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The effects of cognitive and behavioural therapies for anxiety disorders on depression: a meta-analysis

Published online by Cambridge University Press:  23 September 2016

P. Cuijpers ,
I. A. Cristea ,
E. Weitz ,
C. Gentili  and
M. Berking
P. Cuijpers*
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
I. A. Cristea
Affiliation:
Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania Department of General Psychology, University of Padova, Padova, Italy
E. Weitz
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
C. Gentili
Affiliation:
Department of General Psychology, University of Padova, Padova, Italy
M. Berking
Affiliation:
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
*
*Address for correspondence: P. Cuijpers, Ph.D., Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: [email protected])
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Abstract

Background

The effects of cognitive behavioural therapy of anxiety disorders on depression has been examined in previous meta-analyses, suggesting that these treatments have considerable effects on depression. In the current meta-analysis we examined whether the effects of treatments of anxiety disorders on depression differ across generalized anxiety disorder (GAD), social anxiety disorder (SAD) and panic disorder (PD). We also compared the effects of these treatments with the effects of cognitive and behavioural therapies of major depression (MDD).

Method

We searched PubMed, PsycINFO, EMBASE and the Cochrane database, and included 47 trials on anxiety disorders and 34 trials on MDD.

Results

Baseline depression severity was somewhat lower in anxiety disorders than in MDD, but still mild to moderate in most studies. Baseline severity differed across the three anxiety disorders. The effect sizes found for treatment of the anxiety disorders ranged from g = 0.47 for PD, g = 0.68 for GAD and g = 0.69 for SAD. Differences between these effect sizes and those found in the treatment of MDD (g = 0.81) were not significant in most analyses and we found few indications that the effects differed across anxiety disorders. We did find that within-group effect sizes resulted in significantly (p < 0.001) larger effect sizes for depression (g = 1.50) than anxiety disorders (g = 0.73–0.91). Risk of bias was considerable in the majority of studies.

Conclusions

Patients participating in trials of cognitive behavioural therapy for anxiety disorders have high levels of depression. These treatments have considerable effects on depression, and these effects are comparable to those of treatment of primary MDD.

Keywords

Cognitive behavioural therapygeneralized anxiety disordermajor depressionpanic disordersocial anxiety disorder
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3451 - 3462
Copyright
Copyright © Cambridge University Press 2016 

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References

Acarturk, C, Cuijpers, P, van Straten, A, de Graaf, R (2009). Psychological treatment of social anxiety disorder: a meta-analysis. Psychological Medicine 39, 241–254.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA, Brown, GK (1996). BDI-II, Beck Depression Inventory: Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA, Carbin, MG (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77–100.CrossRefGoogle Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Beutel, ME, Scheurich, V, Knebel, A, Michal, M, Wiltink, J, Graf-Morgenstern, M, Tschan, R, Milrod, B, Wellek, S, Subic-Wrana, C (2013). Implementing panic-focused psychodynamic psychotherapy into clinical practice. Canadian Journal of Psychiatry 58, 326–334.CrossRefGoogle ScholarPubMed
Craske, MG (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety 29, 749–753.Google Scholar
Cuijpers, P, Berking, M, Andersson, G, Quigley, L, Kleiboer, A, Dobson, KS (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry 58, 376–385.Google Scholar
Cuijpers, P, Donker, T, Weissman, MM, Ravitz, P, Cristea, IA (2016). Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis. American Journal of Psychiatry 173, 680–687.Google Scholar
Cuijpers, P, Sijbrandij, M, Koole, S, Huibers, M, Berking, M, Andersson, G (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical Psychology Review 34, 130–140.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Warmerdam, L, Andersson, G (2008). Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 8, 36.CrossRefGoogle ScholarPubMed
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.Google Scholar
Ekers, D, Webster, L, Van Straten, A, Cuijpers, P, Richards, D, Gilbody, S (2014). Behavioural activation for depression: an update of meta-analysis of effectiveness and sub group analysis. PLoS ONE 9, e100100.Google Scholar
Goldberg, DP, Krueger, RF, Andrews, G, Hobbs, MJ (2009). Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2043–2059.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.Google Scholar
Hedges, LV, Olkin, I (1985). Statistical Methods for Meta-Analysis. Academic Press: Orlando, FL.Google Scholar
Higgins, JPT, Altman, DG, Gotzsche, PC, Juni, P, Moher, D, Oxman, AD, Savovic, J, Schulz, KF, Weeks, L, Sterne, JAC, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011). The Cochrane collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal 343, d5928–d5928.Google Scholar
Higgins, JPT, Green, S (eds) (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration.Google Scholar
Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal (Clinical Research Edition) 327, 557–560.Google Scholar
Hunot, V, Churchill, R, Silva de Lima, M, Teixeira, V (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 1, CD001848.Google Scholar
Ioannidis, JPA, Patsopoulos, NA, Evangelou, E (2007). Uncertainty in heterogeneity estimates in meta-analyses. British Medical Journal (Clinical Research Edition) 335, 914–916.Google Scholar
Kraemer, HC, Kupfer, DJ (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 59, 990–996.Google Scholar
Milrod, B, Leon, AC, Busch, F, Rudden, M, Schwalberg, M, Clarkin, J, Aronson, A, Singer, M, Turchin, W, Klass, ET, Graf, E, Teres, JJ, Shear, MK (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry 164, 265–272.CrossRefGoogle ScholarPubMed
Mitte, K (2005). Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychological Bulletin 131, 785–795.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, A, Altman, DG (2009). The PRISMA Group. Preferred Reporting Items for Systemic Reviews and Meta-Analyses: the PRISMA statement. PLoS Medicine 6, e1000097.Google Scholar
Newby, JM, McKinnon, A, Kuyken, W, Gilbody, S, Dalgleish, T (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review 40, 91–110.Google Scholar
NICE (2011). Generalised Anxiety Disorder and Panic Disorder in Adults: Management, Guidance and Guidelines. National Institute for Health and Clinical Excellence: London.Google Scholar
Orsini, N, Bottai, M, Higgins, J, Buchan, I (2006). HETEROGI: Stata Module to Quantify Heterogeneity in a Meta-Analysis. Stata Statistical Software Components.Google Scholar
Sánchez-Meca, J, Rosa-Alcázar, AI, Marín-Martínez, F, Gómez-Conesa, A (2010). Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clinical Psychology Review 30, 37–50.Google Scholar
Siev, J, Chambless, DL (2007). Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders. Journal of Consulting and Clinical Psychology 75, 513–522.Google Scholar
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