Self-ratings Of Anxiety Research Articles

Seeking and Sharing Mental Health Information on Social Media During COVID-19: Role of Depression and Anxiety, Peer Support, and Health Benefits.

This study conducted a cross-sectional online survey (N = 865) to determine whether self-ratings of depression and anxiety, perceived peer support, and perceived health benefits of social media predicted mental health–related information seeking and sharing behaviors during the COVID-19 pandemic. Hierarchical regression models showed only depression self-ratings, anxiety self-ratings, and perceived health benefits predicted information seeking, whereas depression self-ratings, anxiety self-ratings, perceived peer support, and perceived health benefits all predicted information sharing. There was a statistically significant positive interaction of anxiety self-ratings and perceived peer support on information sharing. Participants’ experience of COVID-19 predicted both information seeking and sharing. Mental health–related information seeking and sharing differed across social media platforms, with YouTube, Facebook, and Instagram used most for information seeking and Facebook, Instagram, and Twitter used most for information sharing. Findings suggest social media mental health–related seeking and sharing behaviors have the potential to facilitate coping surrounding mental health.

Music-like stimuli affect the emotional processing of words and facial expressions

The present study used the affective priming paradigm to understand interference and facilitation effects of cross-modal emotional interactions; specifically, the ability for five-chord progressions to affect processing efficiency of visual targets. Twenty-five-chord progressions were selected based on the degree that they fulfilled participants’ automatically formulated expectations of how each musical sequence should sound. The current study is an extension of previous research that revealed the influence of music-like stimuli on the identification of valence in emotional words. The potential of music-like stimuli to affect emotional processing, as measured by the efficiency of valence categorization, was assessed across two experiments. Experiment 1 presented word-targets, whereas Experiment 2 presented facial expressions. The processing of words and faces primed with affectively congruent chord-progressions was facilitated, whereas the processing of words primed with affectively incongruent chord-progressions was not. Incongruent pairings with faces engendered interference effects and the second experiment revealed a predictive relationship between behavioral processing speed and self-ratings of anxiety. The processing of word-targets was compared to facial expressions in the presence and absence of music. The results suggest that short musical sequences influence individuals’ emotional processing, which could inform intervention research into how to attenuate potential attention biases.

A test of the ‘parent distortion’ hypothesis when assessing generalised anxiety disorder in boys with an autism spectrum disorder

The ‘parent distortion’ hypothesis regarding assessment of a child's anxiety state was examined in the mothers of 128 boys with an autism spectrum disorder. Mothers’ own generalised anxiety disorder (GAD) and their ratings of their sons’ GAD were compared with the boys’ self-ratings and the ratings of the boys given by a clinician. Boys’ cortisol concentrations were also explored for their association with these three sources of GAD ratings. Results indicated that mothers’ GAD was significantly and directly correlated with the ratings they gave for their sons’ but that only mothers who were above-minimally anxious gave ratings of their sons’ anxiety that significantly agreed with those from the clinicians. Minimally-anxious mothers appeared to underestimate their sons’ anxiety, and these effects generalised to their sons’ self-ratings of anxiety. Associations between the boys’ cortisol concentrations suggested an interaction between the presence of the diurnal fluctuation in boys’ cortisol concentrations and mothers’ anxiety states.

Self-ratings of Everyday Memory Problems in Patients with Acquired Brain Injury - A Tool for Rehabilitation

Introduction: Memory problems are common in everyday life of patients with acquired brain injury (ABI). Some patients with ABI also have problems with self-monitoring/awareness. The ecological validity of neuropsychological tests for everyday life memory problems is questionable. Can self-report instruments supply complementary information? Aims: 1) To document the frequency/impact of self-reported memory problems in a sample of consecutive referrals of ABI patients using PEEM and REEM. 2) To characterize the instruments with respect to psychometrics and internal consistency. 3) To document differences in memory problem patterns for various kinds/localization of brain lesions, and associated anxiety/ depression symptoms. Methods: A descriptive retrospective study of consecutive referrals of ABI patients was performed. Ratings from the Evaluation of Everyday Memory (EEM), in a patient version (PEEM) and a version for relatives/proxies (REEM) were analysed as well as self-ratings of anxiety and depression. Results: The EEM instruments displayed good psychometric characteristics. The mean PEEM score were close to the tenth percentile of healthy controls. PEEM and REEM versions were strongly inter-correlated. Sex, age, and lesion characteristics did not matter much with one exception. Right-hemisphere lesion patients rated their memory problems significantly lower than the proxy, for all other lesions it was vice versa. Anxiety and depression symptoms were associated with memory problems.

