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Vila-Merkle H, González-Martínez A, Campos-Jiménez R, Martínez-Ricós J, Teruel-Martí V, Lloret A, Blasco-Serra A, Cervera-Ferri A. Sex differences in amygdalohippocampal oscillations and neuronal activation in a rodent anxiety model and in response to infralimbic deep brain stimulation. Front Behav Neurosci 2023; 17:1122163. [PMID: 36910127 PMCID: PMC9995972 DOI: 10.3389/fnbeh.2023.1122163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Depression and anxiety are highly comorbid mental disorders with marked sex differences. Both disorders show altered activity in the amygdala, hippocampus, and prefrontal cortex. Infralimbic deep brain stimulation (DBS-IL) has anxiolytic and antidepressant effects, but the underlying mechanisms remain unclear. We aimed to contribute to understanding sex differences in the neurobiology of these disorders. Methods In male and female rats, we recorded neural oscillations along the dorsoventral axis of the hippocampus and the amygdala in response to an anxiogenic drug, FG-7142. Following this, we applied DBS-IL. Results Surprisingly, in females, the anxiogenic drug failed to induce most of the changes observed in males. We found sex differences in slow, delta, theta, and beta oscillations, and the amygdalo-hippocampal communication in response to FG-7142, with modest changes in females. Females had a more prominent basal gamma, and the drug altered this band only in males. We also analyzed c-Fos expression in both sexes in stress-related structures in response to FG-7142, DBS-IL, and combined interventions. With the anxiogenic drug, females showed reduced expression in the nucleus incertus, amygdala, septohippocampal network, and neocortical levels. In both experiments, the DBS-IL reversed FG-7142-induced effects, with a more substantial effect in males than females. Discussion Here, we show a reduced response in female rats which contrasts with the higher prevalence of anxiety in women but is consistent with other studies in rodents. Our results open compelling questions about sex differences in the neurobiology of anxiety and depression and their study in animal models.
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Affiliation(s)
- Hanna Vila-Merkle
- Neuronal Circuits Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Alicia González-Martínez
- Neuronal Circuits Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Rut Campos-Jiménez
- Neuronal Circuits Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Joana Martínez-Ricós
- Neuronal Circuits Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Vicent Teruel-Martí
- Neuronal Circuits Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Ana Lloret
- Department of Physiology, Faculty of Medicine, Health Research Institute INCLIVA, CIBERFES, University of Valencia, Valencia, Spain
| | - Arantxa Blasco-Serra
- Study Group for the Anatomical Substrate of Pain and Analgesia (GESADA) Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Ana Cervera-Ferri
- Neuronal Circuits Laboratory, Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
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The Role of Comorbid Mood Disorders in Cognitive Behavioral Therapy for Childhood Social Anxiety. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Children with a social anxiety disorder have worse treatment outcomes after Cognitive Behavior Therapy (CBT) than children with other anxiety disorders. Anxiety disorders and mood disorders are strongly related and especially social anxiety is related to high comorbidity rates with mood disorders. The aim of the study was to investigate how comorbid mood disorders are related to treatment outcomes after CBT and whether this can explain the worse outcomes for childhood social anxiety.
Methods
Participants were 152 referred clinically children (7–18 years) with either a social anxiety disorder (n = 52) or another anxiety disorder (n = 100) of whom 24.3% (n = 37) had a comorbid mood disorder. Child anxiety, internalizing symptoms, and quality of life were measured pre-treatment, post-treatment, 3 months and 1 year after treatment, using child and both parents’ report.
Results
Children with a primary social anxiety disorder more often had a comorbid mood disorder than children with another primary anxiety disorder. Children with a mood disorder had more severe anxiety problems before treatment. Comorbid mood disorders were related to greater anxiety reductions after treatment. The worse outcomes for children with a primary social anxiety disorder remained after controlling for comorbid mood disorders.
Conclusions
Findings stress the importance of future studies examining why the presence of a comorbid mood disorder is associated with greater anxiety reductions, and other factors that explain the worse treatment outcomes found for childhood social anxiety disorder.
