title: Depression does not affect the treatment outcome of CBT for panic and agoraphobia: results from a multicenter randomized trial.
abstract: BACKGROUND
  Controversy surrounds the questions whether co-occurring depression has negative effects on cognitive-behavioral therapy (CBT) outcomes in patients with panic disorder (PD) and agoraphobia (AG) and whether treatment for PD and AG (PD/AG) also reduces depressive symptomatology.
  
  
  METHODS
  Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary PD/AG (DSM-IV-TR criteria) treated with a 12-session manualized CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression (DSM-IV-TR major depression, dysthymia, or both: 43.2% CBT, 42.7% controls) were compared to patients without depression regarding anxiety and depression outcomes (Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, Beck Depression Inventory) at post-treatment and follow-up (categorical). Further, the role of severity of depressive symptoms on anxiety/depression outcome measures was examined (dimensional).
  
  
  RESULTS
  Comorbid depression did not have a significant overall effect on anxiety outcomes at post-treatment and follow-up, except for slightly diminished post-treatment effect sizes for clinician-rated CGI (p = 0.03) and HAM-A (p = 0.008) when adjusting for baseline anxiety severity. In the dimensional model, higher baseline depression scores were associated with lower effect sizes at post-treatment (except for MI), but not at follow-up (except for HAM-A). Depressive symptoms improved irrespective of the presence of depression.
  
  
  CONCLUSIONS
  Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatology.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Emmrich
authors.forename: Katja
authors.initials: K
authors.lastname: Beesdo-Baum
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Gloster
authors.forename: Susanne
authors.initials: S
authors.lastname: Knappe
authors.forename: Michael
authors.initials: M
authors.lastname: Höfler
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
authors.forename: Jürgen
authors.initials: J
authors.lastname: Deckert
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerlach
authors.forename: Alfons
authors.initials: A
authors.lastname: Hamm
authors.forename: Tilo
authors.initials: T
authors.lastname: Kircher
authors.forename: Thomas
authors.initials: T
authors.lastname: Lang
authors.forename: Jan
authors.initials: J
authors.lastname: Richter
authors.forename: Andreas
authors.initials: A
authors.lastname: Ströhle
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D016584:Panic Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome