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An examination of the bidirectional relationship between functioning and symptom levels in patients with anxiety disorders in the CALM study

Published online by Cambridge University Press:  02 October 2014

L. A. Brown ,
J. L. Krull ,
P. Roy-Byrne ,
C. D. Sherbourne ,
M. B. Stein ,
G. Sullivan ,
R. D. Rose ,
A. Bystritsky  and
M. G. Craske
L. A. Brown
Affiliation:
Department of Psychology, University of California, Los Angeles, USA
J. L. Krull
Affiliation:
Department of Psychology, University of California, Los Angeles, USA
P. Roy-Byrne
Affiliation:
University of Washington at Harborview Medical Center, Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations (CHAMMP), Seattle, WA, USA
C. D. Sherbourne
Affiliation:
RAND Corporation, Santa Monica, CA, USA
M. B. Stein
Affiliation:
Department of Psychiatry and Department of Family & Preventive Medicine, University of California, San Diego, USA
G. Sullivan
Affiliation:
South Central VA Mental Illness Research Education and Clinical Center, North Little Rock, AK, USA University of Arkansas for Medical Sciences, Little Rock, AR, USA
R. D. Rose
Affiliation:
Department of Psychology, University of California, Los Angeles, USA
A. Bystritsky
Affiliation:
Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, USA
M. G. Craske*
Affiliation:
Department of Psychology, University of California, Los Angeles, USA
*
*Address for correspondence: M. G. Craske, Ph.D., Department of Psychology, UCLA, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. (Email: craske@psych.ucla.edu)
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Abstract

Background

Patients with anxiety disorders suffer marked functional impairment in their activities of daily living. Many studies have documented that improvements in anxiety symptom severity predict functioning improvements. However, no studies have investigated how improvements in functioning simultaneously predict symptom reduction. We hypothesized that symptom levels at a given time point will predict functioning at the subsequent time point, and simultaneously that functioning at a given time point will predict symptom levels at a subsequent time point.

Method

Patients were recruited from primary-care centers for the Coordinated Anxiety Learning and Management (CALM) study and were randomized to receive either computer-assisted cognitive-behavioral therapy and/or medication management (ITV) or usual care (UC). A cross-lagged panel design examined the relationship between functional impairment and anxiety and depression symptom severity at baseline, 6-, 12-, and 18-month follow-up assessments.

Results

Prospective prediction of functioning from symptoms and symptoms from functioning were both important in modeling these associations. Anxiety and depression predicted functioning as strongly as functioning predicted anxiety and depression. There were some differences in these associations between UC and ITV. Where differences emerged, the UC group was best modeled with prospective paths predicting functioning from symptoms, whereas symptoms and functioning were both important predictors in the ITV group.

Conclusions

Treatment outcome is best captured by measures of functional impairment as well as symptom severity. Implications for treatment are discussed, as well as future directions of research.

Keywords

Anxietyfunctioningprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 3 , February 2015 , pp. 647 - 661
Copyright
Copyright © Cambridge University Press 2014 

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