Research design

A pilot randomized waiting list-controlled design was used in this study to evaluate the effects of an intervention protocol whose development was in complete. Details of participant enrollment and group assignments are shown in Fig. 1. This is an independent research paper with a different objective from that conducted by Nakao et al. [9].

Fig. 1
figure1

Details of participant enrollment and group assignment

Participants

Participants were recruited from among residents living in Kakogawa-city, Hyogo, Japan using public advertisements. During the recruitment period (between September and October 2017), 67 applicants met the following inclusion criteria: (i) age > 60 years, (ii) proficiency in Shogi, and (iii) provision of written informed consent. Exclusion criteria included medical morbidities, such as dementia, which prevented completion of the test battery of self-rated questionnaires; in practice, however, no participant was excluded. Participants were assigned to the intervention group or the waiting-list control group before the baseline assessment (Time 1), conducted at the Kakogawa Shogi Plaza. Subjects allocated to the latter were instructed to visit the same location after six weeks to undergo an additional assessment (Time 2), followed by the S-CBT program. A third assessment (Time 3) was conducted for all participants after the intervention program. This study was approved by the Human Subjects Committee of Naruto University of Education and was conducted between September and December 2017.

S-CBT program

The S-CBT program was conducted over six 90-min sessions. The intervention took about 45 min and was initiated after 45 min of instruction regarding Shogi delivered by a female player. Each group was supervised by a licensed clinical psychologist with 15 years of experience in CBT. The intervention was adapted from a general cognitive-behavioral stress management program for older adults with anxiety and depression [6]. The main components are as follows.

Session 1: social support

“What kinds of conversation skills are necessary for enjoying Shogi with others?” The quiz format was designed to promote the desire for social support.

Session 2: distraction and behavioral inhibition

We discussed improvements in behavioral strategies after delivering a lecture on “how to improve mood after losing a Shogi game and feeling sad”.

Session 3: problem-solving skills

Another lecture was delivered on “how to create a solution when the next move is not known in Shogi” to improve problem-solving skills.

Session 4: self-reinforcement

The third lecture on self-reinforcement referred to “the trick to challenge a strong opponent is stressful in Shogi” aimed to present reinforcers with the challenge of increasing their own difficult tasks.

Session 5: negative automatic thoughts

Finally, a lecture on cognitive distortion was delivered to increase cognitive flexibility and “to resolve the idea while considering what has been lost by Shogi”.

Session 6: summary of previous sessions

Sessions 1 to 5 of the program were reviewed through a quiz administered in session 6, to promote the incorporation of the cognitive and behavioral skills acquired in each session into daily life, and the ability to cope with stressors.

Participants’ cognitive-behavioral variables were compared before the start of the CBT program and after sessions. Moreover, we evaluated participants’ levels of anxiety and depressive symptoms before the start of each S-CBT session.

Measures

Demographics

We obtained baseline data on participants’ age and sex.

The Japanese version of the K6

The K6 [10] is an instrument for measuring psychological distress that includes six items rated on a 5-point Likert-type scale, with higher scores indicating more depressive and anxiety symptoms. In the present study, the K6 was administered before the start of each S-CBT session.

The Japanese version of the abbreviated Lubben social network scale (LSNS-6)

The LSNS-6 [11] is used to measure social support that includes three items rated on a 6-point Likert-type scale, with higher scores indicating more social support. LSNS-6 was administered at Times 1, 2, and 3.

Distraction and behavioral inhibition

Distraction was indexed by a single item (“When I feel depressed, I engage in distraction activities”) rated on a 5-point Likert-type scale (1 = never; 5 = usually), with a higher score indicating more distraction activities. Distraction was assessed at Times 1, 2, and 3. Behavioral inhibition was indexed by a single item (“I am not able to do anything if I feel sad”) rated on a 5-point Likert-type scale (1 = never; 5 = usually), and a higher score indicating that the behavior was inhibited. Behavioral inhibition was assessed at Times 1, 2, and 3.

Problem-solving skill

Problem-solving skills were assessed by a single item (“I am confident that I can come up with many solutions to combat stress”) rated on a 5-point Likert-type scale (1 = absolutely not; 5 = extremely), with higher scores indicating better problem-solving skills. Problem-solving skills were assessed at Times 1, 2, and 3.

Self-reinforcement

Self-reinforcement was indexed by a single item (“I am good at praising myself”) rated on a 5-point Likert-type scale (1 = not at all; 5 = very much so), with a higher score indicating better self-reinforcement. Self-reinforcement was assessed at Times 1, 2, and 3.

Negative automatic thought

Negative automatic thoughts were assessed was assessed by a single item (“My unpleasant thoughts and memories persist”) rated on a 5-point Likert-type scale (1 = never; 5 = usually), with higher scores indicating more negative automatic thoughts. Negative automatic thoughts were assessed at Times 1, 2, and 3.

Subjective well-being scale (SWB)

The SWB [12] measures feelings and satisfaction with life using six items rated on a 5-point Likert-type scale, with higher scores indicating stronger subjective well-being. The SWB was administered at Times 1, 2, and 3.

Data analyses

First, the participation rate in the S-CBT program was calculated. Participants who completed fewer than four sessions were considered as dropouts and thus excluded from the data analyses; the difference in dropout rates between the groups was examined.

As there are many critical views on the p-value in recent years [13], the effect size was calculated to clarify the intervention effect. This was a pilot study with a small sample size, and standardized effect sizes (Cohen’s d) [14], and 95% confidence intervals (95% CIs) were calculated for K6, according to the baseline (Session 1) value for each group. Similarly, Cohen’s d and 95% CIs were calculated for the LSNS-6 and SWB, and the domains of distraction and behavioral inhibition, problem-solving skills, self-reinforcement, and negative automatic thoughts, according to the Time 1 values for each group. Thus, in the intervention group, Time 2 was post-intervention, and Time 3 was the follow-up; and in the waiting list control group, Time 3 was post-intervention (Fig. 1). Cohen’s d values around 0.2, 0.5, and 0.8 are generally considered small, medium, and large, respectively; the larger the Cohen’s d value, the greater the effect [14]. Cohen’s d was considered statistically significant when the lower and upper 95% CIs did not cross zero. All analyses were performed using HAD 16.0 [15].

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