Exploring the effects of the ‘Seasons for Growth’ intervention for pupils experiencing change and loss

The purpose of this study was to critically evaluate the impact of the Seasons for Growth (SFG) programme for pupils experiencing loss and change. SFG is a manualised group intervention led by a trained facilitator (a ‘companion’) for young people aged 6 to 18 who have experienced significant loss (Graham, 1996). A repeated measures design was used whereby two groups of Year 7 and Year 8 pupils (N=5; N=7) took part in the study, within a mainstream secondary school. Pupils’ self-ratings of anxiety, self-concept, depression and emotional resiliency were collected pre-intervention, post-intervention and, at two months’ follow-up. All pupils were interviewed individually to explore their experiences and perceptions of the SFG programme. Qualitative and quantitative analysis of the data provided evidence that the SFG programme had a positive and significant impact on pupils’ emotional health and coping behaviours. The findings of this study are discussed in relation to the wider theoretical framework and the practice of educational and child psychology.

Acoustic characteristics of public speaking: Anxiety and practice effects

This study describes the relationship between acoustic characteristics, self-ratings, and listener-ratings of public speaking. The specific purpose of this study was to examine the effects of anxiety and practice on speech and voice during public speaking. Further examination of the data was completed to examine the illusion of transparency, which hypothesizes that public speakers think their anxiety is more noticeable to listeners than it really is. Self-rating and acoustic speech data were reported on two separate speeches produced by 16 college-aged individuals completing coursework in interpersonal communication. Results indicated that there were significant relationships between acoustic characteristics of speech and both self- and listener-ratings of anxiety in public speaking. However, self-ratings of anxiety were higher than listener ratings, indicating possible confirmation of the illusion of transparency. Finally, data indicate that practice patterns have a significant effect on the fluency characteristics of public speaking performance, as speakers who started practicing earlier were less disfluent than those who started later. Data are also discussed relative to rehabilitation for individuals with communication disorders that can be associated with public speaking anxiety.

Effects of Escitalopram on Anxiety and Respiratory Responses to Carbon Dioxide Inhalation in Subjects at High Risk for Panic Disorder

Individuals with panic disorder and those at high risk for panic disorder due to a positive family history seem to have elevated sensitivities to the panicogenic effects of carbon dioxide (CO2) inhalation as well as abnormal ventilatory responses to low doses of CO2 exposure. Many reports have described a reduction in anxiety responses in individuals with panic disorder after a brief treatment with a variety of medications effective in the treatment of panic disorder, but few of these have used placebo control. Thirty-two unmedicated individuals who had either a past history of panic attacks or a family history of treated panic disorder and who demonstrated, at baseline, a panic attack after either a single breath of 35% CO2 or 3 minutes of exposure to 5% CO2 or a decline in minute volume during 3 minutes of exposure to 5% CO2 were randomized to 2-week trials of escitalopram at 10 mg daily or placebo and, after a 1-week washout, to a 2-week trial of the alternate condition. Placebo and escitalopram conditions did not differ by changes in anxiety responses to high-dose, single-breath, or low-dose continuous-breathing CO2 exposures. Ventilatory abnormalities were no more likely to resolve with escitalopram than with placebo. Self-ratings of anxiety and depressive symptoms showed little change over time with either escitalopram or placebo. Escitalopram did not produce greater changes than placebo in panic responses or in ventilatory abnormalities seen during CO2 exposure. Future studies concerning the effects of antidepressants on responses to CO2 challenge should use a placebo-controlled design.