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Klein Breteler J, Ikani N, Becker ES, Spijker J, Hendriks G. Comorbid depression and treatment of anxiety disorders, OCD, and PTSD: Diagnosis versus severity. J Affect Disord 2021; 295:1005-1011. [PMID: 34706408 DOI: 10.1016/j.jad.2021.08.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/10/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although anxiety and depression are highly comorbid disorders, it remains unclear whether and how a concurrent depression affects the outcome of anxiety treatment. METHOD Using anonymized routine outcome monitoring (ROM) data of 740 patients having received specialized treatment for an anxiety disorder, OCD, or PTSD, this study investigates whether a comorbid diagnosis of depression and/or self-reported depression severity levels relate to the patients' improvement following anxiety treatment. RESULTS The results show that both the patients with and those without comorbid depression had profited similarly from the anxiety, OCD, or PTSD treatment, regardless of whether depression was merely diagnosed prior to treatment or based on self-reported severity (and assuming a smallest effect size of interest of d = 0.35/r = .2). Importantly, the post-treatment reductions in self-reported depressive symptoms were strongly and positively related to the reductions in self-reported anxiety symptoms and disorder-related disability. LIMITATIONS Causal inferences cannot be made due to the retrospective cross-sectional design. CONCLUSIONS The outcomes obtained in a naturalistic patient sample support current treatment guidelines recommending evidence-based treatment for anxiety disorders, OCD, and PTSD in patients with and without a comorbid depression. Future treatment studies are recommended for investigate the (bi)directionality of anxiety and depressive symptoms throughout treatment.
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Affiliation(s)
- J Klein Breteler
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Overwaal, Center of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands.
| | - N Ikani
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Overwaal, Center of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands; Center of Expertise for Depression, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands
| | - E S Becker
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands
| | - J Spijker
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Center of Expertise for Depression, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands
| | - G Hendriks
- Department of Psychology, Behavioural Science Institute, Radboud University, Experimental Psychopathology and Treatment, Montessorilaan, 6500 HE, Nijmegen, Gelderland 6525 HR, the Netherlands; Overwaal, Center of Expertise for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders, Pro Persona, Institute for Integrated Mental Health Care, Nijmegen, the Netherlands
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Kline AC, Cooper AA, Rytwinski NK, Feeny NC. The Effect of Concurrent Depression on PTSD Outcomes in Trauma-Focused Psychotherapy: A Meta-Analysis of Randomized Controlled Trials. Behav Ther 2021; 52:250-266. [PMID: 33483121 PMCID: PMC7826446 DOI: 10.1016/j.beth.2020.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
The co-occurrence of depression with posttraumatic stress disorder (PTSD) is common and associated with greater severity and impairment than PTSD alone, but the effects on PTSD treatment outcomes are unclear. This study investigated the impact of baseline depression on PTSD symptom change and dropout in a meta-analysis of 44 randomized controlled trials (N = 4,866) of trauma-focused psychotherapies for PTSD. Analyses included 107 active (k = 71) and control (k = 36) conditions. Baseline depression was indexed within samples as (a) continuous symptom severity (e.g., Beck Depression Inventory), standardized across depression measures and (b) proportion of patients with comorbid depressive disorder diagnosis. Among active conditions reporting continuous depression scores (k = 62), greater depression severity predicted smaller PTSD treatment effect sizes (ß = -.36, p = .002), but not dropout (ß = .25, p = .18). Categorical depressive diagnosis rates (k = 29)-reported less frequently-were not associated with treatment effects or dropout in active conditions. Greater depression severity may reflect a risk factor for attenuated response in PTSD psychotherapies, potentially demanding complementary strategies within trauma-focused interventions. Variability between trials in baseline depression symptoms may suggest the need to consider this sample characteristic when comparing treatment outcomes across studies.
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Spijker J, Muntingh A, Batelaan N. Advice for Clinicians on How to Treat Comorbid Anxiety and Depression. JAMA Psychiatry 2020; 77:645-646. [PMID: 32293658 DOI: 10.1001/jamapsychiatry.2020.0601] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jan Spijker
- Pro Pergratersona Mental Health Care, Depression Expertise Center, Nijmegen, the Netherlands.,Radboud University Nijmegen, the Netherlands
| | - Anna Muntingh
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Neeltje Batelaan
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
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Stressful Life Events Are Associated With Health-Related Quality of Life During Cardiac Rehabilitation and at 2-yr Follow-up in Patients With Heart Failure. J Cardiopulm Rehabil Prev 2020; 39:E5-E8. [PMID: 30688794 DOI: 10.1097/hcr.0000000000000385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE According to recent literature, stressful life events might represent an important risk factor of health-related quality of life (HRQoL) in patients with heart failure. The aim of this study was to evaluate the association between stressful life events and HRQoL in patients with heart failure after acute coronary syndrome, both during cardiac rehabilitation and during 2 yr of follow-up. METHODS Patients with heart failure (n = 481; 75% male; mean age: 58 ± 9 yr) were evaluated for sociodemographic, clinical, and mental distress factors including stressful life events, anxiety and depression symptoms, perceived social support, and type D personality. Health-related quality of life was evaluated at baseline and at follow-up by telephone interview. Patients were also tested for exercise capacity at baseline. RESULTS Stressful life events were associated with impaired HRQoL independently of sociodemographic characteristics, clinical factors, mental distress, social support, and type D personality. CONCLUSION Stress level due to experiencing stressful life events should be specifically assessed during cardiac rehabilitation, as it is associated with patients HRQoL.
