MATERIALS AND METHODS Participants
The research team advertised the program using recruitment flyers and the provider's email notifications. Some recruited patients were selfreferred, and primary care providers also referred patients whom they identified during consultations as meeting the study's criteria and who expressed interest in volunteering to participate in the study. Participants could voluntarily withdraw from the study at any time. The nature of the intervention required regular and continued followup. The research team attempted to make contact by telephone with anyone who missed an appointment and excluded those participants who missed two appointments from continued participation in the study.
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The Madigan Army Medical Center Institutional Review Board reviewed and approved the protocol. The study obtained informed consent from all participants prior to their answering any questionnaires or participating in any treatments.
A nonrandomized, selfselected population of 37 patients enrolled in the program, with 68% (n = 25) completing the study. The research team included participants in the study if they were (1) between the ages of 18 and 60 and (2) had an established diagnosis of anxiety confirmed by review of electronic medical records or who had a score of > 10 out of a possible 21 on the Generalized Anxiety Disorder 7 (GAD7) Scale. The research team also tested participants' baseline levels of thyroid stimulating hormone to rule out thyroid disorders . The study excluded individuals if they had (1) diabetes; (2) renal failure; (3) psychotic disorders , schizophrenia, or manic depressive disorder ; (4) newly identified or uncontrolled hypothyroidism or hyperthyroidism; (5) a history of cancer, including patients who were undergoing chemotherapy/radiation treatment or were in remission; (6) morbid obesity; (7) coronary artery disease; and (8) any physical limitations that prevented them from walking long distances. In analyzing the results, the research team excluded six participants (16%) who had missed more than two treatment appointments and six participants (16%) who never started therapy, deciding not to participate after consenting.