Virtual Reality Cognitive Behavior Therapy for Public Speaking Anxiety

Public speaking anxiety (PSA) is a common phobia. Although cognitive behavior therapy (CBT) is preferred, difficulties arise with the exposure component (lack of therapist control, patient's inability to imagine, self-flooding, loss of confidentiality resulting from public exposure). Virtual reality CBT (VRCBT) enables a high degree of therapist control, thus overcoming these difficulties. This study examined whether VRCBT is an alternative to CBT. Participants with PSA were randomly assigned to VRCBT (28 participants), CBT (30 participants), and wait list control (WLC; 30 participants). VRCBT and CBT were significantly more effective than WLC in anxiety reduction on four of five anxiety measures, and on subject's self-rating of anxiety during a behavioral task. No significant differences were found on observer ratings of the behavioral task. However, twice as many participants dropped out from CBT than from VRCBT. Our results demonstrated that VRCBT is an effective and brief treatment regimen, equal to CBT.

Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary-care settings

This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients. Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBT session were also collected. Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N=74), in terms of self ratings of anxiety, depression, and expectations for improvement. Computer-assisted CBT programs provide a practice-based system for disseminating evidence-based mental health treatment in primary-care settings while maintaining treatment fidelity, even in the hands of novice clinicians.

Effects of a Yoga Program on Cortisol Rhythm and Mood States in Early Breast Cancer Patients Undergoing Adjuvant Radiotherapy: A Randomized Controlled Trial

Objectives. This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer center. Eighty-eight stage II and III breast cancer outpatients are randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to radiotherapy treatment. Assessments include diurnal salivary cortisol levels 3 days before and after radiotherapy and self-ratings of anxiety, depression, and stress collected before and after 6 weeks of radiotherapy. Analysis of covariance reveals significant decreases in anxiety (P < .001), depression (P = .002), perceived stress (P < .001), 6 a.m. salivary cortisol (P = .009), and pooled mean cortisol (P = .03) in the yoga group compared with controls. There is a significant positive correlation between morning salivary cortisol level and anxiety and depression. Yoga might have a role in managing self-reported psychological distress and modulating circadian patterns of stress hormones in early breast cancer patients undergoing adjuvant radiotherapy.

Response of the HPA-axis to alcohol and stress as a function of alcohol dependence and family history of alcoholism

Dysfunction of the hypothalamic-pituitary-adrenal (HPA)-axis has been observed in chronic alcoholics and in non-alcoholic sons of alcoholic parents, while genetic and environmental factors, such as stress, may play a significant role in the development of alcoholism. The present study was designed to investigate the response of the HPA-axis to alcohol and stress as a function of family history of alcoholism and chronic alcohol abuse. We determined changes in plasma adrenal corticotrophin (ACTH) and cortisol concentrations in response to a placebo or an alcohol (0.50g ethanol/kg body wt) drink and to a stress task performed 30 min following ingestion of either the placebo or the alcohol drink in social and heavy drinkers with [high risk (HR)] and without [low risk (LR)] a family history of alcoholism. Thus, four groups of healthy male individuals, low risk with no alcohol-dependence diagnosis (LRNAD), high risk with no alcohol-dependence diagnosis (HRNAD), low-risk alcohol dependent (LRAD) and high-risk alcohol dependent (HRAD), participated in the four experimental sessions given in random order. Basal plasma ACTH levels of LRNAD participants were higher from those of the other three groups of participants. Basal plasma cortisol levels of HRAD participants were higher from those of LRNAD and HRNAD but not of LRAD participants. The stress-induced increases of plasma ACTH and cortisol concentrations were more pronounced in LRNAD participants. The alcohol drink prevented the stress-induced increases in plasma ACTH and cortisol of all groups of participants. The self-ratings of anxiety were attenuated in LRNAD and LRAD participants in the alcohol only session and in HRNAD and HRAD participants in the alcohol plus stress session. In conclusion, there are differences in the activity of the HPA-axis as a function of family history and alcohol dependence, while the effect of an alcohol drink on the self-rating of anxiety may be influenced by both family history and stress.

