Physiological Symptoms Of Anxiety Research Articles

Impact of background music listening on anxiety in cancer patients undergoing initial radiation therapy: a randomized clinical trial

BackgroundPatients undergoing radiation therapy (RT) often experience anxiety, which may jeopardize the treatment success. The efficacy of music interventions in reducing anxiety remains contentious. This randomized trial aimed to evaluate the impact of music listening on anxiety symptoms in patients undergoing initial RT.MethodsFirst-time RT patients were randomly allocated to experimental and control groups. The Brief Symptom Rating Scale (BSRS-5), Distress Thermometer (DT), and Beck Anxiety Inventory (BAI-C) were administered pre- and post-RT. Changes in physiological anxiety symptoms were monitored over 10 consecutive days starting from the first day of RT. The experimental group received music during RT; the control group did not. The generalized linear mixed model was used to estimate the pre–post difference in the BSRS-5, DT, and BAI-C scores between the music intervention and control group.ResultsThis study included 50 patients each in the experimental and control groups. BSRS-5 and DT scores were significantly reduced in the experimental group post-RT (p = 0.0114 and p = 0.0023, respectively). When music listening was discontinued, these scores rebounded. While the posttest BAI-C score was significantly lower in the experimental group (p < 0.0001), the pre–post difference between the two groups was not significant (p = 0.0619). On cessation of music listening, the BAI-C score also rebounded.ConclusionsFor cancer patients undergoing initial RT, music listening intervention significantly reduced anxiety symptoms measured using the BSRS-5, DT, and BAI-C scores after two weeks. Our results demonstrate the effectiveness of music listening intervention in reducing anxiety symptoms, thereby potentially improving the quality of life of cancer patients undergoing RT.

A systematic review of nonpharmacological interventions to reduce procedural anxiety among patients undergoing radiation therapy for cancer.

The primary objective was to assess the efficacy of nonpharmacological interventions delivered to adults with cancer, in the radiation oncology department, just prior to, or during radiation therapy, in reducing levels of self-reported procedural anxiety. The secondary objectives were to assess the efficacy of these interventions in reducing physiological symptoms of procedural anxiety and anxiety-related treatment disruptions. Systematic review. Electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials) were searched from inception up until February 2022. Population: Adult patients with cancer undergoing external beam radiation therapy. Nonpharmacological interventions delivered within the radiation therapy department. Comparison: standard care controls, or standard care plus an alternative intervention. level of self-reported procedural anxiety (primary), physiological symptoms of anxiety (secondary) and measures of anxiety-related treatment disruptions (secondary). Two reviewers independently extracted data. A meta-analysis was originally planned but deemed not feasible as the studies could not be confidently pooled for meta-analysis, due to the variability in the interventions, study designs and the generally low number of studies. Therefore, a narrative synthesis is presented. Screening of 2363 records identified nine studies that met inclusion criteria: six studies of music interventions, two of video-based patient education and one of aromatherapy. Overall, three studies received a global rating of strong methodological quality and low risk of bias. Three studies reported a significant effect of the intervention on reducing the primary outcome of self-reported procedural anxiety: two music interventions (both strong methodological quality), and one video-based patient education (moderate methodological quality). One of the studies (a music intervention) also reported a significant reduction in the secondary outcome of physiological symptoms of procedural anxiety (systolic blood pressure). The evidence for nonpharmacological interventions delivered to adults with cancer just prior to, or during radiation therapy, in reducing levels of self-reported procedural anxiety is limited, with very few well-designed studies. There is a need for interventions for procedural anxiety during radiation therapy to be evaluated through rigorous randomised controlled trials.

Computational Modeling of Self-Referential Processing Reveals Domain General Associations with Adolescent Anxiety Symptoms.

What an adolescent thinks about themselves, commonly termed self-referential processing, has significant implications for youth long-term psychological well-being. Self-referential processing plays an important role in anticipatory and reactive processing in social contexts and contributes to symptoms of social anxiety. Previous work examining self-referential processing largely focuses on child and adolescent depression, relying on endorsement and reaction time for positive and negative self-describing adjectives in a self-referential encoding task (SRET). Here, we employ computational methods to interrogate the latent processes underlying choice reaction times to evaluate the fit of several drift-diffusion models of youth SRET performance. A sample of 106 adolescent, aged 12-17 (53% male; Mage = 14.49, SD = 1.70) completed the SRET and self-report measures of anxiety and depression. Our results support the utility of modeling the SRET, where the rate of evidence accumulation (i.e., drift rate) during negative self-referential processing was related to social anxiety above-and-beyond mean task performance. Our regression analyses indicated that youth efficiency in processing of self-referential views was domain general to anxiety, highlighting the importance of assessing both social and physiological anxiety symptoms when predicting SRET performance. The computational modeling results revealed that self-referential views are not uniquely related to depression-related constructs but also facets of anxiety.

Associations between aversive learning processes and transdiagnostic psychiatric symptoms in a general population sample

Symptom expression in psychiatric conditions is often linked to altered threat perception, however how computational mechanisms that support aversive learning relate to specific psychiatric symptoms remains undetermined. We answer this question using an online game-based aversive learning task together with measures of common psychiatric symptoms in 400 subjects. We show that physiological symptoms of anxiety and a transdiagnostic compulsivity-related factor are associated with enhanced safety learning, as measured using a probabilistic computational model, while trait cognitive anxiety symptoms are associated with enhanced learning from danger. We use data-driven partial least squares regression to identify two separable components across behavioural and questionnaire data: one linking enhanced safety learning and lower estimated uncertainty to physiological anxiety, compulsivity, and impulsivity; the other linking enhanced threat learning and heightened uncertainty estimation to symptoms of depression and social anxiety. Our findings implicate aversive learning processes in the expression of psychiatric symptoms that transcend diagnostic boundaries.

Integrating Acceptance and Commitment Therapy With Functional Analytic Psychotherapy: A Case Study of an Adult Male With Mixed Depression and Anxiety

Acceptance and commitment therapy (ACT) gained support for treating transdiagnostic features of major depressive (MDD) and generalized anxiety disorders (GAD). However, ACT’s intrapersonal emphasis may be insufficient for targeting interpersonal treatment goals. Integrating ACT with functional analytic psychotherapy offers theory-based strategies for responding to ACT-specific processes through the contingent interpersonal relationship thereby targeting both intra- and interpersonal treatment goals. Yet, no research examined the efficacy of this integrative approach (i.e., functional-analytic acceptance and commitment therapy [FACT]) in treating comorbid MDD and GAD. In this case study, we conceptualized a man with comorbid MDD and GAD from a FACT perspective, described FACT treatment across 28 sessions, and presented pretreatment, termination, and 6-month posttreatment data on FACT-specific treatment targets. Depression symptoms, self-compassion, mindfulness, and interpersonal relationships improved despite unchanged physiological anxiety symptoms throughout treatment. These preliminary data provide clinicians with a conceptual framework for treating clients using FACT and may guide future research on integrative treatment approaches.

Evaluating a Web-Based Social Anxiety Intervention Among Community Users: Analysis of Real-World Data.

BackgroundSocial anxiety is both harmful and prevalent. It also currently remains among the most undertreated major mental disorders, due, in part, to socially anxious individuals’ concerns about the stigma and expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions may render them particularly helpful in addressing these concerns, and they are also highly scalable, but most tend to be only somewhat effective without therapist support. However, a recent evaluation of a new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called Overcome Social Anxiety found that it was highly effective.ObjectiveThe initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in symptom severity among university undergraduates. The aim of this study was to extend the results of the initial study and investigate their generalizability by directly evaluating the intervention’s effectiveness among a general community sample.MethodsWhile signing up for Overcome Social Anxiety, users consented to the usage of their anonymized outcome data for research purposes. Before and after completing the intervention, users completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors (Avoidance Questionnaire).ResultsParticipants who completed the intervention (102/369, 27.7%) experienced significant reductions in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001; Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42).ConclusionsOur results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the general community. The completion rate is the highest documented for a fully automated intervention for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of anxiety, and stress in addition to symptoms of social anxiety.

The Impact of Yoga Nidra and Seated Meditation on the Mental Health of College Professors.

Background:World statistics for the prevalence of anxiety and mood disorders shows that a great number of individuals will experience some type of anxiety or mood disorder at some point in their lifetime. Mind–body interventions such as Hatha Yoga and seated meditation have been used as a form of self-help therapy and it is especially useful for challenging occupations such as teachers and professors.Aims:In this investigation, we aimed at observing the impact of Yoga Nidra and seated meditation on the anxiety and depression levels of college professors.Materials and Methods:Sixty college professors, men and women, aged between 30 and 55 years were randomly allocated in one of the three experimental groups: Yoga Nidra, seated meditation, and control group. Professors were evaluated two times throughout the 3-month study period. Psychological variables included anxiety, stress, and depression.Results:Data analysis showed that the relaxation group presented better intragroup results in the anxiety levels. Meditation group presented better intragroup results only in the anxiety variable (physical component). Intergroup analysis showed that, except for the depression levels, both intervention groups presented better results than the control group in all other variables.Conclusions:Prepost results indicate that both interventions represent an effective therapeutic approach in reducing anxiety and stress levels. However, there was a tendency toward a greater effectiveness of the Yoga Nidra intervention regarding anxiety, which might represent an effective tool in reducing both cognitive and physiological symptoms of anxiety.

Chronic Physical Health Conditions and Emotional Problems From Early Adolescence Through Midadolescence

ObjectiveChronic physical health conditions are highly prevalent in youth, frequently persisting into adulthood and contributing to the current and future health care burden in the United States. Our study evaluated associations of chronic physical health conditions with depressive and physiological anxiety symptoms in a community sample of youth and examined how those associations changed from early to midadolescence. MethodsIn this longitudinal study of 5147 youth, students and their caregivers were interviewed when youth were in grades 5 (mean age = 11), 7 (mean age = 13), and 10 (mean age = 16). Caregivers reported family sociodemographics, youth race/ethnicity, and youth chronic physical health history at baseline. Youth reported their depressive symptoms at each time point and their physiological anxiety symptoms at grades 7 and 10. ResultsAt age 11, 28.5% had experienced a chronic physical health condition. Having any chronic physical health condition was related to elevated depressive symptoms at age 11 (2.05 ± 0.05 vs 1.89 ± 0.03; mean ± standard error; P < .01) and anxiety symptoms at age 16 (2.72 ± 0.06 vs 2.55 ± 0.04; P < .05). Experiencing multiple conditions was also related to experiencing more depressive symptoms (b = 0.13; P < .01) and physiological anxiety symptoms (b = 0.13; P < .05). After adjusting for previous mental health symptoms, having any condition still predicted anxiety at age 16. ConclusionsChildren with chronic physical health conditions have an increased risk of depressive symptoms and physiological anxiety symptoms, especially in early and midadolescence. Repeated screening for these symptoms may help identify children in need of interventions.

Loneliness and Anxiety Sensitivity: Understanding Behavioural Avoidance in the Lonely

The current study investigated the putative relationship between loneliness and anxiety sensitivity (AS. Socially embedded, normal, and lonely participants (N=308) completed 4 reliable and valid measures, Revised UCLA loneliness scale, the State- Trait Anxiety Inventory Trait scale (STAI-T), Anxiety Sensitivity Index (ASI), and Fear Questionnaire (FQ). A positive relationship between loneliness and AS was found. After controlling for trait anxiety, AS predicted group differences between the lonely and normal, however this difference was not found between the lonely and socially embedded groups. Avoidance produced a significant multivariate main effect but did not predict group differences after controlling for trait anxiety and AS. It was concluded that avoidance in lonely individuals may be due partially to an enhanced sensitivity to the physiological symptoms of anxiety (AS) elicited distinctively within social contexts. Future research utilising multidimensional models of loneliness and attachment measures are suggested.

