Cognitive Behavioral Therapy in Psychiatric Nursing in Japan

Table 2

Details of comparative studies (9 cases).

Study	Methods			Results	Effect sizes
	Subjects	Therapist(s)	Design
Kobori et al. (2014) [19]	Patients with anxiety disorders (obsessive-compulsive disorder, anorexia, and social anxiety disorder)	3 nurses; 3 doctors; 1 pharmacist; 2 psychiatric social workers; 13 clinical psychologists	Single-arm trial (); 12 weekly sessions of 50-minute individual CBT	Symptoms of depression (PHQ-9) and anxiety (GAD-7) improved significantly after intervention ()	Moderate effect on PHQ-9 (, 95% CI −0.08 to 1.39) and GAD-7 (, 95% CI −0.01 to 1.46)
Okada (2013) [17]	Female patients with unipolar depression	1-2 nurses	Single-arm trial (); 8 weekly sessions of 90-minute group CBT	Depressive symptoms (BDI-II) improvement after intervention (); improvement in cognitive impairment (DAS24) within 6 months of completion of intervention (); improvement in cognition and behavior in everyday life and with respect to other significant ones (interview data)	Moderate effect on BDI-II (, 95% CI −0.23 to 1.22)
Kunikata (2013) [18]	Persons with psychiatric illnesses living in the community (schizophrenia and mood disorder)	1 director (nurse); 1 facilitator (nurse)	Single-arm trial (); 12 biweekly sessions of 120-minute group CBT	No significant changes in self-esteem (RSES) or mood status (POMS) before and after intervention; mental sense of control (WHO-SUBI subscale) and psychiatric symptoms (BPRS) showing improvement before and after intervention ()	Moderate effect on RSES (, 95% CI −1.36 to 0.10)
Yoshinaga et al. (2013) [20]	Patients with social anxiety disorder	1 nurse; 1 doctor; 3 clinical psychologists; 1 psychiatric social worker	Single-arm trial (); 14 weekly sessions of 90-minute individual CBT	Social anxiety symptoms (LSAS, SPS, SIAS, FQ-SP, SFNE) showed improvement during and at the end of intervention (); after intervention, 73% of participants were judged to be treatment responders and 40% met the criteria for remission	Large effect on LSAS (, 95% CI 0.70 to 2.33)
Sakano et al. (2010) [21]	Inpatients with major depressive disorder and the related depressive symptoms	1 trainer (psychologist); 1-2 subtrainers (psychologist and nurse)	Single-arm trial (); 5 weekly sessions of 60-minute group CBT (for improving adequate emotional expression and interpersonal skills, inhibition of aggression, and preventing depression)	Depressive symptoms (BDI), social interaction anxiety (SIAS), social skills (SSS), fear of negative evaluation (SFNE), and QOL (WHOQOL-26) all showed improvement after the intervention (). In follow-up, improvement of fear of negative evaluation (SFNE) was maintained; long-term maintenance of other improvements was not observed	Moderate effect on BDI (, 95% CI −0.16 to 1.30)
Sakano et al. (2010) [22]	Inpatients with major depressive disorder and the related depressive symptoms	1 trainer (psychologist); 1-2 subtrainers (psychologist and nurse)	Single-arm trial (); 5 weekly sessions of 60-minute group CBT (for improving stress coping and depression)	After the intervention, anxiety and depressive symptoms (BDI, SRS-18 sub-items), lethargy (SRS-18 sub-items), and QOL (WHOQOL-26) showed improvement (); additionally, diversification of stress coping strategies (TAC-24) and increased ability to control stress (CARS) were observed (); however, long-term effects were not observed	Small effect on BDI (, 95% CI −0.44 to 1.00)
Watanabe et al. (2011) [16]	Patients with residual depression and refractory insomnia	5 doctors; 1 nurse	Randomized controlled trial; intervention group () received usual care + 4 weekly sessions of 40-minute individual CBT; control group () received only usual care	Compared to the control group, the intervention group’s insomnia (ISI) and depressive symptoms (GRID-HAMD) had improved ()	Large effect on ISI (, 95% CI 0.90 to 2.58)
Kumagai et al. (2003) [15]	Hospitalized patients with schizophrenia	1 nurse	Randomized controlled trial; intervention group () received group occupational therapy + 16 twice-weekly sessions of 120-minute group CBT; control group () received only group occupational therapy	Compared to the control group, the intervention group had improved knowledge of disease self-management, speech skill, and social activity score (REHAB sub-items); there was no significant difference in QOL (WHOQOL-26) between the two groups	Moderate effect on DS score of REHAB (, 95% CI −0.12 to 1.34)
Okuno et al. (2000) [23]	Elderly patients with depression	2 doctors; 1 nurse (observer)	Single-arm trial (); 8 weekly sessions of 60-minute group CBT	After the intervention, 7 patients (39%) showed improvement (BDI reduction rate > 50%); regarding BDI subscale, loss of interest/pleasure and hypochondriac showed significant improvement (), and suppression, depressed mood, self-denial, and physical symptoms, also significantly improved ()	Large effect on BDI (, 95% CI 0.25 to 1.77)

Pre- to posteffect sizes (Cohen’s ) of CBT arm for each study were recalculated using same formula. BDI-II, Beck Depression Inventory-II; BPRS, Brief Psychiatric Rating Scale; CARS, Cognitive Appraisal Rating Scale; CBT, Cognitive Behavioral Therapy; DAS24, Dysfunctional Attitude Scale-24; FQ-SP, Fear Questionnaire-Social Phobia Subscale; GAD-7, Generalized Anxiety Disorder-7; GRID-HAMD, GRID-Hamilton Depression Rating Scale; ISI, Insomnia Severity Index; LSAS, Liebowitz Social Anxiety Scale; PHQ-9, Patient Health Questionnaire-9; POMS, Profile of Mood States; REHAB, Rehabilitation Evaluation of Hall and Baker; RSES, Rosenberg Self-Esteem Scale; SFNE, Short Form Fear Of Negative Evaluation; SIAS, Social Interaction Anxiety Scale; SPS, Social Phobia Scale; SRS-18, Stress Response Scale; SSS, Social Skills Scale; TAC-24, Tri-axial Coping Scale-24; WHO-SUBI, WHO-Subjective Well-Being Inventory; WHOQOL-26, WHO Quality of Life-26.