TY - JOUR
T1 - The influence of comorbid anxiety on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder
AU - van Bronswijk, Suzanne C.
AU - Lemmens, Lotte H.J.M.
AU - Huibers, Marcus J.H.
AU - Arntz, Arnoud
AU - Peeters, Frenk P.M.L.
PY - 2018/5
Y1 - 2018/5
N2 - Background: Anxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. Methods: Depressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales. Results: Approximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments. Limitations: Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater. Conclusions: A preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder.
AB - Background: Anxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. Methods: Depressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales. Results: Approximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments. Limitations: Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater. Conclusions: A preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder.
KW - Anxiety disorder
KW - Anxiety symptoms
KW - Cognitive therapy
KW - Depression
KW - Interpersonal psychotherapy
UR - http://www.scopus.com/inward/record.url?scp=85042460823&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042460823&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2018.02.003
DO - 10.1016/j.jad.2018.02.003
M3 - Article
AN - SCOPUS:85042460823
SN - 0165-0327
VL - 232
SP - 52
EP - 60
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
IS - May
ER -