Report on “Radiation Disaster Recovery Studies”
Course: Radioactivity Social Recovery Course
Name: Russell Sarwar Kabir
Regarding “Radiation Disaster Recovery Studies”
The thrust of response and arc of recovery to the disasters of March 11, 2011, havedeveloped into environmental and social circumstances that are characterized by chronic
features on the landscape and lived experience of those affected. The unprecedented characterof the nuclear elements of the historical event loomed heavily over the minds of observers
and disaster-affected residents alike through the mutual and intuitive acknowledgement ofradionuclides as noxious agents that beget a pervasive sense of fear, anxiety, hopelessness,and helplessness (i.e., psychological distress) due to their uncertain effects in tandem with thefrailty of human control over natural disasters and their consequences. Restoration from theduress of chronic environmental disasters onset by radiation is thought to require a long-view
approach to reconstruction that both acknowledges pervasive uncertainty and takes aim at
repairing the social fabric through community engagement (Reich & Goto, 2015).
Psychosocial consequences are known to be one of the most significant issues thatemerge from these events, indicating that efforts should be made to improve existing
frameworks of emergency consequence preparedness and recovery management. Due to theirrelative rarity and heterogeneity, numerous guidelines rather than explicit instructions havebeen proposed to equip commissioners and decision makers with key points to create flexible
and actionable plans for public mental health. Recommendations for managing thepsychological consequences of nuclear incidents derive from the evidence-informed effort
spearheaded by Hobfoll et al. (2007). The five essential principles are to promote (1) a senseof safety, (2) calming, (3) self- and community efficacy, (4) social connectedness, and (5)hope (Hobfoll et al., 2007; Dainiak et al., 2011). In a seminal paper for this domain,
Gouweloos et al. (2014) thoroughly reviewed the available literature on guidelines forpsychosocial care after chronic contamination events but found that no studies met the design
criteria suitable for effectiveness research. Instead, public resiliency to the circumstances ofnuclear disaster response and recovery are thought to benefit from projects that invoke asense of common purpose (Gouweloos et al., 2014). Self-determination of acceptable risks
can be facilitated through co-expertise activities to create radiological protection culture,
which creates a context for enabling personal control and empowerment for coping withdisaster. Crucially, this is achieved by adopting adaptive behaviors for everyday life andfacilitating habits, skills, and networks for instrumental and social support.
In one prominent and specific example of hospital nurses as individuals affected byand participants in the radiation disaster recovery process, the ability to cope with daily life
burdens and work-related stressors was actually found to be more important for mental healthsupport than that of acquiring greater knowledge, information, and know-how for control
methods related to radiation as the source of the disaster (Nukui et al., 2017). This
underscores the need to provide broadly appropriate, flexible, and evidence-based mental

health promotion programs as support for affected but individuals in the recovery phase. A
major recommendation for continued efforts to improve mental health outcomes after these
events would thus incorporate health promotion with activities that create or co-exist withefforts to establish services within communities to maintain public health services or foster
environmental risk monitoring and protection culture. The field of public mental health is aburgeoning extension of epidemiological efforts to account for the distribution of mental
conditions and the coordination of prevention and promotion activities related to theiridentification and management. In pursuit of the latter, public mental health tools that possessa track record under disaster recovery circumstances at the community level for calming,
self-efficacy, and adaptive behavior among populations with known risk factors as areas ofneed (i.e., mothers, children, the elderly, caregivers, and community members) would besuitable for filling the gap in candidate templates for actionable and programmable solutions.
