Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing

Abstract

The primary focus of classic cognitive behavioural therapy (CBT) for depression and anxiety is on decreasing symptoms of psychopathology. However, there is increasing recognition that it is also important to enhance wellbeing during therapy. This study investigates the extent to which classic CBT for anxiety and depression leads to symptom relief versus wellbeing enhancement, analysing routine outcomes in patients receiving CBT in high intensity Improving Access to Psychological Therapy (IAPT) Services in the UK. At intake, there were marked symptoms of anxiety and depression (a majority of participants scoring in the severe range) and deficits in wellbeing (a majority of participants classified as languishing, relative to general population normative data). CBT was more effective at reducing symptoms of anxiety and depression than repairing wellbeing. As a result, at the end of treatment, a greater proportion of participants met recovery criteria for anxiety and depression than had moved from languishing into average or flourishing levels of wellbeing. Given the importance of wellbeing to client definitions of recovery, the present results suggest a greater emphasis should be placed on enhancing wellbeing in classic CBT.

Magnetic resonance imaging for individual prediction of treatment response in major depressive disorder: a systematic review and meta-analysis

“…We would advise authors of future studies to publish non-significant results as well as significant but less accurate results, since both are potentially useful in comparing the merits of different modalities. Second, the number of studies predicting the effects of psychotherapy, specifically cognitive therapy, outcome was low, resulting in a blind spot for a commonly deployed treatment in MDD 68 . Third, cross-validation in small samples results in large variation of the estimated accuracy, and as indicated above, accuracy reduces with larger sample heterogeneity 67 , 69 .…”

Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression.

“…Second, secondary analyses of randomized controlled trials as well as routine outcome measurements of traditional CBT for depression reveal that CBT satisfactorily repairs elevations in negative affect back to general population average levels but fails to enhance positive affect (Dunn, 2019;Widnall, Price, Trompetter, & Dunn, 2019). Similarly, a functional magnetic resonance imaging study found impaired processing of positive stimuli in participants who had recovered from depression (Arnold et al, 2011).…”

Magnetic resonance imaging for individual prediction of treatment response in major depressive disorder: a systematic review and meta-analysis

“…Although we did contact authors for additional information, response was poor, so we were unable to rule out reporting bias for modality differences. Second, the number of studies predicting psychotherapy outcome was low, resulting in a blind spot for one of the most commonly deployed treatment modalities in MDD (63) . Third, cross-validation in small samples results in large variation of the estimated accuracy and as indicated above, accuracy reduces with larger sample heterogeneity (62,64).…”