{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:27:40Z","timestamp":1787027260792,"version":"build-2736575974"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T00:00:00Z","timestamp":1679529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>\n                    Extreme and long-term social withdrawal, first described in Japan as\n                    <jats:italic>Hikikomori<\/jats:italic>\n                    , has now become a globally recognized mental health problem. Intervention studies severely lag behind epidemiological and phenomenological research. We present two descriptive case reports of Japanese university students with\n                    <jats:italic>Hikikomori<\/jats:italic>\n                    who participated in an early phase test of a structured intervention involving physical activities that was developed and facilitated by clinicians and physical education specialists\u2014Human Movement Consultation (HMC). The two recipients (19- and 29-years old at the start of treatment) completed approximately 40 consultation sessions delivered over 3 years consisting of a combination of outdoor workouts (i.e., walking, running, and cycling) and interpersonal sports (e.g., table tennis, badminton, and tennis). Changes in social withdrawal behavior were independently rated from clinical health records using a structured scale (the Glasgow\n                    <jats:italic>Hikikomori<\/jats:italic>\n                    Scale; GHS). Behavioral observations and scale data for both cases indicated improvements from pre-treatment levels of social withdrawal. At the end of the intervention, both had returned to normative levels of functioning. Case A returned to university and Case B secured a new job upon the completion of HMC. To help advance our understanding of treatment options, these case descriptions analyze potential change mechanisms in order to understand how HMC can support recovery from extreme social withdrawal. One key observation is that both outdoor workouts and interpersonal sports offer a non-threatening method of enabling\n                    <jats:italic>Hikikomori<\/jats:italic>\n                    to engage in interpersonal interactions. Such connections via structured activities may allow the reinstatement of social skills in a graded manner. In addition, an initial focus on physical experiences may help promote psychological and social connectedness without triggering the social fears and challenges that underlie the\n                    <jats:italic>Hikikomori<\/jats:italic>\n                    state. The findings from these two cases offer a framework to guide further research and the development of exercise-based interventions for this hidden and often neglected group.\n                  <\/jats:p>","DOI":"10.3389\/fpsyt.2023.1084384","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T02:25:29Z","timestamp":1679538329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["An examination of the potential benefits of expert guided physical activity for supporting recovery from extreme social withdrawal: Two case reports focused on the treatment of Hikikomori"],"prefix":"10.3389","volume":"14","author":[{"given":"Keiko","family":"Yokoyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadaaki","family":"Furuhashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maki","family":"Rooksby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamish J.","family":"McLeod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1192\/bji.2020.20","article-title":"International experience of hikikomori (prolonged social withdrawal) and its relevance to psychiatric research","volume":"18","author":"Tan","year":"2021","journal-title":"BJPsych Int."},{"key":"B2","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1002\/wps.20804","article-title":"Hikikomori: a hidden mental health need following the COVID-19 pandemic","volume":"19","author":"Rooksby","year":"2020","journal-title":"World Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1007\/s00127-011-0411-7","article-title":"Does the \u201chikikomori\u201d syndrome of social withdrawal exist outside Japan?","volume":"47","author":"Kato","year":"2012","journal-title":"Soc Psychiatry Psychiatr Epidemiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1177\/0020764019859379","article-title":"No longer culture-bound: hikikomori outside of Japan","volume":"65","author":"Bommersbach","year":"2019","journal-title":"Int J Soc Psychiatry."},{"key":"B5","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1111\/pcn.12895","article-title":"Hikikomori: multidimensional understanding, assessment, and future international perspectives","volume":"73","author":"Kato","year":"2019","journal-title":"Psychiatry Clin Neurosci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1177\/0020764014535758","article-title":"Identification of the hikikomori syndrome of social withdrawal: psychosocial features and treatment preferences in four countries","volume":"61","author":"Teo","year":"2014","journal-title":"Int J Soc Psychiatry."},{"key":"B7","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1177\/0004867415581179","article-title":"Youth social withdrawal behavior (hikikomori): a systematic review of qualitative and quantitative studies","volume":"49","author":"Li","year":"2015","journal-title":"Aust N Z J Psychiatry."},{"key":"B8","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1177\/0020764012437128","article-title":"Social isolation associated with depression: a case report of hikikomori","volume":"59","author":"Teo","year":"2013","journal-title":"Int J Soc Psychiatry."},{"key":"B9","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.evopsy.2013.01.016","article-title":"tat des lieux, points communs et diffrences entre des jeunes adultes retirants sociaux en France et au Japon (Hikikomori)","volume":"78","author":"Furuhashi","year":"2013","journal-title":"L'vol Psychiatr."},{"key":"B10","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1177\/0020764014553003","article-title":"Hikikomori in Spain: a descriptive study","volume":"61","author":"Malag\u00f3n-Amor","year":"2015","journal-title":"Int J Soc Psychiatry."},{"key":"B11","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1177\/0020764013504560","article-title":"Prolonged social withdrawal disorder: a hikikomori case in Spain","volume":"60","author":"Ovejero","year":"2013","journal-title":"Int J Soc Psychiatry."},{"key":"B12","doi-asserted-by":"publisher","first-page":"191","DOI":"10.2190\/7WEQ-216D-TVNH-PQJ1","article-title":"Hikikomori, is it a culture-reactive or culture-bound syndrome? 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