Total brain volume (TBV) derived from brain MRI is an important marker of brain structural health in middle-aged and older adults, but MRI is resource-intensive and not always feasible in largescale or repeated assessments. We examined whether dual-energy X-ray absorptiometry (DXA)-derived head composition measures can estimate MRI-derived TBV in middle-aged and older adults. This study included 314 participants (≥ 40 years) who underwent whole-body DXA (head ROI manually defined using a sub-region tool) and 3T brain MRI within 1 year. MRI-derived TBV was defined as the sum of gray and white matter volumes. We developed multivariable linear regression models using either DXA-derived head lean-and-fat mass or head fat mass as the primary predictor. Nested models were fitted: Model 1 (predictor only), Model 2 (+ age and sex), and Model 3 (+ BMI). Apparent model performance was summarized using R² and RMSE, and internal validation was performed using 1,000 bootstrap resamples to obtain optimism-corrected performance estimates. Calibration was evaluated using calibration-in-the-large (CITL) and calibration slope. Agreement between observed and predicted TBV was assessed using Bland–Altman analysis. Sensitivity analyses additionally adjusted for the MRI–DXA measurement interval and evaluated sex-stratified performance. Model 3 was treated as the prespecified primary model because it was the fully adjusted model including clinically relevant covariates. In Model 3, both head lean-and-fat mass and head fat mass were positively associated with TBV, whereas age was negatively associated and male sex was associated with larger TBV. Across the nested models, optimism-corrected bootstrap validation showed broadly similar performance, with numerically slightly higher R² values and lower RMSE values for Model 3. Calibration was favorable in both predictor-based primary models (CITL approximately 0; calibration slope approximately 1.00). Bland–Altman analyses showed small mean bias with evidence of proportional bias across the TBV range. Bootstrap validation indicated stable performance. Sensitivity analyses yielded similar results after accounting for measurement interval and across sex strata. DXA-derived head composition measures can provide a practical approximation of MRI-derived TBV in middle-aged and older adults, with good calibration and stable internal validation performance.

Background Individuals with severe mental illnesses (SMIs) experience anxiety that impairs functioning and quality of life. This cluster randomized trial evaluated exposure-based cognitive behavioral therapy (ebCBT) integrated into assertive community treatment (ACT) teams to reduce anxiety.Methods Fifteen ACT teams were allocated to ebCBT + ACT (k = 8, n = 50) or ACT-only (k = 7, n = 43). The intervention followed four steps: situation identification, four-component analysis (behavior, cognition, emotion, physical symptoms), psychoeducation, and graded exposure. Staff received 50 h training and bimonthly supervision over 12 months. Co-primary outcomes were trait and social anxiety; secondary outcomes were psychiatric symptoms, functioning, quality of life, and recovery.Results The ebCBT + ACT group showed significant improvements in State-Trait Anxiety Inventory-Trait scores at 12 months (AMD = -5.30, 95% CI = -8.71 to -1.90, p = 0.002, d = -0.64) and 18 months (AMD = -7.22, 95% CI = -12.1 to -2.34, p = 0.004, d = -0.60). Brief Fear of Negative Evaluation scores showed near-significant improvement at 18 months (AMD = -3.70, 95% CI = -7.44 to 0.04, p = 0.052, d = -0.40). Secondary outcomes, including global functioning, recovery, and quality of life, also improved. Cost-effectiveness analyses indicated favorable cost-effectiveness for anxiety outcomes.Conclusions Embedding ebCBT within ACT services may reduce anxiety-related fear and avoidance and enhance recovery-related outcomes in individuals with SMI. These findings support the feasibility and clinical value of integrating structured psychological interventions into intensive community-based outreach services.

