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1.
Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments. However, little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults. Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were randomly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment. After controlling for cognitive ability at pre-treatment, cognitive behaviour therapy resulted in significantly greater reductions, than waitlist, on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition. Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period. In contrast no significant differences were found between groups on measures of worry and well-being. In conclusion, group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric populations and gains maintain for at least three months. 相似文献
2.
《Cognitive behaviour therapy》2013,42(3):180-192
Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity. 相似文献
3.
V. Robin Weersing Araceli Gonzalez John V. Campo Amanda N. Lucas 《Cognitive and behavioral practice》2008,15(2):126-139
Mood and anxiety disorders in youth are disabling, distressing, and prevalent. Furthermore, depression and anxiety frequently co-exist, may share several etiological factors, and respond to similar interventions. In this paper, we report preliminary results from a treatment adaptation project designed to condense existing cognitive behavioral therapy protocols for anxiety and depression to their core components and combine them into a brief, integrated treatment suitable for the broad population of internalizing youth seen in primary care. Specifically, we discuss: (a) the rationale for targeting anxiety and depression in pediatric primary care and the deployment-focused treatment development model; (b) the content of our behaviorally based treatment program; and (c) clinical outcomes of 2 sample cases with comorbid depression and anxiety. 相似文献
4.
Laura B. Allen Kamila S. White David H. Barlow M. Katherine Shear Jack M. Gorman Scott W. Woods 《Journal of psychopathology and behavioral assessment》2010,32(2):185-192
Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The
current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site
clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic
disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder
(GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder
severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater
reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not
an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid
anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed. 相似文献
5.
Rachel M. Butler Emily B. O’Day Michaela B. Swee Arielle Horenstein Richard G. Heimberg 《Behavior Therapy》2021,52(2):465-477
We examined the outcomes of individual cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) in a sample of 93 adults seeking treatment in a university outpatient clinic specializing in CBT for SAD. Treatment followed the structure of a manual, but number of sessions varied according to client needs. After approximately 20 weeks of therapy, patients’ social anxiety had decreased and their quality of life had increased. Patients with more severe SAD or comorbid major depressive disorder (MDD) at pretreatment demonstrated higher levels of social anxiety averaged across pre- and posttreatment. However, clinician-rated severity of SAD, comorbid MDD, or comorbid generalized anxiety disorder did not predict treatment outcome. Higher pretreatment scores on measures of safety behaviors and cognitive distortions were associated with higher social anxiety averaged across pre- and posttreatment and predicted greater decreases from pre- to posttreatment on multiple social anxiety outcome measures. We found no predictors of change in quality of life. Those with high levels of safety behaviors and distorted cognitions may benefit more from CBT, perhaps due to its emphasis on targeting avoidance through exposure and changing distorted thinking patterns through cognitive restructuring methods. Our study lends support to the body of research suggesting that manualized CBT interventions can be applied flexibly in clinical settings with promising outcomes for patients over a relatively short course of therapy. 相似文献
6.
Lissa Davis 《Behavior Therapy》2010,41(3):296-305
This study examined the impact of comorbidity on treatment outcome and the effects of cognitive behavioral therapy (CBT) for anxiety and depressive disorders on comorbid disorders in a naturalistic sample of 150 patients presenting to an anxiety disorders clinic. The following results were observed across principal (i.e., most severe) diagnoses. Patients with comorbid anxiety and depressive disorders presented for treatment with higher severity of their principal disorder than patients without comorbidity. However, the presence of comorbidity did not predict dropout or poor treatment response, and patients demonstrated significant improvement in their principal disorders regardless of comorbidity. The frequency of clinically severe and subclinical (i.e., not severe enough to meet diagnostic criteria) comorbid conditions decreased significantly over the course of treatment. The implication of these findings for the classification and treatment of emotional disorders is discussed. 相似文献
7.
