Comparing the Effectiveness of Cognitive-Behavior Therapy, Transdiagnostic Psychotherapy, and Pharmacotherapy on Anxiety and Depressive Symptoms in Women with Comorbid Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD)

In Iran, women more than men suffer from depressive and anxiety disorders. Comorbid generalized anxiety disorder (GAD) and major depression disorder (MDD) is the most common form of comorbidity involving depression and anxiety. One of the essential problems of this comorbidity is more symptom severity in comparison to MDD and GAD alone, and this might lead to higher illness severity and chronicity. Common interventions for GAD and MDD are cognitive behavior therapy (CBT), transdiagnostic psychotherapy, and pharmacotherapy. However, these two disorders are typically treated separately, and there is a dearth of information on tackling them in comorbid conditions. This study aimed to compare the effectiveness of CBT, transdiagnostic psychotherapy, and pharmacotherapy on depressive and anxiety symptoms in women with comorbid MDD and GAD.

In this study, a single case study using multiple baseline design with follow–up was implemented. Individual baseline acted as control periods. Following individual baseline, treatments were delivered weekly, with each treatment session lasting up to 50 min. On completion of treatments, the patients were followed up for 1 and 3 months. Six women with comorbid MDD and GAD who came for treatment to counseling centers and psychiatrist's office in Marivan City, Iran from the beginning to the end of autumn 2019, were enrolled in the study and randomly assigned in three treatment groups. All patients met the Diagnostic and statistical manual of mental disorders (DSM–5) criteria for MDD and GAD. The inclusion criteria were as follows: having signs and symptoms of both disorders (MDD and GAD), being older than 18 years, and having consent to participate in the research. The exclusion criteria were unwillingness to continue the treatment, not completing the research questionnaires, and identifying any new disorder at each stage of the treatment. The study measures included Beck Depression Inventory (BDI–II) (Beck et al., 1996) and Beck Anxiety Inventory (BAI) (Beck & Steer, 1990). CBT and transdiagnostic psychotherapy consisted of 12 sessions, one session per week. Pharmacotherapy, consisted of a combination of Alprazolam and Sertraline presented. The obtained data were analyzed with reliable change index (RCI) and recovery percentage. Leeds reliable change indicator software was used to calculate the reliable change index.

Results showed that symptoms of depression and anxiety significantly were reduced by all three treatments. Improvements of patient's anxiety were 57% in CBT, 50% in transdiagnostic, and 63% in pharmacotherapy. According to Blanchard and Schwarz's (1988) criteria, the recovery percentage of all patients was higher than 50. Therefore, the improvements in anxiety symptoms have been significant in all six patients. Also, the RCI was higher than the Z value (1.96), so with 95% confidence, we can say that the improvement was due to therapeutic interventions. In the follow–up phase, improvements in anxiety were maintained and improvement percentage of CBT, transdiagnostic, and pharmacotherapy were 50%, 51%, and 60%, respectively. Based on results, improvements in depression symptoms for CBT, transdiagnostic, and pharmacotherapy were 64%, 55%, and 56%, respectively. These results were maintained in the follow–up phase at 57%, 52%, and 50%, respectively. As seen, all improvement percentages in the intervention and follow–up phase were above 50 and therefore, based on Blanchard and Schwarz's criteria, these results were clinically significant. The RCI was greater than 1.96, in the intervention and follow–up phases indicating that improvements in depression symptoms were statistically significant.

Although all three treatments caused significant improvements in anxiety and depression symptoms, pharmacotherapy was slightly more effective in treating anxiety and CBT was slightly more effective in treating depression. Based on these results, when treating comorbid GAD and MDD, if the symptoms of anxiety are more severe, pharmacotherapy is preferred and if the symptoms of depression are more severe, CBT is preferred.