety, fear of negative evaluation from others, avoidance behavior, and self-disclosure were investigated. Undergraduate students (n=308) completed self-report measures assessing the above factors. The results of cluster analysis by the Ward method showed that social anxiety, fear of negative evaluation from others, and avoidance behavior were composed of three clusters: Low social anxiety, Moderate social anxiety, and High social anxiety. A one-way analysis of variance conducted on these clusters indicated that the High social anxiety cluster had lower self-disclosure scores concerning hobbies, and difficult experiences, compared to the other clusters. Moreover, the multiple regression analysis showed that avoidance behavior had significant effects on each type of self-disclosure. These findings suggest that the reduction of avoidance behavior might affect the increase of self-disclosure.</p>

本研究の目的は、ポジティブな社会的出来事の否認を測定する尺度であるThe Disqualification of Positive Social Outcomes Scale(DPSOS)日本語版を作成し、信頼性・妥当性を検討することであった。大学生392名を対象に、集団式質問紙調査を行った。確認的因子分析の結果、11項目1因子構造が認められた。さらに、内的整合性、収束的妥当性、弁別的妥当性および評価に対する恐れとの関連について検討した。その結果、高い内的整合性が示された。妥当性については、社交不安および維持要因との関連が認められたことから収束的妥当性、抑うつより社交不安との関連が示されたことから弁別的妥当性が確認された。また、DPSOSは否定的評価に対する恐れより肯定的評価に対する恐れと強く関連することが明らかになった。最後に、DPSOS日本語版の応用および今後の展望について考察した。(著者抄録)

社交不安症/社交不安障害(SAD)の認知行動療法においては、スピーチ場面をはじめとするエクスポージャーが広く用いられている。そのため、スピーチ場面における心理学的メカニズムを的確に理解することが重要となる。本研究では、SAD患者を対象にスピーチ課題を行い、維持要因であるコストバイアス、主観的不安、自己評価との関係性について、検討を行った。44名のSAD患者が参加した。分析の結果、他者からの否定的評価の恐れによりコストバイアスが活性化され、不安や自己評価に影響するプロセスが認められた。以上を踏まえて、SADにおけるスピーチ場面のエクスポージャーや認知的再体制化について論じられた。(著者抄録)

Background: Computerized cognitive behaviour therapy (CCBT) programs can provide a useful self-help approach to the treatment of psychological problems. Previous studies have shown that CCBT has moderate effects on depression, insomnia, and anxiety. The present study investigated whether a supplement drink that includes L-carnosine enhances the effect of CCBT on psychological well-being. Methods: Eighty-seven participants were randomly allocated to a control group, CCBT, or CCBT with supplement drink. The CCBT and CCBT with supplement drink groups received six weekly self-help CCBT program instalments, which consisted of psycho-education about stress management and coping, behaviour activation, and cognitive restructuring. The CCBT group consumed a bottle of the supplement soft drink every morning through the 6 weeks. This program was delivered by an e-learning system on demand and also included a self-help guidebook. Seventy-two participants completed the program or were assess at the end of the study. Results: ANOVA revealed that there were significant interactions (times x groups) for POMS tension-anxiety and fatigue. The CCBT group showed significantly improved tension-anxiety scores, whereas the CCBT with drink group showed significant improvements on fatigue. Conclusion: The self-help CCBT program reduced the subjective experience of tension-anxiety in this group of workers. The addition of a supplement drink enhanced the effect of CCBT on fatigue, providing one possible approach to enhancement of such programs.