Self-focused attention is a well-established factor in social anxiety disorder. Our previous study found that perceiving oneself as being watched or evaluated in social contexts exacerbates this tendency, but it remains unclear whether the perception of gaze or evaluation serves as the initial trigger for these cognitive processes. This study used ecological momentary assessment to investigate the temporal sequence of these perceptions and their impact on self-focused attention and social anxiety symptoms. Thirty-eight participants (17 male, 21 female) completed self-reported web assessments three times daily for 10 days. Measures included perceived evaluation, gaze perception, self-focused attention, and anxiety experienced in social situations. A total of 569 data points were collected and analyzed with multilevel structural equation modeling to compare two competing theoretical models. One model posited that perceived evaluation preceded gaze perception, and the other that gaze perception preceded perceived evaluation. The latter received stronger empirical support, indicating that gaze perception elicits the perceived evaluation, which subsequently increases self-focused attention and social anxiety symptoms. However, model fit differences were small, leaving the alternative model where perceived evaluation precedes gaze perception as a plausible explanation. Gaze perception plays a pivotal role in triggering social anxiety symptoms by fostering the perceived evaluation and amplifying self-focused attention. Interventions targeting gaze perception and sensitivity to evaluation may help reduce social anxiety symptoms.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition associated with impairments across educational, occupational, and social domains. Individuals with ADHD are often exposed to misunderstanding and negative evaluation, which can contribute to stigma and psychological distress. Recently, “masking”—efforts to conceal or compensate for ADHD-related characteristics to meet social expectations—has been discussed as a potential behavioral response to stigma, yet empirical research on this phenomenon remains limited. This narrative review synthesizes English-language research on public stigma and self-stigma related to ADHD and examines how stigma may be associated with masking behaviors in ADHD, drawing on conceptual insights from the literature on autism spectrum disorder (ASD) and other related fields. In addition, the review situates these processes within the Japanese cultural context, highlighting how cultural characteristics may intensify stigma and contribute to distinctive patterns of masking. By integrating cross-cultural perspectives and highlighting gaps in the current literature, this review underscores the need for ADHD-specific conceptual frameworks, culturally sensitive research, and longitudinal studies to clarify the mechanisms linking stigma and masking. These insights highlight the need for ADHD-specific and culturally sensitive frameworks to inform future research and intervention development.

Mind wandering (MW) varies in its functional consequences depending on both its intentionality (intentional vs. unintentional) and the content of thought. While previous studies have examined these dimensions separately, little is known about how combinations of content features—such as temporal orientation and emotional valence—are shaped by intentionality. This study investigated whether intentional and unintentional MW differ in content when temporal orientation (past vs. future) and emotional valence (positive, neutral, negative) are considered in combination. Participants reported the content of their MW episodes, which were categorized accordingly. The results showed that unintentional MW was more frequently associated with neutral or negative past-oriented content, whereas intentional MW was more often linked to positive or negative future-oriented content. These findings suggest that the effects of MW content vary depending on intentionality, particularly when multiple content dimensions are considered together. This study contributes to a deeper understanding of the functional heterogeneity of MW by highlighting the interaction between intentionality and thought content.

Rumination and worry, as maladaptive emotion regulation strategies, perpetuate internalizing symptoms of depression and anxiety. However, examinations of dysfunctional mind wandering (MW)-internally oriented thoughts that contribute to emotion dysregulation-and its underlying the cognitive mechanisms related to internalizing symptoms remains limited. This study aimed to identify dysfunctional types of MW associated with internalizing symptoms of depression and anxiety by distinguishing between the intentionality and content of MW. The results indicate that trait rumination and worry sequentially mediate the relationship between the frequency of unintentional MW, which encompasses vague, future-oriented, and negative content, and internalizing symptoms. Furthermore, both single and chained mediation effects were identified in the relationship between unintentional negative MW and internalizing symptoms, with worry acting either as a sole mediator or as a subsequent mediator following rumination in a chain mediation pathway. This study offers novel insight into the distinct roles of rumination and worry as maladaptive emotion regulation strategies, particularly regarding dysfunctional MW types and their contributions to internalizing symptoms of depression and anxiety.