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Asp M, Lindqvist D, Fernström J, Ambrus L, Tuninger E, Reis M, Westrin Å. Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care. PLoS One 2020; 15:e0227364. [PMID: 31895938 PMCID: PMC6939935 DOI: 10.1371/journal.pone.0227364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. METHODS 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. RESULTS SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001). CONCLUSIONS Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.
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Affiliation(s)
- Marie Asp
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
- * E-mail:
| | - Daniel Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Johan Fernström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Livia Ambrus
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Eva Tuninger
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - Margareta Reis
- Department of Clinical Pharmacology, Linköping University, Linköping, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
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Patient satisfaction with primary healthcare services: are there any links with patients' symptoms of anxiety and depression? BMC FAMILY PRACTICE 2018; 19:90. [PMID: 29921234 PMCID: PMC6009850 DOI: 10.1186/s12875-018-0780-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/25/2018] [Indexed: 11/25/2022]
Abstract
Background The aim of our study was to determine the association of anxiety and depression symptoms, as well as the main socio-demographic factors, with patients’ satisfaction with primary healthcare services. Methods The respondents were asked to fill out an anonymous questionnaire that included information on the patients’ gender, age, place of residence, education, ethnicity, the type of clinic they visited and the presence of chronic diseases. Patient satisfaction was evaluated by using a short version of the Patient Satisfaction Questionnaire. We also used the Hospital Anxiety and Depression Scale. Results Poor evaluations of primary healthcare services were more characteristic of males, older patients, those living in district centres and villages, individuals with lower (secondary or lower) education levels, respondents of Russian ethnicity (compared to Lithuanian), patients with chronic diseases and higher anxiety and depression symptom scores. In the final regression analysis, better satisfaction with primary healthcare services was observed in respondents who were less depressed, of Polish ethnicity and who were living in a city rather than a village. Conclusions Being more depressed or anxious, living in the district centre or countryside related to patients’ worse satisfaction with primary healthcare services. The results of nationality of patients and their satisfaction are ambiguous. The is strong correlation between the symptoms of depression and anxiety.
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Chlebowy DO, Batscha C, Kubiak N, Crawford T. Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes. J Racial Ethn Health Disparities 2018; 6:71-76. [DOI: 10.1007/s40615-018-0500-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/25/2018] [Accepted: 05/07/2018] [Indexed: 12/26/2022]
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Talkovsky AM, Green KL, Osegueda A, Norton PJ. Secondary depression in transdiagnostic group cognitive behavioral therapy among individuals diagnosed with anxiety disorders. J Anxiety Disord 2017; 46:56-64. [PMID: 27707524 DOI: 10.1016/j.janxdis.2016.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022]
Abstract
Anxiety and depression co-occur at high rates, and their comorbidity typically creates a more severe clinical presentation then either alone. The effect of comorbid depression appears to vary across anxiety and related disorders. Transdiagnostic treatments present a promising option to improve comorbid conditions by targeting shared factors (e.g., information processing biases). The purpose of this study was to examine the reciprocal effects of secondary depression in transdiagnostic group cognitive behavioral therapy for anxiety (TGCBT). 120 individuals diagnosed with a primary anxiety disorder, 42 of whom had a depressive diagnosis, were enrolled in 12 weeks of TGCBT. Depressed individuals were compared to those without a depressive diagnosis on both clinician-rated and self-reported anxiety and depression following TGCBT. Although depressed individuals scored higher on most indices of anxiety at pre-treatment, both groups improved similarly with some evidence of greater improvement among those with comorbid depression. All individuals improved in self-reported depressive symptoms and comorbid depression improved to subclinical levels. These results posit TGCBT as an effective, efficient option for treating patients with anxiety and comorbid depression.