Matching major elements of the global standard Hobfoll guidelines for providing of
calming and self-efficacy after disasters with chronic features, relaxation programs are
known for their versatility, cost-effectiveness, and ability to help people obtain selfregulatory coping skills. Self-Active Relaxation Therapy (SART; Ohno, 2015) is a physicalrelaxation approach to psychological rehabilitation that grew out of the suite of movementtasks developed in the Japanese psychotherapy known as Dohsa-hou, or the body movement
method. The program for SART is designed to stretch, twist, and release areas of the upper,
lower, and whole body through a set of movements which are guided by a practitioner andperformed “self-actively” by a client such that they can learn to recognize anxious tension in
the body and perform instrumental actions on their own to achieve a relaxed state. A shortversion of SART has been investigated as a salon activity for the elderly, mothers raisingchildren, special needs students, and children adapting to school as a context and means of
psychological support. The full program has also been applied to clinical settings forpsychological and developmental conditions, and longitudinally provided for community
contexts as a means to assist residents facing long-term disaster recovery circumstances inJapan. My process toward “radiation disaster recovery studies” has been based in the training
and experience I received for providing and evaluating stress management applications of
SART. I have stipulated the properties and effects of the psychotherapy through academic
research and synthesized them with the public mental health needs of disaster recovery. My
progress toward vetting the program with valid methods and instrumentation is detailed in thethesis summary below.
Title of Doctoral Thesis:Interoceptive attention tendencies and their role in applications of Self-Active Relaxation
Therapy
Summary of Doctoral Thesis:
Mental health promotion programs targeted at the community recovery of disasters(e.g., areas with chronic environmental stressors) must be sufficiently broad and balanced
enough to appeal to healthy people while still raising awareness of common mental disordersand providing a skill that is meaningful for adaptive behavioral adjustments to relevant
everyday stressors (Reich & Goto, 2015; Maeda, Oe, & Suzuki, 2018). This thesis identifies
SART as a stress management program based on a Japanese psychotherapy that has beenused as a vehicle for mental health support in disaster recovery and (1) provides
comprehensive and culturally appropriate steps to address the validity of its underpinning
framework in body awareness constructs, and (2) evaluates degrees of its effectiveness as apublic mental health promotion program for applications to aforementioned contexts vis-à-vis
its proposed mechanism of psychological change.
Despite its known utility and continuity as a program in disaster-affected areas,
aspects of the evidence basis of SART have remained unspecified, especially with regard to
the theoretical framework that should be used to assess effectiveness for its claims toproviding changes in positively construed body awareness. Due to its systematic validation,
cumulative evidence across numerous research contexts, and progress toward instrument
maturity with operationalizable constructs, components of the regulatory awareness of bodily
sensations, or interoceptive attention tendencies, captured by the instrument known as theMultidimensional Assessment of Interoceptive Awareness (MAIA) were chosen as a
candidate system of constructs.
As a result of the psychometric evaluations of the properties of the Japanese versionof the MAIA (Study 1), evidence of structural (internal) validity for the theoretical structureof the MAIA was supported. Concurrent with previous studies demonstrating criterionrelated validity, the difference in mean scores among participants experienced andinexperienced with contemplative and bodymind health practices suggested that the MAIA
framework for interoceptive attention tendencies constructs are sensitive to change related tobehavioral health practices that hold promise as candidates for intervention in bodily-focused
psychological conditions. For cross-cultural validity, approximate metric invariance was
supported by comparison of information criteria, and analysis of salient loadings supported
factor determinacy. These findings suggested that the Japanese and English MAIA
instruments measure dimensions of interoceptive attention tendencies that are comparable interms of factor loadings. Providing indications of empirical support for the MAIA dimensions
in collaborative research with the cognitive psychology laboratory, Study 2 evaluatedincremental validity considerations using resting-state EEG power indices. The negative
relationship discovered between Self-Regulation and theta power aligns with other studies
that have connected self-reported tendencies to cognitive interference reduction and relief
from anxiety through their trait coherence and adds to the discussion of psychobiologicalimplications for interoceptive processes. Predictive incremental validity for factor structuresof the MAIA that retain Self-Regulation was also established through supported regressions
onto trait anxiety that largely replicated the test of construct validity in the original validation(Study 3.1). Theoretical convergence between the scales made to track changes in SART
applications also indicated emic-etic support for interoceptive attention tendencies as acommon platform as focal body awareness constructs were found to correlate with the MAIA
dimensions in a convergent manner (Study 3.2).