BackgroundDietary management in diabetic patients is affected by psychosocial factors and the social-environmental context. Ecological momentary assessment (EMA) allows patients to consistently report their experiences in real-time over a certain period and across different contexts. Despite the importance of dietary management, only a few EMA studies have been conducted on dietary management and psychosocial factors in patients with type 2 diabetes; further evidence must be gathered. Therefore, this study examined dietary management and psychosocial factors using EMA, comparing type 2 diabetes patients with healthy adults.MethodsA total of 20 patients with type 2 diabetes and 16 healthy adults underwent EMA. Relying on event-contingent recordings, this study evaluated the participants’ mood (e.g., anxiety, anger, vigor), appetite (hunger, craving), meal types (e.g., breakfast), location (e.g., eating out), companions (e.g., family), and dietary lapses (e.g., I ate a larger portion of a meal or snack than I intended) before and after meals. Dietary lapse recording after meals was paired with psychosocial data before meals. Only the type 2 diabetes patients used a sensor-based glucose monitoring system (Freestyle Libre Pro, Abbot) and wearable activity monitors (GT3X-BT, ActiGraph).ResultsThe EMA produced a total of 4,254 responses. Dietary lapse predicted two-hour postprandial glucose through a sensor-based glucose monitoring system. Multilevel logistic regression analyses were performed. For diabetes patients, dietary lapse was affected by vigor, fatigue, and cravings before eating. Meanwhile, for healthy adults, only fatigue before meals affected dietary lapse, and increased vigor from dietary intake was associated with dietary lapse. In both type 2 diabetes patients and healthy adults, eating-out situations were linked to dietary lapse.ConclusionThe results suggest differences in psychosocial factors influencing dietary lapse between patients with type 2 diabetes and healthy adults. EMA is well suited to assess psychosocial factors that drive dietary management in diabetic patients. This study further discussed the possibility of individual approaches using EMA data.

University students, especially those with attention-deficit/hyperactivity disorder (ADHD), experience distress due to procrastination. However, the existing treatment for adult ADHD does not adequately address procrastination. A brief procrastination-focused cognitive behavioral therapy program was developed for the current study, and its effects on procrastination, depression, and life satisfaction were assessed. Using a single-case AB design, procrastination behaviors and mood during the baseline and intervention periods were recorded. Data from 24 students with ADHD symptoms (mean age = 20.42 years,SD= 1.50) were analyzed using interrupted time series and counterfactual analyses. The effects of the program on the depressive symptoms and life satisfaction were also examined. The intervention changed the trajectory of the students’ procrastination behaviors, significantly reducing them compared with baseline. They also reported improved life satisfaction following the intervention. This novel intervention appears effective in reducing procrastination among university students with ADHD symptoms.

Previous research has identified cognitive factors for suicide (e.g. hopelessness, perceived burdensomeness, and thwarted belongingness), rumination and decentering as influential factors in suicidal ideation. Although it has been suggested that rumination and hopelessness may mediate the relationship between perceived burdensomeness/ thwarted belongingness and suicidal ideation, and decentering may reduce rumination and hopelessness, the underlying mechanisms remain underexplored. This study aimed to examine how cognitive factors influence suicidal ideation through the mediating role of response styles in daily life. Twenty-eight participants (10 males, 17 females, and one identifying as other) completed web-based self-report questionnaires four times per day over seven consecutive days. The surveys assessed cognitive factors, response styles, and suicidal ideation. Multilevel structural equation modeling was used to compare models in which perceived burdensomeness, thwarted belongingness, and decentering influenced suicidal ideation either directly or indirectly via rumination and hopelessness. Perceived burdensomeness and thwarted belongingness were found to influence concurrent suicidal ideation partially through rumination. Decentering was associated with reduced rumination. Only hopelessness significantly predicted subsequent suicidal ideation. These findings highlight that responses to interpersonal cognitions can induce hopelessness and suicidal ideation, whereas decentering reduces rumination. This suggests that targeting not only cognitive factors but also rumination and decentering may be an effective approach to reducing suicidal ideation in the short term.

