Individuals with hikikomori and their families’ cognitive behavioral factors: A prospective study

The cognitive behavioral variables of a family that influence the improvement of prolonged social withdrawal (hikikomori) remain unclear. This study prospectively and experimentally examined the effects of family behavioral repertoire and family interaction on hikikomori recovery. The participants were selected from family associations and support centers in the Kanto region of Japan; the study was performed from May 2017 to March 2018. Overall, seven family members (four mothers and three fathers, aged 55–73) of hikikomori individuals (five males and two females, aged 20–47) participated in four 90-min individual sessions targeting cognitive behavioral variables (family behavioral repertoire, cognition of contingency, family interaction, and target behaviors); the intervention sessions were customized according to family characteristics, and participants were followed up at one, three, and six months after the intervention. Of these, three participants demonstrated improvements in up to two cognitive-behavioral variables after the intervention; furthermore, in all three cases, the social interactions of the hikikomori individuals increased later than the changes in their families. The time differences in these alterations suggest a causal relationship between family cognitive behavioral variables and recovery from hikikomori. However, Spearman’s correlation coefficients using the difference values from the pre-assessment were not significant for the hikikomori individuals’ social interactions and the families’ cognitive behavioral variables. These correlation analyses were preliminary because of the small sample size. Further studies with larger sample sizes and robust study designs are needed to confirm these findings.