Relationships between worry and depressive symptoms during two group therapies for generalized anxiety disorder

Martins, Daniel Santos; Sampaio, Thiago Pacheco de Almeida; Lotufo Neto, Francisco

doi:10.1590/0047-2085000000361

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Original Article • J. bras. psiquiatr. 71 (2) • Apr-Jun 2022 • https://doi.org/10.1590/0047-2085000000361 copy

Relationships between worry and depressive symptoms during two group therapies for generalized anxiety disorder

A inter-relação entre preocupações e sintomas depressivos em adultos com ansiedade generalizada

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

Generalized anxiety disorder (GAD) is a chronic and disabling disorder associated with various impairments and shows a significant prevalence in the worldwide and Brazilian populations. This study aimed to investigate the longitudinal relationship of two symptoms relevant to the disorder (worry and depressive symptoms) in the context of a randomized clinical trial (RCT) by using a cross-lagged panel model (CLPM) analysis.

Methods:

A total of 92 adult patients with GAD were randomized to receive ten sessions of either acceptance‐based group behavioral therapy (ABBT) or nondirective supportive group therapy (NDST). Treatment had four time-point measures. Worries were measured using the Penn State Worry Questionnaire (PSWQ), and depression was measured using the Depression Anxiety Stress Scales (DASS-D).

Results:

The NDST model revealed significant paths from worry to depression (first wave) and from depression to worry (second wave). There was no other significant cross-lagged effect. These data show that there was an influence between symptoms only during one of the treatment groups, and without a homogeneous and constant pattern in any of the cross-lagged routes.

Conclusion:

A supportive group psychotherapy potentially interferes with the pattern of the direct relationship between worries and depressive symptoms in adults with GAD.

Keywords
Anxiety; anxiety disorders; worry; depression; psychotherapy

		Total (n = 92)	NDST (n = 46)	ABBT (n = 46)
Gender
	Female	68 (73.9%)	34 (73.9%)	35 (76%)
	Male	24 (26.1%)	12 (26.1%)	11 (24%)
Age, mean (SD), y		36.6 (12.4)	34.8 (10.6)	38.4 (13.8)
Education:
	Elementary school:	2 (2.2%)	0 (0.0%)	2 (4.3%)
	Post-high School:	26 (28.3%)	14 (30.4%)	12 (26.1%)
	Higher education:	64 (69.5%)	32 (69.6%)	32 (69.6%)
Family status:
	Married/de facto:	23 (25.0%)	13 (28.3%)	10 (21.7%)
	Single /separated:	69 (75.0%)	33 (71.7%)	36 (78.3%)
Curent psychiatric Treatment:		33 (35.9%)	16 (34.8%)	17 (36.9%)
Comorbid disorders:
	Major depressive disorder (MDD)	56 (60.9%)	28 (60.9%)	28 (60.9%)
	Panic disorder (PD)	38 (41.3%)	17 (37.0%)	21 (45.7%)
	Agoraphobia	26 (28.3%)	16 (34.8%)	10 (21.7%)
	Social phobia	19 (20.7%)	11 (23.9%)	8 (17.4%)
	Obsessive compulsive disorder (OCD)	5 (5.4%)	2 (4.3%)	3 (6.5%)
	Post-traumatic stress disorder (PTSD)	4 (4.3%)	1 (2.2%)	3 (6.5%)

Variable		D1	D2	D3	D4	P1	P2	P3	P4	N	Mean	SD
Group ABBT
	D1	1.00								46	15.74	10.24
	D2	0.263	1.00							34	13.35	9.15
	D3	.434 ^* * Significant at the 0.05 level (2-tailed).	.560 ^ Significant at the 0.01 level (2-tailed).	1.00						21	9.52	11.12
	D4	.443 ^* * Significant at the 0.05 level (2-tailed).	.599 ^ Significant at the 0.01 level (2-tailed).	.530 ^* * Significant at the 0.05 level (2-tailed).	1.00					21	9.52	9.92
	P1	.446 ^ Significant at the 0.01 level (2-tailed).	0.314	0.189	0.155	1.00				46	66.33	11.29
	P2	-0.055	.496 ^ Significant at the 0.01 level (2-tailed).	0.258	0.054	.368 ^* * Significant at the 0.05 level (2-tailed).	1.00			34	60.47	8.48
	P3	0.077	.488 ^* * Significant at the 0.05 level (2-tailed).	0.095	0.255	0.427	.499 ^* * Significant at the 0.05 level (2-tailed).	1.00		21	53.10	10.61
	P4	0.263	.518 ^* * Significant at the 0.05 level (2-tailed).	.509 ^* * Significant at the 0.05 level (2-tailed).	0.313	0.282	.558 ^* * Significant at the 0.05 level (2-tailed).	.723 ^ Significant at the 0.01 level (2-tailed).	1.00	20	55.55	9.68
Group NDST
	D1	1.00								46	16.91	10.72
	D2	.389 ^* * Significant at the 0.05 level (2-tailed).	1.00							27	11.41	9.72
	D3	.472 ^* * Significant at the 0.05 level (2-tailed).	.691 ^ Significant at the 0.01 level (2-tailed).	1.00						23	11.57	8.82
	D4	.415 ^* * Significant at the 0.05 level (2-tailed).	.782 ^ Significant at the 0.01 level (2-tailed).	.766 ^ Significant at the 0.01 level (2-tailed).	1.00					23	16.00	10.58
	P1	.489 ^ Significant at the 0.01 level (2-tailed).	.453 ^* * Significant at the 0.05 level (2-tailed).	0.291	0.333	1.00				46	66.15	9.91
	P2	0.142	.563 ^ Significant at the 0.01 level (2-tailed).	0.286	.491 ^* * Significant at the 0.05 level (2-tailed).	.654 ^ Significant at the 0.01 level (2-tailed).	1.00			27	64.93	10.15
	P3	0.156	.705 ^ Significant at the 0.01 level (2-tailed).	.503 ^* * Significant at the 0.05 level (2-tailed).	.604 ^ Significant at the 0.01 level (2-tailed).	.702 ^ Significant at the 0.01 level (2-tailed).	.791 ^ Significant at the 0.01 level (2-tailed).	1.00		23	62.04	10.20
	P4	0.039	.569 ^ Significant at the 0.01 level (2-tailed).	.467 ^* * Significant at the 0.05 level (2-tailed).	.520 ^* * Significant at the 0.05 level (2-tailed).	.718 ^ Significant at the 0.01 level (2-tailed).	.808 ^ Significant at the 0.01 level (2-tailed).	.906 ^ Significant at the 0.01 level (2-tailed).	1.00	23	63.65	11.68

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[1] Address for correspondence: Daniel Santos Martins. Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César – 05403-903 – São Paulo, SP, Brasil. E-mail: dsm209@gmail.com