Hostname: page-component-89b8bd64d-shngb Total loading time: 0 Render date: 2026-05-11T12:26:02.439Z Has data issue: false hasContentIssue false
  • English
  • Français

The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis

Published online by Cambridge University Press:  24 January 2018

Erica Weitz ,
Annet Kleiboer ,
Annemieke van Straten  and
Pim Cuijpers
Erica Weitz*
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
Annet Kleiboer
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
Annemieke van Straten
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
Pim Cuijpers
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
*
Author for correspondence: Erica Weitz, E-mail: e.weitz@vu.nl
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

More than half of patients who present with depressive disorders also have elevated comorbid anxiety symptoms. Given the high comorbidity between these disorders, it is important to understand the extent that psychotherapies for depression additionally ameliorate symptoms of anxiety.

Methods

Systematic searches were conducted in PubMed, PSYCinfo, EMBASE, and the Cochrane Registry of Controlled Trials. Included studies were randomized controlled trials that compared psychotherapy compared with a control condition for the treatment of adults with a primary diagnosis or elevated symptoms of depression and that examined the effects of treatment on anxiety outcomes. Acute phase depression and anxiety (continuous measure) outcomes were extracted. Effect sizes were calculated by subtracting the average post-treatment scores of the psychotherapy group from the average post-treatment scores of the comparison group divided by the pooled standard deviation.

Results

Fifty-two studies of varying quality met the inclusion criteria. Pooled effect sizes showed that anxiety outcomes were significantly lower in the psychotherapy conditions than in control conditions at post-treatment [g = 0.52; 95% confidence interval (CI) 0.44–0.60; NNT (numbers-needed-to-treat) = 3.50]. Moderate heterogeneity was observed (I2 = 55%, 95% CI 40–66). Bivariate metaregression analysis revealed a significant association between depression and anxiety effect sizes at post-treatment Longer-term follow-ups of up to 14 months post-baseline showed indications for a small lasting effect of psychotherapy on anxiety outcomes (g = 0.27).

Conclusions

This meta-analysis provides evidence that psychotherapy aimed at depression can also reduce anxiety symptoms in relation to control conditions.

Keywords

Anxietydepressionpsychotherapymeta-analysis

Information

Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 13 , October 2018 , pp. 2140 - 2152
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Acarturk, C, Cuijpers, P, van Straten, A and de Graaf, R (2009) Psychological treatment of social anxiety disorder: a meta-analysis. Psychological Medicine 39, 241–254.Google Scholar
Ammerman, RT, Putnam, FW, Altaye, M, Teeters, AR, Stevens, J and Van Ginkel, JB (2013) Treatment of depressed mothers in home visiting: impact on psychological distress and social functioning. Child Abuse & Neglect 37, 544–554.Google Scholar
Andersson, G, Begstrom, J, Hollandare, F, Carlbring, P, Kaldo, V and Ekselius, L (2002) Internet-based self-help for depression: randomised controlled trial. British Journal of Psychiatry 187, 456–461.Google Scholar
Batink, T, Peeters, F, Geschwind, N, van Os, J and Wichers, M (2013) How does MBCT for depression work? Studying cognitive and affective mediation pathways. PLoS ONE 8, 1–13.Google Scholar
Bohlmeijer, ET, Fledderus, M, Rokx, TAJJ and Pieterse, ME (2011) Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: evaluation in a randomized controlled trial. Behaviour Research and Therapy 49, 62–67.Google Scholar
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR and Mancill, RB (2001) Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585–599.Google Scholar
Buhrman, M, Syk, M, Burvall, O, Hartig, T, Gordh, T and Andersson, G (2015) Individualized guided internet-delivered cognitive behaviour therapy for chronic pain patients with Comorbid depression and anxiety a randomized controlled trial. Clinical Journal of Pain 31, 504–516.Google Scholar
Buntrock, C, Ebert, D, Lehr, D, Riper, H, Smit, F, Cuijpers, P et al. (2015) Effectiveness of a web-based cognitive behavioural intervention for subthreshold depression: pragmatic randomised controlled trial. Psychotherapy and Psychosomatics 84, 348–358.Google Scholar
Carlbring, P, Hägglund, M, Luthström, A, Dahlin, M, Kadowaki, Å, Vernmark, K et al. (2013) Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial. Journal of Affective Disorders 148, 331–337.Google Scholar
Chesney, MA, Chambers, DB, Taylor, JM, Johnson, LM and Folkman, S (2003) Coping effectiveness training for men living with HIV: results from a randomized clinical trial testing a group-based intervention. Psychosomatic Medicine 65, 1038–1046.Google Scholar
Chiesa, A, Mandelli, L and Serretti, A (2012) Mindfulness-based cognitive therapy versus psycho-education for patients with major depression who did not achieve remission following antidepressant treatment: a preliminary analysis. Journal of Alternative and Complementary Medicine 18, 756–760.Google Scholar
Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences. 2nd edn. Hillsdale, NJ: Erlbaum.Google Scholar
Cramer, H, Salisbury, C, Conrad, J, Eldred, J and Araya, R (2011) Group cognitive behavioural therapy for women with depression: pilot and feasibility study for a randomised controlled trial using mixed methods. BMC Psychiatry 11, 82.Google Scholar
Cuijpers, P, Berking, M, Andersson, G, Quigley, L, Kleiboer, A and Dobson, KS (2013a). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry/La Revue Canadienne de Psychiatrie 58, 376–385.Google Scholar
Cuijpers, P, Cristea, IA, Weitz, E, Gentili, C and Berking, M (2016) The effects of cognitive and behavioral therapies for anxiety disorders on depression: a meta-analysis. Psychological Medicine 46, 3451–3462.Google Scholar
Cuijpers, P, Driessen, E, Hollon, SD, van Oppen, P, Barth, J and Andersson, G (2012) The efficacy of non-directive supportive therapy for adult depression: a meta-analysis. Clinical Psychology Review 32, 280–291.Google Scholar
Cuijpers, P, Geraedts, AS, van Oppen, P, Andersson, G, Markowitz, JC and van Straten, A (2011) Interpersonal psychotherapy for depression: a meta-analysis. The American Journal of Psychiatry 168, 581–592.Google Scholar
Cuijpers, P, Sijbrandij, M, Koole, S, Huibers, M, Berking, M and Andersson, G (2014) Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical Psychology Review 34, 130–140.Google Scholar