Michelle G. Newman Amy Przeworski Aaron J. Fisher Thomas D. Borkovec 《Behavior Therapy》2010,41(1):59-72
The current study examined the impact of comorbidity on cognitive and behavioral therapies for generalized anxiety disorder (GAD) as well as the impact of these therapies on diagnoses comorbid to GAD. Seventy-six treatment-seeking adults with principal diagnoses of GAD received 14 sessions of therapy. Most (n = 46; 60.5%) of the sample had at least one comorbid diagnosis. Although the presence of comorbid diagnoses was associated with greater severity of GAD symptoms at pretreatment, greater severity of comorbid major depression, simple phobia, and social phobia was associated with greater change in symptoms of GAD in response to treatment, with no effect on maintenance of gains during a 2-year follow-up. Further, psychotherapy for principal GAD led to a reduction in number of comorbid diagnoses and in severity of social phobia, simple phobia, and major depression at posttreatment. At 2-year follow-up severity of social and simple phobia remained below pretreatment levels, whereas severity of depression was no longer significantly below pretreatment levels. These results suggest that although people with comorbid disorders enter treatment with more severe GAD symptomatology, they demonstrate greater change, and therefore such comorbidity does not diminish the efficacy of cognitive and behavioral therapies for GAD. In addition, the impact of these treatments for GAD may generalize to reduced severity of simple phobia, social phobia, and major depression; however, gains in severity of major depression are not maintained. 相似文献
8.
ABSTRACTThe aim of this study was to examine the extent to which cognitive emotion regulation strategies were “common or transdiagnostic correlates” of symptoms of depression and anxiety and/or “specific correlates” distinguishing one problem category from the other. The sample comprised 582 13- to 16-year-old secondary school students. Symptoms of depression and anxiety were measured by the SCL-90, and cognitive emotion regulation strategies were measured by the CERQ, in a cross-sectional design. Multivariate regression analyses were performed. Before controlling for comorbidity, the same cognitive emotion regulation strategies that were related to symptoms of depression were also related to symptoms of anxiety. However, after controlling for comorbid anxiety symptoms, rumination, self-blame (only girls), positive reappraisal, and positive refocusing (the latter two inversely) were uniquely (and significantly) associated with depression symptoms; and after controlling for comorbid depression symptoms, catastrophising and other-blame were uniquely related to anxiety symptoms. The results supported the cognitive content-specificity model, in which anxiety is supposed to be uniquely characterised by thoughts concerning the overestimation of threats and harm, and depression is supposed to be uniquely characterised by negative evaluations of self, and of past and future events. 相似文献
9.
Alloy LB Abramson LY Whitehouse WG Hogan ME Panzarella C Rose DT 《Journal of abnormal psychology》2006,115(1):145-156
Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression. 相似文献
10.
Westra HA 《Cognitive behaviour therapy》2004,33(4):161-175
While cognitive behavioural therapy is highly effective in the treatment of anxiety and depression, a substantive number of individuals either refuse treatment, fail to respond to treatment or respond only partially. Arguably, ambivalence about change or about engaging in treatment tasks may in part be related to incomplete recovery rates in cognitive behavioural therapy. Motivational interviewing is a client-centred, directive treatment originally developed in the addictions domain whose goal is to enhance motivation for change by understanding and resolving ambivalence. This method has consistently received support for enhancing outcomes in the addictions domain, particularly when used as an adjunct to further treatment. As yet, motivational methods have not been generalized to the treatment of prevalent mental health problems, such as anxiety and depression. The present paper presents the application of a treatment targeting motivation (motivational interviewing adapted for anxiety and depression) to the management of resistance in cognitive behavioural therapy for 3 clients with mixed anxiety and depression. Motivational interviewing is conceived as an adjunct to highly effective traditional cognitive behavioural therapy methods, which is indicated for use with clients resistant to and significantly ambivalent about change-based techniques for managing anxiety or alleviating depression. 相似文献
11.
《Cognitive and behavioral practice》2020,27(2):136-148
Psychological distress, such as anxiety, depression, and posttraumatic stress disorder (PTSD), is commonly comorbid with obesity in veterans. The feasibility and acceptability of an integrated cognitive behavioral treatment approach has been tested in nonveteran settings but has yet to be tested among obese veterans with comorbid anxiety, depression, and PTSD. This paper describes such a framework, highlighting a flexible delivery method, transdiagnostic treatment approach, and attention to treatment barriers examined in a prior qualitative assessment. Brief vignettes are used to illustrate clinical decision-making procedures and treatment activities. The feasibility and acceptability as well as potential next steps for research and clinical benefits are also described. 相似文献
12.