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Abstract
BACKGROUND The use of psychotropic medications, particularly antidepressants, is common in patients with inflammatory bowel disease (IBD) in spite of a lack of their robust efficacy in this population. This review provides an overview of the use trends of different classes of antidepressant and anti-anxiety medication and their effects on mood, nervous system function, gastrointestinal physiology and immunity drawing from the literature available in the general population, other medical conditions, and when available, patients with IBD. It also covers the evidence base for the actions, efficacy, and potential complications of antidepressants organized by different classes. METHODS We conducted a PubMed search of articles relating the different drug classes probed to the terms above in different populations of interest. All types of articles were accepted including case reports and series, open and randomized trials, reviews, and expert opinion. We also examined the reference lists of the publications found. RESULTS Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are the most commonly prescribed agents for anxiety and depression in patients with IBD, though their efficacy for these conditions in the general population are mild to moderate at best. SSRIs are generally well tolerated, though at higher doses, they, like most antidepressant classes, can be associated with activation, serotonergic syndrome, and increased suicidal ideation. TCAs have many more serious side effects but have some shown efficacy for functional GI symptoms. A newer class, the serotonin noradrenergic reuptake inhibitors (SNRIs), can be effective for refractory depression, anxiety and chronic pain syndromes with a side effect profile similar to both SSRIs and more mild manifestations of TCAs. Mirtazapine has moderate efficacy for depression if sedation and weight gain side effects are tolerated and some small support for use in nausea and vomiting. Bupropion targets dopamine and noradrenaline reuptake and has moderate efficacy for depression, and some small support for use in fatigue and smoking cessation. Buspirone has an indication for generalized anxiety disorder though studies show only a minimal benefit. It has some growing evidence for use in functional dyspepsia. Most of these agents have physiological effects on the brain, immune system, and gastrointestinal tract (with the exception of bupropion) hence their therapeutic and side effects manifested in these systems. CONCLUSION Antidepressant medications are frequently prescribed for depression, anxiety disorders, and chronic pain syndromes, but overall support for their efficacy is modest at best. Psychological interventions have growing support for having much more robust effects without the side effects of antidepressants and should be considered first-line treatment or at least an adjunct to psychotropic medications for these conditions.
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Bomyea J, Lang A, Craske MG, Chavira DA, Sherbourne CD, Rose RD, Golinelli D, Campbell-Sills L, Welch SS, Sullivan G, Bystritsky A, Roy-Byrne P, Stein MB. Course of symptom change during anxiety treatment: Reductions in anxiety and depression in patients completing the Coordinated Anxiety Learning and Management program. Psychiatry Res 2015; 229:133-42. [PMID: 26228164 PMCID: PMC4656042 DOI: 10.1016/j.psychres.2015.07.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/19/2015] [Accepted: 07/19/2015] [Indexed: 01/25/2023]
Abstract
When treating anxious patients with co-occurring depression, research demonstrates that both types of symptoms independently improve. The current analyses examined how reductions in anxiety and depression may be interrelated both during treatment, as well as over time following treatment. Participants were 503 individuals with one or more DSM-IV anxiety disorders who completed a collaborative care anxiety management program. Anxiety and depression were assessed at each treatment session (i.e., session by session data) and also at 6, 12, and 18-month post-baseline assessments (i.e., long-term outcomes data). Mediation analyses examined changes in symptoms in session by session data and long-term outcomes data. Anxiety and depression changed reciprocally in session by session data; change in anxiety mediated change in depression to a greater extent than vice versa. In the long-term outcomes data, change in anxiety mediated change in depression. However, the reverse mediation model of the long-term outcomes period revealed that accounting for changes in depression altered the effect of time on anxiety. Thus, temporal change during active treatment may share similarities with those related to maintaining gains after treatment, although differences arose in the reverse mediation models. Limitations of the methodology and implications of anxiety treatment for depression outcomes are discussed.
