Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression?

Jeffrey R. Vittengl, Lee Anna Clark, Jasper Smits, Michael E. Thase, Robin B. Jarrett

Research output: Contribution to journalArticle

Abstract

Background: Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. Methods: Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. Results: Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. Limitations: Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. Conclusions: Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.

LanguageEnglish (US)
Pages150-158
Number of pages9
JournalJournal of Affective Disorders
Volume242
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cognitive Therapy
Anxiety Disorders
Depression
Major Depressive Disorder
Anxiety
Social Phobia
Fluoxetine
Therapeutics
Outpatients
Placebos

Keywords

  • Anxiety disorders
  • Cognitive therapy
  • Comorbidity
  • Fluoxetine
  • Major depressive disorder
  • Social anxiety disorder

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression? / Vittengl, Jeffrey R.; Clark, Lee Anna; Smits, Jasper; Thase, Michael E.; Jarrett, Robin B.

In: Journal of Affective Disorders, Vol. 242, 01.01.2019, p. 150-158.

Research output: Contribution to journalArticle

Vittengl, Jeffrey R. ; Clark, Lee Anna ; Smits, Jasper ; Thase, Michael E. ; Jarrett, Robin B. / Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression?. In: Journal of Affective Disorders. 2019 ; Vol. 242. pp. 150-158.
@article{5e669faa4e9c40d1a4ffba54da2c68e6,
title = "Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression?",
abstract = "Background: Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. Methods: Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. Results: Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. Limitations: Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. Conclusions: Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.",
keywords = "Anxiety disorders, Cognitive therapy, Comorbidity, Fluoxetine, Major depressive disorder, Social anxiety disorder",
author = "Vittengl, {Jeffrey R.} and Clark, {Lee Anna} and Jasper Smits and Thase, {Michael E.} and Jarrett, {Robin B.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jad.2018.08.053",
language = "English (US)",
volume = "242",
pages = "150--158",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

TY - JOUR

T1 - Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression?

AU - Vittengl, Jeffrey R.

AU - Clark, Lee Anna

AU - Smits, Jasper

AU - Thase, Michael E.

AU - Jarrett, Robin B.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. Methods: Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. Results: Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. Limitations: Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. Conclusions: Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.

AB - Background: Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. Methods: Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. Results: Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. Limitations: Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. Conclusions: Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.

KW - Anxiety disorders

KW - Cognitive therapy

KW - Comorbidity

KW - Fluoxetine

KW - Major depressive disorder

KW - Social anxiety disorder

UR - http://www.scopus.com/inward/record.url?scp=85054101998&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054101998&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2018.08.053

DO - 10.1016/j.jad.2018.08.053

M3 - Article

VL - 242

SP - 150

EP - 158

JO - Journal of Affective Disorders

T2 - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -