The influence of comorbid anxiety on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder

• Published in: Journal of affective disorders 2018-05, Vol.232, p.52-60
• Main Authors: van Bronswijk, Suzanne C., Lemmens, Lotte H.J.M., Huibers, Marcus J.H., Arntz, Arnoud, Peeters, Frenk P.M.L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anxiety disorder; Anxiety Disorders - complications; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Anxiety symptoms; Chronic Disease; Cognitive therapy; Cognitive Therapy - methods; Depression; Depressive Disorder, Major - complications; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Diagnostic and Statistical Manual of Mental Disorders; Female; Follow-Up Studies; Humans; Interpersonal psychotherapy; Male; Middle Aged; Patient Dropouts - statistics & numerical data; Phobic Disorders - complications; Phobic Disorders - psychology; Phobic Disorders - therapy; Psychiatric Status Rating Scales; Psychotherapy - methods; Treatment Outcome
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2018.02.003

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. 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. 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. Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater. 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. •There is no consensus on how comorbid anxiety affects treatment for Major Depressive Disorder (MDD).•We examined the effects of comorbid anxiety in CognitiveTherapy (CT) and Interpersonal Psychotherapy (IPT) for MDD.•Comorbid anxiety (symptoms and disorders) was associated with a more favorable depression change in CT as compared to IPT.•During follow-up however, comorbid anxiety was not associated with differences between CT and IPT.•In both conditions, individuals with a comorbid anxiety disorder were more likely to dropout.