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Trajectories of depression and generalised anxiety symptoms over the course of cognitive behaviour therapy in primary care: an observational, retrospective cohort

Published online by Cambridge University Press:  16 June 2022

Clarissa Bauer-Staeb ,
Emma Griffith ,
Julian J. Faraway  and
Katherine S. Button Open the ORCID record for Katherine S. Button [Opens in a new window]
Clarissa Bauer-Staeb
Affiliation:
Department of Psychology, University of Bath, Bath, UK
Emma Griffith
Affiliation:
Department of Psychology, University of Bath, Bath, UK Avon and Wiltshire NHS Mental Health Partnership Trust, Bath, UK
Julian J. Faraway
Affiliation:
Department of Mathematical Sciences, University of Bath, Bath, UK
Katherine S. Button*
Affiliation:
Department of Psychology, University of Bath, Bath, UK
*
Author for correspondence: Katherine S. Button, E-mail: k.s.button@bath.ac.uk
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Abstract

Background

Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for depression and anxiety. However, most research has focused on the sum scores of symptoms. Relatively little is known about how individual symptoms respond.

Methods

Longitudinal models were used to explore how depression and generalised anxiety symptoms behave over the course of CBT in a retrospective, observational cohort of patients from primary care settings (n = 5306). Logistic mixed models were used to examine the probability of being symptom-free across CBT appointments, using the 9-item Patient Health Questionnaire and the 7-item Generalised Anxiety Disorder scale as measures.

Results

All symptoms improve across CBT treatment. The results suggest that low mood/hopelessness and guilt/worthlessness improved quickest relative to other depressive symptoms, with sleeping problems, appetite changes, and psychomotor retardation/agitation improving relatively slower. Uncontrollable worry and too much worry were the anxiety symptoms that improved fastest; irritability and restlessness improved the slowest.

Conclusions

This research suggests there is a benefit to examining symptoms rather than sum scores alone. Investigations of symptoms provide the potential for precision psychiatry and may explain some of the heterogeneity observed in clinical outcomes when only sum scores are considered.

Keywords

CBTdepressiongeneralised anxietyprimary carepsychotherapysymptom trajectories
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 10 , July 2023 , pp. 4648 - 4656
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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