Cuijpers, P, Sijbrandij, M, Koole, SL, Andersson, G, Beekman, AT and Reynolds, CFI (2013b). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry 12, 137–148.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L and Andersson, G (2008) Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 8, 36.Google Scholar
De Maat, S, Dekker, J, Schoevers, R and De Jonghe, F (2006) Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Psychotherapy Research 16, 566–578.Google Scholar
Dobkin, RD, Menza, M, Allen, LA, Gara, MA, Mark, MH, Tiu, J et al. (2011) Cognitive-Behavioral therapy for depression in Parkinson's disease: a randomized, controlled trial. American Journal of Psychiatry 168, 1066–1074.Google Scholar
Ekers, D, Richards, D and Gilbody, S (2008) A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine 38, 611–623.Google Scholar
Evans, RL and Connis, RT (1995) Comparison of brief group therapies for depressed cancer patients receiving radiation treatment. Public Health Reports 110, 306–311.Google Scholar
Faramarzi, M, Alipor, A, Esmaelzadeh, S, Kheirkhah, F, Poladi, K and Pash, H (2008) Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine. Journal of Affective Disorders 108, 159–164.Google Scholar
Fava, M, Alpert, JE, Carmin, CN, Wisniewski, SR, Trivedi, MH, Biggs, MM et al. (2004) Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychological Medicine 34, 1299–1308.Google Scholar
Fledderus, M, Bohlmeijer, ET, Pieterse, ME and Schreurs, KM (2012) Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychological Medicine 42, 485–495.Google Scholar
Freedland, KE, Carney, RM, Rich, MW, Steinmeyer, BC and Rubin, EH (2015) Cognitive behavior therapy for depression and self-care in heart failure patients: a randomized clinical trial. JAMA Internal Medicine 175, 1773–1782.Google Scholar
Freedland, KE, Skala, JA, Carney, RM, Rubin, EH, Lustman, PJ, Davila-Roman, VG et al. (2010) Treatment of depression after coronary artery bypass surgery. Archives of General Psychiatry 66, 387–396.Google Scholar
Furukawa, TA, Noma, H, Caldwell, DM, Honyashiki, M, Shinohara, K, Imai, H et al. (2014) Waiting list may be a Nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatrica Scandinavica 130, 181–192.Google Scholar
Furukawa, TA, Watanabe, N and Churchill, RA (2004) Psychotherapy plus antidepressant for panic disorder with or without agoraphobia systematic review. British Journal of Psychiatry 188, 305–312.Google Scholar
Gitlin, LN, Harris, LF, McCoy, MC, Chernett, NL, Pizzi, LT, Jutkowitz, E et al. (2014) A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans. Annals of Internal Medicine 159, 243–252.Google Scholar
Gloaguen, V, Cottraux, J, Cucherat, M and Blackburn, I (1998) A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 49, 59–72.Google Scholar
Goldberg, DP, Krueger, RF, Andrews, G and Hobbs, MJ (2009) Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2043–2059.Google Scholar
Grote, NK, Swartz, HA, Geibel, SL, Zuckoff, A, Houck, PR and Frank, E (2009) A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services 60, 313–321.Google Scholar
Haringsma, R, Engels, GI, Cuijpers, P and Spinhoven, P (2006) Effectiveness of the Coping with Depression (CWD) course for older adults provided by the community-based mental health care system in the Netherlands: a randomized controlled field trial. International Psychogeriatrics 18, 307–325.Google Scholar
Hautzinger, M and Welz, S (2004) Kognitive verhaltenstherapie bei depressionen im alter: Ergebnisse einer kontrollierten vergleichsstudie unter ambulanten bedingungen an depressionen mittleren schweregrads. Zeitschrift fur Gerontologie und Geriatrie 37, 427–435.Google Scholar
Hedges, L and Olkin, I (1985) Statistical Methods for Meta-analysis. Academic Press: Orlando.Google Scholar
Higgins, JP, Green, S (eds) (2011) Chapter 8: assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions. Version 5. http://handbook.cochrane.org/.Google Scholar
Hofmann, SG and Smits, JAJ (2008) Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry 69, 621–632.Google Scholar
Hsiao, FH, Lai, YM, Chen, YT, Yang, TT, Liao, SC, Ho, RTH et al. (2014) Efficacy of psychotherapy on diurnal cortisol patterns and suicidal ideation in adjustment disorder with depressed mood. General Hospital Psychiatry 36, 214–219.Google Scholar
Hunot, V, Churchill, R, Silva de Lima, M and Teixeira, V (2007) Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews, CD001848, 1–93.Google Scholar