Finally, fitness for use of the MAIA with SART was evaluated in a series ofapplications of SART to a stress management program. Building upon the findings from
Study 1 suggesting that interoceptive attention tendencies are sensitive to change, positive

body awareness enhancement was observed in two contexts of university students (Study 4)
and nurses (Study 5) for state anxiety and the MAIA dimensions of Attention Regulation,
Self-Regulation, and Trusting. These findings show that the MAIA framework and SART
possess indicators and degrees of effectiveness in applications of targeted positive change via
body awareness in public mental health settings. Body Listening was especially responsive to
SART among hospital nurses with elevated trait anxiety. While former SART studies haveobserved qualitative reports of body awareness and within-subject changes in mood andstress responses with case-control designs in children, this is the first set of studies tosystematically account for changes with a formal framework of body awareness in adults andcompared with a test-retest control group.
The relaxation effect of SART has been triangulated across previous studies withelectromyography and reports of mood state and body awareness regulation in clinical andapplied settings. Consistent with this reporting, the manipulation check for state anxiety
reduction as an indication of relaxation was also supported by the findings through strong
effect sizes in samples of university students and hospital nurses. This suggests that SART
provides one of the cardinal benefits advised by the Hobfoll et al. (2007) guidelines toprovide “calming” in a systematic fashion. Furthermore, a line to the promotion of “selfefficacy” can be drawn through the web of relevant psychological indicators if the MAIA isutilized in SART programs designed for such purposes. Indicating “collective efficacy”,
SART was consistently applied over seven years and seamlessly integrated into affectedareas of Iwate Prefecture. Overall, SART was available and deliverable for public mental
health in ways that connected community members of temporary housing complexes, andeven recovery housing areas later in the disaster recovery process.
The psychosocial consequences of chronic events such as nuclear and radiation
disasters are known to be some of the most significant issues that emerge in their wake,indicating that efforts should be made to explore and improve existing frameworks for their
management. Public mental health tools such as stress management have shown such anability to promote calming, self-efficacy, and adaptive behavior for populations with known
risk factors at the community level and under disaster recovery circumstances. SART as acommunity program was successfully and continually applied bi-annually to disaster-affectedareas for groups as diverse as mothers, children, elderly, caregivers, and community
members. In this manner, comparing the criteria of Hobfoll et al. (2007), the results that as
many as five of the MAIA factors for within-subject changes and three factors between,
SART or similar programs might be suitable for filling the gap in candidate templates forpsychologically informed recovery management. This would indicate that stress management
configurations of SART possess high fitness and utility to the circumstances and processes ofchronic disaster recovery.
Conclusion
To fill a pressing need for a candidate disaster recovery management program for
public mental health, the studies in this dissertation aimed: (1) to propose SART as a solution(i.e., chief independent variable) by leveraging an intact and globally utilized framework ofconstructs for body awareness changes from health practices and psychotherapies

operationalized by interoceptive attention tendencies (i.e., primary set of dependent
variables); (2) to probe the previous literature on the framework of these constructs for open
questions on their validity; (3) to address validity questions for the use of interoceptive
attention tendencies in Japan vis-à-vis integrated measurement properties and crossdisciplinary inferences; and (4) to observe their role in applications of SART as a tool todetermine its ability to contribute to domains of sensibility about the body, the regulation ofmood states, and the management of stress through the deliberate practice of relaxation.
Overall, my dissertation provided a framework of common constructs of interest to
the mechanism of body awareness change in SART with interoceptive attention tendencies
measured by the MAIA and offers evidence of positive body awareness enhancement fromstress management applications employing SART, especially with regard to the supportedchanges along the dimensions of Attention Regulation, Self-Regulation, and Trusting in
healthy groups, and Body Listening among hospital nurses with anxiety proneness.
Comprehensively addressing questions of validity, it offers indicators of effectiveness for asystem of constructs in a mental health promotion format that could be flexibly and feasibly
applied to address the needs of individuals undergoing community recovery from disasters
with chronic features (Landsman-Dijkstra, van Wijck, Groothoff, & Rispens, 2004; Reich &Goto, 2015; Nukui et al., 2017).
