論文

Objectives This article aims to describe the newly developed Japanese practice guidelines for psychological distress of adult individuals with cancer who have elevated levels of psychological distress. Methods We conducted systematic reviews and Delphi consensus rounds to determine the levels of certainty of evidence and strength of recommendation. Results In our proposed flow of care, all individuals with cancer should initially be provided with general support, comprising supportive communication, detection of psychological distress, attendance to their needs, and differentiating physical conditions that mimic psychological distress. If a patient still has significant psychological distress despite such support, more specific care for psychological distress should be considered. Collaborative care has strong evidence base and is strongly recommended. Evidence for psychotherapy for psychological distress and fear of cancer recurrence is moderate to strong, however, recommendations for these interventions were weakened because of the heterogeneity of interventions and lack of formal training system. Evidence of pharmacotherapy was weak. Thus, anxiolytics are weakly recommended only for short term and should be accompanied with psychosocial support. Antidepressants are weakly recommended when a patient is diagnosed with depression. Early specialized palliative care, care for caregivers and peer support are not recommended as a sole means to alleviate psychological distress, due to the scarce supporting evidence. Provision of these interventions is not hindered when they aim to improve the outcomes other than psychological distress, such as quality of life, symptom burden and self-efficacy. Discussion New practice guidelines for psychological distress of adult individuals with cancer have been developed.

Background: Caregivers of people with dementia frequently experience an elevated level of psychological distress and burden. This study aimed to examine the effectiveness of a group-format multi-component programme which is based on cognitive behavioural therapy and positive psychology. Methods: Family caregivers of dementia were allocated (1:1) to the intervention group and the wait-list control group, stratified by age (<65 years, ≥65 years) and care status (at home or in an institution). The intervention group received a six-session, 10-week, group-format programme. The primary outcome was the Hospital Anxiety Depression Scale (HADS). Secondary outcomes were the short-version of the Zarit Burden Interview (personal strain and role strain), Neuropsychiatric Inventory Questionnaire, Dementia Caregiver Positive Feeling Scale, and Self-Compassionate Reactions Inventory. The evaluations were conducted at baseline, 10 weeks (post-intervention), and 14 weeks (follow-up). Results: The analyses were performed with 64 registered participants. In the whole sample, no significant effect was observed on HADS. There was medium effect on role strain (P = 0.04, partial η2 = 0.08). Positive feelings of caregiving increased after the intervention but were not maintained at follow-up. In the subgroup analysis of caregivers under 65 years of age, a statistically significant effect was observed for personal strain (P = 0.03, partial η2 = 0.16). An interaction effect was also found for the total score of positive feelings of caregiving (P < 0.05, partial η2 = 0.02) and the meaning of caregiving (P = 0.02, partial η2 = 0.10). Conclusions: This programme did not show significant improvement in depression and anxiety of caregivers of dementia; however, it reduced the burden of their role conflict (role strain) and yielded favourable short-term effects on the positive feelings and the meaning of caregiving among the participants. Also, the programme effectively reduced the personal strain of caregivers under 65 years.

Aim: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented stress. Mindfulness-based interventions (MBIs) are known to be effective in reducing stress. However, it is unclear how long-term outcomes differ between those who continue mindfulness practice after MBIs and those who do not. In this study, we hypothesized that those who continued mindfulness practice would have higher stress tolerance, and we examined this hypothesis through a survey of MBI graduates. In this study, we examined the association between the continuation of mindfulness practice among MBI completers and individual stress during the COVID-19 epidemic. Methods: A cross-sectional survey of MBI graduates was conducted. The physical and mental health states were compared between those who established a habit of mindfulness practice (practice group) and those who did not (no practice group). Results: The data were collected from 95 participants (response rate: 53.7%). Of the total respondents, 66 (69.5%) practiced mindfulness. Although the degree of perceived stress due to the COVID-19 pandemic was not statistically different between the practice and no practice groups, the practice group showed significantly lower levels of depression (p = 0.007), higher levels of resilience (p = 0.006), higher levels of overall health (p = 0.006), and higher levels of mental health (p = 0.039). The effect of mindfulness practice on reducing depression was fully mediated by resilience. Conclusion: Among MBI graduates, those who regularly practiced mindfulness had lower levels of depression and higher levels of physical and mental health. Thus, the continuation of mindfulness practice increases resilience, buffers against new stressors such as the COVID-19 pandemic, and has the potential to prevent depression.

マインドフルネスに対する関心が，近年急速に高まっている。諸外国ではマインドフルネス的介入についての実証的研究成果が蓄積される一方，日本では，まだその効果に関するエビデンスがほとんどない。そこで，我々の大学で進めている，不安障害やウェルビーイングに対する介入研究について，先行研究の結果を含めて紹介する。そのあとで，われわれの取り組みから見えてきた，マインドフルネス認知療法（Mindfulness-Based Cognitive Therapy: MBCT）を実施するにあたっての注意点や課題について，適用，個人の問題の解決法を扱わない点，不快な体験の強度の問題，ネットを用いたアドヒアランスを高めるための工夫の4点について考察を行った。

慶應義塾大学にて進行中の，乳がん患者さん対象のマインドフルネス認知療法，J. HalifaxらのGRACEプログラムを参考に開発した，緩和ケア医療従事者を対象とした，マインドフルネスに基づいた燃え尽き防止のプログラムを紹介した。

Since the development of mindfulness-based cognitive therapy (MBCT), which integrates cognitive-behavioral therapy and mindfulness-based stress reduction, its effectiveness in preventing the recurrence of depression has been demonstrated. Mindfulness-based interventions (MBIs) such as MBCT and mindfulness-based stress reduction have rapidly spread in the field of psychiatry and mental health. To date, MBIs have been proven as effective for treating depression, anxiety, addiction, cancer, chronic pain, etc. Interventions to improve mental health are also spreading in the field of school education and business. Based on these backgrounds, we first reviewed the development of MBCT and its basic structure as an example of MBI. We then overviewed the effects of MBIs on each condition (e.g., depression, anxiety, psycho-oncology), followed by the current status and issues relevant to MBIs in Japan. Finally, we discussed the challenges regarding MBIs in Japan such as verifying the effects of nonstandardized MBIs and clarifying the mechanisms of effects and the measures for dissemination.

本研究では,全国の精神科医療機関3,734施設に対して集団精神療法の施行実態や課題を調査した。回答施設数は730件(回収率19.6%),無効回答2件を除く728件を解析対象とした。集団精神療法を実施する施設は201件(27.6%)であった。1施設あたり平均4.2(SD=6.7)の集団精神療法を実施し,平均時間は77.2分(SD=35.1),平均回数は9.2回(SD=6.3),平均参加人数は8.2人(SD=5.3),平均スタッフ数は2.4人(SD=1.4)であった。対象疾患はうつ病が128件(63.7%),統合失調症が110件(54.7%),発達障害が107件(53.2%)の順に多かった。用いる手法は心理教育が139件(69.2%),認知行動療法が128件(63.7%),社会生活スキルトレーニングが120件(59.7%)等であった。コスト算定方法は精神科デイケア/ナイトケアが92件(45.8%),精神科ショートケアが73件(36.3%),通院集団精神療法が53件(26.4%)等であった。実施施設の約半数が自施設の集団精神療法の充足度を低く評価し,労力やコストが報酬に見合わない,職員の人数不足,職員が集団精神療法に従事する時間がない,スキルを持った職員がいない等を課題に挙げた。本調査の限界に回収率の低さが挙げられ,解釈には注意を要する。更なる分析を加え,詳細な実態を把握する必要がある。(著者抄録)