Ioannidis, JPA, Patsopoulos, NA and Evangelou, E (2007) Uncertainty in heterogeneity estimates in meta-analyses. British Medical Journal 335, 914–916.Google Scholar
Joffe, R, Bagby, R and Levitt, A (1993) Anxious and nonanxious depression. American Journal of Psychiatry, 150, 1257–1258.Google Scholar
Johansson, R, Ekbladh, S, Hebert, A, Lindström, M, Möller, S, Petitt, E et al. (2012a). Psychodynamic guided self-help for adult depression through the internet: a randomised controlled trial. PLoS ONE 7.Google Scholar
Johansson, R, Sjöberg, E, Sjögren, M, Johnsson, E, Carlbring, P, Andersson, T et al. (2012b). Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial. PLoS ONE 7, 1–9.Google Scholar
Jonkers, CCM, Lamers, F, Bosma, H, Metsemakers, JFM and van Eijk, JTM (2012) The effectiveness of a minimal psychological intervention on self-management beliefs and behaviors in depressed chronically ill elderly persons: a randomized trial. International Psychogeriatrics 24, 288–297.Google Scholar
Kelly, JA, Murphy, DA, Bahr, R, Kalichman, SC, Morgan, MG, Stevenson, Y et al. (1993) Outcome of cognitive-behavioral and support group brief therapies for depressed, HIV-infected persons. American Journal of Psychiatry 150, 1679–1686.Google Scholar
Kivi, M, Eriksson, MCM, Hange, D, Peterson, E-L, Vernmakr, K, Johansson, B et al. (2014) Internet-based therapy for mild to moderate depression in Swedish primary care: short term results from the PRIM-NET randomized controlled trial. Cognitive Behaviour Therapy 43, 289–298.Google Scholar
Korte, J, Bohlmeijer, ET, Cappeliez, P, Smit, F and Westerhof, GJ (2012) Life review therapy for older adults with moderate depressive symptomatology: a pragmatic randomized controlled trial. Psychological Medicine 42, 1163–1173.Google Scholar
Kraemer, HC and Kupfer, DJ (2006) Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 59, 990–996.Google Scholar
Laidlaw, K, Davidson, K, Toner, H, Jackson, G, Clark, S, Law, J et al. (2008) A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression. International Journal of Geriatric Psychiatry 23, 843–850.Google Scholar
Lamers, SMA, Bohlmeijer, ET, Korte, J and Westerhof, GJ (2015) The efficacy of life-review as online-guided self-help for adults: a randomized trial. Journals of Gerontology – Series B Psychological Sciences and Social Sciences 70, 24–34.Google Scholar
Lemma, A and Fonagy, P (2013) Feasibility study of a psychodynamic online group intervention for depression. Psychoanalytic Psychology 30, 367–380.Google Scholar
Lynch, D, Tamburrino, M, Nagel, R and Smith, MK (2004) Telephone-based treatment for family practice patients with mild depression. Psychological Reports 94, 785–792.Google Scholar
Maina, G, Forner, F and Bogetto, F (2005) Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders. Psychotherapy and Psychosomatics 74, 43–50.Google Scholar
Malouff, JM, Thorsteinsson, EB and Schutte, NS (2007) The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clinical Psychology Review 27, 46–57.Google Scholar
Martin, PR, Aiello, R, Gilson, K, Meadows, G, Milgrom, J and Reece, J (2015) Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: an exploratory randomized controlled trial. Behaviour Research and Therapy 73, 8–18.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL and Borkovec, TD (1990) Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy 28, 487–495.Google Scholar
Milgrom, J, Holt, C, Holt, CJ, Ross, J, Ericksen, J and Gemmill, AW (2015) Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up. Archives of Women's Mental Health 18, 717–730.Google Scholar
Mitte, K (2005) Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychological Bulletin 131, 785–795.Google Scholar
Naeem, F, Gul, M, Irfan, M, Munshi, T, Asif, A, Rashid, S et al. (2015) Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan. Journal of Affective Disorders 177, 101–107.Google Scholar
Naeem, F, Sarhandi, I, Gul, M, Khalid, M, Aslam, M, Anbrin, A et al. (2014) A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan. Journal of Affective Disorders 156, 224–227.Google Scholar
Pot, AM, Bohlmeijer, ET, Onrust, S, Melenhorst, A-S, Veerbeek, M and De Vries, W (2010) The impact of life review on depression in older adults: a randomized controlled trial. International Psychogeriatrics 22, 572–581.Google Scholar
