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22 - Case Formulation for Complexity and Comorbidity in Anxiety Disorders and Depression

from Part Five - Complexity and Comorbidity in Anxiety Disorders and Depression:

Published online by Cambridge University Press:  06 January 2022

Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
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Summary

Anxiety disorders and depression are the most prevalent mental disorders, and although psychological interventions (particularly CBT) have been shown to be effective, treatment response is often suboptimal, given that, in many cases, patients have complex presentations and frequent comorbidities. Especially in such cases, a good case formulation is essential. Case formulation derives from the initial assessment and guides intervention by conceptualizing the presenting symptoms, the underlying etiological mechanisms, and their origin. A good conceptualization should successfully inform treatment and should be evidence-based, combining research data with personalized features of each case. According to the level of analysis, we can distinguish between case, diagnosis/presenting problem formulation, and symptom level/specific problem formulation. For complex and comorbid depression and anxiety disorders, we should include additional elements and also select the most appropriate conceptualization model for our particular case.

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Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
, pp. 461 - 474
Publisher: Cambridge University Press
Print publication year: 2022

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References

Alford, B. A., & Gerrity, D. M. (1995). The specificity of sociotropy-autonomy personality dimensions to depression vs. anxiety. Journal of Clinical Psychology, 51(2), 190195. https://doi.org/10.1002/1097-4679(199503)51:2<190::AID-JCLP2270510207>3.0.CO;2-S3.0.CO;2-S>CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publications.Google Scholar
Antony, M. M., Ledley, D. R., & Heimberg, R. G. (Eds.). (2006). Improving outcomes and preventing relapse in cognitive-behavioral therapy. Guilford Press.Google Scholar
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327335.CrossRefGoogle Scholar
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., … & Cassiello-Robbins, C. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875. https://doi.org/10.1001/jamapsychiatry.2017.2164Google Scholar
Beck, J. (1995). Cognitive therapy: Basics and beyond. Guilford Press.Google Scholar
Beck, J. (2005). Cognitive therapy for challenging problems: What to do when the basics don’t work. Guilford Press.Google Scholar
Brown, T. A., & Barlow, D. H. (1992). Comorbidity among anxiety disorders: Implications for treatment and DSM-IV. Journal of Consulting and Clinical Psychology, 60(6), 835844.Google Scholar
Bruce, T., J., & Sanderson, W. C. (2010). Understanding and managing treatment-resistant panic disorder. In Treatment Resistant Anxiety Disorders: Resolving Impasses to Symptom Remission. Routledge.Google Scholar
Bystritsky, A. (2006). Treatment-resistant anxiety disorders. Molecular Psychiatry, 11(9), 805814. https://doi.org/10.1038/sj.mp.4001852Google Scholar
Cândea, D., Stefan, S., Matu, S., Mogoase, C., Iftene, F., David, D., & Szentagotai, A. (2018). REBT in the treatment of subclinical and clinical depression. Springer.Google Scholar
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and Anxiety, 35(6), 502514. https://doi.org/10.1002/da.22728CrossRefGoogle ScholarPubMed
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461470. https://doi.org/10.1016/0005-7967(86)90011-2Google Scholar
Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific foundations of cognitive theory and therapy of depression. John Wiley & Sons.Google Scholar
Cuijpers, P., Cristea, I. A., Weitz, E., Gentili, C., & Berking, M. (2016). The effects of cognitive and behavioural therapies for anxiety disorders on depression: A meta-analysis. Psychological Medicine, 46(16), 34513462. https://doi.org/10.1017/S0033291716002348Google Scholar
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: A meta-analysis of direct comparisons. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 12(2), 137148. https://doi.org/10.1002/wps.20038CrossRefGoogle ScholarPubMed
Cuthbert, B. N. (2014). The RDoC framework: Facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 13(1), 2835. https://doi.org/10.1002/wps.20087Google Scholar
David, D. (2012). Tratat de Psihoterapii cognitive si comportamentale [Compendium of Cognitive and Behavioral Psychotherapies]. Polirom.Google Scholar
David, D. (2013). Psihologie clinica si psihoterapie. Fundamente [Clinical Psychology and Psychotherapy. Fundamentals]. Polirom.Google Scholar
David, D. & Cristea, I. (2018). The new great psychotherapy debate: Scientific integrated psychotherapy vs. plurality. Why cognitive-behavior therapy is the gold standard in psychotherapy and a platform for scientific integrated psychotherapy. Journal of Evidence-Based Psychotherapies, 18(2), 117. https://doi.org/10.24193/jebp.2018.2.11Google Scholar
David, D., Cristea, I., & Hofmann, S. G. (2018a). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004CrossRefGoogle ScholarPubMed
David, D., Lynn, S. J., & Montgomery, G. H. (2018b). Evidence-based psychotherapy: The state of the science and practice. Wiley Blackwell.CrossRefGoogle Scholar
David, D., & Montgomery, G. H. (2011). The scientific status of psychotherapies: A new evaluative framework for evidence-based psychotherapies. Clinical Psychology: Science and Practice, 18(2), 8999. https://doi.org/10.1111/j.1468-2850.2011.01239.xGoogle Scholar