Familial association of anxiety sensitivity and psychopathology

The purpose of this study was to examine the association between parental (biological mother and father) and adult-offspring anxiety sensitivity (AS), and to determine whether parental AS is related to psychopathology in offspring. We obtained offspring (N=174) self-ratings of anxiety, mood, and stress symptoms, and assigned psychiatric diagnoses using a semistructured clinical interview. Biological mothers, fathers, and offspring independently completed a self-report measure of AS. We hypothesized that (1) there would be a positive relation between parental and offspring AS, and (2) AS in parents would be positively associated with psychopathology in offspring. Results indicated that paternal (but not maternal) AS was associated with offspring AS and psychopathology.

The time taken to complete quality of life questionnaires in an advanced cancer trial

8592 Background: Respondent burden is important when designing trials in advanced cancer. We determined the time taken to complete a set of quality of life questionnaires (TTTCQ) in a randomized trial of sertraline in advanced cancer. Methods: Participants recorded the times they started and finished an 11 page questionnaire of 187 items including the Centre for Epidemiologic Studies Depression Scale, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy General and Fatigue scales, and 4 other validated instruments. Determinants of the TTTCQ were sought amongst the self-ratings of anxiety, depression, fatigue, trouble concentrating, other aspects of quality of life, and other characteristics including age, Karnofsky Performance Status (KPS) and treatment. Distributions are summarised by their median, interquartile range (25th to 75th percentiles, IQR) and interdecile range (10th to 90th percentiles, IDR). Associations were assessed with Spearman’s rank correlation coefficient (r), and differences with the Mann-Whitney test. All p-values are two-sided. Results: The TTTCQ was available for 128 of 150 subjects (85%). Median age was 66 (IQR 59 to 73), median KPS was 80 (IQR 70 to 90), and 63% were male. The median TTTCQ was 30 mins (IQR 23 to 40, IDR 15 to 50), equating to a median of 10 secs per item (IQR 7 to 13, IDR 5 to 16). The TTTCQ was modestly correlated with age and KPS (r = 0.19, p = 0.04 for both). Age and KPS were not correlated (r = 0.03, p = 0.8). Subjects aged 60 or older had a median TTTCQ 10 mins longer than those 59 or younger (35 v 25 mins, p = 0.002). Subjects with a KPS of 100, 90, 80, and 70 or less had a median TTTCQ of 20, 25, 31, and 35 mins respectively. TTTCQ was modestly correlated with self-ratings of: problems coping with treatment, dry mouth, feeling dizzy or lightheaded (r = 0.22 to 0.25, p = 0.01). Correlations were weak or non-existent with all measures of depression, anxiety, trouble concentrating, emotional well-being, and overall well-being (r = 0.10 to 0.18, p = 0.04 to 0.25). TTTCQ was unaffected by gender, opioids, steroids and number of previous cytotoxic regimens. Conclusions: Respondent burden was less of a problem than anticipated and little affected by treatments or self-rated psychological problems. No significant financial relationships to disclose.

Anxiety responses to CO 2 inhalation in subjects at high-risk for panic disorder

Background A number of reports have shown that patients with panic disorder have greater anxiety responses to the inhalation of enhanced carbon dioxide mixtures than do well controls or patients with other psychiatric illnesses. Three earlier studies have shown that well individuals who have first-degree relatives with panic disorder also experience more anxiety following CO 2 than do controls without such a family history. The following was undertaken to confirm and extend these findings. Methods Well subjects at high risk for panic disorder (HR-P, n = 132) had a first-degree family member with treated panic disorder but no personal history of panic attacks. Low-risk subjects (LR-C, n = 85) had no such family history. All underwent a diagnostic interview with the SADS-LA and completed a battery of self-rating scales before undergoing two CO 2 challenges. One involved a single vital capacity breath of air and then of 35% CO 2 and the other 5 min of air and then 5 min of 5% CO 2. Results In comparison to the LR-C group, HR-P subjects had higher scores on various self-ratings of anxiety and depression and were more likely to have a lifetime diagnosis of MDD or of an anxiety disorder. NEO neuroticism and a history of MDD were the most important of these measures in separating the high-risk and low-risk groups. As predicted, the HR-P subjects experienced more anxiety following 35% CO 2 exposure. The removal of individuals with lifetime diagnosis of MDD or of an anxiety disorder eliminated the relationship of neuroticism to CO 2-induced anxiety and strengthened the relationship between the CO 2 response and a family history of panic disorder. Five minutes of 5% CO 2 produced much lower increases in anxiety than did the 35% exposure, but a dose by group interaction suggested that increasing exposure increased anxiety preferentially in the high-risk subjects. Conclusion The results confirm earlier findings in indicating that a family history of panic disorder conveys a liability to experience anxiety with CO 2 exposure. They also suggest that this anxiety may reflect several discrete diatheses of relevance to the heritability of panic disorder.

