Recent years have seen the effectiveness of virtual reality exposure therapy (VRET) in treating anxiety, supported by increasing evidence. However, more research based on empirical scientific approaches is necessary to verify its implementability. In this paper, we share our experience piloting VRET in a psychiatric clinic and outline future prospects and concerns, citing relevant sections of the Consolidated Framework for Implementation Research.

Preventive interventions before the problems occur are not to be implemented, as its effects are less visible than those of treatment to solve existing problems. However, given the deterioration of children’s mental health in school settings and the negative impact of the COVID-19 pandemic, it is an impending issue to promote and implement preventive intervention in school. This review described the current research trends and challenges of mental health prevention education in school through the social implementation of the Universal Unified Prevention Program for Diverse Disorders (Up2-D2). In this review, we discussed research issues in social implementation, such as examining efficacy, selecting measurements, expanding targeted population, sophisticating and shortening of components, selecting from existing programs, and training young researchers. In addition, challenges on the practical side, such as finding key persons, creating class time, training implementers, obtaining funds for management, and doing public relations were also discussed.

Benzodiazepine (BZD) anxiolytics are commonly prescribed for patients with anxiety disorders not only by psychiatrists but also by primary care physicians. Although BZD have been reported to increase the risk of dependence, cognitive decline, and fall, it is difficult to discontinue BZD especially in case with high-dose and/or long-term use the medication due to the development of dependence. Therefore, we developed expert consensus for patients taking long-term and/or high-dose use of BZD. In addition, we also developed training program for disseminating treatment strategy in multidisciplinary approach.

This article outlines the epidemiology, clinical features, and treatment of obsessive-compulsive disorder (OCD) patients comorbid with bipolar disorder (BD) (OCD-BD patients). The prevalence of BD in OCD patients, and of OCD in BD patients is high. OCD-BD patients often have other psychiatric comorbidities, reduced functioning, and less insight into their OCD compared to patients with pure OCD. The primary goal of OCD treatment in OCD-BD patients is to stabilize mood using mood stabilizers. Atypical antipsychotics augmentation to mood stabilizers may also be effective. When using SSRIs, mood stabilizers, or atypical antipsychotics should be used in combination and patients should be closely monitored to prevent mania. The potential of memantine as a treatment for OCD in OCD-BD patients is also discussed.

The implementation rate of Cognitive Behavioral Therapy (CBT) in Japan, which is effective in improving symptoms of obsessive-compulsive disorder, has been very low. Various forms and approaches of CBT have been developed, and consistently demonstrated effectiveness in the treatment of OCD. Currently, only physicians and nurses are eligible for insurance coverage when conducting CBT for OCD. Recognizing insurance coverage for licensed psychologists who implement CBT as a form of psychotherapy could potentially increase the implementation rate of CBT for OCD patients in psychiatric clinics. The combination of research and training programs for mixed CBT can reduce the implementation burden of CBT for cognitive-behavioral therapists, providing significant benefits for OCD patients. In future CBT research for OCD, there is an expectation to verify the safety and effectiveness of CBT developed through consumer needs surveys, as well as to examine cost-effectiveness through healthcare economic evaluation studies.

Some evidence shows that socially anxious people struggle with utilizing mental health services continuously. Therapist self-disclosure at starting of the services is suggested to be an effective way of building a relationship with clients. However, the extent to which socially anxious people value therapist self-disclosure remains unclear. This study investigates the degree of preference and fear of socially anxious people toward such self-disclosure by conducting a questionnaire survey on 240 adults. As a result of correlation and path analyses, it was observed that socially anxious people tend to fear therapist self-disclosure; in particular, the fear of being evaluated positively and negatively directly influences this tendency. Consequently, at the beginning of psychotherapy, it is suggested that therapists should use only assuring self-disclosures, thus communicating to clients that therapists understand their narrative. Additionally, therapists should avoid using other kinds of self-disclosures excessively.

We introduced mindfulness practice to our outpatient psychosomatic medicine clinic specializing in anxiety and depression. In addition to open-ended single-session classes, we offer various courses including Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy. Interventional research has shown that regular mindfulness practice increases dispositional mindfulness and reduces anxiety and depressive symptoms. Furthermore, patients report that mindfulness practice promoted non-reactive attitudes, focused attention, and a calm state of mind. In the discussion, we address various considerations for practicing mindfulness in the clinical setting and future developments in research and clinical practice.

Exposure is an effective way to limit the fear of injection. However, there is a marked drop in the anxiety level between exposure and an actual injection, making effective step-by-step exposure difficult. In this case, we report the progress of a patient in whom we were able to draw blood utilizing a surface anesthetic seal to reduce his anxiety level. Psychologist, physician, and nurse collaborated well during the care of this patient.