Vol.11, No.1

2021

April

2021

International Journal of Brief Therapy and Family ScienceVol. 11, No. 1, 2021

CONTENTS
Original Paper: Research and Experiment
Examination of the effect of a marital symmetrical communication pattern and the amount ofcommunication on problem-solving: Attempt to apply Integrated Information Theory to the familysystemKoubun Wakashima Kazuma Sakamoto Gen Takagi
Saeko Kamoshida Taku Hiraizumi Norimasa Itakura
Michiko Ikuta Kohei Sato Ryoko Hanada ........................................................................ 1-13

Original Paper: Research and Experiment
A pilot study to assess positive and negative post-divorce parental disclosures
Konomi Asai Keigo Asai ................................................................................................ 14-25

Original Paper: Research and Experiment
Family Structure and Adolescent Eating Disorder Tendencies
Takahiro Kozuka Atsushi Utsumi
Koubun Wakashima Keisuke Shimizu ..................................................................... 26-41

Original Paper: Research and Experiment
The relationship between fear of COVID-19 and coping behaviors in Japanese university
students
Gen Takagi Koubun Wakashima Kohei Sato3)
Michiko Ikuta Ryoko Hanada Taku Hiraizumi ...................................................... 42-57

Short Case Report
Chronically Absent High School Boy Returns to School－Not Creating the Bad Guy－
Masahumi Nakamura ..................................................................................................... 58-63

International Journal of Brief Therapy and Family Science
2021 Vol. 11, No.1, 1-13
< Original Paper: Research and Experiment >Examination of the effect of a marital symmetrical communication pattern and the amount ofcommunication on problem-solving: Attempt to apply Integrated Information Theory to the family system

Koubun Wakashima 1), Kazuma Sakamoto 1), Gen Takagi 2), Saeko Kamoshida 1), Taku Hiraizumi 2),
Norimasa Itakura 3), Michiko Ikuta 4), Kohei Sato 5), Ryoko Hanada 6)
1)

Graduate School of Education, Tohoku University

2)

Tohoku Fukushi University

3)

Gifu University

4)

Kanagawa University of Human Services

5)

Yamagata University

6)

Tokyo Woman's Christian University

ABSTRACT. The purpose of this study is to elucidate the qualities of family systems that are more capable of solving problems. In
this study, we applied the schema of Integrated Information Theory (IIT), which explains the phenomenon of consciousness, tofamily research and tested the following hypothesis: higher symmetry leads to greater problem-solving ability in morecommunicative couples. We understood the couple's difference from the symmetry of their communication, and the couple's
interaction from how much they communicate. We also distinguished between ordinary and problem contexts when investigating thedifference and interaction in couples. The questionnaire survey was conducted to 312 married respondents (156 males, 156 females;
average age 45.18 years). We took the couple's problem-solving ability as a dependent variable, and communication score,symmetry score, and an interaction term for both scores as independent variables, and performed hierarchical regression analysis
for both ordinary and problem contexts respectively. As a result of this analysis, it was shown that, in ordinary contexts: (1) greater
symmetry means greater solution-oriented attitude in more communicative couples; and (2) relationship-maintaining attitude isgreater in more communicative and complementary couples. It was also shown that, in problem contexts: (1) solution-oriented
attitude is greater in more communicative couples; and (2) complementary means greater relationship-maintaining attitude in morecommunicative couples. In the future, it will be necessary to test the hypothesis having controlled for the nature of the problem.
KEY WORDS: Integrated information theory, Family system, communication, problem-solving

multidimensional
Introduction

phenomenonof

consciousness. IIT was presented by Tononi

Integrated Information Theory (IIT) is a(2004) as neuroscientists have sought to explain

theory in neuroscience that explains thethe phenomenon of consciousness in recent

multidimensional phenomenon ofyears. There are around 100 billion neurons in

CORRESPONDENCE TO: Wakashima, K. Graduate

the entire brain, around 80 billion of which are

School of Education, Tohoku University. 27-1 Kawauchi,

found in the cerebellum. The thalamocortical

Aoba Ward, Sendai City, Miyagi Prefecture, 980-8576, Japan.

system, which is made up by the cerebral

e-mail: kobun.wakashima.d3@tohoku.ac.jp

cortex and the thalamus, contains around 20

1

2

Wakashima et al.

billion neurons. If the cerebellum is removed

such as eating dinner together and sharing their

due to some disease, language and movement

time. The study posits two products ofbecome difficult. No problems arise, however,difference and interaction in couples andwith consciousness. This means that thefamilies: the couple's problem-solving ability

multidimensionalofand family resilience. "Family structures" (e.g.,

consciousness cannot be explained according to"bonds within the family", "power relations",

the number of neurons. Integrated Information"openness"), and "family functions" (e.g.,

Theory is one theory for solving this sort of"family’s problem-solving abilities”, “family

problem.

theresilience”), have often been used as variables

phenomenon of consciousness arises from thein research into families. The phenomenon wedifference

interaction

experience as consciousness is considered not(integration) amongst neurons. Difference andas a single amalgamation constructed frominteraction create consciousness. Difference

difference and integration, but rather as aand interaction mean greater amounts offunction they create as a whole. Accordingly,

information.

Wakashima et al. (2018) used variables relatedThisphenomenon

theory(diversity)

positsandthat

Attempts are underway to apply IIT as ato the couple’s “family functions”, such assystem theory to spousal and familial systems.

problem-solving ability and family resilience,

When applying IIT to family research, threeaspoints need tobe discussed: (1) what

examined the influence exerted on a couple’s

constitutes the difference in a family; (2) what

problem-solving ability and family resilience

constitutes interaction in a family; and (3) whatbyis the product created by difference andcommunication within the couple. The resultsinteraction in a family. However, no clear

indicated that the following two points wereanswers to these questions have been obtained.

positively related to problem-solving ability

Here, Wakashima et al. (2018) investigated theand family resilience: (1) less difference inhypothesis that "the couple who has the higher“ways of thinking” and “preferences”; and (2)score in both difference and interaction has

higher amounts of communication within thehigher problem-solving abilities and resilience

couple. In other words, the hypothesis was notthan other couples". This study measures

supported. This may be due to the following

difference in couples through three facets:reasons.

"ways

of

thinking",theWakashimadifference

and

et

al.

(2018)

amountofand(1) First, there is the possibility that the"abilities". Interaction in couples is perceived

three facets used to measure the difference infrom amounts of communication that arecouples, i.e., “ways of thinking”, “preferences”,

measuredinfromverbaland “abilities”, ended up measuring how bad aacouple's

couple’s relationship is. Namely, there may

conversations, and non-verbal communication

have been a negative bias. Therefore, it iscommunicationtwo"preferences",

outcomes.

such

ways:
as

Attempt to apply Integrated Information Theory to the family system3

necessary to measure the difference in couples

solving is achieved by selecting and executing

in a manner that avoids the occurrence ofthe solutions usually used by convergent

negative bias as much as possible. One way of

thinking. On the other hand, extraordinary

doing this is, as in the present study, to examine

circumstances are considered to be situations indifferences that arise within couples bywhich a novel problem arises or emerges

measuring symmetry and complementarity. To

because of inadequate handling of the problem.

start, “difference” in integrated information

In such situations, it is thought that the problem

theory refers to the difference that can produce

can be solved by creating a new solution

the amount of information. Symmetry isthrough diffusional thinking and then selecting

defined as being based on homogeneity, whilst

and executing an action through convergent

complementarity is based on heterogeneity

thinking. Thus, the amount of information(Watzlawick et al., 1967). Considered from therequired is different between ordinary andperspective

extraordinaryof

information

amounts,

circumstances

becausethemeanwhile: if complementarity is where A

thinking process in problem-solving is different

makes a suggestion, and B accepts thatbetween them. Accordingly, a variable forsuggestion, and the amount of information held

ordinary/extraordinary circumstances needs to

by A is 1, then the amount held by AB will also

be introduced.

be 1. On the other hand, if symmetry is where A

Adding to the reasons and solutions above,

makes a suggestion, B also makes a suggestion,

we have also chosen to measure family

the information amount held by A is one, andfunctions by taking problem-solving ability, athe information amount held by B is also 1,

function easily interpretable within a narrow

then the amount held by AB will be 2. Here, therange, as our dependent variable. Previously,

value of 2 is the minimum; there is also the

problem-solving ability and resilience havepossibility that the two suggestions may also

been used as dependent variables, but sincelead to a third perspective. Thus, in this study,

resilience indicates a potential ability of thewe operationally defined symmetry as highfamily, it may not be appropriate to handle it asinformation content and complementarity asa result. In other words, it is difficult to

low information content.

interpret. The purpose of this study is therefore(2) Second, amounts of information may

limited to an examination of problem-solving

differ between ordinary circumstances andability, and we conducted our investigation

extraordinary

having posited the following hypothesis:

circumstances.

In

ordinary

circumstances, there may not be a need for soHighersymmetry

leads

to

greatermuch information. Ordinary circumstances areproblem-solving ability in more communicative

situations in which there are no problems or

couples.

problems are well managed when they occur. In
such situations, it is thought that problem

Methods

4

Wakashima et al.

Procedure

couples

We used a survey company to conduct an

We asked for responses to a 22-item 5-point

online questionnaire survey of 312 marriedscale questionnaire formed by adding one item,

couples of Japan (156 males, 156 females;“22. Difference in roles,” to the 21-item 5-point

average age 45.18 years, ±11.708). We included

scale created by Wakashima et al. (2018) for

details explaining the survey (regarding themeasuring the difference in couples. This scaleaims of the survey, handling of personalconsists of three factors: “ways of thinking”,

information, feedback on the results, and“preferences”, and “abilities”. We asked forconsent) at the start of the questionnaire, andresponses here in Part A and Part B respectively.

obtained responses only from participants who

We used it because we thought that thegave their consent.

differences between couples could be measured

Scalesin three specific aspects. However, a negative

The questionnaire was composed of threebias between the couple could have arisen.

parts. Part A asked respondents to recall andNote that since the aim of this study is to

respondinvestigate

toquestionsabout“ordinarythedifference

that

produces

circumstances”. Part B asked respondents to

information in a couple from symmetry in therecallcouple’s communication, we have not used thisandrespondtoquestionsabout“circumstances in which the couple or family is

as a variable in testing our hypothesis.

facing an issue or problem”. Part C asked(3) Scale on Symmetry andrespondents to recall and to respond toComplementary in Conversation (SSCC)

questions about“the couple and/or the family.”

We asked for responses to the 13-item

For counterbalancing, half of the sample were6-point scale created by Kobayashi (2012) for

given questionnaires structured in the ordermeasuring symmetry in conversation. This

“Part A → Part B → Part C” and the otherscale is a single-factor structure. Higher total

half “Part C → Part B → Part A.” At thescores on this scale indicate conversational

start of Part B, respondents were asked to freely

symmetry, whilst lower total scores indicate

describe the problematic circumstances they

conversational

pictured. The following scales were used.

instructional text was altered before use to ask(1) Face sheet

the respondent to imagine the conversation withcomplementarity.

The

We used the survey company’s respondent

their spouse. "You will argue with your spouseattribute data for age and sex. We included

until you are satisfied, even if you disagree

three other questions at the start of thewith your spouse," are examples of items suchquestionnaire about a number of children,

as. We asked for responses here in Part A andspouse cohabitation/non-cohabitation, and childPart B respectively.

cohabitation/non-cohabitation.

(4) Communication scale(2) Scale for measuring the difference in

We asked for responses to the 14-item

Attempt to apply Integrated Information Theory to the family system

7-point

communication

scale

created5byto talk peacefully and try to prevent the

Wakashima et al. (2018). This scale uses twelve

deterioration of the relationship by not arguing.

items of direct communication scale (Itakura,Higher total scores for these base scales2013), and two items assessing “how good/badindicate greater problem-solving ability in a

the relationship between the father and mothercouple. We asked for responses here in Part C.

is” (namely: father and mother spend a lot of(6) Family resilience scale

time talking with each other; father and motherWe asked for responses to the 30-item

often eat dinner together), which is a subscale

4-point family resilience scale created by

of

for

Ohyama and Nozue (2013). Family resilience ismother-father

defined as how a family recovers and remoulds

relationships”(Hida & Kariya, 1992). This scale

as a family unit through critical circumstances

is a single-factor structure. Higher total scores(Walsh, 1998). This scale is composed of fiveon this scale indicate higher amounts offactors: “connection”, “trust in family ability”,

communication in couples. "1. talking about“balance

everyday relationships" is an example of anindividual”, “spirituality”, and “socioeconomic

item. We asked for responses here in Part A andresources”. Higher total scores for these basePart B respectively.

scales indicate greater family resilience. We(5) Family Problem Solving Scale (FPSS)

asked for responses here in Part C. Family“interparental

concordance

inquiring

into

scale

betweenrelationships

and

the

We asked for responses to the 25-item

resilience is a concept that broadly predicts

4-point family problem-solving scale created

how a family adapts, structured not only by thebycouple’sfamily’s problem-solving skills but also by

problem-solving ability is defined as “the skills

notions such as how well the family ispossessed by a couple to make constructive

supported by the society around it, their ability

progresstheto reframe unsolved problems in a positive light,

processes of periodically defining issues,and their ability to accept some problems as

clarifying the details, conceiving of solutions,

unsolvable. We used this scale to measure themaking decisions, and implementing andholistic adjustment of the family. However, thistesting solutions” (Saito et al. 2020). The scale

study supposes that difference and interaction

is composed of two factors: “attitude to solve

in a couple create amounts of information thatthe problem” and “attitude to maintain theare considered to increase the number ofrelationship”. "Attitude to solve the problem"

problem-solving strategies available to therefers to the propensity of couples to produce

couple;and execute solutions, communicate honestly

hypothesis, we chose to use only the FPSS,

with each other, and engage in collaborative

which directly measures problem-solving skills.

problem-solving. "Attitude to maintain the(7) The item for measuring social desirability

relationship" refers to the tendency for couples

bias

Saito

et

al.

through(2020).

A

communicationinaccordingly,

when

testingour6

Wakashima et al.

We asked for responses to the notion that

refuse or stop providing responses; responses“generally, the couple needs to share the same

will be processed statistically and not be

opinions” in a 1-item, 4-point fashion, in orderpersonally identifiable; and the results of theto measure social desirability bias in couples.

survey will be used solely for the purposes of

We excluded from our analysis any participants

research.

who gave the response “4. Very applicable” tothis question item. We asked for answers here

Results

after participants had finished responding toWeexcluded

from ouranalysis any

Part C.

participants that responded “4. Very applicable”(8) Manipulation checks

to the question item for measuring social

We asked for responses on a 3-item 4-point

desirability (“generally, the couple needs tobasis regarding the degree to which participants

share the same opinions”), and any participants

were able to picture “ordinary circumstances”

that responded “1. Not at all” to one or more of

in Part A, “circumstances in which the couple

the question items in our manipulation checks

or family is facing an issue or problem” in Part

regardingB, and “the couple and/or the family” in Part C.

questionnaire asked the participants to imagine.

We excluded from our analysis any participants

We thus excluded 31 participants from ourwho responded “1. Not at all” to one or more ofanalysis, leaving 281 analysis subjects. Table 1

the question items. We asked for responses here

shows the statistical values recorded for each

after participants had finished responding to thescale.

question item for measuring social desirability.

Sorting the nature of the problems

Ethical considerations

thecircumstances

that

the

On the basis of the free responses obtained

The survey was conducted anonymously. We

for the “circumstances in which the couple orpaid consideration to informed consent andfamily is facing an issue or problem” asinvasiveness, indicating at the beginning of thepictured in Part B, we sorted the nature of thequestionnaire that: the particulars of the survey

problems

and response thereto are voluntary; participants“problems for the couple”, “problems for the

may refuse or stop providing responses;

family”,

participants will suffer no loss even if they“external problems”, “uncategorizable”, anddescribed“problems

into
for

six
the

categories:
individual”,

Table 1: Statistical values recorded for each scale
Ordinary: Symmetry
Problem: Symmetry
Ordinary: Communication
Problem: Communication
Solution-oriented attitude
Relationship-maintaining attitude

n

min

max

M

SD

281
281
281
281
281
281

1.77
2.08
1.43
1.21
1.06
1.29

5.23
5.62
7.00
7.00
4.94
4.71

3.50
3.51
4.97
4.95
3.29
3.09

0.52
0.52
1.04
1.07
0.68
0.63

Attempt to apply Integrated Information Theory to the family system

7“no answer”. The ”problems for the couples"the couple, such as financial issues or mattersgroup was categorized as those that are

relating to old age; we sorted such responses as

described as occurring between two parties“problems for the family”. Table 2 is awith a spouse. The most common statements

frequency distribution chart for each category.

were about differences of opinion and sense of“Problems for the family” represents thevalues with spouses and about marital conflicts.

majority of responses, at n=146, followed by

The

group

“problems for the couple” at n=56, which

categorized problems that are described ascovers 19.9%. In total, 71.9% of respondents

occurring between children and their parents'

pictured issues that arise within the household,generation and relatives, as well as problems

i.e., “problems for the couple” or “problems forthat affect the whole family, such as thethe family,” whilst only 1.4% of respondents

economic situation and caregiving issues within

pictured “external problems” such as natural

the family. The most common statements weredisasters.

about child care, the economic situation in the

Examininghome, and parental care issues. "Problems forvariables

the individuals" group was categorized as thoseWe"problems

for

the

family"therelationships

betweenperformed

hierarchicalregressionthat were described as being problems that theanalysis for ordinary and problem contexts

respondents themselves were having. The mostrespectively, using: solution-oriented attitudecommonscore and relationship-maintenance attitude

respondents'

statements
own

were

work

about

troubles,thementalscore

asdependent

variables;andinstability, and health problems. "External

communication score, symmetry score, and an

problem" groups were categorized as thoseinteraction term for both scores as independent

describing conflicts with persons outside thevariables. In order to reduce the risk offamily or regarding social problems. The most

multicollinearity when adding the interactioncommon statements were descriptions ofterm, we standardized the independent variabledisasters.

wasscores to have an average of 0 and a standard

categorized as those that are impossible todeviation of 1. Our method of analysis is asclassify without a specific description of thefollows. In the first step, we added the

problem.

communication score and symmetry score. In"Uncategorizable"

group

Some responses were difficult to judge

the second step, we added the interaction term

between being problems for the family or forfor both scores, and tested the significance ofTable 2: Problem circumstance category frequency distribution chart
Category

CoupleFamilyIndividual

External

n

56

146

10

4

Uncategoriz
able
2

%

19.9%

52.0%

3.6%

1.4%

0.7%

N/A

Total

63

281

22.4%

100%

8

Wakashima et al.

any increase in the coefficient of determination.

(β=.59,Here, a significant increase in the coefficient ofrelationship.