Separate dimensions of anxiety differentially predict alcohol use among male juvenile offenders

IntroductionAlthough research has documented robust prospective relationships between externalizing symptomatology and subsequent adolescent alcohol use, the extent to which internalizing symptoms such as anxiety may increase risk for alcohol consumption remains controversial. Recent evidence suggests that one possible reason for mixed findings is that separate dimensions of anxiety differentially confer risk for alcohol use. The present study tested two dimensions of anxiety, worry and physiological anxiety symptoms, as predictors of alcohol use and misuse in a longitudinal sample of juvenile offenders. MethodsParticipants were 818 male juvenile offenders drawn from a larger multi-site, longitudinal study. Zero-inflated Poisson regression models estimated the influence of anxiety symptoms on typical drinking quantity, frequency of binge drinking, and alcohol dependence symptoms. ResultsResults indicate that physiological anxiety and worry symptoms showed differential relations with alcohol use risk. Physiological anxiety was positively associated with increased risk for typical alcohol involvement, frequency of binge drinking, and alcohol dependence symptoms, whereas worry was negatively associated with all alcohol use outcomes. ConclusionsCurrent findings underscore the importance of considering anxiety as a multidimensional construct when examining the prospective relation between anxiety and adolescent alcohol use risk.

A closer look at the nature of anxiety in weight loss surgery candidates.

Depression among weight loss surgery (WLS) candidates is common. Anxiety in this population is less studied. Untreated anxiety persists post-surgery and is associated with poor surgical outcomes. The current study sought to explore the nature of anxiety in WLS candidates. Given shared symptoms of anxiety and obesity, we hypothesized that physiological symptoms of anxiety would be most common. In this retrospective study, the medical records of 174 pre-WLS candidates at a large medical center were reviewed. Each completed a comprehensive medical, surgical, and psychological evaluation as part of standard of care. Data from these evaluations were abstracted. One hundred forty-three candidates completed the Beck Anxiety Inventory (BAI). A Principal Components Analysis (PCA) with varimax rotation was used to identify the factor structure of the BAI. The sample consisted of primarily middle-aged (46.0 ± 13.24 years), married (60.8%), Caucasian (65.7%), females (79%) with Class III obesity (Body Mass Index = 50.1 ± 10.68) and mild anxiety (8.86 ± 8.70). Forty-four percent of the sample endorsed clinically significant anxiety. PCA revealed a four-factor structure that explained 56.28% of the variance in the BAI. The four factors were: 1) cognitive-emotional distress, 2) autonomic hyperarousal, 3) neurophysiologic concerns, and 4) body temperature. Clinically significant anxiety is common among WLS candidates. Cognitive-emotional clustering of anxiety symptoms was more common than hypothesized. This is notable given the overlap of physiological symptoms of anxiety and obesity. Findings lend support for the utility of psychotherapeutic approaches tailored to address maladaptive thoughts to address anxiety and potentially improve WLS outcomes.

Influence of alcohol on social anxiety: An investigation of attentional, physiological and behavioral effects

Social anxiety disorder and alcohol use disorders are highly comorbid. It remains unclear, however, if and how alcohol influences attentional processes and physical symptoms in social anxiety. In a balanced-placebo-design, high and normally socially anxious participants gave a speech while performing a task, which simultaneously measures internal and external attention. Only high anxious participants showed a preferential processing of external probes, which was eliminated by alcohol or the mere expectation of drinking alcohol. Furthermore, alcohol reduced facial blushing as well as self-reported social anxiety during public speaking. Decreases in anxiety were significantly associated with a reduction of the external focus in the high anxious group. Understanding alcohol as a substance influencing cognitive processes as well as physiological symptoms of anxiety further contributes to our understanding of alcohol use as a safety behavior in social anxiety disorder.

CONVERGENCE OF DEPRESSION AND ANXIETY SYMPTOMS IN FRIENDSHIP DYADS.

Despite psychometric rationale to include multiple informants, psychological assessment typically involves data collected from the patient (target) only, particularly with regard to depressive and anxious symptomatology. This study addressed this gap in the literature by assessing convergence between targets and their close friends (informants) in an ethnically diverse sample of young adults. One hundred and thirty-nine friendship dyads completed a packet of questionnaires including different versions administered to the targets and informants, with targets completing the standard questionnaire battery focused on their own symptoms and informants completing questionnaires on their view of the target participants' symptoms, rather than their own characteristics. Measures were included to assess a wide range of symptomatology, including behavioral, cognitive, and physiological symptoms of anxiety and depression. The target-informant correlations were largely significant and of small-to-medium magnitude. In addition, target-informant agreement was higher in more visible symptoms (e.g., behavioral) than in less visible symptoms (e.g., physiological) of anxiety and depression. Interestingly, level of closeness in the relationship did not influence the magnitude of correlations. Implications for future research and integration into clinical assessment practices are discussed.