Gender specific effects of a mild stressor on alcohol cue reactivity in heavy social drinkers

Rationale Stress plays an important role in the development and maintenance of alcohol-abuse. Some of the effects of stress on alcohol-related behaviours, however, appear to be gender-dependent. Aim The present study set out to examine the effects of stress on feelings of desire for alcohol, skin conductance response and alcohol consumption in the presence of alcohol-related cues in relation to gender. Participants were heavy non-dependent alcohol drinkers. Methods Thirty-two (16 males) participants drinking more than 21 units of alcohol per week were randomly allocated to undergo the experimental stress (based on the ‘Trier Social Stress’ Test) or the non-stress procedure before the alcohol cue exposure procedure, during which participants handled and smelled their preferred drink. Mood and saliva cortisol level changes were used as indices of the stress effects, while alcohol craving, skin conductance and alcohol consumption were the cue reactivity measures. Results Self ratings of anxiety and tension increased and cortisol levels remained high in the stress compared to the non-stress condition; no gender differences were found. Stress induced gender-specific effects with regard to skin conductance response and alcohol consumption measurements. Stressed females did not show an increase from baseline in the skin conductance response during the alcohol cue-exposure session, which was observed in the non-stressed females; they also consumed less alcohol than males under stress. Conclusion Female participants respond less to alcohol-related cues when in a negative mood state. Such a finding suggests that females when in a negative mood may be less sensitive to positive incentive processes mediating cue reactivity compared to males.

Evaluation of a Treatment Program for Sexually Abused Adult Males

This study evaluated the effectiveness of an individual treatment program for five adult males who experienced childhood sexual abuse. A treatment manual focusing on abuse-related self-blame, anger, and anxiety was developed. Daily self-blame, anger, and anxiety self-ratings were completed before and throughout treatment. A multiple-baseline approach was used to evaluate treatment effects. Overall findings indicated that most participants experienced significant reductions in self-blame, anger, and anxiety as a result of their involvement in the sexual abuse treatment program. Treatment was particularly helpful in decreasing feelings of self-blame and anger. The study made an important initial contribution to the development of systematic treatment outcome research for a population of individuals that has received relatively little attention. The results have implications for future clinical and research efforts with sexually abused adult males.

Electronic pain questionnaires: A randomized, crossover comparison with paper questionnaires for chronic pain assessment

Electronic questionnaires for pain assessment are becoming increasingly popular. There have been no published reports to establish the equivalence or psychometric properties of common pain questionnaires administered via desktop computers. This study compared responses to paper (P) and touch screen electronic (E) versions of the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain Disability Index (PDI), while examining the role of computer anxiety and experience, and evaluating patient acceptance. In a randomized, crossover design 189 chronic pain patients completed P and E versions of the SF-MPQ and PDI, and self-ratings of anxiety, experience, relative ease and preference. Psychometric properties were highly similar for P and E questionnaires. For the SF-MPQ, 60% or more of subjects gave equivalent responses on individual descriptors and PPI scale, with 80% rating within ±1 point for an 11-point VAS. Correlations for the SF-MPQ scales ranged from 0.68 to 0.84. For the PDI, 60% or more of subjects responded within ±1 point on individual questions, and the total score correlation was 0.67. Comparison of mean difference scores revealed no significant differences between modes for any of the questionnaire items or scores. Anxiety and experience scores showed no significant associations through correlations and high/low comparisons. Although nearly half of subjects reported no computer training, anxiety ratings were low, and considerably more subjects rated the E questionnaires as easier and preferred. Findings are consistent with test-retest reliability data, and support the validity and acceptance of electronic versions of the SF-MPQ and PDI.