Connie Veazey Karon F. Cook Melinda Stanley Eugene C. Lai Mark E. Kunik 《Journal of clinical psychology in medical settings》2009,16(3):243-253
Parkinson’s disease (PD) is a chronic medical illness with a high incidence of psychiatric comorbidity, specifically depression
and anxiety. Research on treatment of such psychiatric complications is scarce. Non-pharmaceutical treatment options are especially
attractive. Cognitive behavioral therapy (CBT) is a psychotherapeutic treatment option that has been successful in other chronically
medically ill populations with comorbid depression and anxiety. The current research had two aims. The first was to pilot
the feasibility of screening and identifying PD patients with symptoms of anxiety and depression in a specialized outpatient
clinic. The second aim was to pilot the feasibility of telephone-administered CBT for the treatment of depression and anxiety
in persons with PD, which was done through a case series comparing telephone-administered CBT to a Support strategy. A fairly
large portion (67.5%) of patients screened in the outpatient clinic were identified as having symptoms of anxiety and/or depression.
Results also indicated that CBT delivered via the telephone is a useful approach for targeting psychiatric symptoms in this
population. A case example is given to illustrate the clinical considerations associated with delivering therapy via telephone
to persons with PD.
This study was conducted at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. The first author was previously
affiliated with the Houston Center for Quality of Care and Utilization Studies. 相似文献
13.
Brady D. Nelson 《Cognition & emotion》2016,30(3):417-429
The parietal cortex is critical for several different cognitive functions, including visuospatial processing and mathematical abilities. There is strong evidence indicating parietal dysfunction in depression. However, it is less clear whether anxiety is associated with parietal dysfunction and whether comorbid depression and anxiety are associated with greater impairment. The present study compared participants with major depression (MDD), panic disorder (PD), comorbid MDD/PD and controls on neuropsychological measures of visuospatial processing, Judgement of Line Orientation (JLO), and mathematical abilities, Wide Range Achievement Test (WRAT) Arithmetic. Only comorbid MDD/PD was associated with decreased performance on JLO, whereas all psychopathological groups exhibited comparably decreased performance on WRAT Arithmetic. Furthermore, the results were not accounted for by other comorbid disorders, medication use or psychopathology severity. The present study suggests comorbid depression and anxious arousal are associated with impairment in visuospatial processing and provides novel evidence indicating mathematical deficits across depression and/or anxiety. Implications for understanding parietal dysfunction in internalising psychopathology are discussed. 相似文献
14.
Tina C. Montreuil Ashok K. Malla Ridha Joober Claude Bélanger Gail Myhr Martin Lepage 《International journal of group psychotherapy》2016,66(2):225-245
Social anxiety has received scant attention in studies of schizophrenia and related psychoses. However, some data suggest it may be an obstacle to vocational and functional outcome. This pilot study investigated the feasibility of a group-based cognitive behavioral therapy (CBGT) to reduce social anxiety in those at risk for developing psychosis or in the early phase. Twenty-nine patients with first-episode psychosis (FEP) or at ultra high risk for developing psychosis or often referred to as at-risk mental state (ARMS) with comorbid social anxiety attended a CBGT intervention weekly for 14 weeks in 90-minute sessions. Baseline, post-treatment, and follow-up ratings of social anxiety were measured using the Social Interaction Anxiety Scale, the Social Phobia Inventory, and the Brief Social Phobia Scale. Psychotic symptoms and general psychopathology were also measured before and after the intervention. Results suggest that the proposed CBGT is feasible and beneficial for socially anxious patients at risk, or with experience of, psychosis. Participants significantly improved on three outcome measures of social anxiety after completing this intervention (all p’s < .002). Participants who completed treatment also showed a significant reduction on measures of depression and negative symptoms. Future research should examine the relative efficacy of this brief manualized CBGT intervention for the treatment of social anxiety and psychotic symptoms in a larger randomized controlled trial. 相似文献
15.
《Cognitive and behavioral practice》2014,21(4):485-493
Cognitive-behavioral therapy (CBT) is an empirically supported psychological treatment for anxiety disorders. These treatments have primarily been developed to target primary anxiety disorders, despite the fact that these disorders frequently co-occur with a diagnosis of depression. Empirical evidence provides guidance regarding how to treat an individual with a primary anxiety disorder with comorbid depression; however, there is limited data regarding how to translate these findings into clinical practice. Improving our understanding of how CBT is currently being used in practice among experts is integral to learning whether modifications to protocols lead to more or less effective treatments. Accordingly, we surveyed expert CBT clinicians about their assessment and treatment approaches and what challenges they face in formulating and treating mood and anxiety comorbidity. Most experts reported that their assessment includes a semistructured interview and self-report measures to determine breadth and hierarchical ordering of comorbidity severity. Symptom severity, client's goals, temporal onset of disorders, presence of suicide risk, and potential for early treatment success were reported as factors to consider when deciding where to begin treatment. Almost three quarters of experts surveyed indicated that they usually take some type of sequential treatment approach when treating primary anxiety disorders with comorbid depression. The top three reported challenges associated with treating comorbid presentations were client's motivation/energy, hopelessness/pessimism, and ongoing need for risk assessment. Implications for the nature and timing of CBT interventions in “real-world” clinical practice are discussed. 相似文献
16.