When

we

determination indicates that the influence ofinteraction

term

for

symmetry score on solution-oriented attitudecommunication score and symmetry score, thescore and relationship-maintenance attitude

variation of the coefficient of determination

score varies according to communication scoreincreased significantly (F(1,277)=4.86, p<.05),

level. In order to check the significance of theand the interaction term (β=.11, p<.05) showedinteraction term, we obtained simple linear

a significant relationship for the two scores.

regression lines for communication scores with

Next, when we took relationship-maintenancestandard deviations of +1 and -1 respectively.

attitude score as a dependent variable, andTable 3 shows the results of hierarchicalregression

analysisordinary-context
when

showedathensignificant
added

the

ordinary-context

added ordinary-context communication score

performedusing

and symmetry score, significant relationships

communication

andwere shown for communication score (β=.11,

symmetry.
First,

p<.001)

p<.05) and symmetry score (β=.38, p<.001).
we

took

solution-oriented

Next, the variation of the coefficient of

attitude score as a dependent variable, anddetermination

was

not

significant

added ordinary-context communication score(F(1,277)=1.16, p>.10) when the interaction

and symmetry score, communication scoreterm for ordinary-context communication score

Table3: Hierarchical regression analysis for ordinary - context communication and symmetryβ
Solution-oriented
attitudeRelationship-maintaining
attitude.59 ***.02.11 *-.38 ***

Step 1
Communication
Symmetry
Step 2.11 *Communication x symmetry
2

Adjust R
ΔR 2
*

.35

***

-.06

***

.37
.01 *

.14

***

.14 ***.00

p <.05 ** p <.01 *** p <.001
Table4: Hierarchical regression analysis for problem - context communication and symmetryb
Solution-oriented
attitudeRelationship-maintaining
attitude.61 ***.03.14 *-.41 ***

Step 1
Communication
Symmetry
Step 2
Communication x symmetry

Adjust R 2
ΔR 2*

p <.05 ** p <.01 *** p <.001-.22 ***-.05.38 ***.38 ***.00.17 ***.21 ***.05 ***

Attempt to apply Integrated Information Theory to the family systemand symmetry score was added.

we took relationship-maintenance attitude score

Table 4 shows the results of hierarchicalregression

analysis

performed

using

problem-context communication and symmetry.
First,

when

we

took

9

solution-oriented

as a dependent variable and added theinteraction

term

for

problem-context

communication score and symmetry score, thevariance of the coefficient of determination

attitude score as a dependent variable andincreased

added problem-context communication score

p<.001), and a significant relationship wasand symmetry score, a significant relationshipshown for the interaction term (β=-.22, p<.001).

was shown for the communication score (β=.61,

Lastly, in order to check the interaction term,

p<.001). Next, when we added interaction term

we obtained simple linear regression lines fromfor problem-context communication score anda regression equation using communication

symmetry score, the variance of the coefficientscores with standard deviations of +1 and -1

ofsignificant

respectively. These results suggest that, in(F(1,277)=1.22, p>.10). Next, when we took

couples which in ordinary contexts have more

relationship-maintenance attitude score as acommunication, greater symmetry will mean adependent variable and added ordinary-context

greater solution-oriented attitude (Figure 1).

communication score and symmetry score,

Furthermore, in couples with less symmetry insignificant

forproblem contexts, more communication willcommunication score (β=.14, p<.05) andmean greater relationship-maintaining attitude

symmetry score (β=.41, p<.001). Next, when

(Figure 2).

determination

wasrelations

not

were

shown

Solution-oriented attitude

4
3.8
3.6

significantly(F(1,277)=16.55,

Ordinary-context
communication 1SD

3.4
3.2
3

Ordinary-context
communication
+1SD

2.8
2.6
2.4
2.2
2
-1SD
+1SD
Ordinary-context symmetry

Figure 1: Interaction effect between ordinary-context communication and symmetry

10

Wakashima et al.

and more ordinary-context communication may
Discussion

have a better capacity for solution-devising andThis study applied the Integrated Information

decision-making. These results support theTheory (IIT) schema to family systems,

hypothesis that greater symmetry will indicate

controlled between ordinary and problem

greater

contexts, and examined the effect exerted bycommunicative couples in ordinary contexts. In

communication amount and symmetry between

Integrated Information Theory, as described bycouples on problem-solving ability. Below, ourTononihypothesis will be considered from theconsciousness (information amount) is createdperspectives of solution-oriented attitude andby interaction (integration) and difference

relationship-maintaining attitude.

(diversity) amongst neurons. In this research,

Examining factors related to solution-oriented

we applied this IIT schema to a study of theattitudefamily, and examined (1) symmetry as the

Our

examinationofproblem-solving(2004),

theabilityinphenomenon

more

of

solution-orienteddifference in the family, (2) amount of

attitude indicated that greater symmetry means

communication as the interaction in the family,a greater solution-oriented attitude for moreand (3) problem-solving ability as the productcommunicative couples in ordinary contexts.

createdAccordingly, couples with greater symmetry

Wakashima et al (2018) measured differencebydifferenceandinteraction.

Figure 2: Interaction effect between problem-context communication and symmetry

Attempt to apply Integrated Information Theory to the family system

11from three facets, namely “ways of thinking,”

reaching a consensus amongst the family’s“preferences,” and “abilities,” but this approachviews and strengthening bonds can itself be an

was problematic due to the possible influenceeffective means for solving issues that ariseof negative bias on the responses from thewithin the family system, for problems that

couples. In this study, we measured thearise outside of the family system it may bedifference in the couple through communication

more effective to have family members

symmetry and complementarity, so as to avoid

conceive of a large number of possible

the influence of negative bias insofar as

solutions. In other words, less information ispossible.

communication

required to solve family-internal problems than

indicates consensus in the opinions of a couple;family-external problems. Since the majority of

one spouse makes a suggestion, and the otherthe problems recalled in our study were

spouse accepts that suggestion. Meanwhile,family-internal,

symmetrical communication indicates that thecommunication amount was the only factor to

spouses present differing opinions and a newpositively influence solution-oriented attitude.

perspective may arise from their differing

In future research it will be necessary to test

views. The results of our study prove that, in

our hypothesis having controlled for the natureordinary contexts, couples that communicateof the problem (i.e., whether it arises within or

more, and more symmetrically, will have theoutside of the family system).

greatest amounts of information, thus having a

Examining

positive influence in the division of solutions

relationship-maintaining attitude

Complementaryand in decision-making.

inproblemfactors

relatedcontexts

toOur examination of relationship-maintaining

Meanwhile, in problem contexts, only theattitude indicated that more communication

communication amount positively influencedmeans greater relationship-maintaining attitude

solution-oriented attitude, and symmetry had nofor complementary couples in problem contexts.

relation. Conceivably, this is related to the

Accordingly, couples with less symmetry andnature of the problems pictured by respondents

more problem-context communication may

in our study. “Problems for the couple”

have

between spouses, and “problems for theSymmetry involves repeating assertions thatfamily” such as childcare and family finances,conflict with the other partner, and thus whilst

and familial connections in old age, represented

this increases the amount of information within

71.9% of all responses in this study. Thesethe couple, there is also the possibility of afamilial and spousal problems are issues thatnegative influence being exerted on thearise within the family system. Meanwhile,

relationship between the two spouses. In fact,“external problems” such as natural disasters

regardless of context, symmetry showed a

and accidents can be understood as issues thatnegative influence on relationship-maintaining

arise outside of the family system. While

attitude. In complementary couples, there will

lessconflictinproblem-solving.

12

Wakashima et al.

be more communication in which one spousetaken as a dependent variable. Meanwhile, theaccepts the other’s assertions, which stabilizes

hypothesis found no support in ordinary

the couple’s relationship from the perspective

contexts in which relationship-maintainingof

attitude is taken as a dependent variable, nor in

relationship-maintaining

attitude.

As

discussed above, if the nature of the problem

problem contexts.

facing a family is internal to the family system,

One issue with our study is the bias in thethen stabilizing the couple’s relationship itself

nature of the problems recalled by ourcan be an effective means of solution.

respondents. We did not control for the nature

However, if complementary roles becomeof the problems recalled by our respondents for

fixed, the ideas of only one spouse are always

problematic contexts. As a result, in 71.9% ofused, therefore leading to lower amounts ofcases, respondents recalled problems that arose

information. Greater amounts of information

within the family system. If the setting of a

may be required for problems external to the

problem is outside of the family system, morefamily system; when facing such problems,

information is required to solve the issue thanmaintaining the couple’s relationship may not

in family-internal settings. This means that

constitute an effective means of solving thewhilstissue. Thus, whilst we can say that it isrelationship maintenance may themselves beimportant to have less symmetry and more

effective means for solving problems within thecommunication, when the aim is led by afamilyrelationship-maintainingi.e.,require not only more communication but alsostabilizing the couple’s relationship, there isthe creation of symmetrical communication

nonetheless a need for the detailed investigation

patterns and the conception of numerous

into the role played by relationship-maintaining

possible solutions. In future research, it will be

attitude in a couple’s problem-solving ability

necessary to test the hypothesis after having

after having controlled for the nature of thecontrolled for the nature of the problem.

problem.

Additionally, although more symmetrical andattitude,increased

system,communicative
Conclusion

communication

family-external

couplesmay

andproblems

havebetterproblem-solving ability, if they become too

The purpose of this study was to apply

symmetrical then relationship maintenanceIntegrated Information Theory to the family

becomes difficult, which thereby lessens

system. We thus investigated the influence

problem-solving ability. Looking to the future,exerted on the problem-solving ability by how

further investigation may be needed into themuch and

connection

howsymmetricallya couplebetweenacouple’s

attitudeandcommunicates. Our results show that thesolution-oriented

study’s hypothesis is supported only in ordinary

relationship-maintaining attitude.

contexts in which solution-oriented attitude isAttempt to apply Integrated Information Theory to the family system

Acknowledgements

13

Saito, A., Okuyama, S., Sakamoto, K., &This study received the following grant. We

Wakashima, K. 2020. Development andappreciate this grant. JSPS KAKENHI Grant

validation of the Japanese version of Family

Number JP 17K04191

ProblemSolving

Scale.

International

Journal of Brief Therapy and Family
Reference
Hida,

Science, 10 (1), 1-12..

M.,

Kariya,Y.

1992.

Perceived

interparental

concordanceandrelationships

with

in

parents

thefemaleadolescents. Bulletin of the Faculty of
Education,

Fukushima

Tononi, G. 2004. An information integration
theoryofconsciousness.

BMC

Neuroscience, 5, 42.
Wakashima, K., Sakamoto, K., Hiraizumi, T.,

University,

Itakura, N., Ikuta, M., Sato, K., & Hanada,

Education, Psychology, 51, 55-63. [inR. 2018. Attempt to apply Integrated

Japanese] 飛田操・狩谷佳子．1992．両

Information Theory to family system: Focus

親の「仲の良さ」の認知と親子関係．福

on

島大学教育学部論集，51，55−63．

Journal of Brief Therapy and Family

Itakura, N. 2013. Examining the association of
direct and indirect communication in family
withadolescents.

AnnualReportofmaritalrelationship.

International

Science, 8 (2), 49-69.
Walsh, F. 1998. Strengthening family resilience.
The Guilford Press.

Graduate School of Education, Tohoku

Watzlawick, P., Bavelas, J. B. & Jackson, D. D.

University, 62, No.1, 273-282. [in Japanese]

1967. Pragmatics of human communication:

板倉憲政．家族内の直接的コミュニケー

A

ションと間接的コミュニケーションのpathologies, and paradoxes. NY: W. W.

関連性．東北大学大学院教育学研究科研Norton & Company. [in Japanese] 山本和

究年報，62（1），273−282．

郎（監訳）．1998．人間コミュニケーシ

Kobayashi, T. 2012. Development of the Scale
on Symmetry and Complementarity inConversation. International Journal of Brief
Therapy and Family Science, 2 (1), 16-22.
Ohyama, N. & Nozue, T. 2013. Developmentof a Family Resilience Scale: Investigationof the reliability and validity. Japanese
Journal of Family Psychology, 27, No.1,
57-70. [in Japanese] 大山寧寧・野末武義．
2013．家族レジリエンス測定尺度の作成
及び信頼性・妥当性の検討．家族心理学
研究，27（1），57−70．

studyofinteractional

patterns,

ョンの語用論：相互作用パターン、病理とパラドックスの研究．二瓶社．

International Journal of Brief Therapy and Family Science
2021 Vol. 11, No.1, 14-25<Original Paper: Research and Experiment>

A pilot study to assess positive and negative post-divorce parental disclosures
Konomi Asai1)
1)

Keigo Asai2)

Department of Pediatrics, Kushiro city general hospital

ABSTRACT.

2)

Hokkaido University of Education

Post-divorce parental disclosures(P-DPD), in which parents tell their children about their ex-spouse after a divorce,has an impact on the parent–child relationship. Previous research has assumed that P-DPD is negative. The present study aimed todevelop a parental disclosure scale that includes positive aspects. Additionally, we investigated the effects of parental disclosure on
children’s mental health. Sixty-one Japanese participants who experienced parental divorce were asked to respond to the parental
disclosure scale, as well as the parental affinity scale, mental health scale, and items on socio-demographic information. The results
indicated that the factor structure of the P-DPD scale included 19 items and two factors. The P-DPD scale showed adequate internalreliability. Although positive parental disclosure did not directly affect children’s mental health, it indirectly improved mental healththrough the affinity to the live-in parent. Further, only in the group with interaction with the separated parent did negative parent
disclosure increase the affinity for the separated parent. These results suggest that positive parental disclosure is important in Japan.
The P-DPD scale that assessed both positive and negative aspects could be expected to be used to determine the quality of the parent–child relationships after divorce.
KEY WORDS: Divorce, Parental disclosure, Parent–child relationship, Children’s affinity with parents

Introduction

Children from divorced families particularly

Divorce affects not only both the spouses but

show sadness, anxiety, and anger, especially at

also the mental health of their children. The

their parents, and carry concerns about their life

impacts of divorces on children’s mental

and financial situation after the divorce (Odagiri,

development vary with the age of the2005). Other researchers have reported that thechild; for the cases of young children,effects of parental divorce on children are shortregressive

term (Hetherington, 1984, 1990; Furstenberg &phenomena,

anxiety,andabusive behavior are commonly seen

Cherlin, 1991; Gately & Schwebel, 1992).

(Wallerstein & Kelly, 1975). Even ten years after

In Japan, the number of divorces has been

their parents’ divorce, many children retain vivid

declining since 2003. Meanwhile, we note thatmemories of that time and continue to have grief,

divorce between spouses with minor children

resentment toward their parents, and a sense ofaccounts for 58.1% of the total (Ministry ofloss (Wallerstein, 1985).
。

CORRESPONDENCE TO: Konomi Asai. Department of

Health, Labour and Welfare of Japan, 2018).
。

More than 60% of divorced men and women say

Pediatrics, Kushiro city general hospital, 1-12, Shunkodai,

their divorce has caused them worries about

Kushiro-shi, Hokkaido 085-0822 JAPANtheir children (Ministry of Health, Labour ande-mail: fullmoony_v@icloud.com

Welfare of Japan, 1997). In a 2016 survey, the

14

15

ASAI & ASAI

number of single-parent households in Japanproblems, (2) details on the divorced father, (3)was estimated at 1.42 million, with divorce

ups and downs of the mother’s job, (4) parenting

being the most common reason for the single-

issues, and (5) personal concerns (Koerner,

parent status (Ministry of Health, Labour andWallace, Lehman, & Raymond, 2002; Koerner,

Welfare of Japan, 2017). In the post-divorce

Wallace, Lehman, Lee, & Escalante, 2004).

family, one of the major issues is how to deal

These five disclosures are associated with highwith the children. The relationship between thepsychosomatic symptoms in daughters, andseparated parent and the child is anothertalking in depth and in detail about financial

challenge for post-divorce families. In Japan,

problems, parenting issues, and personal worries

when parents divorces, in many cases, thetends to be significantly associated with low

children live with their mothers (Ministry of

mother–child intimacy (Koerner et al., 2002).

Health, Labour and Welfare of Japan, 2017). In

The finding that a daughter’s worry about her

single-parent households, even if there is nomother mediates P-DPD and the daughter’s

relationship with the father after the divorce, thepsychosomatic

memory of the father remaining in the home has

daughters who receive P-DPD exhibit anxiety,a significant impact on the family, and “how thedepression, and psychosomatic symptoms as amother talks about the father” is important inresult of their worry about their mother. In

shaping the child’s perception of the father; theaddition, studies have found an association

mother often unconsciously strengthens the

between psychosomatic symptoms and problem

mother–child union by making the father the

behaviors in children, regardless of sex (Koerner“bad guy” (Horita, 2005).

et al., 2004).

symptoms

suggests

that

Parental disclosure is defined as the verbal

Children who experienced parental divorce

communication of personal, confidential, or

often suffer from loyalty conflicts and tend tohitherto unknown information by parents to theirlean on one parent to avoid these conflicts

children (Donovan, Thompson, LeFebvre, &(Arditti, 1999; Golish, 2003; Koerner, Jacobs &Tollision, 2016). It plays an important role in theRaymond, 2000). In some cases, negative P-

parent–child relationship, but its impact on child

DPD has led to the formation of parent–childdevelopment and parent–child relationships

coalitions and high levels of closeness andvaries in the literature. Studies have formulated

satisfaction with the live-in parent (Afifi &the concept of post-divorce parental disclosures

McManus, 2010). When P-DPD contains(P-DPD), in which the custodial/live-in parent

negative information, when it contains details

discloses to the child the matters (mainlythat harm the other parent, when it is notnegative information) caused by the divorce. P-

developmentally appropriate information, or

DPD from mothers to their daughters in single-

when it forces the child to act as a mediator orparent households that experienced divorce

sounding board for both parents or to judge

within the past two years include (1) financial

which of the parents is correct, it has a negativeA PILOT STUDY TO ASSESS POSITIVE AND NEGATIVE
POST-DIVORCE PARENTAL DISCLOSURES

impact

on

the

child

(Afifi,

16

McManus,examined the negative results of parents

Hutchinson, & Baker, 2007). Whether a childdisclosing information to their children and,perceives P-DPD as positive or negative isfurthermore, how one can suppress suchimportant (Afifi et al., 2010). P-DPD can be

negative ones and turn the discourse to thehelpful if the information helps the childpositive chances for the future adjustment ofunderstand events within the family (Toller &children. The results of these studies have

McBride, 2013), reduces the child’s anxiety andcontributed to our understanding of post-divorce

uncertainty (Afifi & Schrodt, 2003), or gives thefamily communication issues. However, as it

child the opportunity to get to know their parents,

depends on how the child perceives it, concerns

learn about themselves, and better understandabout the negative impact of P-DPD on children

the rules, roles, and values of the family (Dolgin,

remain, and some parents may be hesitant to

1996; Koerner, et al., 2004).

engage in P-DPD. If the content of the P-DPD is

One of the most negative effects of parental

positive and benign for both parents and children,

divorce on children is the fact that the conflict

it will be better received. However, the impact of

between parents continues after the divorce

positive parental disclosures, as shown by(Odagiri, 2010). To help children adjust to the

Gumina (2009) and the Supreme Court of Japan

major changes that come with their parents’(2014), has not been investigated. In addition,

divorce, it is important that both parents (1) tellstudies dealing with Japanese families havethe child together, (2) refrain from making

shown that mothers communicate in a way thatnegative comments about the ex-spouse in theallows them to mediate between the father andpresence of the child, (3) emphasize that thethe child (Toda, Makino, & Sugawara, 2002;

divorce is not the child’s fault, (4) explain the

Itakura, 2010).

reasons for the divorce in broad terms without

The present study focused on how parents tellgoing into detail, and (5) address the child’s

their children about their marriage and theirquestions and doubts (Gumina, 2009). A similar

former spouse after divorce. Particularly inview has been expressed in Japan (SupremeJapan, there is a stereotype that it is difficult for

Court of

Recent parental

parents to cooperate in raising children after

disclosures research has focused on parents’divorce and that it is better for the separated

attitudes toward parental disclosures (Kang,parent to watch over their children’s growthGanong, Chapman, Coleman, & Ko, 2017; Kang

from afar (Odagiri, 2010). Therefore, it is& Ganong, 2020). Parents are concerned about

conceivable that a live-in parent is unlikely to

involving their children in parental issues

tell a child about a separated parent. However, inthroughalsoJapan, just as mothers mediate between children

recognize that negative parental disclosures may

and fathers (Toda et al., 2002; Itakura, 2010),

harm their children (Kang et al., 2017).

indirect

Japan,

parental2014).

disclosures.