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10), 788796. https://doi.org/10.1038/nrn2345Google Scholar
Ellis, A. (1987). A sadly neglected cognitive element in depression. Cognitive Therapy and Research, 11(1), 121145. https://doi.org/10.1007/BF01183137Google Scholar
Furukawa, T. A., Weitz, E. S., Tanaka, S., Hollon, S. D., Hofmann, S. G., Andersson, G., … & Cuijpers, P. (2017). Initial severity of depression and efficacy of cognitive-behavioural therapy: Individual-participant data meta-analysis of pill-placebo-controlled trials. British Journal of Psychiatry, 210(3), 190196. https://doi.org/10.1192/bjp.bp.116.187773CrossRefGoogle ScholarPubMed
Garland, A., & Scott, J. (2008). Chronic depression. In Whisman, M. A. (Ed.), Adapting cognitive therapy for depression: Managing complexity and comorbidity. Guilford Presss.Google Scholar
Hayes, S. C., & Hofmann, S. G. (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. Context Press.Google Scholar
Hofmann, S. G., & Hayes, S. C. (2018). The future of intervention science: Process-based therapy. Clinical Psychological Science, 216770261877229. https://doi.org/10.1177/2167702618772296CrossRefGoogle Scholar
Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Review: Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409416. https://doi.org/10.1002/da.21888CrossRefGoogle ScholarPubMed
Ingram, R. E., & Luxton, D. D. (2005). Vulnerability–stress models. In Hankin, B. L. & Abela, J. R. Z. (Eds.), Development of psychopathology: A vulnerability–stress perspective. Sage Publications.Google Scholar
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., … & Wang, P. (2010). Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 748751. https://doi.org/10.1176/appi.ajp.2010.09091379Google Scholar
Keogh, E., & Reidy, J. (2000). Exploring the factor structure of the Mood and Anxiety Symptom Questionnaire (MASQ). Journal of Personality Assessment, 74(1), 106125. https://doi.org/10.1207/S15327752JPA740108Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., … & Wang, P. S. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289(23), 3095. https://doi.org/10.1001/jama.289.23.3095CrossRefGoogle ScholarPubMed
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Liu, J., Swartz, M., & Blazer, D. G. (1996). Comorbidity of DSM-III-R major depressive disorder in the general population: Results from the US National Comorbidity Survey. British Journal of Psychiatry, 30, 1730.CrossRefGoogle Scholar
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H.-U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States: Anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169184. https://doi.org/10.1002/mpr.1359Google Scholar
Kessler, R. C., Stang, P., Wittchen, H.-U., Stein, M., & Walters, E. E. (1999). Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychological Medicine, 29(3), 555567. https://doi.org/10.1017/S0033291799008375Google Scholar
Krueger, R. F., & Markon, K. E. (2006). Reinterpreting comorbidity: A model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology, 2, 111133. https://doi.org/10.1146/annurev.clinpsy.2.022305.095213CrossRefGoogle ScholarPubMed
Lilienfeld, S. O., & Treadway, M. T. (2016). Clashing diagnostic approaches: DSM-ICD versus RDoC. Annual Review of Clinical Psychology, 12, 435463. https://doi.org/10.1146/annurev-clinpsy-021815-093122CrossRefGoogle ScholarPubMed
McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52(10), 938946.CrossRefGoogle ScholarPubMed
Otto, M. W., Powers, M. B., Stathopoulou, G., & Hofmann, S. G. (2008). Panic disorder and social phobia. In Adapting cognitive therapy for depression: Managing complexity and comorbidity. Guilford Press.Google Scholar
Persons, J. (2008). What is the case formulation approach to cognitive-behavior therapy? In Persons, J. (Ed.), The case formulation approach to cognitive-behavior therapy. Guilford.Google Scholar
Persons, J., & Tompkins, M. A. (2007). Cognitive-behavioral case formulation. In Eells, T. D. (Ed.), Handbook of psychotherapy case formulation (pp. 290316). Guilford Press.Google Scholar
Sackett, D., Strauss, S., & Richardson, W. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Churchill Livingstone.Google Scholar
Weinstock, L. M., & Whisman, M. A. (2007). Rumination and excessive reassurance-seeking in depression: A cognitive-interpersonal integration. Cognitive Therapy and Research, 31(3), 333342. https://doi.org/10.1007/s10608-006-9004-2Google Scholar
Weitz, E., Kleiboer, A., van Straten, A., & Cuijpers, P. (2018). The effects of psychotherapy for depression on anxiety symptoms: A meta-analysis. Psychological Medicine, 48(13), 21402152. https://doi.org/10.1017/S0033291717003622CrossRefGoogle ScholarPubMed
Weitz, E. S., Hollon, S. D., Twisk, J., van Straten, A., Huibers, M. J. H., David, D., … & Cuijpers, P. (2015). Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy: An individual patient data meta-analysis. JAMA Psychiatry, 72(11), 1102. https://doi.org/10.1001/jamapsychiatry.2015.1516CrossRefGoogle ScholarPubMed
Whisman, M. A. (Ed.). (2008). Adapting cognitive therapy for depression: Managing complexity and comorbidity. Guilford Press.Google Scholar
Whisman, M. A., & Weinstock, L. M. (2008). Initial assessment, case conceptualization, and treatment planning. In Whisman, M. A. (Ed.), Adapting cognitive therapy for depression: Managing complexity and comorbidity. Guilford Press.Google Scholar

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