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Affiliation(s)
- Jessica Bomyea
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Ariel Lang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,VA San Diego Health Care System Center of Excellence for Stress and Mental Health, San Diego, La Jolla, CA, USA
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Denise A. Chavira
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Raphael D. Rose
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Stacy S. Welch
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Greer Sullivan
- RAND Corporation, Santa Monica, CA, USA,Department of Psychiatry University of Arkansas for Medical Sciences, Little Rock, AR, USA,VA South Central Mental Illness Research, Education, and Clinical Center University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alexander Bystritsky
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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MacLaren Kelly J, Jakubovski E, Bloch MH. Prognostic subgroups for remission and response in the Coordinated Anxiety Learning and Management (CALM) trial. J Clin Psychiatry 2015; 76:267-78. [PMID: 25562579 PMCID: PMC4930076 DOI: 10.4088/jcp.13m08922] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/12/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Most patients with anxiety disorders receive treatment in primary care settings. Limited moderator data are available to inform clinicians of likely prognostic outcomes for individual patients. We identify baseline characteristics associated with outcome in adults seeking treatment for anxiety disorders. METHOD We conducted an exploratory moderator analysis from the Coordinated Anxiety Learning and Management (CALM) trial. In the CALM trial, 1,004 adults who met DSM-IV criteria for generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and/or posttraumatic stress disorder (PTSD) were randomized to usual care (UC) or a collaborative care intervention (ITV) of cognitive-behavioral therapy and/or pharmacotherapy between June 2006 and April 2008. Logistic regression was used to examine baseline characteristics associated with remission and response overall and by treatment condition. Receiver operating curve (ROC) analyses identified subgroups associated with similar likelihood of response and remission of global anxiety symptoms. Remission was defined as score < 6 on the 12-item Brief Symptom Inventory (BSI-12) anxiety and somatization subscales. Response was defined as at least 50% reduction on BSI-12, or meeting remission criteria. RESULTS Randomization to ITV over UC was often the strongest predictor of outcome. Several baseline patient characteristics were associated with poor treatment outcome including comorbid depression, increased severity of underlying anxiety disorder(s) (P < .001), low socioeconomic status (perceived [P < .001] and actual [P < .05]), and limited social support (P < .001). Patient characteristics associated with particular benefit from ITV were being female (P < .05), increased depression (P < .01)/GAD severity (P < .05), and low socioeconomic status (P < .05). ROC analysis demonstrated prognostic subgroups with large differences in response likelihood. CONCLUSIONS Further research should focus on the effectiveness of implementing the ITV intervention of CALM in community treatment centers where patients typically are of low socioeconomic status and may particularly benefit from ITV. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00347269.
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Affiliation(s)
| | | | - Michael H. Bloch
- Yale Child Study Center and the Department of Psychiatry of Yale
University in New Haven, CT
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Fracalanza K, McCabe RE, Taylor VH, Antony MM. The effect of comorbid major depressive disorder or bipolar disorder on cognitive behavioral therapy for social anxiety disorder. J Affect Disord 2014; 162:61-6. [PMID: 24767007 DOI: 10.1016/j.jad.2014.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear. METHODS The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD. RESULTS At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD. LIMITATIONS Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT. CONCLUSION Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.
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Affiliation(s)
- Katie Fracalanza
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Anxiety Treatment and Research Centre, St. Joseph׳s Healthcare Hamilton, ON, Canada.
| | - Valerie H Taylor
- Department of Psychiatry, Women׳s College Hospital, Toronto, ON, Canada
| | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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15
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Herzer F, Wendt J, Hamm AO. Discriminating clinical from nonclinical manifestations of test anxiety: a validation study. Behav Ther 2014; 45:222-31. [PMID: 24491197 DOI: 10.1016/j.beth.2013.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 11/28/2022]
Abstract
Test anxiety, although being a very common, severe, and impairing psychological disorder, is not coded as a separate diagnosis in the DSM or ICD. In the present study we investigated whether the Test Anxiety Inventory can be used to discriminate clinical and subclinical levels of test anxiety by comparing patients who seek treatment for their test anxiety in an outpatient clinic with carefully matched students with normal test anxiety. The data from 47 test-anxious patients as well as 41 healthy university students were examined. Results show that a cutoff score of ≥80 in the Test Anxiety Inventory can discriminate the clinical group from the control students. The symptom pattern of test anxiety was very consistent in the clinical group regardless of the principal diagnosis allocated by the treating clinician. Comorbid depression did not affect the severity of test anxiety. The motivation to avoid failure was one of the most important differences between patients who sought help for their test anxiety and students with nonclinical levels of test anxiety.
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16
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Abstract
Depression and social anxiety disorder (SAD) are two of the most common mental health conditions, and often occur together. Depression is usually identified as the presenting problem, which may result in SAD being overshadowed and undertreated among those with this particular comorbidity. In this case study, diagnostic overshadowing results in successful treatment of depression but delayed identification of SAD, causing an attenuated anxiety treatment response. We present recommendations on how clinicians may more thoroughly assess for comorbid Axis I diagnoses, avoid diagnostic overshadowing, and better integrate treatment approaches for SAD–major depressive disorder (MDD) comorbidity. Mechanisms underlying cognitive-behavioral treatments such as behavioral activation and exposure hold particular promise for promoting improvement in SAD and major depression simultaneously.
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