Autonomic nervous system arousal and cognitive functioning in bipolar disorder

Previous theories about the etiology of cognitive dysfunction in bipolar disorder (BD) emphasized trait factors such as neurological impairment. State factors, other than mood symptoms, that may exacerbate functional deficits have not yet been considered. The purpose of this study was to examine autonomic nervous system (ANS) arousal following cognitive challenge. The study compared patients with BD and healthy controls (HC) in physiological measures and neuropsychological test scores. Thirty euthymic patients with BD and 22 HC completed the study. Participants completed mood [Beck Depression Inventory-II (BDI-II) and Young Mania Rating Scale (YMRS)], anxiety (State-Trait Anxiety Inventory), and substance abuse (Drug Abuse Screening Test-20 item and Alcohol Use Disorders Identification Test) measures. They were connected to an electrogram, a sensitive thermometer for measuring finger temperature, and electrodes that measure galvanic skin response. After a five-min baseline measurement in a restful state, participants completed a computerized neuropsychological battery (CNS Vital Signs). The group with BD reported significantly more mood symptoms (BDI-II, t = 3.71, p < 0.001; YMRS, t = 6.73, p < 0.001) and scored higher on a measure of trait-anxiety (State-Trait Anxiety Inventory, t = 2.91, p < 0.001) than HC. A multivariate analysis of variance revealed higher arousal on all physiological measures in the BD group relative to HC at baseline [F(3,48) = 13.1, p < 0.001] and during cognitive testing [F(3,48) = 11.3, p < 0.001]. The increase in physiological arousal from a restful state to the time of testing was higher for the BD group [F(3,37) = 8.06, p < 0.001]. With respect to cognitive data, HC scored higher than patients with BD across the measures of memory (F = 8.5, p < 0.001), sustained (F = 9.5, p < 0.001) and complex (F = 2.7, p < 0.04) attention, processing speed (F = 10.0, p < 0.001), reaction time (F = 7.8, p < 0.001), cognitive flexibility (F = 19.7, p < 0.001), working memory (F = 10.8, p < 0.001), and social acuity (F = 5.7, p < 0.01), with partial eta-squared from 0.18 to 0.62. Correlational analysis revealed significant associations between various cognitive test scores and changes in physiological arousal from baseline to testing (-0.59 ≤ r ≤ 0.22). Relative to HC, patients with BD experience larger changes in ANS arousal between a restful baseline and cognitive testing, and achieve lower cognitive test scores. Further research is needed to determine whether acute physiological symptoms of anxiety directly compromise cognitive functioning in BD.

The FRIENDS for Life Program for Mexican Girls Living in an Orphanage: A Pilot Study

Anxiety and depression are common problems experienced by children and adolescents that, without an effective intervention, can lead to a series of negative consequences. The aim of this study was to evaluate the effectiveness the Spanish version of the FRIENDS for Life program (Barrett, 2008a, 2008b), a social and emotional skills program that uses cognitive-behavioural techniques for the prevention and early intervention of anxiety and depression. The program was implemented at the selective level of prevention with girls living at an orphanage in Mexico. Participants received the program for 10 consecutive weeks, and pretest and post-test measures were administered. Measures evaluated participants’ anxiety and depressive symptoms and risk status, proactive coping skills, levels of self-concept, self-esteem, and optimism. Social validity was also assessed. Results showed positive changes particularly in optimism and self-concept. Particular items and subscales of the measures also reported statistically significant changes, such as a decrease in worry, physiological symptoms of anxiety, and negative mood, and an increase in self-esteem at home and with peers. Participants evaluated the program as enjoyable and useful. Implications of the findings and further research are discussed.