References:
Dainiak, N., Gent, R. N., Carr, Z., Schneider, R., Bader, J., Buglova, E., ... & Hauer-Jensen,
M. (2011). Literature review and global consensus on management of acute radiation
syndrome affecting nonhematopoietic organ systems. Disaster Medicine and Public HealthPreparedness, 5(3), 183-201.
Gouweloos, J., Dückers, M., Te Brake, H., Kleber, R., & Drogendijk, A. (2014).
Psychosocial care to affected citizens and communities in case of CBRN incidents: asystematic review. Environment International, 72, 46-65.
Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., ... and
Maguen, S. (2007). Five essential elements of immediate and mid–term mass trauma
intervention: Empirical evidence. Psychiatry: Interpersonal and Biological Processes, 70(4),283-315.
Landsman-Dijkstra, J. J., van Wijck, R., Groothoff, J. W., & Rispens, P. (2004). The shortterm effects of a body awareness program: better self-management of health problems forindividuals with chronic a-specific psychosomatic symptoms. Patient Education andCounseling, 55(2), 155-167.
Maeda, M., Oe, M., & Suzuki, Y. (2018). Psychosocial effects of the Fukushima disaster andcurrent tasks. Journal of the National Institute of Public Health, 67(1), 50-58.
Nukui, H., Murakami, M., Midorikawa, S., Suenaga, M., Rokkaku, Y., Yabe, H., & Ohtsuru,
A. (2017). Mental health and related factors of hospital nurses: an investigation conducted 4
years after the Fukushima disaster. Asia Pacific Journal of Public Health, 29(2_suppl), 161S170S.

Ohno, H. (2015). Applications of relaxation to stress management I: principles of self-active
relaxation therapy. Hiroshima Psychological Research Bulletin, 14, 3–11. [In Japanese withEnglish abstract]. doi: 10.15027/39583
Reich, M. R., & Goto, A. (2015). Towards long-term responses in Fukushima. The
Lancet, 386(9992), 498-500.
Other theses published in academic research journals:
Namba S, Makihara S, Kabir RS, Miyatani M, Nakao T. (2016). Spontaneous facial
expressions are different from posed facial expressions: morphological properties anddynamic sequences. Current Psychology, 35 (129): 1-13.
Namba S, Kabir RS, Miyatani M, Nakao T. (2017). Spontaneous facial actions map ontoemotional experiences in a non-social context: toward a component-based approach.
Frontiers in Psychology, 8, 633.
Kabir RS, Haramaki Y, Ki H, Ohno H (2018). Self-Active Relaxation Therapy (SART) andself-regulation: a comprehensive review and comparison of the Japanese body movement
approach. Frontiers in Human Neuroscience, 12, 21.
Namba S, Kabir RS, Miyatani M, Nakao T. (2018). Dynamic displays enhance the ability todiscriminate genuine and posed facial expressions of emotion. Frontiers in Psychology, 9.
Haramaki Y, Kabir RS, Abe K, Yoshitake T. (2019). Promoting self-regulatory managementof chronic pain through Dohsa-hou: single case series of low-functioning hemodialysis
patients. Frontiers in Psychology, 10, 1394.
Kabir RS. (2019). Interoceptive attention tendencies predict trait anxiety in undergraduate
students and hospital nurses participating in stress management programs. Bulletin of the
Graduate School of Education, Hiroshima University, Part III (68), 111-120.
Kabir RS, Abe K, Haramaki Y. (2019). Convergent associations between interoceptive
attention tendencies and the experience of embodied self-awareness and feeling states related
to self-active relaxation tasks. The Japanese Journal of Rehabilitation Psychology, 45 (1),55-66.
Abe K, Kabir RS, Haramaki Y. (2019). Referencing the body for mood state regulation: an
examination of stress management using Dohsa-hou as a primary prevention program fornurses. Environmental and Occupational Health Practice, 1-6.