A new study that is published in the current issue of Psychotherapy and Psychosomatics examines the role of a specific form of psychotherapy, cognitive therapy, in anxious-depression. The study authors noted in their research review that anxious-depressed patients can have a poorer response to pharmacotherapy compared to nonanxious-depressed patients, which often prompts consideration of other treatments.
Based on the transdiagnostic principles of cognitive therapy (CT), the investigators predicted that anxious-depressed patients would respond equally well to CT as nonanxious-depressed patients.
In the study, adults (n = 523) with recurrent major depressive disorder received 12 to 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.
The authors concluded that these 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.
Material adapted from Journal of Psychotherapy and Psychosomatics.
Smits, J.A.J., Minhajuddin, A., Thase, M.E., & Jarrett, R.B. (2012). Outcomes of Acute Phase Cognitive Therapy in Outpatients with Anxious versus Nonanxious Depression. Psychother Psychosom, 81:153-160.