They

To be brief, previous P-DPD studies havecommunicationinfluencestherelationship between children and parents. Thus,

15
17

ASAI & ASAI

it is conceivable that the live-in parent’s positive

Based on Koerner, Wallace, Lehman, Lee, andtalk about their ex-spouse may enhance theEscalante (2004), Afifi and Afifi (2009), andchildren’s mental health and change their own

Afifi and McManus (2010), we prepared 25

perceptions of their ex-spouses. From theitems on topics related to separated parents: 15

backgrounds, the study is aimed to create a P-

items on PPD and 16 items on NPD. For each

DPD scale to measure parental disclosures,

item, the current frequency was asked using theincluding positive parental disclosures (PPD),

four-item scale from 1 (never) to 4 (frequently).

and clarified the impact of PPD and negative

The questionnaire contained the following

parental disclosures (NPD) on children’s mental

instruction. The live-in parent is denoted by “X”

health via perceptions of parents.

and the separated parent is denoted by “Y.” If the
live-in parent is the mother, please answer by

Methods

adding “your mother” to “X” and “your father”

Participants

to “Y” (example: X (your mother) tells me that

This study included 13 male and 48 female

Y (your father) will still cherish me after theparticipants who experienced parental divorce.

divorce.). If the live-in parent is the father,please answer by adding “your father” to “X”

Procedures
The participants were invited offline andand “your mother” to “Y.”Parental affinity scale

online both. On social media, we asked

The parental affinity scale (Toda et al., 2002)

managers of closed communities targetingis a 10-item self-reported scale that has two

offspring who experienced the divorce of theirsubscales: “affinity with father” (five items, e.g.,parents to cooperate in the survey and invited“I like my father”) and “affinity with mother”

users to participate. No monetary compensation(five items, e.g., “I respect my mother”). Theor other incentive for participating was given.

two items of “I have a good relationship with myThose who expressed interest in participating inmother” and “I have a good relationship with mythe study were directed to an online survey

father” were modified to “I am satisfied with myplatform.

relationship with my mother” “I am satisfied

This study was not reviewed by a research

with

my

relationshiptotarget

with
those

my

father,”ethics review committee because there was norespectively,

who

had

ethics review committee at the time this study

experienced a divorce. These items were each

was conducted. Nonetheless, this study adhered

rated on a five-point scale ranging from 1

to the Guidelines for Good Clinical Practice and(strongly disagree) to 5 (strongly agree). Rather

norms of the 2002 Declaration of Helsinki.

than summarizing the scores as those for fathers
and for mothers, we summarized them according

Measuresto live-in and separated status.

Post-divorce parental disclosure scale

Mental healthA PILOT STUDY TO ASSESS POSITIVE AND NEGATIVE
POST-DIVORCE PARENTAL DISCLOSURES

The

Cornell medical index (Brodman,

Erdmann, Lorge, Wolff, & Brondbent, 1949) for18
16of the hypothetical model because we chose thesaturation model.

depression (9 items), anger (9 items), andOther analyses were conducted using R 3.6.0

anxiety (6 items) was used for the indicators of(R core team, 2019). a and correlations between

mentalthethe P-DPD scale and other measures wereparticipants were asked to choose between 2

established by calculating Pearson’s correlation(yes) and 1 (no). A lower score indicated better

coefficients. All statistical analyses used two-

mental health.

tailed tests. Pairwise deletion was used forSocio-demographic information

missing data.

health.

Foreachsymptom,

We asked participants to provide their sex, age,
age when parents divorced, years since their

Resultparents’ divorce, parental authority, parents’

Table 1 gives the participants’ socio-

remarriage, interaction with separated parent,

demographic information. Of the 61 participants,

and current economic situation.

most were female (78.7%) and in their 20s(55.7%).

Statistical analyses

In the EFA, a scree plot of the eigenvalues was

Exploratory factor analysis (EFA) andconstructed and showed a strong support for theconfirmatory factor analysis (CFA) were

two-factor structure. We identified a total of two

performed using Mplus version 8.1 (Muthén &factors with eigenvalues larger than 1.00. Based

Muthén, 2017). EFA was performed using

on the standard factor loading of equal to or

weighted least squares with adjusted means andgreater than .35 without cross loading, wevariance (WLSMV) and based on eigenvalues

eliminated six items from the 25-item scale after>1. We also performed EFA with promax

examining the pattern matrix of the promax

rotation to test the theoretical structure of the P-

rotation. In Table 2, the factor loadings of the

DPD scale. CFA was also performed using

scale are represented.

WLSMV.

As suggested by EFA, the two-factor model

We used the following fit indices to evaluate

was proposed in the CFA. The goodnesses-of-fit

the confirmatory factor analysis model: root

were good: CFI, .984; TLI, .982; RMSEA, .076

mean square error of approximation (RMSEA),(CI: .046–.101); WRMR, .949 (Table 2). The

comparative fit index (CFI), Tucker–Lewis

reliability coefficients were sufficiently high forIndex (TLI), and weighted root mean squarepositive (a = .916) and negative disclosure (aresidual (WRMR). Goodness-of-fit indices were

= .812).

estimated with criteria given by Hu & Bentler

The correlations between the P-DPD scale(1999) and Yu (2002). For the hypotheticaland other scales were estimated, of which themodel of parental disclosure’s impact on mental

coefficients are presented in Table 3. PPD

health, we did not determine the goodness of fit

showed a significantly positive correlation with

15
19

ASAI & ASAI

Table 1 Participants’ characteristics
N (%)
Sex
Male
13 (21.3%)
Female48 (78.7%)
Age (years)
10s
11 (18.0%)
20s
34 (55.7%)30s
14 (23.0%)40s
2 (3.3%)Agewhenparents M = 10.4
divorced (years; n = 60) (SD = 6.03)
Number of years since M = 184.52
parents’divorce (SD=(months; n = 60)
115.92)
Parental authority
Father17 (27.9%)
Mother39 (63.9%)
Other
5 (8.2%)
Remarriage
FatherYes
23 (37.7%)
No
26 (42.6%)
Unidentified
12 (19.7%)
MotherYes
17 (27.9%)
No
39 (63.3%)
Unidentified
5 (8.2%)
Interaction with separated parentHave
31 (50.8%)
Not have30 (49.2%)
Economic situation
Very wealthy
3 (4.9%)Wealthy
12 (19.7%)
Neither
27 (44.3%)
Somewhat poor
12 (19.7%)
Very poor
7 (11.5%)
affinity with the live-in parent (ALP) (r = .42).
ALP showed a significantly negative correlation
with mental health (r = -.59). Number of years
since

parents’divorcewassignificantly

correlated with affinity with the separated parent(ASP) (r = -.64).

Structural equation modeling was tested toinvestigate the impact of P-DPD on mental
health (Figure. 1). In both groups with andwithout interaction with the separated parent,
PPD increased ALP (interaction with theseparated parent, β = .49, p <.01; no interaction
with the separated patent β= .47, p<.01), and
ALP was associated with better mental health(interaction with the separated parent β = -.65, p<.001; no interaction with the separated parent β= -.44, p <.01).
In addition, NPD increased ASP only in thegroup that had interaction with the separated
parent (β = .37, p <.01).
Discussion
This study developed a P-DPD scale andassessed the impact of parental disclosure on
children’s mental health. Factor analyses
confirmed the two-dimensionality of the scale
for positive disclosure and negative disclosure.
Previous parental disclosure scales (Koerner etal., 2004; Afifi et al., 2009; Afifi et al., 2010)
consisted of items related to negative content.
With the addition of items related to positive
content, our P-DPD scale could measure bothaspects. Especially, in Japan, positive talk by themothers about the fathers has been found toincrease children’s affinity with their father(Toda et al., 2002). Therefore, the P-DPD scale
allowed the measurement of the impact of thepositive narrative by the live-in parent regarding
the separated parent on the children.
The a coefficient in our P-DPD scale yielded
sufficient values, which suggests adequate
reliability. However, the validity was not

A PILOT STUDY TO ASSESS POSITIVE AND NEGATIVE
POST-DIVORCE PARENTAL DISCLOSURES

Table 2 Factor Loadings for the P-DPD scale
Items

20
16

Standardized loadings
EFA
CFA
F1
F2
F1
F2

Positive parental disclosure
19 X tells me that Y will still cherish me after the divorce. .994

-.176

.976

-

16 X tells me clearly that I am always free to meet Y after .973 -.330 .969
the divorce.
14 X tells me clearly that I can interact freely with Y after .964 -.265 .956
the divorce.
18 X tells me that Y is always thinking of me even after the .914 -.172 .897
divorce.
17 X tells me clearly that my relationship with Y will not .896 -.160 .892
change even after the divorce.
15 X tells me clearly that Y’s love for me will not change .827 -.214 .836
even after the divorce.
7 X tells me about Y’s current relationships (remarried, .803 .325 .829
not remarried, etc.).
6 X tells me about where Y currently lives.
.755 .326 .798
4 X talks to me about how Y is doing currently.
.738 .362
2 X tells me happy memories with Y.
.738 .045 .726
5 X tells me about Y’s hobbies, which Y was doing when .684 .476
they were married.
3 X positively talks to me about their memories of their .626 .002 .559
marriage.
Negative parental disclosure
12 X tells me that it is Y’s fault that they have divorced.
-.055 .934
.934
13 X tells me about their dissatisfaction with Y.
-.058 .930
.929
11 X talks to me about how terrible they felt being with Y. -.012 .915
.921
23 X tells me that Y doesn’t care about me and X.
-.147 .910
.847
21 X tells me that it does no good to meet with Y.
-.420 .902
8 X tells me about how Y disappointed them.
.087 .894.917
22 X says that Y does not need to know how I am doing. -.351 .888
24 X shows me that Y is currently unable to see me.
-.114 .854
.815
9 X tells me that their marital relationship was not good .110 .810
.832
since before.
25 X told me “I divorced for your sake.”.052 .717.736
20 X tells me that I am not the cause of their divorce.
.582 .597
10 X talks to me about how they got divorced, mentioning .332 .576
.654
each other’s reasons.
1 X tells me about Y at the time of their marriage.
.464 .496
Note: X indicates the live-in parent and Y indicates the separated parent. Bolding
indicates placement on a given factor.

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ASAI & ASAI

Table 3 Descriptive statistics of the P-DPD Scale
Pearson’s correlation coefficients
Mean (SD) NPD ALP
ASP
MHContact with Years
separatedsinceparentdivorce(n = 60)
PPD 14.38 (6.04) .07
.42**
.25
-.25
-.16
-.29
NPD 16.79 (7.31)
-.09
.13
.12
.07
.00
ALP 14.79 (5.99)-.04-.59***-.11.05
AEP 12.54 (5.63).07-.17-.64***
MH
10.20 (5.28).11-.08
Note: PPD = Positive parental disclosure, NPD = Negative parental disclosure, ALP =affinity with the live-in parent, ASP = Affinity with the separated parent, MH = Mental
health.
**p <.01, ***p <.001.
-.07( .03)
.24
(.26)

PPD

.49 **( .47 **)

ALP

.02(-.28).02(.15)-.65***(-.44**)e-.24( .16).02( .31)NPD.37 **(-.18)

e

MH
.07

e

.50
(.26)

(-.04)

ASP
.14
(.11)
-.06
( .17)

Figure 1. Effect of parental disclosure on the offspring’s mental health model. Note:
PPD = Positive parental disclosure, NPD = Negative parental disclosure, ALP =affinity with the live-in parent, ASP = Affinity with the separated parent, MH = Mental
health. Results at top for interaction with the separated parent group and in parentheses
for no interaction with the separated parent group.
**p <.01, ***p <.001.

A PILOT STUDY TO ASSESS POSITIVE AND NEGATIVE
POST-DIVORCE PARENTAL DISCLOSURES

22
16

sufficiently examined. It will be necessary toincrease in ASP due to rebelliousness against theconsider the relevance of the P-DPD scale in the

live-in parent. However, our study did not

future. Regarding the impact of parental

examine whether children wanted to interact

disclosure on children, our results revealed thatwith their separated parent or how children

PPD indirectly improved mental health throughperceived parental disclosure. Therefore, future

ALP.

studies should be conducted that include these

Gumina(2002)

strengthenedtheimportance of the way the live-in parent

variables.

communicates with their children over the

Limitations

divorces in the past. Our study showed that

The present study has a number of limitations.

providing PPD, rather than not providing NPD,First, the number of participants was small andmay indirectly enhance the mental health of

the attributes were not uniform. Our participants

children.

were half in their twenties, and on average, their

Meanwhile, the lack of effects of NPD on

parents had been divorced for more than fifteen

live-in parents (Koerner et al., 2002) may haveyears. Therefore, the frequency and content ofbeen influenced by the fact that the divorce ofparental disclosure by the live-in parent and theour participants’ parents occurred 15 years in theway the child perceived it may be different frompast. This may also explain the view that thethat immediately after the divorce. In addition,effects of parental divorce are short term

although the present analysis was based on the(Hetherington, 1984, 1990; Furstenberg &classification of live-in and separated parent, theCherlin, 1991; Gately & Schwebel, 1992).

frequency of parental disclosure may differ

The present results showed that NPD

between live-in parents who are mothers andincreased ASP only in the group with interaction

fathers. Furthermore, 78.7% of the participants

with the separated parent. In the absence ofwere female. It is necessary to verify whether

interaction

parent,there are differences by gender. In the future,

information conveyed by the live-in parent andafter controlling for the attributes of thememories of the pre-divorce home create theparticipants, parental disclosure ought to be

image of the separated parent (Hotta, 2005).

investigated by dividing it into cases where the

Meanwhile, when there is interaction with the

live-in parent is the father or the mother.

with

the

separated

separated parent, the child creates an image ofSecond, we did not take into account how

the separated parent from meeting the separated

children perceived parental disclosure, as notedparent (Odagiri, 2005, 2010). If the child wants

above. Children may perceive PPD negatively

to interact with the separated parent, he or she

based on nonverbal information, such as when

could perceive the high NPD of the live-in

the live-in parent makes facial expressions thatparent as a refusal to interact with the other

could be deemed contradictory to their spoken

parent or develop feelings of disgust towards the

PPD. Future research should also investigate

live-in parent. Thus, there may be a relative

how children assessed the parental disclosure of

15
23

ASAI & ASAI

their live-in parents.

Afifi, T. D., & McManus, T. (2010). Divorce

Third, as we used a saturated model to test thedisclosure and adolescents’ physical andhypothetical model, we could not showmental health and parental relationship quality.

goodness-of-fit. Since the saturation model is

Journal of Divorce and Remarriage, 51, 83-

completely dependent on a particular data set

107. doi:10.1080/10502550903455141.

and its properties, we should consider theAfifi, T. D., & Schrodt, P. (2003). Uncertainty

goodness-of-fit of the hypothetical model inand the avoidance of the state of one’s family

future studies.

in step families, postdivorce single-parent

Conclusionfamilies, and first-marriage families. Human

This study developed a P-DPD scale that
contains positive elements overlooked inprevious

studies,andhasCommunication

Research,

29,

516-532.

doi:10.1111/j.1468-2958.2003.tb00854.x.

demonstrated

Afifi, T. D., McManus, T., Hutchinson, S., &sufficient internal consistency. The scale shown

Baker, B. (2007). Inappropriate parental

that PPD indirectly enhanced children’s mental

divorce disclosures, the factors that prompt

health. These findings contribute to thethem, and their impact on parents’ andextension of the concept of P-DPD, which had

adolescents’

well-being.

Communication

previously been assumed to be negative. Further,monographs,

74,

78-102.

the development of this research will lead to thedoi:10.1080/03637750701196870.

identification of ways in which children can

Arditti, J. A. (1999). Rethinking relationships

develop good relationships with their separated

between divorced mothers and their children:and live-in parents after divorce.

Capitalizing on family strengths. Family
Relations, 48, 109-119. doi: 10.2307/585074.

Acknowledgements

Brodman, K., Erdmann, A. J., Lorge, I., Wolff,

This paper is part of the master thesis of theH. G., & Brondbent, T. H. (1949). The Cornell

first author. The authors would like to express

Medical Index: an adjunct to medical

their gratitude to the first author’s supervisor, Dr.

interview. Journal of the American Medical

Keizo Hasegawa, Professor Emeritus at Tohoku

Association,

University.

doi:10.1001/jama.1949.02900410026007.

140,

530-534.

Dolgin, K. G. (1996). Parent’s disclosure of their
References

own concerns to their adolescent children.

Afifi, T. D., & Afifi, W. A. (2009). Adolescents’

Personal Relationships, 3, 159-169.

physiological reactions to their parents’

Donovan, E. E., Thompson, C.M., LeFebvre, L.,negative disclosures about the other parent in& Tollision, A. C. (2016). Emerging adultdivorced and nondivorced families. Journal

confidants judgments of parental openness:of Divorce and Remarriage, 50, 517-540.

Disclosure

quality

doi:10.1080/10502550902970496.

relational

closeness.

andpost-disclosure
Communication

A PILOT STUDY TO ASSESS POSITIVE AND NEGATIVE
POST-DIVORCE PARENTAL DISCLOSURES

Monographs,

84,

179-199.

doi:10.1080/03637751.2015.1119867.

24
16

Itakura, N. (2010). Relationship between
indirect and direct communication between

Furstenberg, F. E., & Cherlin, A. (1991).

parents from their child’s point of view.

Divided Families. Harvard University Press.

Japanese Journal of Family Therapy, 27, 274-

Gately, D., & Schwebel, A. I. (1992). Favorable

283. (In Japanese with English abstract.)

outcomes in children after parental divorce.

Kang, Y., Ganong, L., Chapman, A., Coleman,

Journal of Divorce & Remarriage, 18, 57-78.

M., & Ko, K. (2017). Attitudes toward

doi:10.1300/J087v18n03_04.

parental

Golish, T. D. (2003). Stepfamily communication

disclosurestochildrenandadolescents by divorced and married parents.

strengths: Understanding the ties that bind.

FamilyRelation,

Human Communication Research, 29, 41-80.

doi:10.1111/fare.12278.

66,

839-853.

doi:10.1111/j.1468-2958.2003.tb00831.x.

Kang, Y., & Ganong, L. (2020). Divorced

Gumina, J. M. (2009). Communication of thefathers’ perceptions of parental disclosure todecisiontodivorce:A

retrospective

qualitative study. Journal of Divorce andRemarriage,50,

220-232.

doi:10.1080/10502550902717921.

children.

FamilyRelations,69, 36-50.

doi:10.1111/fare.12410.
Koerner, S. S., Jacobs, S. L., & Raymond. M.
(2000). When mothers turn to their adolescent

Hetherington, E. M. (1984). Stress and coping indaughters: Predicting daughters’ vulnerability

children and families. New Directions forto negative adjustment outcomes. FamilyChild Development, 24, 7-33.

