A new study that is published in the current issue of Psychotherapy and Psychosomatics examines the role of a specific form of psychotherapy, cognitive behavioral therapy (CBT), for patients with panic disorder and agoraphobia and co-morbid depression. Controversy surrounds the questions whether co-occurring depression has negative effects on CBT outcomes in patients with panic disorder and agoraphobia and whether treatment for panic disorder and agoraphobia also reduces co-morbid depressive symptomatology.
Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary panic disorder and agoraphobia (based on DSM-IV-TR criteria) who were treated with a 12-session manualized, exposure-based CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression, which included major depression, dysthymia, or both (43.2% received CBT, 42.7% were controls) were compared to patients without depression on anxiety and depression outcome measures. These included the Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, and Beck Depression Inventory at post-treatment and follow-up. Further the role of severity of depressive symptoms on anxiety/depression outcome measures was examined.
The researchers found that co-morbid 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 a 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). Additionally, dysphoric symptoms improved irrespective of the presence of clinical depression.
Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatology.
Material adapted from Journal of Psychotherapy and Psychosomatics.
Emmrich, A., Beesdo-Baum, K., Gloster, A.T., Knappe, S., Höfler, M., Arolt, V., Deckert, J., Gerlach, A.L., Hamm, A., Kircher, T., Lang, T., Richter, J., Ströhle, A., Zwanzger, P., & Wittchen, H.-U. Depression Does Not Affect the Treatment Outcome of CBT for Panic and Agoraphobia: Results from a Multicenter Randomized Trial. Psychother Psychosom 2012;81:161-172