Psychometric Properties of a Korean Version of the Pain Anxiety Symptoms Scale-20 in Chronic Pain Patients

The Pain Anxiety Symptoms Scale (PASS-20) consists of 20 items designed to assess four aspects of pain-related anxiety: cognitive anxiety, escape-avoidance behaviors, fear of pain, and physiological symptoms of anxiety. Although the PASS-20 is a well-established measure of pain-related anxiety in Western samples, different cultures may yield a different factor structure or different associations with pain-related outcome variables. The purposes of this study were (1) to examine the factor structure of a Korean language version of the PASS-20 (KPASS-20); (2) to examine reliability and construct validity of the KPASS-20; and (3) to compare the findings of this study with those of the original psychometric study using a Western sample. A total of 166 patients seeking treatment in a university pain management center located in Seoul, Korea participated. Results indicated that the KPASS-20 consists of three factors, "fearful thinking," "physiological response," and "avoidance," and has adequate reliability and construct validity estimates. On the mean total score of the KPASS-20, the Korean sample had a significantly higher score than the original Western sample. In addition, in correlation analyses between the total score of the KPASS-20, physical functioning, and pain severity, the Korean sample had significantly higher coefficients, whereas similar differences were not found in the analyses of psychological functioning and depression. The findings provide preliminary support for the reliability and validity of the KPASS-20.

The Impact of Acculturative Stress and Daily Hassles on Pre-adolescent Psychological Adjustment: Examining Anxiety Symptoms

Acculturative stress in relation to anxiety symptoms has not been examined empirically in young Hispanic populations. The present study, conducted with 138 pre-adolescent Hispanic youngsters, investigated this relationship. The findings suggested that acculturative stress was related to physiological, concentration, and worrisome symptoms of anxiety. After decomposing acculturative stress, it became evident that perceived discrimination accounted for a large proportion of the variance in the relationship between acculturative stress and anxiety. Immigration-related stress was mostly associated with worry symptoms. Finally, total daily hassles were an independent predictor of concentration and physiological anxiety symptoms. Implications for prevention interventions and future research are discussed.

Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression

High rates of irritable bowel syndrome (IBS) symptoms have been reported in individuals diagnosed with anxiety and depressive disorders. However, most studies have investigated these relations in a single disorder, rather than a heterogeneous group of patients, thereby not allowing for comparisons across anxiety disorders and depression, or for considering the effects of comorbidity. Thus, the present study investigated the symptoms of IBS in a diverse group of patients ( N = 357) by administering questionnaires and a diagnostic interview. A high frequency of IBS symptoms was found in patients with panic disorder, generalized anxiety disorder, and major depressive disorder. However, the frequency of IBS symptoms in patients with social anxiety disorder, specific phobia, and obsessive-compulsive disorder was comparable to rates found in community samples. In addition, anxiety sensitivity and illness attitudes and intrusiveness were predictive of elevated IBS symptomatology. Together, these findings emphasize the role physiological symptoms of anxiety and worry in the co-occurrence of the anxiety disorders and IBS.

Internalizing Symptoms in Latinos: The Role of Anxiety Sensitivity

Latin American youth in the United States tend to report more internalizing symptoms than white non-Latino youth, yet little is known about the factors that may contribute to such differences. The present study examined the role that anxiety sensitivity, gender, and ethnic minority status may play in the expression of internalizing symptoms across Latin American adolescents (n = 116) and white non-Latino adolescents (n = 72) in the United States and Colombian adolescents in Colombia (n = 163). Results provide evidence that because fear of anxiety related phenomena and physiological symptoms of anxiety in particular may be normative in Latino culture anxiety sensitivity does not amplify somatic complaints for Latin American and Colombian youth as it does for white non-Latino youth. Results further suggest that anxiety sensitivity and being female predicted anxiety and depressive symptoms independent of cultural background. Implications of the findings to our understanding of cultural variability in internalizing symptoms are discussed.

Cognitive Behavior Therapy: Basic Principles and Recent Advances

Cognitive behavior therapy (CBT) is a pragmatic, action-oriented treatment approach that has become a widely used psychotherapy for major mental disorders. CBT methods were initially developed for depression and anxiety disorders (1–3), and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse; they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder (3, 4–7). This article delineates the core principles of CBT, describes procedures used in clinical practice, and notes some of the recent advances that have been made in this treatment method. The extensive research supporting the efficacy of CBT is briefly reviewed.