title: Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients.
abstract: OBJECTIVE
  There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma.
  
  
  METHODS
  We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale.
  
  
  RESULTS
  Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma.
  
  
  CONCLUSIONS
  Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.
authors.affiliation: Faculty of Contemporary Society, Kobe Yamate University, Kobe, Japan; Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan. Electronic address: ishimots@gmail.com.
authors.forename: Sakie
authors.initials: S
authors.lastname: Shimotsu
authors.affiliation: Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Horikawa
authors.affiliation: Nagasaki University of Foreign Studies, Nagasaki, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Emura
authors.affiliation: Faculty of Psychology, Doshisha University, Kyoto, Japan.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan; Komachi Clinical Psychology Office, Kanagawa, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Nagao
authors.affiliation: Graduate School of Education, Hiroshima University, Hiroshima, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ogata
authors.affiliation: Medical Corporation Heartopia Hosomi Clinic, Miyazaki, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Hiejima
authors.affiliation: Medical Corporation Heartopia Hosomi Clinic, Miyazaki, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hosomi
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D012649:Self Concept; D057545:Social Stigma; D016896:Treatment Outcome
keywords: Cognitive behavior therapy; Cognitive restructuring; Depression; Japan; Self-esteem; Self-stigma