Electronic pain questionnaires: A randomized, crossover comparison with paper questionnaires for chronic pain assessment

Electronic questionnaires for pain assessment are becoming increasingly popular. There have been no published reports to establish the equivalence or psychometric properties of common pain questionnaires administered via desktop computers. This study compared responses to paper (P) and touch screen electronic (E) versions of the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain Disability Index (PDI), while examining the role of computer anxiety and experience, and evaluating patient acceptance. In a randomized, crossover design 189 chronic pain patients completed P and E versions of the SF-MPQ and PDI, and self-ratings of anxiety, experience, relative ease and preference. Psychometric properties were highly similar for P and E questionnaires. For the SF-MPQ, 60% or more of subjects gave equivalent responses on individual descriptors and PPI scale, with 80% rating within ±1 point for an 11-point VAS. Correlations for the SF-MPQ scales ranged from 0.68 to 0.84. For the PDI, 60% or more of subjects responded within ±1 point on individual questions, and the total score correlation was 0.67. Comparison of mean difference scores revealed no significant differences between modes for any of the questionnaire items or scores. Anxiety and experience scores showed no significant associations through correlations and high/low comparisons. Although nearly half of subjects reported no computer training, anxiety ratings were low, and considerably more subjects rated the E questionnaires as easier and preferred. Findings are consistent with test-retest reliability data, and support the validity and acceptance of electronic versions of the SF-MPQ and PDI.

Comparison of anxiety assessments between clinicians and patients with acute myocardial infarction in cardiac critical care units

Although anxiety is common after acute myocardial infarction and can adversely affect physical recovery, it is not part of the routine clinical assessment of patients with myocardial infarction. Furthermore, evidence suggests that patients and clinicians differ significantly in their assessments of patients' anxiety levels. To determine the extent to which clinicians assess anxiety in patients with acute myocardial infarction and to compare patients' self-ratings with their clinicians' assessments. In a prospective, descriptive study, 101 patients used the Spielberger State Anxiety Index to assess their anxiety during the first 48 hours after admission for acute myocardial infarction. Patients' scores were compared with nurses' and physicians' assessments of the patients' anxiety as reported in the medical record. Only 45 patients (45%) had anxiety assessments noted in the record. Of those 45, 26 patients (58%) were described simply as anxious without any further description of the level of anxiety. Eleven (24%) of those 45 patients had behaviors of anxiety recorded, again without any indication of the level of anxiety. No association between patients' self-assessments and their clinicians' assessments was apparent (lambda = .03; P > .05). Anxiety was not routinely assessed, despite nearly half the patients reporting moderate to extreme anxiety when asked. When clinicians assessed anxiety, their assessments did not match patients' self-ratings of anxiety. A simple, easy-to-use instrument for discriminating levels of anxiety is needed.

Kernels of truth or distorted perceptions: Self and observer ratings of social anxiety and performance

This study compared self and observer ratings of social performance and anxiety among individuals with social anxiety disorder, nonclinical controls, and participants with dysthymia serving as clinical controls. The purpose was to elucidate whether self-perceptions of individuals with social anxiety disorder reflect observable performance and anxiety differences, negative self-perceptions, or an interaction of the two. Participants engaged in three role-played interactions, and self and observer ratings of performance and anxiety were obtained. In general, self-ratings of anxiety and performance were more negative (greater anxiety and poorer performance) than were observer ratings. Interactions of rating source and diagnosis indicated the discrepancy between self and observer ratings of both anxiety and performance was significantly greater among participants with social anxiety disorder. Observers, however, generally noted differences across the groups in both anxiety and performance. The discrepancies between self and observer ratings of anxiety were related to negative evaluation fears and negative thought patterns, while performance discrepancies were related to negative thought patterns. Treatment implications are discussed.