Time-varying moderation of treatment outcomes by illness duration and comorbid depression in generalized anxiety disorder.
Open accessAbstract
OBJECTIVE: To extend the sparse literature on moderators, we used time-varying effect modeling (TVEM; Tan, Shiyko, Li, Li, & Dierker, 2012) to examine how depressive symptoms and duration of generalized anxiety disorder (GAD) moderated effects of 3 treatments for GAD (applied relaxation [AR], cognitive-behavioral therapy [CBT], and nondirective therapy [ND]) over time using intensive repeated measures. METHOD: In a secondary analysis of Borkovec and Costello (1993), 66 GAD clients were randomly assigned to AR (n = 23), CBT (n = 23), or ND (n = 20). Clients received 12 therapy sessions over 6 weeks, and after 2 weeks of posttreatment assessment, had 2 additional weekly fading sessions. They completed thrice daily anxiety ratings during this 10-week period. GAD duration (Anxiety Disorders Interview Schedule-Revised) and depressive symptoms (Hamilton Depression Rating Scale) were assessed at baseline. RESULTS: Longer GAD duration predicted less anxiety reduction in CBT and ND relative to AR. These effects were pronounced in the later phase of treatment, suggesting benefits of focused relaxation practice for clients with longer duration. Higher depression predicted better response to CBT than AR and ND. The moderation effects were also more noticeable in the later phase. In multilevel analyses, a similar moderation pattern held at 1-year follow-up on clinician-rated measures. CONCLUSION: GAD clients with long-standing symptoms may benefit more from repeatedly practicing fewer skills than learning multiple skills. On the other hand, clients with comorbid depression may respond better to CBT than AR, perhaps because CBT includes cognitive interventions that can generalize to depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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People with longer-duration generalized anxiety disorder benefit more from a component treatment such as cognitive therapy or self-control desensitization than from combined CBT, while the opposite holds for shorter-duration generalized anxiety disorder.
“those with longer duration of GAD benefitted more from a component treatment, CT or SCD, than from combined CBT, whereas the opposite was true for those with shorter duration GAD [34,35].”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [35]
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Experimental — accuracy not yet measuredPeople with higher comorbid depression symptoms benefit more from combined CBT than from applied relaxation or nondirective therapy.
“those higher comorbid depression symptoms benefitted more from combined CBT than from AR or nondirective therapy [35]”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [35]
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“At the same time, it is possible that mechanisms of change related to GAD duration might not be specific to the type of skills taught in AR. Newman and Fisher (2013) found that compared with CBT, self-reported duration of GAD also predicted better outcomes from other single-component interventions…”
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Self-citation
- Authors
- Newman, M. G., Shin, K. E., & Lanza, S. T.
- Affiliations
- Pennsylvania State University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2019-03
- Volume
- 87
- Issue
- 3
- Pages
- 282-293
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC6632089
- OpenAlex
- W2913496528
- Cited by
- 12
- References
- 55
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 2
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- ScholarSphere (Penn State Libraries) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (MH-39172)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- generalized anxiety disorder, treatment moderators, disease duration, comorbid depression, depressive symptoms, applied relaxation, cognitive behavioral therapy, non-directive therapy, anxiety reduction, treatment response
- MeSH terms
- Adult, Anxiety Disorders, Depression, Female, Humans, Male, Middle Aged, Person-Centered Psychotherapy, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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