Pots, WTM, Meulenbeek, PAM, Veehof, MM, Klungers, J and Bohlmeijer, ET (2014) The efficacy of mindfulness-based cognitive therapy as a public mental health intervention for adults with mild to moderate depressive symptomatology: a randomized controlled trial. PLoS ONE 9, 1–12.Google Scholar
Qiu, J, Chen, W, Gao, X, Xu, Y, Tong, H, Yang, M et al. (2013) A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer patients with major depression. Psychosomatic Obstetrics & Gynecology 34, 60–67.Google Scholar
Richards, D, Timulak, L, O'Brien, E, Hayes, C, Vigano, N, Sharry, J et al. (2015) A randomized controlled trial of an internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression. Behaviour Research and Therapy 75, 20–31.Google Scholar
Sanchez-Meca, J, Rosa-Alcazar, AI, Marin-Martinez, F and Gomez-Conesa, A (2010) Psychological treatment of panic disorder with or without agoraphobia: a meta-analysis. Clinical Psychology Review 30, 37–50.Google Scholar
Savard, J, Simard, S, Giguère, I, Ivers, H, Morin, CM, Maunsell, E et al. (2006) Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects. Palliative & Supportive Care 4, 219–237.Google Scholar
Serfaty, MA, Haworth, D and Buszewicz, M (2009) Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care. Archives of General Psychiatry 66, 1332–1340.Google Scholar
Simson, U, Nawarotzky, U, Friese, G, Porck, W, Schottenfeld-Naor, Y, Hahn, S et al. (2008) Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome. Diabetic Medicine 25, 206–212.Google Scholar
Smits, JAJ, Minhajuddin, A and Jarrett, RB (2009) Cognitive therapy for depressed adults with comorbid social phobia. Journal of Affective Disorders 114, 271–278.Google Scholar
Strong, V, Waters, R, Hibberd, C, Murray, G, Wall, L, Walker, J et al. (2008) Management of depression for people with cancer 4 (SMaRT oncology 1): a randomised trial. Lancet 372, 40–48.Google Scholar
Swartz, HA, Frank, E, Zuckoff, A, Cyranowski, JM, Houck, PR, Cheng, Y et al. (2008) Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. American Journal of Psychiatry 165, 1155–1162.Google Scholar
Talbot, N, Chaudron, L, Ward, EA, Duberstein, PR, Conwell, Y, O'Hara, MW et al. (2011) A randomized effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories. Psychiatric Services 62, 374–380.Google Scholar
Tovote, KA, Fleer, J, Snippe, E, Peeters, ACTM, Emmelkamp, PMG, Sanderman, R et al. (2014) Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care 37, 2427–2434.Google Scholar
Vernmark, K, Lenndin, J, Bjärehed, J, Carlsson, M, Karlsson, J, Öberg, J et al. (2010) Internet administered guided self-help versus individualized e-mail therapy: a randomized trial of two versions of CBT for major depression. Behaviour Research and Therapy 48, 368–376.Google Scholar
Vitriol, VG, Ballesteros, ST, Florenzano, RU, Weil, KP and Benadof, DF (2009) Evaluation of an outpatient intervention for women with severe depression and a history of childhood trauma. Psychiatric Services 60, 936–942.Google Scholar
von Hippel, PT (2015) The heterogeneity statistic I (2) can be biased in small meta-analyses. BMC Medical Research Methodology 15, 2–8.Google Scholar
Warmerdam, L, van Straten, A, Twisk, J, Riper, H and Cuijpers, P (2008) Internet-Based treatment for adults with depressive symptoms: randomized controlled trial. Journal of Medical Internet Research 10, 1–16.Google Scholar
Watkins, ER, Taylor, RS, Byng, R, Baeyens, C, Read, R, Pearson, K et al. (2012) Guided self-help concreteness training as an intervention for major depression in primary care: a phase II randomized controlled trial. Psychological Medicine 42, 1359–1371.Google Scholar
Wierzbicki, M and Bartlett, TS (1987) The efficacy of group and individual cognitive therapy for mild depression. Cognitive Therapy and Research 11, 337–342.Google Scholar
Wiethoff, K, Bauer, M, Baghai, TC, Möller, H-J, Fisher, R, Hollinde, D et al. (2010) Prevalence and treatment outcome in anxious versus nonanxious depression: results from the German Algorithm Project. The Journal of Clinical Psychiatry 71, 1047–1054.Google Scholar
Zajecka, JM and Ross, JS (1995) Management of comorbid anxiety and depression. Journal of Clinical Psychiatry 56, 10–13.Google Scholar