Relations, 49, 301-309. doi:10.1111/j.1741-

Hetherington, E. M. (1989). Coping with familytransitions: Winners, losers, and survivors.
Child

Development,

60,

221-241.

doi:10.2307/1131066

3729.2000.00301.x.
Koerner, S. S., Wallace, S., Lehman, S. J., &Raymond, M. (2002). Mother-to-daughter
disclosure after divorce: Are there costs andHotta, K. (2005). Family systems and recovery

benefits? Journal of Child and Family Studies

processes in single-parent households: A

11, 469-483. doi:10.1023/A:1020987509405.

study of single-parent households with

Koerner, S. S., Wallace, S., Lehman, S. J., Lee,school-age boys. Journal of Japanese clinical

S. A., & Escalante, K. A. (2004). Sensitive

psychology, 23, 361-372. (In Japanese withmother-to-adolescent disclosure after divorce:

English abstract.)

Is the experience of sons different that of

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria
for fit indexes in covariance structuredaughters? Journal of Family Psychology, 18,
46-57. doi:10.1037/0893-3200.18.1.46.

analysis: Conventional criteria versus new

Ministry of Health, Labour and Welfare of Japan.

alternatives. Structural Equation Modeling: A(1997). Divorces from the view point of theMultidisciplinarysocioeconomic survey of vital statistics

Journal,6,

doi:10.1080/10705519909540118.

1-55.

(surveyed

in

FY

1997)

15
25

ASAI & ASAI

<https://www.mhlw.go.jp/www1/toukei/
rikon_8/repo11.html> (May 23, 2020.)
Ministry of Health, Labour and Welfare of Japan.

o_video/index.html> (May 23, 2020)
Toller, P. W., & McBride, M. C. (2013).
Enacting

privacy

rules

and

protecting(2017). Report on the results of thedisclosure recipients: Parents’ communication

nationwide

surveywith children following the death of family

households

inofsingle-parent

fiscal2016.

member. Journal of Family Communication,<https://www.mhlw.go.jp/stf/seisakunitsuite/

13,32-45.

bunya/0000188147.html> (May 23, 2020)

doi:10.1080/15267431.2012.742091.

Ministry of Health, Labour and Welfare of Japan.

Toda, K., Makino, T., & Sugawara, E. (2002).

(2018). Implementation status of the policy of

The relation of mental health, mental-physicalsupporting the self-reliance of a mother anddisorders, and family relationships in latefatherfamily.

adolescence. Bulletin of the Integrated Center<https://www.mhlw.go.jp/stf/houdou/000018

for Educational Research and Training,

9592_00001.html> (May 23, 2020)

Hokkaido University of Education, 3, 221-233.

from

a

singleparentMuthén, L. K., & Muthén, B. O. (2017). Mplus

Wallerstein, J. S. (1985). Children of divorce:user’s guide: eighth edition. Los Angeles,

Preliminary report of a ten-year follow-up of

CA: Author.

order child and adolescents. Journal of

Odagiri, N. (2005). A psychological study ofAmerican Academy of Child Psychiatry, 24,

children in divorced families. Journal of

545-553.

Applied Sociology, 15, 21-37. (In Japanese

7138(09)60055-8.

with English abstract.)
Odagiri, N. (2010). Divorce: To keep walking

doi:10.1016/S0002-

Wallerstein, J. S., & Kelly, J. B. (1975). The
effects of parental divorce: Experience of theforward, Science Inc. (In Japanese, translatedpreschoolby the author of this article.)

Academy of Child Psychiatry, 14, 600-616.

R Core Team (2019). R: A language andchild.

Journalof

Americandoi:10.1016/S0002-7138(09)61460-6.

environment for statistical computing. R

Yu, C. Y. (2002). Evaluating cutoff criteria ofFoundation for Statistical Computing, Vienna,model fit indices for latent variable models

Austria. <https://www.R-project.org/>.

with

Supreme Court of Japan. (2014). “ProtectingYour Children from Divorce Disputes.”<https://www.courts.go.jp/links/video/kodom

binaryandcontinuous

outcomes

Doctoral dissertation, University of California
Los Angeles.

International Journal of Brief Therapy and Family Science
2021 Vol. 11, No.1, 26-41< Original Paper: Research and Experiment or Case Report >Family Structure and Adolescent Eating Disorder Tendencies
Takahiro Kozuka 1) Atsushi Utsumi 2) Koubun Wakashima 3）Keisuke Shimizu 1)
1)

Graduate School of Education and Human Development, Nagoya University.

2)

Stress Care Clinic Lumeto.

3)

Graduate School of Education, Tohoku University.

ABSTRACT. The current study examined (a) the current status of eating problems (eating disorder tendencies: EDT) in Japaneseadolescents and (b) the association between adolescent EDT and a family structure consisting of three dyadic subsystems (marital,
father-adolescent, and mother-adolescent). Participants were 663 high school and university students (341 males and 322 females)in Japan who completed a self-report questionnaire. Survey results revealed that 19 out of 341 males (5.57%) and 53 out of 322
females (16.46%), or 72 out of 663 participants (10.86%) in the entire sample, were categorized as having EDT according to the
EAT-26. The male-to-female ratio of participants with EDT was 1 to 2.8. Many of the female adolescents with lower EAT-26 scores
had a highly cohesive family structure with a balance of power in all dyads. The current findings suggested that adolescent eatingproblems are related to an unbalanced family structure. The clinical implications of these findings for family therapy are discussed.
KEY WORDS: family structure, adolescent eating problems, eating disorder tendencies

serious health problems for adolescents.
Introduction

An eating disorder has no single cause andIn the field of psychosomatic disease, eating

develops as a result of the complex interaction

disorders are a prevalent stress reaction inof several factors; biological, psychological andadolescence (Garner & Garfinkel, 1997).

social factors all play a part (American

Adolescents with eating disorders have long

Psychiatricbeen treated with psychotherapy in Japan. A

Garfinkel, 1997). Some studies have claimed

core component of an eating disorder is athat family relationships play a significant role

fixation upon eating in relation to a distorted

as a risk factor for and as a factor protecting

body image. Eating disorders often develop in

against the development of eating disorders andthe teens to early 20s and are more prevalent ineatingfemales (American Psychiatric Association,

researchers have addressed this problem and2013). Anorexia nervosa (AN), bulimia nervosa

developed therapeutic techniques by examining(BN), and binge eating disorder (BED) are thethe association between family relationships

most common eating disorders and cause

and eating problems (e.g., Selvini-Palazzoli,

CORRESPONDENCE TO: Kozuka, K. Graduate School

1974; Minuchin, Rosman, & Baker, 1978; Fishof Education and Human Development, Nagoya University,& Schlanger, 1999).

Association,

problems.

Some2013; Garner &cliniciansandFuro-cho, Chikusa-ku, Nagoya, 464-8601, Japan

Previous studies involving clinical samples

e-mail: kozuka.takahiro@f.mbox.nagoya-u.ac.jp

took the approach that family relationships

26

27

Kozuka et al.

were related to recovery from and worsening of

problems

regardless

of

their

familyan eating disorder. For example, a good

relationships. The interaction between family

prognosis for an adolescent eating disorder isrelationships and adolescent eating problems

associated with improved family functioning

needs to be discussed.

(Woodside, Lackstrom, Shekter-Wolfson, &Adolescents with eating problems might not

Heinmaa, 1996) and a positive view of family

seek medical attention even though they haverelationships

Deimel,an eating disorder (Nakai, 2000, 2003, 2010;

Herpertz-Dahlman, Mattejat, & Remschmidt,

Nakai, Sato, Tamura, Sugiura, & Hayashi,

1996). From a therapeutic point of view, family

2003; Nakai, Sato, Tamura, Sugiura, & Hayashi,

therapy has been found to be particularly2004), so surveys of the general population are

effective in treating youth diagnosed with

important. Nakai et al. (2004), for example,

non-chronic AN (e.g., Minuchin et al., 1978;

reported that one-third to one-half of female

Russell, Szmukler, Dare, & Eisler, 1987;

adolescents and one-fifth of male adolescents

Stierlin & Weber, 1989).

had eating problems. Moreover, Nakai (2010)(Wewetzer,

However, the fact that adolescent eating
disordersarefamilyschool and university students in 1982, 1992,

relationships needs to be discussed. Garnerand 2002. Nakai reported that (1) the number of(1993) pointed out the vicious cycle in which

under-weight or over-weight adolescents, (2)symptoms are maintained through stressful life

the percentage of the adolescents desiring to beevents, dieting, and feedback from others,

thin, (3) eating problems, such as limited foodbasedintake, binge eating, and purging, (4) the

on

not

attributable

individual

factorstoconducted a large-scale survey of female high

such

as

psychological, genetic, physical, and biologicalfrequency

factors, dysfunctional family relationships, andestimated incidence of eating disorders all

cultural factors as evinced by a desire to be thin.

increased. Several studies also noted that an

In addition, Minuchin, Nichols, & Lee (2007)

eating disorder was likely to develop from aargued that the cyclical interaction of family

desire to diet (e.g. Kobayashi & Kurita, 2005).

relationships causes stress within the family

These findings suggest that typical female

that

response,

adolescents might develop an eating disorder

exacerbating an eating disorder in adolescents.

and that an eating disorder might prolong

Therefore, the pathology of an eating disordereating problems. Hence, eating problems are anin adolescents might be exacerbated by some

important subject that require a broader

specific family interactions or relationships

understanding of the psychological and social

based on personal vulnerability. Dysfunctional

context beyond the framework of a psychiatricfamily interactions and relationships might be adisorder, i.e. whether an eating problem meets

result of an eating disorder rather than a cause.

diagnostic criteria.

inducesaphysiologicalThus, some adolescents may have eatingof

amenorrhea,

and

(5)

the

As noted in the beginning of this paper,Family Structure and Adolescent Eating Disorder Tendencies

eating problems are a pathology that develops

violation

through the complex interaction of several

enmeshment of family members. Moreover,factors, such biological, psychological, andMinuchin et al. (2007) also argued that thesocial

Psychiatriccyclical interaction of family relationships

Association, 2013; Garner, 1997). Family

exacerbated illness, i.e. that stress within therelationships that adolescents encounter in theirfamilyeveryday lives and that continue throughout

Kobayashi & Kurita (2005) surveyed female

theirimportantadolescents and indicated that adolescents withenvironmental factors. When severe, eating

eating disorder tendencies (EDT) feel highly

problems are likely to threaten the lives ofstressed within interpersonal relationships,

adolescents, so family relationships are more ofincluding pressure from parents.

anfactors

lives

issue

(American

areparticularlyforadolescents.

Accordingly,

adolescenteatingproblems

negativefamilyrelationships

might

foster

of

that

28

boundary

exacerbatedled

symptoms.

In

to

the

Japan,

Several previous studies that investigated theassociation

betweenEDT

andfamily(Archibald,

relationships in non-clinical samples indicated

Linver, Graber, & Brooks-Gunn, 2002). In any

that authoritarian parents (Abrantes, Strong,case, the family relationships of adolescents

Ramsey, Lewinsohn, & Brown, 2006), unstablewith eating problems need to be examined tofamilyunderstand the process by which an eating

Newmark-Sztainer, Halcon, Campbell-Forrester,

problem develops and progresses and its&

prognosis and to facilitate prevention andrelationships (Byely, Archibald, Graber, &support.

Brooks-Gunn, 2000) were associated with EDT,

relationships

Blum,

2002)

(McGuire,orconflicted

Story,
familyMinuchin et al. (1978) is a leading study thatsuch as dieting and concern about one’s body

exhibited a comprehension of psychosomatic

image. In contrast, Mellin, Neumark-Szrainer,

disorders arising from the interaction of family

Story, Ireland, & Resnick (2002) found that

relationships and that described a theoreticalfamily cohesion suppressed unhealthy eating bysystem of treatment. Minuchin suggested thatobese adolescents. Several studies have focusedfamilies

on a single dyadic relationship, such as thedisordersofpatients

psychosomatic(1)

father-adolescent dyad or the mother-adolescentenmeshment, (2) parental over-involvement, (3)dyad. Kobayashi & Kurita (2005) reported thatrigidity, and (4) an inability to resolve conflicts,

adolescents with EDT received less social

andsupport from their fathers, and Katena, Imai, &

he

were

with

pointedcharacterizedbyout that a pattern

dysfunctional familyinteractionofpromoted

Shimazaki(2004)

noted

that

fathersomatization. He also proposed an important

over-involvement to some extent suppressed

concept of the boundary between sub-systems

the EDT of adolescents. A mother’s values,

such as the marital dyadic relationship or

appearance, or concern about her body typemother-child dyad, and he suggested that

(Mukai, 2010) and a mother’s attitudes about

27
29

Kozuka et al.

eating (Saito, 2004) were found to beboth males and females would be meaningful.

associated with adolescent EDT.

In addition, previous studies indicated that

Although previous studies focusing on theadolescent EDT was associated with stressors

association between family relationships andarising from trouble in the parent-adolescent

EDT

familyrelationship (Minuchin et al., 2007) or inside or

relationships, those studies merely examinedoutside of the family (Kobayashi & Kurita,

the association between EDT and a single dyad,2005). Kozuka (2011) examined each dyadic

such

the

relationship (marital, father-adolescent, andmother-child dyad. If one views a group, i.e.

mother-adolescent) in detail in non-clinicalthe family, as “a system based on complex

sample.

interactions” (e.g. Hasegawa, 1987), then dyads

relationshipsthat facilitate other dyads, i.e. the marital dyad

adolescents were, based on close cohesion in

facilitatingtheeach dyad, equal, i.e. each member had amother-child dyad, need to be examined

similar amount of influence. Previous studies

comprehensively and in detail.

found

noted

as

the

the

the

importancefather-childfather-child

of

dyad

dyad

or

or

Results

anindicated

generating

association

littlethatfamilystressbetweenforfamilyThus, the current study focuses on how

relationships and EDT (Abrantes et al., 2006;

adolescents view and experience relationships

McGuire et al., 2002; Byely et al., 2000; Mellinwith their family (Shimosaka, 1988; Katena etet al., 2002) and that adolescents perceiveal., 2004), and this study views the family as a

stressors inside or outside of the family

combination of three dyadic sub-systems(Minuchin et al., 2007; Kobayashi & Kurita,(marital dyad, father-adolescent dyad, and2005). Those findings were synthesized withmother-adolescent dyad) from an adolescent’s

the findings from Kozuka (2011), who found an

viewpoint. This study views EDT as an

association between family relationships andindication of adolescent maladaptation and it

stressors as perceived by adolescents, toexamines the association between EDT andformulate a hypothesis.

family structure.

The current study had 2 aims. The first was

Several recent studies investigated maleto investigate the current status of EDT inadolescent EDT (Hayano, 2002) and examinedJapanese adolescents. The second was to test

sex differences in the desire to be thin

the hypothesis that there are fewer adolescent(Uragami Kojima, Sawamiya, & Sakano, 2009).

EDT in a family with a highly cohesive

Hayano (2002), for instance, reported that thestructure and a balance of power and greater

ratio of males with EDT was one-third that ofadolescent EDT in a family with a less cohesive

females in a survey of 245 male university

structure and a power imbalance.

students.

Nevertheless,few

studieshavereported the current status of EDT in both

Methods

males and females. Thus, reporting EDT in

1. Participants and survey period

Family Structure and Adolescent Eating Disorder Tendencies

28
30

Seven hundred and fifty-five adolescents at 2

developed to conduct higher-level systems

high schools in the Tohoku region and 4

research on families. It can efficiently anduniversities in the Kanto, Tohoku, and Kansai

comprehensively

regions were surveyed. Questionnaires wererelationship in a family and depict each dyad

distributed 1) to high school students via their(marital,

classes or homeroom or 2) to university

mother-adolescent) as a single item with little

students during class. Participation in this study

burden for participants. The ICHIGEKI has

was voluntary. A total of 663 data sets,

demonstrated adequate validity (Noguchi et al.,excluding those with missing data and data2009). The ICHIGEKI has a four-factor

from single-parent families, were analyzed.

structure that includes cohesion, interests,

assesseach

dyadicfather-adolescent,andThe sample consisted of 333 high school

power, and openness. The current study used

students (197 males, 136 females) and 330

two of those factors, cohesion and power,

university students (144 males, 186 females).

because these were considered to be main

The mean age of the high school student

aspects in assessing family structure. Noguchi

sample was 16.62 years, SD = .73 (males: M =et al. (2009) reported that a single item on the

16.66, SD = .67; females: M = 16.5 years, SD

ICHIGEKI= .80). The mean age of the university student

cohesion and power as measured with multiple

sample was 20.03 years, SD = 1.57 (males: M =items (cohesion: r = .70; power: r = .52) and20.15 years, SD = 1.83; females: M = 19.93

that a single item had a certain level of validity.

years, SD = 1.33). The mean age of all

Noguchi et al. noted an inverse correlation

participants was 18.32 years, SD = 2.09 (males;

between interests and cohesion (r = -.54) andM = 18.13 years, SD = 2.16; females; M =viewed interests as a concept in contrast to

18.51 years, SD = 2.09).

cohesion. Therefore, interests were excluded

wascloselycorrelated

withfrom the current study because of the burden on
2. Measures

participants and the complexity of ascertaining

1) Demographic characteristics

each dyad. Openness indicates the relationships

Participants were asked to fill in their age,sex, and living arrangements (living with one’s
family,livingalone,

or

some

other

that family members have with people outside
the family and was similarly omitted.
Cohesion, a sub-scale of the ICHIGEKI,

arrangement).

indicates togetherness, intimacy, and a sense of2) Family structuresolidarity

in

each

dyad.

Cohesionwas

The Inventory for Character of Intra-Intermeasured on a six-point scale ranging from

Generation in Kinship (ICHIGEKI: Noguchi,“completely disagree” to “completely agree.”

Kozuka, Usami, & Wakashima, 2009) was used

Higher cohesion scores indicated a higher levelto assess the routine family structure asof cohesion in each dyad. Power, a sub-scale ofperceived by adolescents. The ICHIGEKI was

the ICHIGEKI, indicated the degree of27
31

Kozuka et al.

influence, one’s ability to speak, and one’s

avoid eating when I am hungry,” and “I findability to make decisions and was estimated onmyself preoccupied with food,” and responses

a six-point scale ranging from “completely

are given on a six-point scale ranging fromdisagree” to “completely agree.” Power was“always” to “never.” A response of 1, 2, or 3 isassessed in both directions in each dyad (sixgiven a score of 0, 4 is scored as 1, 5 is scoreddirections in total) to clarify who had power

as 2, and 6 is scored as 3. The cut-off score forover whom. Participants were asked to recall

all 26 items is 20 points. Nakai (2003)

routineareexamined the validity of the EAT-26 in aroutine/ordinary family relationships”) and to

Japanese sample and suggested that a score of

respond with a number. The higher the score for

15 points was an appropriate cut-off score in

power, the stronger the relative power in each

Japan. Therefore, a score of 15 points on the

dyad.

EAT-26 served as the cut-off score in the

3) EDT

current study.

situations(“whatyou

feel

In the current study, EDT were defined as
eating problems that nonetheless did not meet

Results

diagnostic criteria for an eating disorder.