Background: Self-help cognitive behavior therapy (CBT) is a useful approach for the treatment of psychological problems. Recent research on the effectiveness of self-help internet-based CBT (ICBT) indicates that the paradigm moderately improves psychological problems. Furthermore, previous studies have shown that food and drinks containing supplements improve various health conditions. We investigated the effect of a brief self-help ICBT administered with a supplement drink on psychological well-being and somatic symptoms. Methods: In total, 101 healthy workers were enrolled in the 4-week ICBT program, which consisted of psychoeducation on stress management, behavior activation, and cognitive restructuring. The supplement soft drink was taken every day during the program. The participants were instructed to watch on-demand video clips and read the self-help guidebook and supporting comic strip weekly on the Internet or smartphone. The Japanese version of the Profile of Mood States (POMS) was administered before and after completion of the program. Scores on the POMS tension-anxiety (POMS-TA), depression (POMS-D), and fatigue (POMS-F) subscales were used to assess the effect of the program. Somatic symptoms were assessed using the Brief Job Stress Questionnaire. Results: In total, 75 participants continued the program for 4 weeks; however, of those, 27 failed to complete all weekly tasks or meet the post-assessment deadlines. Therefore, the data of 48 participants were included in the analysis. Pre-post intervention comparisons using paired t-tests revealed significant improvement on the POMS-TA, but not the POMS-D or POMS-F subscales. Moreover, participants reported a significant reduction in the severity of low back pain. Conclusion: Our brief intervention moderately improved anxiety levels and the symptom of low back pain. These findings suggest that the brief ICBT program is effective in non-patient populations. Future directions for brief ICBT are discussed.

本研究は，急性心理社会的ストレスに対するコルチゾールの反応性が脅威刺激からの注意解放の困難さと関連するか否かを検討した。この目的のため，手がかり刺激の提示時間を比較的長くした(1,000 ms)空間手がかり課題を用いて怒り顔への注意バイアスを計測した。実験参加者は，急性心理社会的ストレス課題を行った後空間手がかり課題を行った。本研究では，急性心理社会的ストレス課題により上昇した唾液中コルチゾール値に基づき，実験参加者をコルチゾール反応者と非反応者に分けた。その結果，反応者は怒り顔に対する注意の解放困難を示したのに対して，非反応者は怒り顔からの迅速な注意解放を示した。これらの結果は，急性心理社会的ストレスに対するコルチゾールの反応性の高さが脅威刺激からの注意解放の困難さと関連することを示唆する。

Background: The purpose of this study was to investigate the effect of prolonged stress on the salivary adrenal hormones (cortisol, dehydroepiandrosterone [DHEA], DHEA-sulfate [DHEA-S]) of individuals with irritable bowel syndrome (IBS). Methods: The participants were female college students, including 10 with IBS and 16 without IBS (control group), who were scheduled for a 2-week teaching practice at a kindergarten. Participants were asked to collect saliva for determining adrenal hormones immediately and 30 min after awakening and before sleep, 2 weeks before the practice, the first week of the practice, the second week of the practice, and a few days after the practice. Results: Regarding cortisol/DHEA ratio, significantly increased levels were found during the first week of the practice, and a significant interaction between group and time was found the ratio at 30 min after awakening in the IBS group was higher than that in the control group. For the other adrenal hormone indexes, no significant differences due to the presence of IBS were found. Conclusions: Individuals with IBS showed an elevated cortisol/DHEA ratio after awakening compared with individuals without IBS, and the elevated ratio peaked under the prolonged stress. The present study suggests that the cortisol effect is dominant in individuals with IBS under prolonged stress.

Research has demonstrated the effectiveness of both individual and group cognitive behavior therapy (CBT) programs for social anxiety disorder (SAD) with patients in many countries. The present preliminary study reports the effectiveness of individual CBT for Japanese patients with SAD. Fifteen outpatients diagnosed with SAD completed an individual CBT program of six 50-min sessions with several components, including cognitive restructuring to modify cost and probability bias, repeated speech exposure, and homework about idiosyncratic anxiety-provoking situations. The results show that SAD symptoms improved after completion of the program. Large effect sizes were found for cognitive factors of SAD. In addition, repeated speech exposure was highly effective for improving the self-perception of subjective anxiety. The present findings suggest that an individual CBT program can be effective for reducing SAD symptoms with Japanese patients.

