The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis.

IF 16.3 1区医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2023-01-01 DOI:10.1159/000530650

Otto R F Smith, Leif E Aarø, Marit Knapstad

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Abstract

Introduction: The temporal relationship between symptoms and functioning in the context of cognitive behavioral therapy (CBT) for anxiety and depression is not fully understood, and there are few high-quality studies that have examined to what extent late intervention effects of CBT on functioning are mediated by initial intervention effects on symptoms while accounting for the initial effects on functioning and vice versa.

Objective: The aim of the study was to investigate whether intervention effects on symptoms and functioning at 12-month follow-up were mediated by intervention effects on these outcomes at 6-month follow-up.

Methods: Participants with anxiety and/or mild-to-moderate depression were randomly assigned to a primary mental health care service (n = 463) or treatment-as-usual (n = 215). Main outcomes were depressive symptoms (Patient Health Questionnaire [PHQ-9]), anxiety (General Anxiety Disorder-7 [GAD-7]), and functioning (Work and Social Adjustment Scale [WSAS]). Direct/indirect effects were derived using the potential outcomes and counterfactual framework.

Results: The intervention effect on functioning at 12 months was largely explained by intervention effects at 6 months on depressive symptoms (51%) and functioning (39%). The intervention effect on depressive symptoms at 12 months was largely explained by the intervention effect at 6 months on depressive symptoms (70%) but not by functioning at 6 months. The intervention effect on anxiety at 12 months was only partly accounted for by intervention effects at 6 months on anxiety (29%) and functioning (10%).

Conclusions: The findings suggest that late intervention effects of CBT on functioning were to a substantial degree explained by initial intervention effects on depressive symptoms even after accounting for initial effects on functioning. Our results support the importance of symptoms as an outcome in the context of CBT delivered in primary health care.

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焦虑和抑郁认知行为治疗后症状减轻对功能改善的重要性:因果中介分析。

引言:在认知行为疗法(CBT)治疗焦虑和抑郁的背景下，症状和功能之间的时间关系尚不完全清楚，很少有高质量的研究调查了CBT对功能的晚期干预效果在多大程度上是由初始干预对症状的影响介导的，同时考虑了初始干预对功能的影响，反之亦然。目的:本研究的目的是探讨干预对12个月随访时症状和功能的影响是否通过干预对6个月随访时这些结果的影响来介导。方法:患有焦虑和/或轻度至中度抑郁症的参与者被随机分配到初级精神卫生保健服务(n = 463)或常规治疗(n = 215)。主要结局为抑郁症状(患者健康问卷[PHQ-9])、焦虑(一般焦虑障碍-7 [GAD-7])和功能(工作与社会适应量表[WSAS])。使用潜在结果和反事实框架推导了直接/间接影响。结果:干预对12个月功能的影响在很大程度上可以通过干预对6个月抑郁症状(51%)和功能(39%)的影响来解释。干预对12个月时抑郁症状的影响在很大程度上可以用干预对6个月时抑郁症状的影响来解释(70%)，但不能用干预对6个月时功能的影响来解释。12个月时对焦虑的干预效果仅部分被6个月时对焦虑(29%)和功能(10%)的干预效果所解释。结论:研究结果表明，即使在考虑了对功能的初始影响后，CBT对功能的后期干预效果在很大程度上可以通过对抑郁症状的初始干预效果来解释。我们的研究结果支持症状作为初级卫生保健中CBT治疗结果的重要性。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.

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