Efficacy and Underlying Mechanisms of Group Natural Psychotherapy for Anxiety Symptoms

The GAD-7 is a 7-item, self-reported Likert scale used to assess the severity of participants' anxiety symptoms over the past two weeks. Each item is scored from 0 (not at all) to 3 (nearly every day), yielding a total score ranging from 0 to 21, with higher scores indicating greater anxiety severity. The primary endpoint will evaluate the mean change in GAD-7 scores from baseline (Pre-intervention) to post-intervention (Week 4) to determine the efficacy of the intervention.

The Beck Depression Inventory (BDI) is a 21-item, self-reported Likert scale used to measure the severity of depressive symptoms. Each item is scored on a 4-point scale ranging from 0 to 3. The total score is calculated by summing the scores of all 21 items, yielding a total score range from 0 to 63. Higher total scores indicate more severe depressive symptoms.

The Insomnia Severity Index (ISI) is a 7-item self-report instrument assessing the nature, severity, and impact of insomnia over the past two weeks. Each item is rated on a 5-point Likert scale from 0 to 4. The total score is obtained by summing all 7 items, ranging from 0 to 28. Higher total scores reflect a higher severity of insomnia symptoms and greater perceived impairment.

The State-Trait Anxiety Inventory for State Anxiety (STAI-S) is a 20-item self-report scale evaluating a person's current, transient state of anxiety (how they feel "right now"). Items are scored on a 4-point Likert scale from 1 (not at all) to 4 (very much so). After reverse-scoring appropriate items, the total score ranges from 20 to 80. Higher total scores indicate greater levels of current, situational anxiety.

The State-Trait Anxiety Inventory for Trait Anxiety (STAI-T) is a 20-item self-report scale assessing relatively stable, long-term personality traits related to anxiety proneness (how they "generally" feel). Items are scored on a 4-point Likert scale from 1 (almost never) to 4 (almost always). After reverse-scoring appropriate items, the total score ranges from 20 to 80. Higher total scores indicate a greater propensity to experience anxiety as a personality trait.

The Intolerance of Uncertainty Scale (IUS-12) is a 12-item self-report scale measuring negative emotional, cognitive, and behavioral reactions to uncertainty. Each item is rated on a 5-point Likert scale from 1 (not at all characteristic of me) to 5 (entirely characteristic of me). The total score is computed by summing all items, ranging from 12 to 60. Higher total scores represent a lower tolerance for uncertainty and greater anxiety regarding future events.