by Doshisha University

An example of a comic strip used in culturally adapted cognitive-behavioral therapy for Japanese youth. Credit: Shin-ichi Ishikawa and Yoko Kamio

Cognitive-behavioral therapies (CBT) have become increasingly popular over the past few decades. This psychological treatment, used to treat problems including marital issues, eating disorders, anxiety disorders and depression, has been adopted by clinicians around the world. However, the implementation of CBT still lags outside the Western countries where it was first developed.

Researchers examined the most popular CBT programs for young people in Japan, a country that is culturally distinct from the West. After identifying the most predominant CBT programs through a literature review, researchers interviewed authors to understand how these programs were implemented in the country.

The article was published in Clinical Child and Family Psychology Review on 27 July 2023, with contributions from Shin-ichi Ishikawa and Kohei Matsubara of Doshisha University and Kohei Kishida of Japan Society for the Promotion of Science and Kwansei Gakuin University.

"Because CBT was developed among Western cultures, clinical psychologists wrongly assume that it may not be suitable for Japanese youth. Our findings, however, indicate substantial research evidence for the effectiveness of CBT in youth with anxiety and depression in Japan," notes Prof. Ishikawa, also the corresponding author of the article. The authors also found a considerable increase in the number of published research on CBT for Japanese youth in the last two decades.

One major challenge that psychologists outside the West face when adopting CBT is that its content may not be appropriate for patients from non-Western cultural backgrounds. The authors of this article, however, found that top CBT programs in Japan have undergone cultural adaptation to better suit the patients in the country.

Cultural adaptation primarily involves modifying program content and material to include culture-friendly program names, acronyms, illustrations, and characters. For instance, all four predominant CBT programs examined in the study incorporated Japanese cartoon/comic strips known as "Manga" to make the content more relatable to patients. In addition, there are several cultural adaptation strategies that have helped adjust CBT programs and protocols for Japanese youth.

These strategies are based on the user-centered design (UCD) principle to psychosocial interventions and have facilitated the successful implementation of CBT programs by psychologists in Japan.

The article lists several factors that made CBT programs effective among Japanese youth. First, the use of structured but flexible sessions helped improve learning in young people. Second, careful selection of psychologists and high-quality training/consultation ensured that programs were implemented well and that treatment was effective. Third, retaining existing time frames and staff who work in clinical settings helped scale-up CBT services.

According to Prof. Ishikawa, "These findings could encourage dissemination of CBT for youth not only in Japan but also in other countries where the diffusion of evidence-based psychotherapies is lagging."

CBT programs also have several long-term implications for mental health support. In Japan, mental health issues such as anxiety and depression have been linked to educational barriers, particularly absenteeism. CBT could thus play a pivotal role in improving the educational attainment of Japanese students. "We must continue to educate the public about mental health issues in youth beyond educational problems for the next five to ten years and promote evidence-based psychotherapies, specifically CBT," Prof. Ishikawa concludes.

More information: Shin-ichi Ishikawa et al, Cultural Adaptation and Implementation of Cognitive-Behavioral Psychosocial Interventions for Anxiety and Depression in Japanese Youth, Clinical Child and Family Psychology Review (2023). DOI: 10.1007/s10567-023-00446-3

Provided by Doshisha University