Social Anxiety Disorder (SAD) is known as the most common type of Anxiety Disorder. In the cognitive and behavioral model of SAD, cost bias and perceived anxiety control are factors maintaining and mediating SAD symptoms. The relationship between cost bias and perceived anxiety control in social anxiety was investigated in present study. Undergraduate students (n=341) were administered self-report measures assessing each component of SAD symptoms. Path analysis was conducted to identify relationships between these components. The result indicated the high validity of the model (Goodness of Fit Index=.972, Adjusted Goodness of Fit Index=.929, Root Mean Square Error of Approximation=.083). These findings suggest that SAD symptoms could be improved by changing the cost bias and perceived anxiety control.

Organisms prefer to receive rewards sooner rather than later because they excessively discount the subjective value of future rewards, a phenomenon called delay discounting. Recent studies have reported an association between cortisol which is secreted by the hypothalamic pituitary adrenal (HPA) axis and delay discounting. However, no study has examined whether acutely induced psychosocial stress modulates delay discounting. Thus, the present study examined the effect of acute psychosocial stress and its hormonal and inflammatory correlates on the rate of delay discounting. To accomplish this purpose, we assessed the participants' discounting rates using the questionnaire version with inter-temporal choice before and after an acute psychosocial stress task (the Trier Social Stress Test; TSST). The results demonstrated that TSST increased rates of delay discounting in only cortisol responders (not in non-responders), indicating the possible influence of the pathway from the HPA axis to the dopaminergic systems under acute stress. Furthermore, the findings of correlation analysis indicated a U-shaped relationship between baseline level of C-reactive protein and delay discounting rate, suggesting a complex relationship between inflammatory markers and delay discounting rate. (C) 2013 Elsevier Ltd. All rights reserved.

Although interleukin-6 (IL-6) has been investigated frequently in stress research, knowledge regarding the biological processes of IL-6 in association with psychosocial stress remains incomplete. This study focused on salivary IL-6 and reports its temporal variation and biological correlates following acute psychosocial stress. Fifty healthy young adults (39 male and 11 female students) were subjected to the psychosocial stress test 'Trier Social Stress Test' (TSST), wherein the participants were asked to deliver a speech and perform a mental arithmetic task in front of 2 audiences. Collection of saliva samples, measurement of heart rate, and assessment of negative moods by visual analogue scales were conducted before, during, and after TSST. Salivary IL-6 levels increased by approximately 50% in response to the TSST and remained elevated for 20 min after the stress tasks were completed. Cluster analyses revealed that individuals with sustained elevation of IL-6 levels following the TSST exhibited a lower cortisol response compared to individuals with lower IL-6 levels. In the correlation analyses, a greater IL-6 response was associated with a higher heart rate during the mental arithmetic task (r = .351, p < .05) and with a lower cortisol response (r = -.302, p < .05). This study demonstrates that salivary IL-6 levels are elevated for a relatively long period following acute psychosocial stress, and suggests that sympathetic activity and cortisol secretion are involved in elevation of salivary IL-6 levels. (C) 2013 Elsevier B.V. All rights reserved.

本研究は,社交不安障害(SAD)の維持要因である不安のコントロール感を取り上げ,測定尺度を整備するとともに,その特徴について明らかにすることが目的であった.調査の回答に同意の得られた大学生251名およびSAD患者14名に対して,質問紙調査を行った.分析の結果,不安のコントロール感尺度は,回避・冷静・願望の3つの因子から構成されることが明らかにされた.各因子は,SAD症状と中程度の正および負の相関関係が認められた.また,SAD患者は,一般大学生に比べて,SAD症状が有意に高く,不安のコントロール感が有意に低いことが示された.以上から,SAD患者は,SAD症状は高く,不安のコントロール感の低いことが示された.さらに,他の不安障害との違いを検討する必要性についても示唆された.