1. Descriptive statistics

Adolescent EDT were estimated using the

Descriptive statistics for cohesion and power

Japanese version (Mukai, 2001) of the 26-item

assessed with the ICHIGEKI were examined in

Eating Attitudes Test (EAT-26) developed byeach dyad (marital, father-adolescent, andGarner et al., 1982. The EAT-26 has been usedmother-adolescent).

as a screening tool to differentiate healthy
individuals,

individuals

significant

eatingwithdisorder,aclinicallyandat-risk

The EAT-26 was scored using the scoring
method described earlier. The 25th item, “Ienjoy

tryingnewrich

foods”,

wasindividuals. The EAT-26 has been used toreverse-coded (Garner & Garfinkel, 1997).

assess severity in individuals with a clinically

Cronbach’s alpha coefficient is a measure ofsignificant eating disorder and to measure EDT

reliability and was α = .73 for all 26 items, so

in a sample consisting mostly of healthyadequate reliability was confirmed. Table 1

individuals (Mukai, Cargo & Shisslak, 1994).

shows the descriptive statistics for cohesion

The validity of this scale has been examined inandJapan (e.g. Mukai et al., 1994), and it has beenfather-adolescent, and mother-adolescent) andused to assess eating disorders and as an

EAT-26 scores.

indicatorofeatingproblems

in

power

in

studies

involving non-clinical samples (e.g. Mukai,2010).
The EAT-26 consists of 26 statements suchas “I am terrified about being overweight,” “I

2. Adolescent EDT

each

dyad

(marital,

Family Structure and Adolescent Eating Disorder Tendencies

28
32

Table 1. Descriptive Statistics for ICHIGEKI and EAT-26 (N = 663)
high school students
males
females(N= 197)(N= 136)

university students
males
females(N =144)(N =186)

M

SD

M

SD

M

SD

M

SD

between father and adolescent

3.81

1.32

3.71

1.53

3.72

1.24

3.65

1.41

between mother and adolescent

4.19

1.12

4.68

1.25

4.37

1.08

4.87

1.13

between father and mother

3.92

1.33

3.99

1.44

3.94

1.41

3.97

1.39

adolescent vs. father

2.91

1.30

3.35

1.35

3.09

1.13

3.20

1.28

adolescent vs. mother

3.23

1.25

3.29

1.23

3.49

1.18

3.58

1.20

father vs. adolescent

3.74

1.42

3.38

1.41

3.64

1.24

3.49

1.31

father vs. mother

3.44

1.39

3.39

1.33

3.51

1.45

3.66

1.36

mother vs. adolescent

3.89

1.19

4.10

1.12

3.73

1.22

3.99

1.17

mother vs. father

3.61

1.39

3.57

1.35

3.65

1.21

3.62

1.25

6.81

4.80

10.06

7.38

6.40

4.26

9.14

6.96

ICHIGEKI
cohesion

power

EAT-26

Based on the findings of Nakai (2003) as(6.25%) and 25 out of 186 females (13.44%),

were mentioned earlier, the cut-off score on theor 34 out of 330 participants (10.30%), were

EAT-26 was 15 points in the current study.

categorized as having higher EDT (higher

Participants with a score higher than 15 points

scores on the EAT-26). In the total sample, 19

were categorized as having higher EDT (higher

out of 341 males (5.57%) and 53 out of 322

scores on the EAT-26) and those who scoredfemales (16.46%), or 72 out of 663 participants

below 15 points were categorized as lower EDT(10.86%), were categorized as having higher(lower scores on the EAT-26). Table 2 shows

EDT (higher scores on the EAT-26). The

the grouping of high school students, university

male-to-female ratio overall was 1 to 2.8. The

students, and the total sample.

sex ratio in the high school student sample andIn the high school student sample, 10 out of
197 males (5.80%) and 28 out of 136 females

in the university student sample was similar tothat in the total sample.

(20.59%), or 38 out of 333 participants(11.41%), were categorized as having higher

3. Association between family structure andEDT (higher scores on the EAT-26). In theadolescent EDT

university student sample, 9 out of 144 males

27
33

Kozuka et al.

Table 2. Groupings based on Eat-26 Scores
EAT-26highlow

15 points or more

14 points or less

N

％

N

％

N

％

males

197

100.00

10

5.80

187

94.92

females136

100.00

28

20.59

108

79.41

total

333

100.00

38

11.41

295

88.59

high school students

The ratio of male to female participants with higher EAT-26 scores (higher EDT)

1 ： 2.8

university students
males

144

100.00

9

6.25

135

93.75

females186

100.00

25

13.44

161

86.56

total

330

100.00

34

10.30

296

89.70

The ratio of male to female participants with higher EAT-26 scores (higher EDT)

1 ： 2.8

whole
males

341

100.00

19

5.57

322

94.43

females322

100.00

53

16.46

269

83.54

total

663

100.00

72

10.86

591

89.14

The ratio of male to female participants with higher EAT-26 scores (higher EDT)

Family structures were classified in order toexaminetheassociation

between1 ： 2.8

from their family were excluded, and data on

family234 females (mean age: 18.24 years, SD =structure and adolescent EDT. There were

2.13) were analyzed. A Q-mode cluster analysis

marked sex differences in EDT according to theof the two sub-scale scores on the ICHIGEKI

EAT-26, so only female data were used. The

wasperformedforpercentage of males with higher EDT (higher

father-adolescent,andscores on the EAT-26) was less than 10%

dyads1 . The number of clusters were variedthemarital,mother-adolescentamong both high school and university students.
Given the frequency with which female
adolescents

routinelyinteract

with

their

families, those relationships were assumed toplay more of a role for female adolescentsliving with their families than those living apart.
Therefore, 88 females who living alone or apart

1

The score for power, a sub-scale of the ICHIGEKI
developed by Kozuka (2011), in the marital dyad was
obtained by subtracting the score for the mother vs. thefather from the score for the father vs. the mother.
Similarly, the score for power in the father-adolescent
dyad (and mother-adolescent dyad) was obtained bysubtracting the score for the score for the adolescent vs.
the father (mother) from the father (mother) vs. theadolescent. A higher score in the marital dyad indicateda more powerful father. A higher score for power in theFamily Structure and Adolescent Eating Disorder Tendencies

28
34

Figure 1. Profiles of Family Structures for 4 Clusters of Female Adolescents.
Note. CLU. 1 = a highly cohesive structure with a balance of power; CLU. 2 = a less cohesive
structure with a powerful father; CLU. 3 = a structure with average cohesion and a balance of power;
CLU. 4 = a structure with less mother-adolescent cohesion and a powerful mother.

from 2 to 5, and 4 distinct clusters weremother-adolescent cohesion was negative. The

identified. The number of participants in eachfather’s power in the marital dyad was morecluster and the interpretability of each cluster

than +.50SD, and the father’s power inwere examined. The results of cluster analysis

father-adolescent dyad was positive. Therefore,

are shown in Figure 1.

CLU. 2 was designated “a less cohesive

CLU. 1 consisted of 65 participants (28%)

structure with a powerful father.” CLU. 3

from the sample and was designated “a highly

consisted of 97 participants (41%) from thecohesive structure with a balance of power”

sample, and cohesion was average in all of the

because cohesion in each dyad was more

dyad. Adolescents had slightly more power inthan .50SD and power in each dyad was

the father-adolescent dyad, but power was

between -.50SD and +50SD, so it was almost

almost balanced in each dyad in comparison tobalanced in each dyad. CLU. 2 consisted of 54

the other clusters. Thus, CLU. 3 was designatedparticipants (28%) from the sample. In CLU. 2,“a structure with average cohesion and acohesion in the marital and father-adolescentbalance of power.” CLU. 4 was a small groupdyads

of 18 participants (8%) from the sample, and it

was

less

than

-1.00SD,andwasfather-adolescent dyad (or mother-adolescent dyad)
indicated a powerful father (or mother).

designated“astructure

with

less

mother-adolescent cohesion and a powerful

27
35

Kozuka et al.

Table 3. χ2 Test of EAT-26 Scores by Family Structure Cluster.

EAT-26

CLU.1

CLU.2

CLU.3

CLU.4

5

17

14

5

expected frequency

11.39

9.46

17.00

3.15

adjusted residual

-2.45

3.08

-1.05

1.19

60

37

83

13

expected frequency

53.61

44.54

80.00

14.85

adjusted residual

2.45

-3.08

1.05

-1.19

65

54

97

18

high frequency

low

41

frequency

193

total frequency

234

χ2

13.58(3）**p ＜.05Note. CLU. 1 = a highly cohesive structure with a balance of power; CLU. 2 = a less cohesive structure with apowerful father; CLU. 3 = a structure with average cohesion and a balance of power; CLU. 4 = a structure withless mother-adolescent cohesion and a powerful mother.

mother.”

In

CLU.

4,

mother-adolescent

5% level in terms of the ratio of the number ofcohesion was less than -1.00SD. The father’s

participants with higher EDT (higher scores on

power in the father-adolescent dyad was lessthe EAT-26) and participants with lower EDT

than -1.50SD, and the mother’s power in the(lower scores on the EAT-26) between clusters

mother-adolescentthan(χ2 (3) = 13.58, p = .05). Residual analysis+1.50SD. Roughly speaking, CLU. 1 has arevealed that the proportion of participants withhighly cohesive structure with a balance of

higher EDT (higher scores on the EAT-26) was

power, while the other clusters had a structure

significantly lower at the 5% level and that thewith a power imbalance and average or lessproportion of participants with lower EDT

cohesion. Although CLU. 3 is similar to CLU.

(lower scores on the EAT-26) was significantly

1, cohesion in each dyad was not particularly

higher at the 5% level in CLU. 1, which had astrong in CLU. 3.

highly cohesive structure with a balance of

dyad

was

more

A chi-square test was performed with the 4familystructureclusters

aspower.

In

contrast,

theproportionofindependent

participants with higher EDT (higher scores onvariables and a higher score or lower score on

the EAT-26) was significantly higher at the 1%

the EAT-26 as a dependent variable (Table 3).

level in CLU. 2, which had a less cohesive

Results revealed significant differences at thestructure with a powerful father. In the otherFamily Structure and Adolescent Eating Disorder Tendencies

28
36

clusters, there were no associations between

contrast, 5.57% of male adolescents (19 out offamily structure and EDT.

341 males) had higher EDT (higher scores on
the EAT-26). Although a simple comparison of

Discussion

these data is not possible because few studies

This study had 2 aims. The first was to reveal

have examined male EDT, a number of malethe state of EDT in Japanese adolescents. The

high school or university students have EDT. ,second was to examine the association between

The male-to-female ratio was all 1 to 2.8 forfamily structure and EDT. The following

high school students, university students, andhypothesis was tested: fewer adolescent EDT in

the total sample. Epidemiological studies ofa highly cohesive family with a balance of

eating disorders in males have reported a

power and greater adolescent EDT in a lessprevalence of one-twentieth to one-tenth that incohesive family with a power imbalance.

females (American Psychiatric Association,2013). When adolescent eating problems are

1. Adolescent EDT

viewed as a pathology, there is an extremely

In this study, 53 out of 322 female

marked sex difference in prevalence. Whenadolescents (16.46%) were classified as having

those problems are viewed as EDT, however,higher EDT (higher scores on the EAT-26)

their prevalence in males is about one-third thatbased on a total score of 15 points or higher onin females. This suggests that eating problems

the EAT-26. Nakai (2003) used a cut-off score

definitely exist in males as well as in females.

of 15 points on the EAT-26 and found that

Hence, a certain percentage of male and female

14.8% of 961 females ages 15 to 35 years had aadolescents have some form of eating problem,

score above 15 points. Even though the current

regardless of whether they are seen at a medical

results are about 2% higher than those of Nakai

facility or whether or not they are diagnosed(2003), the current findings seem to be almost

with an eating disorder. Eating problems need

the same as those of Nakai (2003) given theto be investigated in non-clinical samples

difference in sample sizes. Thus, these results

including males and females.

suggest that a certain percentage of adolescents
have eating problems.

2. Family structure and adolescent EDT

However, a look at the current sample in

Family structure was classified using cluster

detail indicates that 20.59% of 136 female

analysis and differences in EDT by type ofschool students and 13.44% of 186 femalefamily structure were examined in order touniversity students had higher EDT (higher

reveal the association between family structure

scores on the EAT-26). The percentage of highand adolescent EDT. In CLU. 1, which had aschool students, that is, young people, ishigh cohesive structure with a balance of power,

seemingly higher even when the sample size or

the ratio of participants with higher EDT

sample population is taken into account. In(higher scores on the EAT-26) was lower and27
37

Kozuka et al.

the ratio of participants with lower EDT (lower

their parents, instead of parents being able toscores on the EAT-26) was higher than in theunilaterally influence adolescents, based on aother clusters. In CLU. 2, which had a lesshighly cohesive marital dyadic relationship ascohesive structure with a powerful father, thewell as a highly cohesive parent-adolescentratio of participants with higher EDT (higher

dyadic relationship.

scores on the EAT-26) was higher and the ratio

There were significant differences in theof participants with lower EDT (lower scores

ratio of adolescent EDT among the 4 types ofon the EAT-26) was lower than in the otherfamily structures identified in this study. An

clusters. CLU. 1 is a family structure with aassociation between family structure and EDT

balance of power among the adolescent, mother,was suggested, but all of the family structuresand father based on a higher level of cohesion

had adolescents with higher EDT (higher scoresin all 3 dyads. In contrast, CLU. 2 is a familyon the EAT-26). This implies that the nature ofstructure with a powerful father based on a low

a family’s structure or the nature of each dyadic

level of cohesion. Therefore, families of female

relationshipadolescents with fewer EDT are intimately

adolescent eating problems. Negative family

connected. In addition, a high level of cohesion,

structures (e.g. less cohesion with a power

particularly in the marital and father-adolescentimbalance) can also presumably arise because

dyads, and an equal relationship, i.e. eachan adolescent has eating problems. Eating

member has the same level of influence,

problems are likely to put an adolescent’s life at

suppress adolescent eating problems. Theserisk,

results generally support the hypothesis put

interactions. There is less cohesion in eachforward. Hence, the current results imply that a

dyad and parents are forced to wield power.

highly cohesive family structure with a balance

The current study was unable to determineof power indicate perceived stressors as well as

whether there is a cause-and-effect between

adolescent maladaptation in the form of EDT

family structure and EDT. At the current point(Kozuka, 2011). Moreover, the current findingsin time, however, one can reasonably view

indicate that family cohesion helps to suppress

adolescent eating problems as varying witheating problems in the general population likefamily structure and one can view interaction

high school or university students and to

between adolescents and family members as the

suppress unhealthy eating by obese adolescents

issue. Regardless, the current results suggest

as

that

reportedbyMellinetal.

(2002).

doessuggesting

familynotnecessarily

moremarkedrelationships

arefactors

associatedcause

familysignificant

Consequently, the current findings suggest thatenvironmental

the nature of family relationships is associatedadolescent eating problems and that certain

withfamily relationships are likely to suppress thoseanadolescent’s

problems

duringadolescence. The current results also suggestthat adolescents need to be able to influence

problems.

withFamily Structure and Adolescent Eating Disorder Tendencies

3. Clinical implications

28
38

female sample because of limitations on the

During a session with family members of ansample size. Therefore, future studies should

adolescent with EDT, some clinicians andexamine the current findings in light of sex

researchers have pointed out therapists should

differences. In addition, future studies shouldintervene by clarifying the boundary between

take account of information such as height,

sub-systems (e.g., Minuchin et al., 1978). They

weight, and menstruation in order to examine

suggested that a clear boundary enables

the potential for adolescent eating problems toadolescents to express their thoughts andcreate negative family structures. The current

feelings and interact with their parents and thatstudy used a non-clinical sample to identify

it creates a hierarchical structure that parents

eating problems in the general population.

can lead. However, the current results suggest

Future studies should also consider whether

that therapists should increase cohesion in each

EDT are an extension of eating disorders anddyad and work on the power relationshipthen examine differences between clinicalbetween parents and the adolescent rather thansamples and non-clinical samples in detail.

intervening in the boundary between dyadic
sub-systems. When an adolescent exhibits

Acknowledgements

unhealthy eating, parental action to stop it

This study was conducted as part of amight weaken cohesion in each dyad and create

doctoral thesis submitted to the Graduate

a family structure with a power imbalance.

School of Education, Tohoku University, with

When family cohesion is maintained and an

additions and revisions. In addition, this study

adolescent has less power, therapists need towasintervene in the family structure to allow the

Grant-in-Aid (22・7245) for a JSPS Researchadolescent to make decisions and influence

Fellow.

supported

by

a

JSPS

KAKENHIfellow family members, i.e. having family
members

respecttheautonomy

andReference

decision-making ability of the adolescent.

Abrantes, A. M., Strong, D. R., Ramsey, S. E.,

Problems faced by adolescents have become

Lewinsohn, P. M., & Brown, R. A. (2006).

more complex over the past few years. Given

Characteristics of dieting and nondieting

its applicability in clinical settings, examining

adolescents in a psychiatric inpatient setting.

the association between family structure andJournal of Child and Family Studies, 15(4),adolescent EDT is essential to resolving those419-433.

problems and helping adolescents.

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental

4. Topics for the futureThis study examined the association between
adolescent EDT and family structure in only adisorders (5th ed). Arlington, VA: American
Psychiatric Publishing.
Archibald, A. B., Linver, M. R., Graber, J. A.,27
39

Kozuka et al.

& Brooks-Gunn, J. (2002). Parent-adolescent32-41. [in Japanese] (嘉手納悟・今井章・嶋relationships and girls’ unhealthy eating:

崎裕志 (2004). 女子学生における家族関

Testing

係と摂食障害傾向

reciprocal

effects.

Journalof

Research on Adolescence, 12(4), 451-461.

健康心理学研究, 17,

32-41.)

Byely, L., Archibald, A. B., Graber, J., &Kobayashi, Y. & Kurita, H. (2005). A

Brooks-Gunn, J. (2000). A prospective study

relationship between a tendency towardof familial and social influences on girls’

eating disorders and eating behavior andbodystress in female high school students: The

image anddieting. International

Journal of Eating Disorders, 11, 51-164.

background of extreme dieting behavior,

Fisch, R., & Schlanger, K. (1999). Brief

stress and stress coping. Clinical psychiatry,therapy with intimidating cases: Changing

47 (10), 1053-1062. [in Japanese] (小林由美

the unchangeable. San Francisco, CA:子・栗田廣 (2005). 女子高校生におけるJossey-Bass.

摂食障害傾向と食行動・ストレスとの関

Garner, D. M. (1993). Pathogenesis of anorexia
nervosa. The Lancet, 341, 1631-1635.

連

精神医学, 47(10), 1053-1062.)

Kozuka, T. (2011). Family structure andGarner, D. M. & Garfinkel, P.E. (1997).

communicationinadolescence:

Handbook of treatment for eating disorders“Examination with family stress”. Japanese(2nd ed). New York, NY: Guilford Press.

Journal of Family Psychology, 25 (1), 30-44.

Garner, D. M., Olmsted, M. P., Bohr, Y., &[in Japanese] (狐塚貴博 (2011). 青年期にGarfinkel, P. E. (1982). The eating attitudes

おける家族構造と家族コミュニケーショ

test:

ンに関する研究－青年の認知する家族内

psychometricfeatureandclinicalcorrelates. Psychological Medicine,

ストレスからの検討－

12(4), 871-878.

