Outcomes of Acute Phase Cognitive Therapy in Outpatients with Anxious versus Nonanxious Depression

Department of Psychology, Southern Methodist University, Dedman College, PO Box 750442, Dallas, TX 75275, USA.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 03/2012; 81(3):153-60. DOI: 10.1159/000334909
Source: PubMed


Compared to nonanxious depressed patients, anxious depressed patients respond less to pharmacotherapy, prompting consideration of alternate treatments. Based on the transdiagnostic principles of cognitive therapy (CT), we predicted that anxious depressed patients would respond as well to CT as nonanxious depressed patients.
Adults (n = 523) with recurrent major depressive disorder received 12-14 weeks of CT as part of the Continuation Phase Cognitive Therapy Relapse Prevention Trial. Anxious depressed patients (n = 264; 50.4%) were compared to nonanxious depressed patients (n = 259; 49.6%) on demographic variables, initial severity, attrition, and rates and patterns of response and remission.
Anxious depressed patients presented with greater illness severity and had significantly lower response (55.3 vs. 68.3%) and remission rates (26.9 vs. 40.2%) based on clinician-administered measures. By contrast, smaller between-group differences for attrition, and for response (59.1 vs. 64.9%) and remission (41.7 vs. 48.7%) rates on self-report measures were not significant. Further, anxious depressed patients had greater speed of improvement on self-reported anxiety symptom severity and clinician-rated depressive and anxiety symptom severity measures.
Consistent with prior reports, anxious depressed patients presented with greater severity and, following CT, had lower response and remission rates on clinician-administered scales. However, anxious depressed patients improved more rapidly and response and remission rates on self-report measures were not significantly different from nonanxious depressed patients. Our findings suggest that anxious depressed patients may simply need additional time or more CT sessions to reach outcomes fully comparable to those of less anxious patients.

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    • "; Forand & DeRubeis, in press; Roy-Byrne et al., 2000), and greater risk of suicide (G. A. Fava et al., 2004; Fawcett, Scheftner, Fogg, & Clark, 1990; Johnson , Weissman, & Klerman, 1990; Roy-Byrne et al., 2000). Critically , these patients also demonstrate diminished rates of full treatment response/remission to both psychotherapeutic (Brown et al., 1996; Feske, Frank, Kupfer, Shear, & Weaver, 1998; Frank et al., 2000; Smits, Minhajuddin, Thase, & Jarrett, 2012; but see also Fournier et al., 2009) and pharmacologic depression interventions (Brown et al., 1996; M. Fava et al., 2008). Thus, the weight of the extant evidence suggests that co-occurring anxiety adversely affects the typical efficacy of depression interventions. "
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