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.
Highlights
Anxiety and depressive disorders are prevalent, recurrent, frequently comorbid mental health conditions that are a significant cause of worldwide disability (WHO 2017; Kessler et al 2005, 2007)
There were significant and slightly greater magnitude differences in treatment responsiveness between the groups. Those with complete WEMWBS data showed a greater improvement during treatment in PHQ-9 depression, t(1579) = 10.16, p < .001, and GAD-7 anxiety, t(1579) = 9.70, p < .001, than those without complete WEMWBS data
This study investigated the extent to which routinely delivered classic cognitive behavioural therapy (CBT) repairs symptoms versus enhances wellbeing in a sample of individuals with anxiety and depression
Summary
Anxiety and depressive disorders are prevalent, recurrent, frequently comorbid mental health conditions that are a significant cause of worldwide disability (WHO 2017; Kessler et al 2005, 2007). Wellbeing enhancement is at least as important a part of recovery to patients as relief from symptoms (Zimmerman et al 2006; Demyttenaere et al 2015) and predicts future resilience (Garland et al 2010; Wood and Joseph 2010) This perspective resonates with the broader recovery movement arguing that recovery means individuals living a valued and enjoyable life and minimising the extent to which symptoms impede this goal (Slade 2010). There is evidence of acute and sustained benefit for CBT protocols for specific anxiety disorders, but with a subset of clients not responding or showing a chronic, relapsing course (Hofmann and Smits 2008; Ali et al 2017) This mirrors effective, but sub-optimal, outcomes observed following other psychological and pharmacological treatment modalities for anxiety and depression. Recovery rates in routine practice may be substantially lower than those observed in clinical trials (Lambert 2017)
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