The commonalities between anxiety and depression have been discussed before, but few have delineated the potentially different
mechanisms through which treatments work for these populations. The current study conducted a comprehensive review of child
and adolescent randomized clinical trials that tested cognitive-behavioral therapy (CBT) for anxiety or depression. All studies
were required to have assessed both treatment outcomes and at least one theory-specific process target, including behavioral,
physiological, cognitive, and coping variables. Using a meta-analytic approach, CBT demonstrated positive treatment gains
across anxiety, depression, and general functioning outcomes. CBT for anxiety also produced moderate to large effects across
behavioral, physiological, cognitive, and coping processes, with behavioral targets demonstrating potentially the greatest
change. CBT for depression produced small effects for cognitive processes but nonsignificant effects for behavioral and coping
variables. Findings were generally consistent with CB theory but suggest potentially different mediators in the treatment
of anxiety and depression. Results are discussed in terms of implications for mechanisms research, theories of change, and
treatment development. 相似文献
17.
Jeffrey A. Cully Melinda A. Stanley Mark E. Kunik 《Journal of clinical psychology in medical settings》2007,14(2):160-164
This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill
patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized
controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary
disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one
intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement.
Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic
characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid
mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of
their perceived ability to cope with their medical disease. 相似文献
18.
We tested the hypothesis that the tripartite model [Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and psychometric implications. Journal of Abnormal Psychology, 100, 316-336] can be extended to account for change during treatment for anxiety and depression. Forty-one patients treated naturalistically in private practice with cognitive behavior therapy completed weekly measures of depression, anxiety, negative affect (NA), positive affect (PA), and anxious arousal (AA). Consistent with the model, NA was associated with anxiety and depression during treatment, PA was more strongly related to depression than to anxiety, and AA was more strongly related to anxiety than to depression. As predicted, symptoms of depression and anxiety and NA all decreased during treatment. As predicted, AA also decreased, particularly for patients with panic disorder. PA increased during treatment, but only for patients who showed a significant decline in depression and only over an extended period of treatment. Nearly two-thirds of the variance in anxiety change was accounted for by changes in depression and NA, and just over three-fourths of the variance in depression change was accounted for by changes in anxiety and NA, indicating that much of the change in anxiety and depression across the course of treatment is shared in common. 相似文献
19.
Paul Sadler Suzanne McLaren Britt Klein Megan Jenkins 《Cognitive behaviour therapy》2018,47(2):139-154
Insomnia and depression are two of the most common mental health problems that negatively impact older adults. The burden associated with these highly comorbid conditions requires an innovative approach to treatment. There have been significant advancements in the field of cognitive behaviour therapy for insomnia (CBT-I) over recent years. CBT-I has evolved from targeting homogenous insomnia samples to now showing promising results for comorbid insomnia. CBT-I is not only effective at treating comorbid insomnia, but can also have a positive impact on depression severity. Despite these important clinical developments, limited research has explored whether modifying CBT-I programmes to specifically target comorbid depression could improve outcomes for older populations. This paper reviews recent literature and provides therapeutic recommendations to advance CBT-I for older adults with comorbid insomnia and depression. 相似文献
20.
Niloofar Afari Karen B. Schmaling Scott Barnhart Dedra Buchwald 《Journal of clinical psychology in medical settings》2001,8(4):245-252
The goals of this study were to characterize the frequency of psychiatric disorders among patients with asthma, and to compare differences in functional status among asthma patients with and without comorbid depression and anxiety disorders. Fifty patients with confirmed asthma were administered the Diagnostic Interview Schedule for DSM-III-R and completed the Medical Outcomes Study Short Form-36 Health Survey. Patients with asthma had a higher lifetime prevalence of major depression, panic disorder, and agoraphobia, but a lower prevalence of social phobia, compared to lifetime prevalence rates for psychiatric disorders in a national probability sample. Participants with comorbid asthma and major depression had poorer physical and mental health functioning and health perception than did asthma patients without major depression. The results suggest that certain psychiatric disorders are common among patients with asthma and that depression is associated with significantly increased functional morbidity. These findings underscore the need for the appropriate detection and treatment of these comorbid conditions. 相似文献