BackgroundPsychological inflexibility is a core concept of acceptance and commitment therapy (ACT), which is a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and maintain a penile erection sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men younger than 40 years, whereas biological factors are more likely to be the underlying cause in older men. ObjectiveThis web-based cross-sectional study examined differences in depression, anxiety, and psychological inflexibility among men with ED younger and older than 40 years in a Japanese population. MethodsWe used a web-based survey to gather data from various community samples. ED was assessed by the International Index of Erectile Function‐5 (IIEF-5) questionnaire, while depression, anxiety, and psychological inflexibility were evaluated by the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Valuing Questionnaire–Obstacle Subscale (VQ-OB) questionnaires. The chi‐square test estimated the scores of PHQ-9 and GAD-7 among men with ED, comparing those younger than 40 years and those older than 40 years. Additionally, a two-way ANOVA was conducted with ED severity and age group as independent variables, assessing psychological inflexibility. ResultsValid responses from 643 individuals (mean age 36.19, SD 7.54 years) were obtained. Of these, 422 were younger than 40 years (mean age 31.76, SD 5.00 years), and 221 were older than 40 years (mean age 44.67, SD 2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≥10 between men with ED younger and older than 40 years (P<.001). On the other hand, there was no difference in the prevalence of anxiety as judged by GAD≥10 (P=.12). The two-way ANOVA revealed that the interactions for CFQ (P=.04) and VQ-OB (P=.01) were significant. The simple main effect was that men with ED younger than 40 years had significantly higher CFQ (P=.01; d=0.62) and VQ-OB (P<.001; d=0.87) scores compared to those older than 40 years in moderate ED and severe ED. Additionally, it was found that men younger than 40 years with moderate to severe ED had significantly higher CFQ (P=.01; d=0.42) and VQ-OB (P=.02; d=0.38) scores compared to men younger than 40 years without ED. On the other hand, no interaction was found for AAQ-II (P=.16) scores. ConclusionsTo the best of our knowledge, this web-based cross-sectional study is the first to examine the relationship between psychological inflexibility and ED. We conclude that men with moderate and severe ED younger than 40 years have higher psychological inflexibility and might be eligible for ACT.

Abstract Abnormal self-referential processing, such as ruminating and worrying, has been shown to sustain internalising symptoms including depression and anxiety. However, examinations of the specific types of dysfunctional mind wanderings (MWs), which are real-time and fluctuating internally-oriented thoughts that trigger abnormal self-referential processing, and the cognitive processes that contribute to internalising symptoms have been limited. This study aimed to identify dysfunctional MWs associated with psychological symptoms by differentiating between intentionality and MW content. This study found that high-frequency intentional MW, particularly focused on past experiences or positive/neutral content, was not associated with internalising symptoms and led to lower levels of worry. The results indicate that rumination and worrying sequentially mediate the link between unintentional MW, which encompasses vague, future-oriented, and negative content and internalisation of symptoms. However, regarding negative unintentional MW and internalising symptoms, pathways in which worry alone served as a mediator were also observed along paths in which rumination and worry were sequentially mediated. This study’s results help us understand that individual traits of rumination and worry play distinct roles in abnormal self-referential processing, particularly within the realm of dysfunctional MW types and their involvement in symptom internalisation.

This study was designed to investigate the relationships between self-focused attention (SFA), other-focused attention (OFA), scanpath length, and fixation count during free speech tasks in the context of social anxiety and metacognitive beliefs. Thirty-nine participants undertook speech tasks while an advanced eye tracker traced each participant’s visual scanpath and fixation count. We performed multiple regression analyses using generalized linear models to dissect the influences of SFA and OFA under varying levels of social anxiety and metacognitive beliefs. Higher subjective SFA during speech tasks with higher social anxiety was linked solely to a short scanpath. In contrast, higher subjective OFA during speech tasks with higher social anxiety was tied exclusively to high fixation counts. Moreover, higher subjective SFA during speech tasks with more positive metacognitive beliefs about SFA was connected solely to a short scanpath, and more negative metacognitive beliefs about OFA were independently associated solely with high fixation counts. Our findings contribute to the field by illustrating a double dissociation between SFA and OFA in relation to scanpath length and fixation count, a relationship that has not been thoroughly examined with traditional fixation time measures. This study also provides preliminary insights into how specific metacognitive beliefs may influence the visual attention strategies of socially anxious individuals during speech tasks. These findings enhance our understanding of SFA and OFA and offer potential directions for further exploration into interventions for social anxiety disorders.

This study was undertaken to translate the Standardised Assessment of Personality – Abbreviated Scale (SAPAS) into Japanese and to evaluate its validity and reliability. SAPAS is one of the most rapid tools for assessing personality disorder (PD) and has excellent sensitivity and good specificity, whereas other PD assessment tools require such a significant investment of time that they are infeasible for large surveys or routine clinical practice. Customary assessment in clinical practice ideally incorporates screening for PD, as it is associated with a substantial public health burden, including premature mortality and increased health service utilization. Furthermore, PD’s status as a key prognostic variable of mental disorders also drives PD screening. While SAPAS has been translated into several languages, there has been no Japanese version. Therefore, we translated SAPAS into Japanese (SAPAS-J) and evaluated its reliability and validity. Study 1 recruited undergraduates to reveal its test–retest reliability. Although its internal consistency was not high, since the intent of the original SAPAS was to assess the broad character of personality disorder with the fewest possible items, minimal correlations between items were reasonable. We tested two factorial models, the single-factor model and the higher-order-single-factor model, and the latter offered better fitting. This higher-order model contained a three-factor structure corresponding to clusters described in DSM-5. It measures general PD traits as a common higher-order latent variable comprising those factors. Correlations of SAPAS-J with the much longer PD screening questionnaire in Study 1 and depressive and anxiety symptoms in Study 2 from the general population support its validity. Although validation for the clinical use of SAPAS-J is limited, our research with non-clinical populations demonstrated sufficient validity to justify its use in the context of psychopathological analog research. Since PD is understood as a continuum, the severity of which is distributed dimensionally, the analog study recruiting from the general population and attempting to reveal psychopathological mechanisms of PD is meaningful.

Abstract The intentionality and content dimensions of mind wandering (MW) are important determinants of its costs and benefits. However, the relationship of intentionality with various combinations of different content dimensions has never been examined. In this study, we aimed to examine whether the content of intentional and unintentional MW differs in terms of temporal orientation, emotional valence, and combinations of these two factors. Results indicated that intentional and unintentional MW did not differ in the frequency of negative valence, whereas a difference was observed in the frequency of negative valence combined with temporal orientation. Unintentional MW was 4.88 times more likely than intentional MW to generate negative past-oriented content, while intentional MW was 2.61 times more likely to generate negative future-oriented content. Furthermore, when compared to intentional MW, unintentional MW was 1.94 times more likely to generate neutral past-oriented content, while intentional MW was 2.17 times more likely to generate positive future-oriented content. These findings show that intentional and unintentional MW have different effects on the content generated, depending on whether the content dimensions are considered separately or combined, which opens crucial new perspectives on understanding the functionality of MW.

Previous studies suggested that self-focused attention (SFA), implicated in social anxiety disorder (SAD), correlates with heightened activity in the right frontopolar area (rFPA), which is the right prefrontal cortex just behind the forehead. Transcranial static magnetic field stimulation (tSMS) is a non-invasive brain stimulation method capable of temporarily suppressing brain function beneath the magnet. We explored whether tSMS on individuals with tendencies toward SAD elicited (1) suppressing rFPA activation during the resting-state and (2) reducing SFA during a subsequent speech task. Twenty-three university students with social anxiety performed two speech tasks. Between tasks, the tSMS group received neodymium magnet stimulation while the sham group received fake magnet stimulation on the rFPA for 20 min. Resting-state rFPA activities was measured using functional near-infrared spectroscopy (fNIRS), while SFA (body sensations and observer perspective), field perspective, and detached mindfulness (DM) perspective were assessed via questionnaires during both speech tasks. The observer perspective means SFA to self-imagery from others’ viewpoint, while the field and DM perspectives mean appropriately focusing on the external environment. The results indicated that tSMS intervention decreased rFPA activity from pre- to post-intervention rest. Then, tSMS reduced SFA to bodily sensations and increased DM perspective from pre- to post-intervention speech, especially in those with high levels of social anxiety. Furthermore, tSMS enhanced the field perspective regardless of social anxiety tendency. The results suggest that tSMS may suppress overactivity in rFPA, reduce SFA to body sensation, and increase adaptive attention in highly socially anxious individuals. Our study suggests the possibility of the clinical application of tSMS for treating SAD.