Articlebronze2012

Depression Does Not Affect the Treatment Outcome of CBT for Panic and Agoraphobia: Results from a Multicenter Randomized Trial

Angela Emmrich · Katja Beesdo‐Baum · Andrew Thomas Gloster · Susanne Knappe · Michael Höfler · Volker Arolt +9 more

38 citations0/0 files storedPsychotherapy and Psychosomatics

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychotherapy Techniques and Applications Psychological Treatments and Assessments

Abstract

BACKGROUND: Controversy surrounds the questions whether co-occurring depression has negative effects on cognitive-behavioral therapy (CBT) outcomes in patients with panic disorder (PD) and agoraphobia (AG) and whether treatment for PD and AG (PD/AG) also reduces depressive symptomatology. METHODS: Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary PD/AG (DSM-IV-TR criteria) treated with a 12-session manualized CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression (DSM-IV-TR major depression, dysthymia, or both: 43.2% CBT, 42.7% controls) were compared to patients without depression regarding anxiety and depression outcomes (Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, Beck Depression Inventory) at post-treatment and follow-up (categorical). Further, the role of severity of depressive symptoms on anxiety/depression outcome measures was examined (dimensional). RESULTS: Comorbid depression did not have a significant overall effect on anxiety outcomes at post-treatment and follow-up, except for slightly diminished post-treatment effect sizes for clinician-rated CGI (p = 0.03) and HAM-A (p = 0.008) when adjusting for baseline anxiety severity. In the dimensional model, higher baseline depression scores were associated with lower effect sizes at post-treatment (except for MI), but not at follow-up (except for HAM-A). Depressive symptoms improved irrespective of the presence of depression. CONCLUSIONS: Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatology.

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References

1959THE ASSESSMENT OF ANXIETY STATES BY RATING 1998The Risk for Early-Adulthood Anxiety and Depressive Disorders in Adolescents With Anxiety and Depressive Disorders 2001Behavioral Activation Treatment for Depression: Returning to Contextual Roots 2005Influence of Psychiatric Comorbidity on Recovery and Recurrence in Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: A 12-Year Prospective Study 2000Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder 1991Cross-cultural Feasibility, Reliability and Sources of Variance of the Composite International Diagnostic Interview (CIDI)1985The Mobility Inventory for Agoraphobia 2007Incidence of Social Anxiety Disorder and the Consistent Risk for Secondary Depression in the First Three Decades of Life

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