25 (1), 30-44.)

Hasegawa,

K.

(1987).

Paradoxandconstructivism. Tokyo: Saikosyobo.

家族心理学研究,

McGuire, M. T., Story, M., Newmark-Sztainer,
D., Halcon, L., Campbell-Forrester, S., &Hayao, H. (2002). A psychological study on

Blum, R.W.M. (2002). Prevalence andeating disorder tendency of male college

correlated weight-control behaviors among

students. Journal of Japanese Clinicalcaribbean adolescent students. Journal of

Psychology, 20 (1), 44-51. [in Japanese] (早Adolescent Health, 31, 208-211.

野洋美

2002 男子大学生の摂食障害傾向に関する心理学的研究

心理臨床学研究, 20 (1), 44-51.)

Mellin, A. E., Neumark-Szrainer, D., Story, M.,
Ireland, M., & Resnick, M. D. (2002).
Unhealthy

behaviorsandpsychosocial

Katena, S., Imai, A., & Shimazaki, Y. (2004).

difficulties among overweight adolescents:

Parent-child relationships of eating disorders

The potential impact of familial factors.

prone

Journal of Adolescent Health, 31, 145-153.

femaleuniversity

students.

The

Japanese Journal of Health Psychology, 17,

Minuchin, S., Rosman, B. L., and Baker, L.

Family Structure and Adolescent Eating Disorder Tendencies

28
40(1978). Psychosomatic families: anorexia

disorders among female college stuents

nervosa in context. Cambridge, CA: Harvard

during past 20 years. Clinical psychiatry, 45

University Press.

(12), 1319-1322. [in Japanese] (中井義勝・

Minuchin, S., Nichols, M. P. and Lee, W. Y.

佐藤益子・田村和子・杉浦まり子・林純(2007). Assessing families and couples: from子 (2003). 大学と短大の女子学生を対象

symptom to system. Boston, MA: Allyn andとした過去 20 年間における摂食障害のBacon.

実態の推移

Mukai, T. (2010). Maternal correlates of

精 神 医 学 , 45 (12),1319-1322.)

adolescent girls’ eating disorder tendencies.

Nakai, Y., Sato, M., Tamura, K., Sugiura, M.,

Journal of Human Environmental Studies, 8&Hayashi, J. (2004). Survey of eating(2), 97-103. [in Japanese] (向井隆代 (2010).

disorders in junior high school, high school

母と娘と摂食障害傾向－娘の思春期とのand university. Clinical psychiatry, 46 (12),

人間環境学研究, 8 (2),1269-1273. [in Japanese] (中井義勝・佐藤関連において－97-103.)

益子・田村和子・杉浦まり子・林純子

Mukai, T., Cargo, M., & Shisslak, C. M. (1994).

(2004). 中学生，高校生，大学生を対象

Eating attitudes and weight preoccupationとした身体像と食行動および摂食障害

among female high school students in Japan.

の実態調査

Journal of Child Psychology and Psychiatry,1269-1273.

35, 677-688.

精 神 医 学 , 46 (12),Noguchi, S., Kozuka, T., Usami, T., &Nakai, Y. (2000). Epidemiology of eating

Wakashima, K. (2009). Development anddisorders. Psychosomatic medicine, 4, 1-9.

Examination of Validity for a Family[in Japanese] (中井義勝 (2000). 摂食障害

Structure Assessment Scale “ICHIGEKI”.

の疫学 心療内科, 4, 1-9.)

AnnualNakai, Y. (2003). Validity of eating attitudes

Report,Education,

TohokuGraduate

SchoolUniversity,

58

of
(1),

test (EAT). Clinical psychiatry, 45 (2),247-265. [in Japanese] (野口修司・狐塚貴

161-165. [in Japanese] (中井義勝 (2003).

博・宇佐美貴章・若島孔文 (2009). 家族

Eating attitudes test (EAT)の妥当性につい

構造測定尺度－ICHIGEKI－の作成と妥て精神医学, 45 (2), 161-165.)

当性の検討

Nakai, Y. (2010). Change of prevalence of
eatingdisordersandeating東北大学大学院教育学研究

科研究年報, 58 (1)，247-266.)

disorderSaito, T. (2004). Influence of family eating

symptoms. Clinical psychiatry, 52 (4),habits and attitudes on eating disorder.

379-383. [in Japanese] (中井義勝 (2010).

Japanese Journal of Family Psychology, 18

摂食障害発症頻度と摂食障害関連症状の(1), 43-55. [in Japanese] (齋藤千鶴 (2004).

時代的変化 精神医学, 52 (4), 379-383.)

女子大学生の摂食障害傾向に及ぼす家族

Nakai, Y., Sato, M., Tamura, K., Sugiura, M.,&Hayashi, J. (2003). Change of eatingの食事文化の影響
43-55.

家族心理学研究, 1,27
41

Kozuka et al.

Selvini-Palazzoli, M. (1974). Self-starvation:
From individual to family therapy in thetreatment of anorexia nervosa. New York,
NY: Jason Aronson.
Russell, G. F., Szmukler, G. I., Dare, C., &Eisler, I. (1987). An evaluation of family
therapy in anorexia nervosa and bulimia
nervosa. Archive of general Psychiatry,
44(12), 1047-1056.
Shimosaka. K. (1988). Anorexia nervosaronkou. Tokyo: Kongoshuppan. [in Japanese](下坂幸三 (1988). アノレクシア・ネルヴ
ォーザ論考 金剛出版)
Stierlin, H. & Weber, G. (1989). Unlocking thefamily door: A systemic approach to theunderstanding and treatment of anorexia
nervosa.

New

York:

Brunner/Mazel

Publishers.
Uragami, R., Kojima, Y., Sawamiya, Y., &Sakano, Y. (2009). Drive for Thinness in
Adolescent Males. Japanese Journal of
Educational Psychology, 57 (3), 263-273. [inJapanese] (浦上涼子・小島弥生・沢宮容子・坂野雄二 (2009). 男子青年における痩身願望についての研究

教育心理学研究, 57 (3), 263-273.)
Wewetzer, C., Deimel, W., Herpertz-Dahlman,
B., Mattejat, F., & Remschmidt, H. (1996).
Follow-up investigation of family relations
in patients with anorexia nervosa. European
Child & Adolescent Psychiatry, 5, 18-24.
Woodside,D.

B.,

Lackstrom,J.

Shekter-Wolfson, L., & Heinmaa, M. (1996).
Long-term follow-up of patient-reported
family functioning in eating disorders after
intensive day hospital treatment. Journal of

Psychosomatic Research, 41(3), 269-277.

International Journal of Brief Therapy and Family Science
2021 Vol. 11, No.1, 42-57< Original Paper: Research and Experiment >The relationship between fear of COVID-19 and coping behaviors in Japanese university students
Gen Takagi1) Koubun Wakashima2) Kohei Sato3) Michiko Ikuta4) Ryoko Hanada5) Taku Hiraizumi1)
1)

Tohoku Fukushi University, Sendai, Japan

2)

Tohoku University Sendai, Japan

3)

Yamagata University Yamagata, Japan

4)

Kanagawa University of Human Services, Japan

5)

Tokyo Woman's Christian University Tokyo, Japan

ABSTRACT. COVID-19 is spreading all over the world, causing various social problems. The purpose of this study was to investigate
the effects of fear of COVID-19 on the coping behavior of university students. 300 Japanese university students responded to thequestionnaire. The results indicated that those who had a high fear of COVID-19 and emphasized tuning into others were more likely
to adopt the coping behaviors of avoidance of contact and stockpiling, while those who emphasized self-determination were more
likely to adopt the coping behaviors of avoidance of contact and focus on health care.
KEY WORDS: Fear of COVID-19, University students, Coping behavior

Subsequently, the number of infected people
Introduction

among Japanese who had not travelled to Wuhan

In December 2019, a novel coronavirus

City increased, and the infection spread(COVID-19) was discovered in the city ofthroughout the country, mainly in Tokyo andWuhan in Hubei Province of China (World

Osaka. On April 16, 2020, the Japanese

Health Organization, 2020b). As of June 23,

government declared a national state of 42

2020, COVID-19 continued to spread on a

emergencies. The declaration of the state ofglobal scale, infecting more than 8,860,331

emergency led to major changes, such as

people in 216 countries and killing 465,740

refraining from going out of the houseindividuals (World Health Organization, 2020a).

unnecessarily, shifting to work at home, andOn January 16, 2020, the first case of COVID-

closing schools. These social changes have

19 infection with a history of stay in Wuhan wasmade people anxious, and in Japan, people areconfirmed in Japan (Minister of Health, Labour

buying a lot of face masks and sanitizers

and Welfare, 2020a).

(stockpiling) (Asahi Shimbun Digital, 2020a).
Due to some people stockpiling more than

CORRESPONDENCE TO: Takagi, G. the department ofnecessary to prevent infection, there were many

wellbeing psychology, A Tohoku Fukushi University, 1-8-1

people who could not get the products even

Kunimi, Aoba-ku, Sendai, 981-8522, Japan.

though the supply should have been sufficient.

e-mail: g-takagi@tfu-mail.tfu.ac.jp

In the absence of accurate information about the
supply of products and effective preventive

42

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Takagi et al.

measures, it can be said that it is a natural

re-testing methods. In addition, the validity ofreaction to become fearful and over-prepared. In

the scale was confirmed by positive correlations

fact, Yıldırım et al. (2021) showed thatwith depression anxiety and awareness ofvulnerability, risk perception, and fear ofvulnerability to infection. Therefore, the FCV-

infection

behaviors.

19S is a valid tool for assessing fear of COVID-

However, this phenomenon is an issue that needs

19. And Wakashima et al. (2020) developed ato be resolved in order to fight infectious

Japanese version of FCV-19S and confirmed its

diseases more effectively.

validity and reliability. Therefore, in the present

increasepreventive

From the point of view of Yıldırım et al.

study, we used this scale to examine the effect of(2021), fear is expected to have a positive aspect

fear of COVID-19 on coping behavior, focusing

in terms of increasing preventive behaviors, buton the reasons for the behavior.

it cannot be denied that under certain conditions,

In this study, university students wereit may increase inappropriate behaviors based on

surveyed. The reason for this is that it has been

misinformation. Therefore, it is necessary topointed out that a certain number of university

examine what factors cause inappropriate

students are negatively affected psychologicallybehaviors such as excessive stockpiling. In thisby the Corona disaster. For example, Cao et al.

study, we examined whether fear-induced(2020) indicate that about 24.9% of college

behaviors

copingstudents have experienced anxiety because of

behaviors such as hand washing and avoiding

the COVID-19 outbreak. In addition, Shun et al.

crowds, or inappropriate coping behaviors such

(2021) reported that 67.05% of Chinese

as excessive stockpiling, focusing on the reasons

university students exhibited traumatic stress,

for the coping behaviors. While it is difficult to46.73% depressive symptoms, 34.73% anxiety

change fear and risk perception, which havesymptoms, and 19.56% suicidal thoughts while

been pointed out to be related to preventive

being forcibly isolated from interpersonal

behaviors, the reasons for these behaviors arecontact. From the above, university students arefactors that can be easily changed by providing

negatively affected by the coronary disaster, andcorrect information and improving literacy. By

it is important to understand the actual situation

showing that reasons mediate the effects of fear

regarding the psychological responses shown byon coping behavior, it is possible to reduce theJapanese university students.

lead

to

recommended

inappropriate coping behavior of over-stocking

On the other hand, not all university students

by intervening with a focus on the reasons forare negatively affected by the coronary disaster,

the behavior, even if fear is high.

and some students may be unaffected under

Ahorsu (2020) developed the Fear of COVID-

certain conditions. Cao et al. (2020) showed that19 Scale (FCV-19S) to measure the fear ofliving in an urban area, living with parents, and

COVID-19. The reliability of this scale washaving a stable household income inhibited theconfirmed in terms of internal consistency andlikelihood of university students experiencing

The relationship between fear of COVID-19 and coping behaviors

44

anxiety during a COVID-19 outbreak. In

terminated from the survey. Those who

contrast, having relatives or acquaintances who

withdrew from responding to the survey were

were infected with COVID-19 was shown toalso excluded from the survey.

increase the likelihood of experiencing anxiety.

The

participants

included

six

whose

It was also shown to be associated with financial

nationality was not Japanese and one whose age

stress, social prejudice, and serious symptoms of

was over 50 years old. Seven individuals were

threat to COVID-19, especially by COVID-19

excluded from the analysis in this study because(Shun et al., 2021). Furthermore, Yıldırım et al.

differences in nationality and a large age gap(2021) pointed out the influence of gender on

were thought to reduce the homogeneity of thefear, indicating that women are more vulnerable

sample. The respondents of the analysis (52 men

to infection, higher perceived risk, higher fear,and 248 women) were in their 18 to 20s with anand more preventive behaviors than men. Until

average age of 19.80 years (SD = 1.36) and were

now, there has been no study that has

Japanese undergraduate and graduate students

investigated the actual state of fear of COVID-

living in Japan. All had agreed to cooperate with

19 in Japanese university students. In the present

the survey. The survey questionnaire wasstudy, we examined the effects of fear ofadministered in May 10 and June 14, 2020.

COVID-19 on coping behaviors, focusing on the

Ethical Consideration

reasons for the behaviors, among Japanese

The first section of the survey stated theuniversity students. We also examined the

purpose of the survey, that participation wasconditions that inhibit or enhance fear.

voluntary, and that the survey was anonymousand personal information would not be disclosed

Methods

to third parties. Additionally, the Tohoku

Procedure

University Graduate School of Education’s

The study used an internet-based survey based

ethics committee granted ethical approval foron Survey Monkey. Informed consent was

this study (ID: 20-1-003).

provided through an online text. The first section

Survey Descriptionof the survey stated the purpose of the survey,

Attributes of the respondents: The surveythat participation was voluntary, and that thequestionnaire asked the sex, age, nationality, andsurveypersonal

residential area (city and prefecture) of each

information would not be disclosed to third

respondent as a free answer. This item wasparties. After confirming everything about thefollowed by a multiple-choice question asking

survey description, they were asked if they

about the respondents’ health condition at theagreed to cooperate with the survey. Only thosetime, which allowed for responses of 1 = "in

who agreed to cooperate in the survey would benormal condition," 2 = "having a fever of 37.5˚Cable to proceed to the questionnaire. On theor higher," 3 = "having a sore throat," 4 =other hand, those who did not agree were

"having a deep fatigue," 5 = "having a cough,"wasanonymous

and

43
45

Takagi et al.

and 6 = "having other symptoms" (Minister offinancially deprived," and "I am satisfied with

Health, Labour and Welfare, 2020b). The

the support I am receiving from the university"

subsequent analysis combined answers thaton a scale of 1="not at all" to 5="very satisfied".

included at least one from choices 3 through 6

The analysis used format of university classes,

into one group and made three groups, including

main means of transportation as their state of

1 = "in normal condition," 2 = "having a fever ofuniversity and life style.

37.5˚ or higher," and 3 = "having other

Family composition: Respondents were asked

symptoms." The next question categorized theabout the number of family members living withdiseases being treated at the time into respiratory

them, their relation to the respondents, their ages,

diseases, mental disorders (anxiety disorder,whether they had respiratory or other diseases,

depression, and other mental disorders), andtheir smoking history, and their pregnancy status

other diseases. Respondents who reported(only female family members living with thehaving a disease were asked to provide the namerespondents), In addition, the respondents wereof the disease using an open-ended questionnaire,

asked about changes in the amount ofand based on this information, they wereconversations and conflict of opinions in theclassified into three categories: 1=respiratory,

family living together in the last month. The

2=mental, and 3=other. Those who reported ananalysis used format of whether they live with

illness but did not respond appropriately to thefamily as their state of family.

disease under treatment, such as "none" in the
open-ended

answer,

were

coded

as

Sources of information about COVID-19:

0.

Respondents were asked a multiple-choice

Subsequent questions asked all respondents

question about media that they regarded as awhether they smoked. All respondents to thisvaluable source of information about COVID-19.

survey were Japanese university students. The

They were also asked to rank such information

analysis used sex, age, health condition, diseasesources from the first to the third based on theirstatus, and smoke status at the time as theirimportance. Specific sources of information

attributes.

indicated in the answers were 1= newspaper, 2 =The state of university and life style:Participants

respondedtothenews on TV, 3 = talk shows on television, 4 =following

websites of public organizations, 5 = news onquestions about their university and lifestyle.

the internet, 6 = Twitter, 7 = Facebook, 8 =They were asked about the timing of the start ofInstagram, 9 = other social networking services

university classes, the format of university("SNS"), and 10 = other media. The analysis

classes, their readiness to take online classes,

used only the most prioritized information

main means of transportation, their exercise

sources and combined choices 6–9 into a single

habits, and their waking and sleeping times.

group called "SNS".

Respondents responded to the three items "I

Presence of persons infected with COVID-19

have the necessary environment to study," "I amaround the respondents: Respondents were

The relationship between fear of COVID-19 and coping behaviors

44
46

asked whether anyone with whom they were(very much). The coping behaviors against

acquainted had contracted COVID-19. Any

COVID-19 measured by these items include

respondent acquainted with an infected person

behaviors to prevent oneself from being infected

was asked to describe their relationship. To

and to prevent others from being infected, asassess the status of COVID-19 infection around

well as behaviors necessary for daily life in thethe respondents, the survey asked whether an

event of coronary disasters.

infected person was 1 = "in the same prefecture,"

Reason for behavior: Respondents were asked

2 = "in the same municipality," or 3 = "in theabout reason for coping behavior againstsame district" as the respondents or 4 = no one

COVID-19. Wakashima et al. (2020) produced 7

was infected around them. The analysis

items to measure the reason for the coping

combined answers 1 through 3 into one group

behavior against COVID-19 based on twoand labelled it 1 = "there is an infected person

perspectives which one is proactive reasons (e.g.,

nearby," and those who answered 4 labelled as 0

“I did it because I felt it was necessary for= "there is no infected person nearby."

myself”) and another one is passive reasons (e.g.,

Measuring a fear of COVID-19: The study“I did it because other people told me to”). Each

used a Japanese version of the Fear of COVID-

of these 7 items was rated on a six-point scale

19

ranging from 1 (not applicable at all) to 6 (highly

Scale("FCV-19S-J")

developedbyWakashima et al. (2020) The Japanese version

applicable).

of the scale that was completed consisted ofgive reasons for their coping behavior toward

seven items in the same manner as the original.

COVID-19

FCV-19S-J asks questions to be answered on a

respondents did not answer the reasons for eachscale of 1 = "I am not afraid of COVID-19 at all"coping behavior, but answered the seven items

to 5 = "I am most afraid of COVID-19." A higherthat asked for reasons once.

score reflects a greater a fear of COVID-19.

Data analysis

Copingbehavior

againstThese items asked respondents toingeneral.

