井野 敬子

2026年9月15日早期公開版。巻・号・頁は未確認。

Importance Despite the rising prevalence of bulimia nervosa and the associated risks of chronicity and severe physical and psychological morbidity, access to effective treatment remains poor. The effectiveness and acceptability of internet-based cognitive behavior therapy (ICBT) for women with bulimia nervosa in clinical settings in East Asia remain unclear. Objective To determine the effectiveness and acceptability of a guided ICBT program to treat women with bulimia nervosa in Japan. Design, Setting, and Participants This randomized clinical trial was conducted at 7 university hospitals in Japan between August 2022 and October 2024. This study enrolled female participants aged 13 to 65 years whose symptoms met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for bulimia nervosa, had a body mass index (BMI) of 17.5 or greater, had internet access, and had no history of practicing CBT-related techniques within the past 2 years. Interventions Both the control and intervention groups received usual care. The intervention consisted of ICBT with additional guidance from a therapist. The therapy program was tailored to Japanese culture and grounded in a specific cognitive behavior model, and it was performed over a 12-week period. Main Outcomes and Measures Severity of bulimia nervosa, measured by the weekly combined frequency of episodes involving binge eating and compensatory behaviors, was assessed by a blinded, independent rating team at baseline and at the 12-week intervention end point. Intention-to-treat analyses were conducted using a linear mixed model with effect sizes calculated using Cohen d. Results A total of 61 women met the eligibility criteria and were randomized to the intervention group (n = 31) or the control group (n = 30). Participants were predominantly young (mean [SD] age, 27.8 [9.0] years), had normal weight (mean [SD] BMI, 21.1 [3.6]), and had a mean (SD) duration of illness of 9.3 (8.8) years; half (31 [50.8%]) were employed. Intent-to-treat analysis revealed that guided ICBT significantly reduced the weekly combined frequency of episodes involving binge eating and compensatory behaviors (by an adjusted mean difference of 9.84 episodes [95% CI, 2.49-17.18 episodes], P = .01; Cohen d = 0.73 [95% CI, 0.21-1.26]). Sensitivity analyses supported these findings. Conclusions and Relevance In this randomized clinical trial, the intervention group experienced a significant decrease in bulimia symptoms compared with the control group, supporting the effectiveness and acceptability of the therapist-guided ICBT program. These findings suggest that integration of therapist-guided ICBT in usual care has the potential to improve accessibility to efficacious treatment options for women with bulimia nervosa. Trial Registration UMIN Clinical Trials Registry Identifier: UMIN00048732

Abstract Background Subthreshold post‐traumatic stress disorder (PTSD) is associated with nearly the same impairment level as full PTSD. However, the standard treatment for subthreshold PTSD remains unclear. Furthermore, no consensus has been reached on the best way to address grief following the improvement of PTSD symptoms. Case Presentation A single Japanese woman in her 50s experienced sudden fear and insomnia after her only son committed suicide. She visited our hospital 6 months after the death and was diagnosed with depression and subthreshold PTSD. Pharmacotherapy slightly improved her depression and insomnia, but no improvement was observed in her PTSD symptoms, therefore she underwent 13 prolonged exposure (PE) sessions, including grief care in the final two sessions. Through imaginal exposure, she was able to feel her anger toward her deceased son and the feelings he had at the time of the suicide for the first time. Furthermore, as she processed her feelings about her son's suicide, her perception changed, which substantially alleviated her depressive and PTSD symptoms. After her PTSD symptoms improved, she felt sadness for his loss. Consequently, the grieving process was facilitated. Conclusion PE incorporating brief grief care may be effective for the bereaved with suicide‐related PTSD symptoms.

Background/objective: Posttraumatic stress disorder (PTSD) is known to be associated with deficits in working memory (WM). However, findings regarding the relationship of PTSD with non-emotional WM have not necessarily been uniform. This study aimed to clarify the relationship between PTSD and non-emotional WM using the N-back task, a well-established WM task.Method: A total of 111 women with PTSD and 120 healthy control women without trauma were enrolled. Most of the patients developed PTSD after experiencing interpersonal violence. Participants completed 0-back and 2-back tasks using non-emotional stimuli (number), as well as a standardised neuropsychological test battery and self-report questionnaires for PTSD and depression symptoms.Results: The PTSD group showed significantly less accuracy in the 2-back task than the control group, while no significant difference was observed in the accuracy of the 0-back task. The PTSD group showed significantly prolonged reaction time compared to controls in both the 0-back and 2-back tasks. The prolonged reaction time in the 2-back task was significantly correlated with more severe overall symptoms and avoidance symptoms in the PTSD group after controlling for age.Conclusion: Individuals with PTSD exhibited reduced WM capacity. Drawing on a relatively large civilian sample, this study contributes to the accumulating evidence of such deficits. Notably, the observed association between WM dysfunction and avoidance symptoms suggests a symptom-specific cognitive profile in PTSD.