Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan

Richard Tighe; Pat McKiernan

doi:10.29333/ajqr/16817

Richard Tighe ¹ ^* , Pat McKiernan ¹

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AM J QUALITATIVE RES, Volume 9, Issue 4, pp. 119-154

https://doi.org/10.29333/ajqr/16817

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Abstract

COVID-19 reinforced maladaptive behaviors found in social anxiety and cultural variants, such as hikikomori and taijin kyofusho. As a result, mental health professionals had to modify their modalities to adapt to the changes that resulted from the pandemic. This study used a qualitative research method and Theory of Mind (ToM) framework exploring ToM deficits resulting from the pandemic and linked to social anxiety. Twenty mental health professionals with experience working in Japan were chosen for the study. The participants had worked in Japan during COVID and held a master's degree or equivalent in a mental health discipline. Participants were interviewed via Zoom, using the COVID Social Anxiety Questionnaire – Version 1 (CSAQ-V1). The findings indicate that the development of the "Silo Effect" greatly influenced maladaptive behaviors found in social anxiety. Many participants modified their approaches to account for ToM deficits exacerbated by COVID-19, the move to telehealth, and restrictions resulting from Japan's pandemic, including addressing humanistic and psychodynamic therapy in light of less proactive clients and changes made to CBT and third-wave CBT to compensate for telehealth. The importance of psychoeducation in tackling the stigma surrounding mental health with families in Japan was also addressed, as well as tackling school refusal. The research opened opportunities for further exploration, such as studies on the Silo Effect and its impact on ToM deficits and the long-term implications of psychoeducation on stigma in Japan. Continued research into how modalities are modified could provide greater clarity into the effectiveness of modalities on social anxiety post-pandemic.

Keywords: Social anxiety, hikikomori, Taijin Kyofusho, school refusal, silo effect, theory of mind, Japan, mental health, psychoeducation, COVID-19

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Citation

Tighe, R., & McKiernan, P. (2025). Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan. American Journal of Qualitative Research, 9(4), 119-154. https://doi.org/10.29333/ajqr/16817

Tighe, R., and McKiernan, P. (2025). Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan. American Journal of Qualitative Research, 9(4), pp. 119-154. https://doi.org/10.29333/ajqr/16817

Tighe R, McKiernan P. Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan. AM J QUALITATIVE RES. 2025;9(4), 119-154. https://doi.org/10.29333/ajqr/16817

Tighe, Richard, and Pat McKiernan. "Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan". American Journal of Qualitative Research 2025 9 no. 4 (2025): 119-154. https://doi.org/10.29333/ajqr/16817

Tighe, Richard et al. "Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan". American Journal of Qualitative Research, vol. 9, no. 4, 2025, pp. 119-154. https://doi.org/10.29333/ajqr/16817

Tighe R, McKiernan P. Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan. AM J QUALITATIVE RES. 2025;9(4):119-54. https://doi.org/10.29333/ajqr/16817