Therefore,

the

COVID-19:

Statistical operations were conducted using

Respondents were asked about their coping

software (SPSS 23.0 and JASP 0.12.2). For

behavior against COVID-19. Wakashima et al.

confirmatory factor analysis (CFA), a robust(2020) produced 19 items to measure the coping

maximum likelihood estimator (MLR) was

behavior against COVID-19 based on the reportapplied in this study. To test goodness of fit, weof the Ministry of Health, Labour and Welfare

conducted the following analyses: comparative(2020c) and article on social issues (Asahi

fit index (CFI), root mean square error of

Shimbun Digital, 2020b). In this study, we usedapproximation (RMSEA), standardized root

the 19 items developed by Wakashima et al.

mean square residual (SRMR) and Bayesian(2020) as a scale of coping behavior against

information criterion (BIC). The cut-off values

COVID-19. Each of these 19 items was rated on

for acceptable model fit used for this study were:a six-point scale ranging from 1 (not at all) to 6

RMSEA < .10 for acceptable fit and < .06 for43
47

Takagi et al.

good fit; CFI > .90 for acceptable fit and >.95 forResults indicated that the modified model

good fit; and SRMR < .10 for acceptable fit and(Model 2) was more acceptable (CFI = .960,< .08 for good fit (Hu and Bentler, 1999; Kline,

RMSEA = .098, SRMR = .053). This was the2011). In exploratory factor analyses (EFA),

final model. The reliability coefficients were

MLR and goemin rotation was applied foralso high (a=.84) and indicted sufficient internal

coping behavior and reason for behavior. We

consistency.

removed items with factor loadings lower

Participants' basic characteristics

than

.35.

Cronbach’s

McDonald’s

omega

alpha

coefficients,

coefficients,

Table

2

shows

participants'

basic

and

characteristics. The present study had 300

correlations between the FCV-19S-J and otherparticipants, mostly women (82%). The results

measures were established by calculatingof the t-test and one-way analysis of variance

Pearson ’ s correlation coefficients. Reported

showed that women scored higher on theeffect sizes are interpreted using Cohen’s d andFCV-19S-J than men. This indicates that womenh2,intervals,

have a stronger fear of COVID-19. As forrespectively. All statistical analyses used two-corona-related symptoms, no one has a fever oftailed tests. For all statistical evaluations, p

37.5˚C or higher, and those who reported having

values less than .05 were considered indicative

other symptoms also had a low percentage

of significant differences. The missing values(4.3%). 95.7% of people are as usual, and thewere visible only in age. Therefore, pairwise

impact of COVID-19 on physical condition

deletion was used for missing data.

among university students is limited. No

including95%

confidence

significant differences were obtained for fear of
Results

COVID-19 due to symptoms. Regarding the

Reliability and validity of Japanese FCV-19S-J

diseasefor university student

respondents

undertreatment,

answered

92.3%"None",

of

the

2.3%

for

Confirmatory factor analyses, as described by"Respiratory", 1.7% for "Mental", and 3.7% forAhorsu et al. (2020), were used to examine the"Other". There was significant difference in fear

goodness of fit. Results showed that the FCV-

of COVID-19 by disease under treatment.

19S-J did not fit well (Table 1).

However, the results of multiple comparisons

To improve the model fit, modification

showed no significant differences between theindices (MIs) were used. The MI between items

disease groups. With regard to smoking status,

1 and 4 (MI = 43.30), between items 3 and 6 (MI4.3% of the respondents were smokers and= 28.46) were higher values and between items

95.7% were non-smokers. There was no2 and 5 (MI = 16.55) were higher values.

significant difference in fear of COVID-19 by

Therefore, a within factor error-covariancestatus of smoke. As of late May, 15.3% of the

between items 1 and 4, between items 3 and 6,

students were taking face-to- face classes. Thisbetween items 2 and 5 (Model 2) was included.

indicates that many students were participating

The relationship between fear of COVID-19 and coping behaviors

44
48

Table 1. Factor Loadings for the FCV-19S-J
Factor loadings

Items

Model 1Model 2

1 I am most afraid of coronavirus-19.

.545

.504

2 It makes me uncomfortable to think about coronavirus-19.

.815

.781

.543

.545

.539

.493

.778

.713

.507

.507

.780

.813

c2

120.121***42.854***

df

14

11

CFI

0.868

0.960

RMSEA

0.159

0.098

90% CI

0.133-0.186

0.068-0.130

SRMR

0.078

0.053

BIC

5186.178

5126.022

FCV-19S-J(a=.84 / w=.86)

3

My hands become clammy when I think about coronavirus19.

4 I am afraid of losing my life because of coronavirus-19.
5
6
7

When watching news and stories about coronavirus-19 onsocial media, I become nervous or anxious.
I cannot sleep because I’m worrying about getting
coronavirus-19.
My heart races or palpitates when I think about getting
coronavirus-19.

Note: CFI, comparative fit; RMSEA, root mean square error of approximation; SRMR,
standardized root mean square residual; and BIC, Bayesian information criterion; ***p < .001

in the classes online. There was no significant

residence. The most important sources ofdifference in fear of COVID-19 by class format.

information are news on TV at 44.3%, websites

There were also no significant differences in theof public organizations at 25.3%, and social

main means of transportation. Regarding the

networking sites at 10%. There was notype of residence, 33.3% of the participants lived

significant difference in fear of COVID-19 bywith their family and 66.9% did not live withthe most important sources of information. Only

their family. There was no significant difference

1% of the respondents knew someone who hadin fear of COVID-19 according to the type ofbeen infected with the COVID-19, and most of

43
49

Takagi et al.

FCV-19-J
N=300

%

Mean

SD

Statistics

Effect Size

Gender
1= Men0= Women
Symptom

52
248

17.3% 2.63
82.7% 2.17

0.70
0.64

t(298)=4.39***d=0.670= Normal condition

287

95.7% 2.57

0.71

t(298)=1.69 n.s.

d=0.481= Having fever

0

0%

-

-

2= Having other symptom

13

4.3%

2.23

0.63

Disease0= Nothing
1= Respiratory
2= Mental
3= Others

276
7
5
12

92.0%
2.3%
1.7%
4.0%

2.58
2.12
2.69
2.12

0.71
0.74
0.59
0.53

F(3, 296)=2.70*

h2=0.03Smoke
1= Yes
0= No

13
287

4.3% 2.53
95.7% 2.57

0.63
0.71

t(289)=1.57 n.s.

d=0.45

15.3% 2.70
84.7% 2.53

0.72
0.63

t(298)=-1.53 n.s.

d=-0.24

38.2% 2.54
61.8% 2.54

0.67
0.75

t(298)=-1.53 n.s.

t(298)=0.27 n.s.

d=0.03F(5, 294)=1.79 n.s.

h2=0.03t(298)=.31 n.s.

d=0.18Class Format
1= Including face to face460= Not including face to254
face
Main Means of Transport
1= Public transport
113
0= Other means
183
Type of Residence
1= Living with family

200

33.3% 2.54

0.75

0= Not living with family

100

66.7% 2.56

0.67

The most important source of information
sourceof information1=
Newspaper

25

8.3%

2.82

0.78

2= News on TV

133

44.3% 2.55

0.67

3= Talk shows on

15

5.0%

2.65

0.87

television
4= Websitesof public

76

25.3% 2.56

0.68

5= Newsorganizations
on the internet

21

7.0%

2.21

0.75

6= SNS30

10.0% 2.53

0.71

1= Yes

3

1.0%

2.43

1.00

0= No

297

99.0% 2.56

0.71

Infection of an acquaintance

Note: “n.s." means "not significant," *p<.05, *** p < .001

The relationship between fear of COVID-19 and coping behaviors

44
50

them (99%) did not know anyone who had been

(2007). The results are shown in Table 6.

infected with the COVID-19. There was no

According to Murayama (2007), the indirect

significant difference in fear of COVID-19

effect is considered significant when the 95%

according to the existence of a corona-infectedconfidence interval obtained from the bootstrap

acquaintance.

method does not include zero. As a result, FCV-

Effects of coronal anxiety on coping behavior

19S-J showed a direct effect on the avoidance ofA factor analysis was conducted of coping

contact and an indirect effect mediated by tuning

behaviors and the reasons for these behaviors.

into others and self-determination. As a result,

Results show that 14 items from three factors

FCV-19S-J showed a direct effect on thewere extracted for coping behavior (Table 3); 6

avoidance of contact and an indirect effectitems from two factors were extracted for

mediated by tuning into others and self-

reasons for the behavior (Table 4).

determination. FCV-19S-J showed a direct

Three factors were identified for coping

effect on the focus on health care and an indirect

behavior: contact avoidance, consisting of items

effect mediated by self-determination. FCV-

such as "Avoided places with large crowds";

19S-J showed a direct effect on the stockpiling

focus on health care, consisting of items such as

and an indirect effect mediated by confirming"Monitored heath condition more carefully than

behavior.

before"; and stockpiling, consisting of items
such as "Purchased food in larger quantities thanDiscussion

usual". The factor structure of the coping

This study examined the reliability and validity

behaviors showed an acceptable fit and theof the Japanese version of the FCV-19S for

reliability of each factor was satisfactory. Twouniversity students in Japan in order to examine

factors were identified for reason for behavior:

the effects of fear of COVID-19 on coping

Tuning into others, consisting of items such as "Ibehavior, focusing on the reasons for thefollowed other people"; and Self-determination,

behavior. As in Ahorsu et al. (2020), the results

consisting of items such as "I did it because I felt

of factor analysis indicated a single factor

it was necessary for myself". The factor

structure. The a coefficient and w coefficient in

structure of the coping behaviors showed a good

FCV-19S-J returned sufficient values, whichmodel fit and the reliability of each factor was

suggests adequate reliability and validity. In

acceptable. The descriptive statistics of these

FCV-19S-J, the goodness of fit was made an

scales are presented in Table 5.

acceptable

To examined direct and indirect effects of fearof COVID-19 on coping behavior mediated by

value

by

assuming

an

error

correlation between items 1 and 4, between
items 3 and 6, between items 2 and 5.

reason for these behavior, the bootstrap method

The average FCV score of Japanese university(bootstrap sample size 5000) conducted withstudents was 2.55. On the other hand, in a survey

PROCESS v2.16.1 created by Preacher et al.

of Spanish university students by Martínez-43
51

Takagi et al.
Table 3. Factor Loadings for the coping behavior
Factor loadings

Items

F1

F2

F3

F1

Avoidance of contact (a=.79 / w=.80)

2

Avoided places with large crowds.

.970

-.160

-.026

1

Avoided places with poor ventilation.

.729

-.005

.072

.666

.030

.054

.351

.246

.000

10 Monitored heath condition more carefully than before.

.081

.629

.107

19 Voluntarily collected information.

-.087

.629

.107

.240

.547

-.124

.188

.485

-.058

14 Concentrated on what you needed to do such as work and study.

.026

.462

-.023

17 Sought connection with others through SNS or the Internet.

-.190

.450

.127

15 Did something you liked that you were able to do at home

.022

.444

-.088

-.033

.404

.083

3

Avoided having a conversation or utterance in proximity to anotherperson.

16 Refrained from eating out.
F2 Focus on health care (a=.71 / w =.75)

4

5

9

My heart races or palpitates when I think about getting
coronavirus-19.
Washed hands, gargled, or sanitized hands and fingers using
alcohol.

Observed changes in your health condition by measuring bodytemperature, etc.

F3 Stockpiling (a =.91 / w =.91)
8

Purchased food in larger quantities than usual.

.028

-.007

.988

7

Purchased commodities in larger quantities than usual.

.032

.028

.815

F1
F2 .621
F3 .282

c

2

df
CFI
RMSEA
90% CI
SRMR
BIC

.313
211.432***
74
0.901
0.079
0.066-0.091
0.062
12472.544

Note: CFI, comparative fit; RMSEA, root mean square error of approximation; SRMR,
standardized root mean square residual; and BIC, Bayesian information criterion; ***p < .001-

The relationship between fear of COVID-19 and coping behaviors

44
52

Table 4. Factor Loadings for the reason for behavior
Factor loadings

Items

F1

F2

4 I followed other people.

.816

-.084

5 I did it because other people told me to.

.741

-.014

.576

-.010

1 I did it because I felt it was necessary for myself.

-.002

.771

3 I did it based on my own decision.

-.259

.604

7 Doing it made me feel secure.

.218

.416

F1 Tuning into others (a=.76 / w=.75)

I did it out of a fear of criticism that would be raised by other6

people.

F2 Self-determination (a=.59 / w=.64)

F1

-

F2

-.065

-

c2

37.753***

df

8

CFI

0.916

RMSEA

0111

90% CI

0.077-0.148

SRMR

0.092

BIC

5598.676

Note: CFI, comparative fit; RMSEA, root mean square error of approximation; SRMR,
standardized root mean square residual; and BIC, Bayesian information criterion;***p < .001

43
53

Takagi et al.

Table 5. Descriptive statistics of the scale
Mean SD Min Max
FCV-19-J

2.55.71 1.00 4.57

Coping behaivior
Avoidance of.94 1.00 6.00

Focus on health care 4.60

.71 1.00 6.00

Stockpilingthat Japanese university students are less fearfulthan other generations. As we have seen above,
the fear of university students in Japan tends tobe low, but Japan as a whole tends to have a high

4.91

contact

comparison with this survey, but it is apparent

3.50 1.43 1.00 6.00

Reason forlevel of fear compared to other countries. It
should be noted that the above discussion is nota statistical study. It is necessary to compare thetendency of fear among Japanese university
students using statistical methods, and this is an
issue for the future.

behavior

In order to also examine the conditions that

Tuning into others

3.33 1.10 1.00 6.00

inhibit or enhance the fear of university students,

Self-determination

4.40

the factors influencing the fear of COVID-19.86 1.00 6.00

was investigated by t-test and analysis of
Lorca, et al. (2020), the average FCV score wasvariance. The results showed that women had a

2.40. In this survey, 82% of the respondents

higher fear of COVID-19. As already mentioned,

were female and 18% were male, which isYıldırım et al. (2021) showed that vulnerability,

roughly the same composition as the genderrisk perception, and fear of infection increase

ratio in this study, so it can be said that Japanesepreventive

university students tend to be slightly higher

symptoms in adolescent and adult females arethan their Spanish counterparts. In addition, ahigher than in males (Oliver & Simmons, 1985),

survey conducted in Spain and the Dominicanand females are known to be at higher risk for

Republic, covering a wide range of generation

post-traumatic stress disorder than males

groups, found that the average FCV was 2.17. In(Weems et al., 2010). These findings suggest

this survey, 26.8% of the respondents werethat women were more emotionally affected bymales and 73.2% were females, which is similar

stress situations than men, and therefore women

to the ratio of males and females in the present

demonstrated a more intense fear of COVID-19.

survey, so it can be said that Japanese university

However, the fear scores did not indicate astudents tend to have a slightly higher FCV. On

significant difference based on other factors

the other hand, in a survey by Wakashima et al.

such as the symptom, disease, smoke, class(2020), which covered a wide range offormat, main means of transport, source ofgenerations in Japan, the average score for FCV

information, whether they lived with their family,

was 3.04. Since there were more males andand whether they knew of an infected

females in this survey (65% and 35%,

acquaintance. Cao et al. (2020) reported that

respectively), it is not possible to make a simple

having a family member or acquaintancebehaviors.

Also,

depressive

The relationship between fear of COVID-19 and coping behaviors

44
54

Table 6. The direct and indirect effects of FCV-19-J on coping behavior
Independent

Mediating variablevariable

Dependent

Effectvariablesize=====>

SE

95% CI

.198

.096

.010

.387

.029

.021

.001

.089

=> Self-determination =>

.111

.040

.043

.200

=====>

.218

.051

.117

.319

.014

.011

-.0002.047=> Self-determination =>

.072

.026

.029

.135

=====>

.362

.115

.136

.589

.039

.025

.005

.112

.032

.024

-.005

.097

FCV-19S-J=> Tuning into others =>FCV-19S-J=> Tuning into others =>FCV-19S-J=> Tuning into others =>=> Self-determination =>Avoidance ofcontact

Focus on healthcare

Stockpiling

infected with COVID-19 would raise people’s

continue to have high levels of fear of COVID-

anxiety and that living with parents would help

19. While there were many students like thereduce their anxiety. They also showed thatlatter in China, there was a certain percentage offinancial stress, social prejudice, and threats tostudents like the former in Japan. In summary,

COVID-19

seriousalthough we cannot exclude the possibility thatpsychiatric symptoms (Shun et al., 2021). The

family members could be a factor in suppressing

results of this study and those reported by Cao etfear of COVID-19, there was no effect in Japanal. (2020) and Shun et al. (2021) showedbecause a certain number of people did not

different results. The reasons for the different

choose to live with family members due to a low

results include differences in the attributes oflevel of fear. It is also possible that the situation

culture and social conditions. In particular, theof infection in Japan was improving at the time

COVID-19 infection situation in Japan was notthis study was conducted, and therefore the needas severe as in China, and restrictions on goingfor family support may not have been high. The

out were not mandatory. It is possible that someeffects of these factors might explain the slightpeople living alone may not have chosen to live

difference in the level of a fear of COVID-19

with their families because of their low fear ofheld among the respondents in this study despite

COVID-19. On the other hand, people who

their varying attributes.

wereassociatedwithwanted to live with their families but could not

To assess the impact of a fear of COVID-19

live with them due to various restrictions may

on people’s coping behavior, this study

43
55

Takagi et al.

examined effect of a fear of COVID-19 on three

coping behaviors based on reasons of tuning intypes of coping behaviors, including avoidance

to others may lead to inappropriate behaviorsof contact, focus on health care, and stockpiling,such

mediated by two reasons for behaviors,

behaviors based on self-determination may lead

including self-determination and tuning toto effective preventive behaviors such asothers. These results showed that fear ofmanaging one's own health. Therefore, even if

COVID-19 had a direct impact on all coping

the fear of COVID-19 was high, it wasbehaviors. Intense fear of COVID-19 increases

suggested that refraining from behaviors based

any coping behavior. This supports the report byon tuning in to others and promoting behaviors

Yıldırım et al. (2021) that vulnerability, risk

based on self-determination might inhibit

perception, and fear of infection increase

inappropriate

preventive behaviors, and a strong fear ofexcessive stockpiling and promote appropriate

COVID-19 increases all coping behaviors. On

coping behaviors such as hand washing.

asstockpiling.

copingConversely,

behaviors

copingsuchas

the other hand, tuning into others is a mediating

There is a need to examine in more detaileffect on an avoidance of contact and stockpiling.

when the fears of university students become

In addition,

self-determination showed aproblematic. For example, when fear exceeds a

mediating effect on avoidance of contact andcertain threshold, negative effects may be more

focus on health care. Tuning into others is

likely to occur. It is necessary to examine inunique for increasing stockpiling. Among thedetail when fear causes problems, rather thanreasons for such behavior, a fear of COVID-19

just fear as a problem. In addition, it is necessary

propelled the act of stockpiling on goods

to compare the fears of university students withthrough the act of tuning to others. Therefore, it

those of other groups. Fear among Japaneseis expected that people with high tuning into

university students tends to be somewhat higher

others are more likely to be actively engaged inthan in other countries and lower than in otherstockpiling because they are strongly influenced

generations in Japan. In this way, it is importantby others. In contrast, self-determination isto understand the characteristics of the target

unique in enhancing focus on health care. People

population

with higher self-determination are more likely toprevention measures accordingly.

and

to

implement

infection

increase their focus on health care because of theimportance they place on their own judgmental

Acknowledgements

criteria. Such findings imply that avoidance ofThe contributors to this study, including thecontact and focus on health care might beresearch

instigated voluntarily in some cases and by fearacknowledged for all their help.

in other cases. The conclusions of this study
indicate that the influence of fear on coping
behavior is mediated by reasons. In particular,

collaborators,

aregratefully

The relationship between fear of COVID-19 and coping behaviors

Reference

44
56

York: Guilford Press.

Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M.,

Martínez-Lorca,

M.,

Martínez-Lorca,

A.,

Griffiths, M. D., & Pakpour, A. H. (2020).

Criado-Álvarez, J. J., & Armesilla, M. D. C.

The fear of COVID-19 scale: Development(2020). The fear of COVID-19 scale:and initial validation. International Journal ofvalidation in Spanish university students.

Mental Health and Addiction, 1-9.

Psychiatry research, 113350.

Asahi Shimbun Digital (2020a). A shortage of

Minister of Health, Labour and Welfare (2020a).

masks and chaos spread across the china. andFirst case of pneumonia linked to novel

customers hit each other. masks prices 10coronavirus.

upwards. the man was arrested for selling a

https://www.mhlw.go.jp/stf/newpage_08906.

poor

mask

html. Accessed: 2020-6-23. [in Japanese] 厚

https://www.asahi.com/articles/DA3S143491

生労働省 (2020). 新型コロナウイルスに

94.html. Accessed: 2020-5-11. [in Japanese]

関連した肺炎の患者の発生について（1 例

朝日新聞デジタル (2020). マスク不足、目）.

quality

中国混乱客が殴り合い・価格１０倍・粗悪

Minister of health, labour and welfare of

品で逮捕者新型肺炎.
Asahi Shimbun Digital

Minister of Health, Labour and Welfare (2020b).

(2020b). Stockpiling

COVID-19 patient and treatment [online].

before the declaration of a state of emergency,

https://www.mhlw.go.jp/stf/newpage_11118.

stores call for calm behavior [online].

html. Accessed: 2020-6-24. [in Japanese] 厚

https://www.asahi.com/articles/ASN465SZ9

生労働省 (2020). 新型コロナウイルス感

N46ULFA029.html?iref=pc_ss_date.

染症の現在の状況と厚生労働省の対応にAccessed: 2021-3-1. [in Japanese] 緊急事態

ついて（令和２年４月 30 日版）.

宣言の前に買いだめ、店側「落ち着いて行

In

動を」.
Cao, W., Fang, Z., Hou, G., Han, M., Xu, X.,
Dong,

Minister of Health, Labour and Welfare (2020c).

J.,&

Zheng,

J.

(2020).

connection

with

the

surveyon

countermeasures against the new coronavirusThe

infection, LINE Corporation conducted a

psychological impact of the COVID-19

nationwide survey asking about the healthepidemic on college students in china.

statusPsychiatry Research, 287:112934.

https://www.mhlw.go.jp/stf/newpage_10695.

ofpeople[online].

Hu, L. & Bentler, P. M. (1999). Cut off criteria

html. Accessed: 2021-3-1. [in Japanese] 新for fit indexes in covariance structure型コロナウイルス感染症対策の調査に関

analysis: Conven-267tional criteria versus

連して LINE 株式会社が健康状況等を尋

newねる全国調査（第２回）を実施します.

alternatives.

Structural

Equation

Modeling, 6(1), 1-55.
Kline, R. (2011). Principles and Practice ofStructural Equation Modeling. 3rd ed. New

Murayama, K. (2009). Mediation analysis andmulti-level

mediation

analysis.

https://koumurayama.com/koujapanese/medi

43
57

Takagi et al.

ation.pdf. Accessed: 2020-6-23. [in Japanese]

effects of the hurricane katrina disaster among

村山航 (2009). 媒介分析・マルチレベル

ethnic minority youth. Journal of Abnormal

媒介分析.

Child Psychology, 38(1), 49-56.

Oliver, J. M. & Simmons, M. E. (1985).
Affective

disordersandmeasuredbydiagnostic

thedepression

as

World

HealthOrganization(2020a).

disease2019.

Coronavirusinterviewhttps://www.who.int/emergencies/diseases/nschedule and the beck depression inventory inovel-coronavirus-2019. Accessed: 2020-6-23.

an unselected adult population. Journal ofWorld Health Organization (2020b). Q&A on

Clinical Psychology, 41(4), 469-477.

coronaviruses

Preacher, K. J., Rucker, D. D., & Hayes, A. F.
(2007).

Addressing moderated mediation

hypotheses:

Theory,methods,

prescriptions.

Multivariate

andBehavioral

Research, 42, 185-227.

(COVID-19).

https://www.who.int/emergencies/diseases/n
ovel-coronavirus-2019/question-andanswers-hub/q-a-detail/q-a-coronaviruses.
Accessed: 2020-6-23.
Yıldırım, M., Geçer, E., & Akgül, Ö. (2021).

Roberts, R. E., Lewinsohn, P. M., & Seeley, J. R.
for

The impacts of vulnerability, perceived risk,(1991).

Screeningadolescentand fear on preventive behaviours against

depression:

a comparison of depression

COVID-19. Psychology, health & medicine,scales. Journal of the American Academy ofChild and Adolescent Psychiatry, 30(1), 5866.
Sun, S., Goldberg, S. B., Lin, D., Qiao, S., &Operario, D. (2021). Psychiatric symptoms,
risk, and protective factors among university
students in quarantine during the COVID-19
pandemic in China. Globalization and Health,17(1), 1-14.
Wakashima, K., Asai, K., Kobayashi, D., Koiwa,
K., Kamoshida, S., & Sakuraba, M. (2020).
The japanese version of the fear of COVID19 scale: Reliability, validity, and relation tocoping behavior. Plos One, 15(11):e0241958
https://doi.org/10.1371/journal.pone.0241958
Weems, C. F., Taylor, L. K., Cannon, M. F.,
Marino, R. C., Romano, D. M., Scott, B. G.,
Perry, A. M., & Triplett, V. (2010). Post
traumatic stress, context, and the lingering

26(1), 35-43.

International Journal of Brief Therapy and Family Science
2021 Vol. 11, No.1, 58-63< Short Case Report >Chronically Absent High School Boy Returns to School－Not Creating the Bad Guy－
Masahumi Nakamura 1)
1)

Kagoshima Immaculate Heart University

ABSTRACT. This is a case study of a high school boy who was chronically absent from school after being bullied in his
extracurricular club. Consultations were conducted with IP and his mother over a period of three months until the boy returned toschool after the seventh session. Solution construction and false solution patterns based on the double description model wereeffective in not creating “bad guys” at school or at home. This article summarizes the consultations and discusses methods that do
not create “bad guy” players.
KEY WORDS: chronic absenteeism，no “bad guy”
，double description model

began
Introduction

saying“maybeI

shouldgotocounseling” and decided to come in for a

Since 2013, the number of young students

consultation. The clients were a high school

who refuse to go to school for 30 days or moreboy (“IP”) and his mother, in her 50s (“Mo.”).

during the school year has been on the rise

IP’s family of five consisted of a father

again, and with 144,031 students classified as(“Fa.”), Mo.，older sister, and older brother“chronic absentees” in 2017, schools are faced(university student).

with a major challenge. This article presents a

The

main

predicament

was

IP’s

case study of a high school boy who became

hyperventilation, and Mo. was unsure of how tochronically absent after being bullied in his

relate with IP. Consultations were conducted

extracurricular club and discusses a “no bad

first with IP and then with Mo. for a total ofguy” method of therapy.

seven sessions held over approximately threemonths, and ended with a return to school.

Case study
IP refused to go to school starting inConsultation 1:

December X-1 and was advised by his club【Consultation with IP】

advisor to go to counseling. IP initially said its

was “not necessary,” but after six months, heupperclassmen in his extracurricular club in

CORRESPONDENCE TO: Nakamura, M. Faculty ofDecember X-1. He hyperventilated again the

Education and Psychology, Kagoshima Immaculate Heart

following week in front of his club activities

University,

advisor, and he developed a fear of crowds

2365,

Amatatsu-cho,Satsumasendai-shi,

hyperventilation

The catalyst for IP’

wasbullyingbyKagoshima 895-0011 JAPANwhen the hyperventilation continued thereafter.

e-mail: m.naka@jundai.k-junshin.ac.jp

He was unable to attend school for the next two

58

59

Nakamuramonths, and although he began to go to thehyperventilation and provided suggestions on

school infirmary in February, he had not

how to communicate with IP. Th. also said: “IPattended classes to date. In response to inquiry

will start to act out his anger from now on, andby the therapist (“Th.”), IP said his objective

although it might seem like bad behavior,

was to “stop hyperventilating.” He explained

please let it go because it is important for him

that

to get that out.”hetendedto

hyperventilate

whenconfronted by others, and that he wasconcerned about the frequency of occurrence.

Consultation 2:

He also said that he was “worried about what to【Consultation with IP】

do about school,” and in response to the Th.’s

school in the past week, and he did not

request for a breakdown, he said, “70% quit

hyperventilate. When asked about school, heschool, 30% continue; I want to keep doing

said: “I’m not sure what I think. I feel like I

club activities.” He had negative experiences

don’t want to go to school, and I’m scared ofwith kids in his class year within the club, andpeople, or more like crowds.” It bothered him

he now felt stronger resistance to them than tothat he hadn’t “told Fa. that he isn’t going to

the upperclassman.

school.” Fa. is strict and IP is afraid of what he

IP had not gone toTh. listened to these events and IP’s current

might say when he is in a foul mood, but

situation and praised his efforts and desire torecently he has been nice and they have been

attend school despite the issues he was facing

watching sports together on television. When IP

with his club and hyperventilation. Th.

came home after having trouble at his club, he

explained the mechanisms of hyperventilation

was happy when his father told him “you didn’t

and how it tended to occur with anticipatory

do anything wrong.” IP has been playing catchanxiety, and said that it would “definitely stopwith Fa. every day. IP assumes he will have no

because it is not something that lasts,” andchoice but to work if he drops out of his current

endedschool, so Th. offered information about online

theconsultation

after

a

final

reconfirmation of goals.

programs as one of many possible options.

【Consultation with Mo.】 Mo. immediately【Consultation with Mo.】 Fa. is aware that IP

stated, “He told me for the first time thishas not been going to school, but since IP

morning that he wants to quit school.” Mo. is

hyperventilated when he was confronted by Fa.

torn between wanting IP to continue school andbefore, Mo. and Fa. discussed and decided notthinking it is okay for him to quit. Fa.

to bring up the subject of school. Regarding theapparently wants IP to go to school andfact that IP had not told Fa. about missing

continue in his club. IP has recently becomeschool, Th. suggested that “IP might feel like hemore vocal in expressing his anger to others.

should make himself look good for Fa., amongTh. explained to Mo. that IP was alreadyother feelings.” Th. suggested that Mo. shouldchanging, and then offered an explanation of

wait for IP to make his own decision, and Mo.

Chronically Absent High School Boy Returns to School60

conveyed a sense of resolve in her reply: “I see,Mo. about his frustration and anger with his

all I need to do is accept him.” Th. suggested inclub when his belongings went missing or

regard to IP and Fa. that, rather than having Fa.

things he had lent out were not returned.

do something, the parents should share
information

andunderstandthecurrent

situation.

Th. stated: “Participating in sports practice
is a positive change. IP needs to feel secureright now, and with a greater sense of assurance,
he will be able to think about the future. Once

Consultation 3:

IP talks to Fa., please be accepting of his【Consultation with IP】

When asked about

feelings as parents. Rather than trying to rushchanges over the past week, IP replied: “Noresults, focus on first accepting his feelings

change, but I have stronger feelings about

about not wanting to go to school.” Mo.

quitting school.” He told Mo. that “it’s okayinquired at the end about getting a written

to tell Fa. that I’m not going to school.” Heopinion to submit to school to adjust thecannot tell Fa. himself because he does notnumber of IP’s days of absence.

know what Fa. will say. From IP’s perspective,
Fa. coached him in sports and was strict with

Consultation 4:

rules, but stopped saying things when IP started【Consultation with IP】

his second year of junior high school. Th.

talking to Fa. about not going to school duringcommented, “Fa. seems to have ideals about

the two weeks since the previous session, but

raising and educating you, but what do you

he realized that Fa. knew when Fa. said “it’sthink?” IP responded, “I don’ think what Fa.

about time you get back.” When Th. asked,

has said is wrong” and “I’m fine with our“What could you do to make yourself feel likerelationship the way it is.” IP is anxious that he

you want to continue with your club at yourwill be called back to school if Mo. tells Fa.

current school,” IP responded, “I don’t knowthat he is not going to school.

how I feel recently. My homeroom teacher

IP did not end up

Th. suggested that “it’s important to befrom 3rd year of junior high told me to comehonest with Fa. about your feelings. ”

talk if I need to, so I think I might go. I don’t

Considering that IP might hyperventilate whenknow what I should do, if I should quit school

talkinghavingor not.” Th. told IP, “You have a lot of strengths

hyperventilated recently, Th. taught IP aboth inside and outside, so I want you to focus

10-second breathing technique and ended theon enjoying your life without thinking about

consultation after practicing together.

school right now.”【Consultation with Mo.】

Recently, IP has【Consultation with Mo.】 A positive change

been going to practices for the sports team heover the past two weeks has been that IP has

used to belong to, and he often talks about his

gotten up by himself in the morning, albeit at aown past accomplishments. He has also told

late hour. IP said that he wants watch his club’

to

Fa.

despite

not

59
61

Nakamuras regional competition in person, but Mo. iswent to summer festival with friends, and met

worried about him going to event.

up with his teacher from junior high school. Th.

Th. commented: “ Fa. chose his words

commented: “It took significant energy to meetcarefully in saying ‘it’s about time you getwith his friends and teacher. The fact that heback.’ Usually, people tend to say things like

was able to talk about not going to school‘go to school.’ IP’s scope of activity isshows that it is becoming something of the past

expanding, and he has more energy, so pleasefor him. This is a good development for IP.”

continue on in the same way.”

Mo. said that IP has started to talk about school
himself, and she has noticed a change in him

Consultation 5:【Consultation with IP】

also.
Over the past two

weeks, IP had a good time going to a summer

Consultation 6:

festival with friends from his elementary and【Consultation with IP】 The change over thejunior high schools and attending a pro sports

past three weeks was going by himself to watch

game with Mo. When Th. asked what he wasregionals. He saw the classmates he doesn’t

thinking about school, IP stated: “I went to see

like, but it didn ’ t bother him. IP said

my junior high teacher and talked honestly“Tomorrow is the opening ceremony at school,

about how I wasn’t going to school. After

so I’d like to go. I’d like to go back to school

talking with my friends and teacher, I am

in September if I can.” He felt “80% sure andstarting to feel a little like going back.” He

20% unsure because I’d be nervous” aboutscaled his feelings about returning to school:attending the opening ceremony. Th. praised“About 50. My friends and teachers said “itIP’s determination to go back to school but

would be a waste” and I’m thinking I should

stated: “You feel 80% sure about going, but

probably go back to my current school.” Th.

feelings can change, so you might haveinquired, “What do you need to raise that fromdifferent thoughts as the time draws closer. It

50 to 60 or 70?” and IP replied, “I think if I talkmight be difficult for you to go, but in that case,to my club peers and my teachers.” Fa. offered

you can just try again later.”

the words: “Be ready if you’re going to go back【Consultation with Mo.】to your club. You just have to rise from the very

any particular change at home. He went out onbottom to the very top.” Th. said “Continue tohis own to cheer his team, and he had talked

enjoy this time and pay attention to yourwith dorm friends on the phone. IP hinted atcurrent feelings.”

going back to school, and Mo. expressed her【 Consultation with Mo. 】

IP has not shown

IP has beenfeelings so far: “There are many things thatenjoying himself over the past two weeks as

I’ve wanted to say. The club advisor told me

well, and the parents did not raise the subject ofthat he has also been ‘holding back fromschool or club. IP stopped by Mo.’s workplace,contacting IP so that he wouldn’t feel

Chronically Absent High School Boy Returns to School

62
60

pressured,” and Fa. has also avoided the subject

able to go to school. It’s important to take itof school.” Th. wrapped up the session with:little by little now, and that will tie into

“It’s difficult to wait, but everyone, including

permanence. He may get tired and not go

the family, is facing the same direction. Pleasesometimes, but please continue to go about incontinue just as you are.”the same way, without changing anything.”

Prior to Consultation 7, Mo. called to

Although another session was planned, it

request a written opinion to submit to school,

was canceled because IP returned to school andand was rescheduled the session for an earlier

had a busy schedule.

date.
Discussion
Consultation 7:【Consultation with IP】

IPIn the two weeks

began

avoiding

schooldue

tohyperventilation triggered by his relationships

since the last session, IP went to school forwithupperclassmen

and

peers

in

his

three days, including for a school event. He was

extracurricular club. He may have also beenable to speak with his teacher about future

impacted prior to such events by pressure fromplans and felt relieved after speaking withhis classmates when he was benched in his firstupperclassmen and peers in his club. Th.

year and by his inability to speak his mind atpraised IP’s attendance and asked, “What do

school or at home (particularly with his father)you think made it okay for you to go toand his tendency to hold things in.

school?” IP said, “There was summer vacation,

At the initial consultation, IP wanted to

and when I saw nationals, I wanted to do myaddress his hyperventilation and he hadclub.” IP reviewed the content of the written

stronger feelings about leaving school rather

opinion. The consultation ended after Th.

than returning. Taking this into account, Th.

offered feedback on IP’s process of change andproposed

the resources available to him.

hyperventilation. Th. provided Mo. with an【Consultation with Mo.】 IP was not able toexplanation of hyperventilation and proposed

attend the opening ceremony, but he went toways to relate to IP. There was no recurrence ofschool for three days after that. He talked a lot

hyperventilation thereafter. Mo. commented in

at home, laughed aloud and was more cheerful.

Consultation 2, “I see, all I need to do is accept

Fa. did not change his behavior whether or nothim,” and seemed to convey a stance of “watch

IP went to school, and plays catch with IP.

and wait” that presented a false solution andDiscussed how to submit the written opinion

contributed to the changes in IP as well. The

and decided on having IP hand it directly to his

parents shared information, and Fa. reached out

teacher at school.

to IP with supportive words such as “you didn’t

Th. stated: “It is a great thing that IP was

a

goal

of

stoppingthedo anything wrong,” “it’s about time you get

59
63

Nakamuraback,” and “you just have to rise from the verybottom to the very top.” IP also had many
resources available and his teachers and friends
were a source of energy.
From the perspective of a double description
model (Wakashima & Hasegawa, 2000) thatcombinesthe

MRI

approachandsolution-oriented approaches, IP may havebenefited from secondary changes brought
about solution talk and use of resources, Mo.’s
resolution and false solution patterns, and afocus on enjoying life as opposed to thinking
about how to go back to school. It should also
be noted that Th. did not refer to the eventswith clubmates in the context of “bullying.” By
conveying to IP that Fa. was not so much an
intimidating presence that he could not talk to,
but that IP might feel like he should makehimself look good for Fa., and that Fa.’sstrictness might come from his parenting andeducational ideals, Th. also reframed Fa. so as
not to create a “bad guy.” This lack of a “badguy” at school and at home may have reduced
IP’s resistance to going back to school andhelped him to take the first step.
Reference
Wakashima, K. & Hasegawa, H. (2000). Yoku
wakaru tanki ryouhou gaido bukku [Brief
Therapy Guidebook]. Kongo Shuppan.