title: Course of symptom change during anxiety treatment: Reductions in anxiety and depression in patients completing the Coordinated Anxiety Learning and Management program.
abstract: When treating anxious patients with co-occurring depression, research demonstrates that both types of symptoms independently improve. The current analyses examined how reductions in anxiety and depression may be interrelated both during treatment, as well as over time following treatment. Participants were 503 individuals with one or more DSM-IV anxiety disorders who completed a collaborative care anxiety management program. Anxiety and depression were assessed at each treatment session (i.e., session by session data) and also at 6, 12, and 18-month post-baseline assessments (i.e., long-term outcomes data). Mediation analyses examined changes in symptoms in session by session data and long-term outcomes data. Anxiety and depression changed reciprocally in session by session data; change in anxiety mediated change in depression to a greater extent than vice versa. In the long-term outcomes data, change in anxiety mediated change in depression. However, the reverse mediation model of the long-term outcomes period revealed that accounting for changes in depression altered the effect of time on anxiety. Thus, temporal change during active treatment may share similarities with those related to maintaining gains after treatment, although differences arose in the reverse mediation models. Limitations of the methodology and implications of anxiety treatment for depression outcomes are discussed.
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA. Electronic address: bomyea@hotmail.com.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bomyea
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; VA San Diego Health Care System Center of Excellence for Stress and Mental Health, San Diego, La Jolla, CA, USA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Lang
authors.affiliation: Department of Psychology, University of California, Los Angeles, CA, USA.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
authors.affiliation: Department of Psychology, University of California, Los Angeles, CA, USA.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Chavira
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.affiliation: Department of Psychology, University of California, Los Angeles, CA, USA.
authors.forename: Raphael D
authors.initials: RD
authors.lastname: Rose
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Golinelli
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Campbell-Sills
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA.
authors.forename: Stacy S
authors.initials: SS
authors.lastname: Welch
authors.affiliation: RAND Corporation, Santa Monica, CA, USA; Department of Psychiatry, University of California, Riverside, USA; VA South Central Mental Illness Research, Education, and Clinical Center University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.affiliation: Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bystritsky
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000639:trends; D003863:Depression / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Anxiety; CBT; Depression; Mediation; Treatment