This study investigated variations in salivary levels of cortisol and dehydroepiandrosterone (DHEA) in a prolonged stressful situation (a two-week teaching practice). Thirty-three women for whom a two-week teaching practice at a kindergarten was scheduled were asked to collect saliva samples at awakening, 30 min after awakening, and bedtime at four time points: two weeks before the practice, the first week of the practice, the second week of the practice, and a few days after the practice. In addition, they completed questionnaires for assessing perceived stress and subjective moods on each day. A linear mixed model indicated that cortisol levels significantly increased during the first and second week of the practice compared with those before and after the practice period, and that DHEA levels significantly decreased after the practice period compared with those at the other time points. Further, cortisol awakening response after the practice period significantly reduced compared with that at the other time points. Scores of perceived stress and negative moods were also higher during the practice period. This study showed that prolonged stress affected cortisol and DHEA secretion during as well as after the stress period. (C) 2011 Elsevier Ltd. All rights reserved.

Objective: In this study, we investigated levels and relative ratios of adrenal hormones (including cortisol, dehydroepiandrosterone [DHEA], and DHEA-sulfate [DHEA-S]) and their psychophysiological correlates under acute psychosocial stress in individuals with irritable bowel syndrome (IBS). Methods: Fifty-three college students participated in the study (male: 42, female: 11; mean age: 22.64 years), including 13 individuals with IBS (IBS group) and 40 individuals without IBS (control group). The participants were exposed to a standardized laboratory stressor, which included delivering a speech and performing a mental arithmetic task. We measured subjective stress levels and salivary cortisol, DHEA, and DHEA-S levels at relevant time points before, during, and after the tasks. Results: DHEA-S level and the DHEA-S/DHEA ratio in the IBS group were significantly lower than those in the control group, and the cortisol/DHEA-S ratio in the IBS group was higher than that in the control group throughout the experiment. In the IBS group, the appraisal of a threat was positively correlated with cortisol levels (r = 0.61), and the appraisal of controllability was negatively correlated with cortisol levels (r = -0.64) and with the cortisol/DHEA ratio (r = -0.71). The control group showed a significant positive correlation between the appraisal of threat and cortisol levels (r = 0.32). Conclusion: The present study indicates that individuals with IBS had lower DHEA-S levels, and that their stressful cognitive appraisals under acute psychosocial stress caused the effects of cortisol to dominate. This adrenal hormone response may be involved in exacerbating abdominal symptoms in individuals with IBS. (C) 2012 Elsevier B.V. All rights reserved.

本研究は,社交不安障害の維持要因であるコストバイアスと,抑うつ症状と関連する不合理な信念を取り上げ,双方の認知が社会不安と関連する程度の違いについて検討することが目的であった.調査の回答に同意の得られた大学生201名を対象に質問紙調査を行った.分析の結果,コストバイアスと不合理な信念は,ともに社会不安・抑うつ症状と中程度の正の相関関係が認められた.また,不合理な信念の影響を制御した際の偏相関係数は,コストバイアスと社会不安の関係が強いことを示した.一方,コストバイアスを制御した際の偏相関係数から,不合理な信念と社会不安の関係の弱まることが示唆された.すなわち,社会不安においては,社会的状況に特化した認知が強く関係することが認められた.以上から,SAD症状の改善には,コストバイアスを低減させる認知療法などのアプローチが有効であると示唆された.

Recent studies of social anxiety disorder (SAD) suggest that cost bias in social situations is an important factor that serves to maintain SAD symptoms, while other studies have reported that depression is strongly related to SAD symptoms. We investigated the possible effects of cost bias on SAD and symptoms of depressive symptoms, and developed a model of the effect of cost bias on social anxiety and depression. In the model, it was assumed that cost bias predicted fear while avoidance mediated the relationship between cost bias and fear in social situations. A path analysis demonstrated that this model provided a good fit to the data. In addition, all path coefficients had a significant effect on each variable. Furthermore, high levels of cost bias were associated with depressive symptoms. These findings support the contention that cost bias is a maintaining factor in SAD symptoms.