Effects Of An Exercise-primed Cognitive Behavioral Therapy Pilot Trial On Anxiety In Adults With Depression

Abstract

Acute exercise improves mood, cognitive function, energy and engagement in people suffering from depression. Priming cognitive behavioral therapy (CBT) sessions with acute exercise may enhance its effectiveness. Anxiety is a common major comorbidity of depression and can make treatments less effective but is also treated with CBT. Priming CBT with exercise may also enhance the anxiolytic response. PURPOSE: To quantitatively and qualitatively analyze the effects of eight weekly virtual CBT sessions primed with either 30 minutes of moderate intensity exercise (ActiveCBT) or quiet-rest (CalmCBT) on anxiety in adults with depression. METHODS: Ten adults diagnosed with DSM-5 depression were randomized to either ‘active’ (n = 5) or ‘calm’ (n = 5) conditions. Participants completed the Generalized Anxiety Disorder-7 (GAD-7) to provide anxiety symptom severity at baseline, final, and 3-month (3 m) follow-up visits. Mean GAD-7 scores and percent change from baseline to final and 3 m were calculated. A qualitative interview was conducted at the final visit. To investigate the conditions’ effects, three coders created a deductive codebook for initial coding to assess feasibility, satisfaction, and feedback of the overall treatment. The coded data was then used to identify the interventions’ effects on anxiety symptoms from the DSM-5 anxiety disorder criteria. RESULTS: Mean GAD-7 scores and standard deviations for the active condition were 15.0 (4.3) at baseline, 4.2 (2.7) at final, and 9.8 (6.5) at 3 m, and for the calm condition were 6.4 (4.4) at baseline, 5.0 (5.2) at final, and 5.3 (1.3) at 3 m. The active/calm conditions resulted in a 72%/22% decrease in GAD-7 score from baseline to final and 35%/17% from baseline to 3 m. Common themes from the qualitative interview included alleviating excessive anxiety and worry, improved ability to control anxiety and worry, and improved sleep quality that were potentially related to pre-CBT condition. CONCLUSIONS: The present results provide preliminary efficacy evidence that priming CBT sessions with exercise may more effectively treat anxiety in a depressed population than standard CBT. The 30 minutes before CBT sessions could be a useful window to engage in anxiolytic preparatory activities prior to therapy. Further research priming CBT with exercise is warranted.