Transactional effects of depression in transdiagnostic group cognitive behavioral therapy for anxiety
Talkovsky, Alexander M.
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Anxiety and depressive disorders co-occur at high rates, and their comorbidity typically creates a more severe clinical presentation than when either occurs alone. Depression shares risk factors with anxiety disorders such as negative affectivity (NA), or the predisposition to experience negative emotions. NA is a higher-order factor that subsumes many cognitive vulnerabilities, and may underlie this comorbidity. Secondary depression affects the treatment of anxiety and is associated with poorer treatment outcomes compared to an anxiety diagnosis alone. Transdiagnostic treatments present a promising option to improve both anxiety and depression by targeting shared risks. Research using transdiagnostic protocols suggests that comorbid and simple cases improve at comparable rates, and that secondary diagnoses significantly improve following treatment. This study aimed to examine the reciprocal effects of secondary depression in transdiagnostic group cognitive behavioral therapy for anxiety. This study also aimed to analyze the role of NA as a transdiagnostic mediator in the treatment of both anxiety and depression. Depressed individuals scored more severely on measures of anxiety, depression, and negative affect, as well as clinician-rated severity of primary anxiety disorder and overall clinical presentation at pre-treatment. However, only the differences in self-reported depression symptoms and NA remained significant at post-treatment. When change in self-reported anxiety was modeled over treatment, the best-fitting model was such that depressed individuals began treatment scoring more severely, improved at a greater rate, and reached a similar outcome to those without a depressive disorder. Analyses of variance revealed that all individuals improved on every measure; depression only had an effect on one self-report measure of anxiety, and the time x depression interaction did not have any effect. All individuals improved in self-reported depression, but there was a main effect of depression and the time x depression interaction was not significant. Among depressed individuals, the clinician-rated severity of the depression diagnoses improved significantly and, on average, dropped from a mild to moderate score to one that is no longer clinically significant based on scoring conventions. The time x depression interactions was not significant in any analyses. Mediation analyses showed that NA fully mediated improvements in anxiety, but only partially mediated improvements in depression.