As clinicians well know, psychiatric comorbidity tends to be the rule rather than the exception for patients presenting for clinical treatment. For anxiety patients with comorbid depression, the clinical trial literature provides encouraging evidence for the degree to which anxiety treatments may be resilient to the influence of depression comorbidity. In comparison, available evidence for the resilience of depression treatment to the effects of anxiety comorbidity is less encouraging, although both areas of inquiry are clearly in need of further controlled study. In this chapter, we have discussed principles that may aid the selection of the appropriate initial targets and strategies for treatment in individuals with co-occurring anxiety and depression. As always, in this enterprise, the clinician and patient are aided by a careful and collaborative functional analysis of the controlling links between negative affective, avoidant, and other maladaptive patterns that can maintain disorders.


Abramowitz, J. S., & Foa, E. B. (2000). Does comorbid major depressive disorder influence outcome of exposure and response prevention for OCD? Behavior Therapy, 31, 795-800. Abramowitz, J. S., Franklin, M. E., Street, G. P., Kozak, M. J., & Foa, E. B. (2000). Effects of comorbid depression on response to treatment for obsessive-compulsive disorder. Behavior Therapy, 31, 517-528. Ball, S. G., Otto, M. W, Pollack, M. H., Uccello, R., & Rosenbaum, J. F. (1995). Differentiating social phobia and panic disorder: A test of core beliefs. Cognitive Research and Therapy, 19, 473-482. Barlow, D. A., Allen, L. B., & Choate, M. L. (2005). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205-230. Barlow, D. H., & Craske, M. G. (2000). Mastery of your anxiety and panic (MAP-3): Therapist guide for anxiety, panic, and agoraphobia (3rd ed.). Oxford, UK: Oxford University Press.

Basoglu,M., Marks, I. M., Swinson, R. P., Noshirvani, H., O'Sullivan, G., & Kuch, K. (1994). Pre-treatment predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure. Journal of Affective Disorders, 30, 123-132.

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1987). Cognitive therapy of depression.

New York: Guilford Press. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press. Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess child hood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children. Psychological Assessment, 7, 73-79.

Black, D. W, Wesner, R. B., Gabel, J., Bowers, W., & Monahan, P. (1994). Predictors of short-term treatment response in 66 patients with panic disorder. Journal of Affective Disorders, 30, 233-241.

Brown, C., Schulberg, H. C., Madonia, M. J., Shear, M. K., & Houck, P. R. (1996). Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. American Journal of Psychiatry, 153, 1293-1300.

Brown, T. A., Antony, M. M., & Barlow, D. H. (1995). Diagnostic comorbidity in panic disorder: Effect on treatment outcome and course of comorbid diagnoses following treatment. Journal of Consulting and Clinical Psychology, 63, 408418.

Brown, T. A., Campbell, L. A., Lehman, C. I., Grisham, J. R., & Mancill, R. B. (2001). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and auto-nomic arousal. Journal of Abnormal Psychology, 110, 585-599.

Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179-192.

Chambless, D. L., Tran, G. Q., & Glass, C. R. (1997). Predictors of response to cognitive-behavioural group therapy for social phobia. Journal of Anxiety Disorders, 11, 221-240.

Clark, D. M., Salkovskis, P. M., Hackmann, A.,Middleton,J., Pavlos, A., & Gelder, M. (1994). A comparison of cognitive therapy, applied relaxation, and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759-769.

Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal ofAbnormal Psychology, 100, 316-336.

Davidson, J. R. T., Potts, N. L. S., Richichi, E. A., Ford, S. M., Krishnan, R. R., Smith, R., et al. (1991). The Brief Social Phobia Scale. Journal of Clinical Psychiatry, 52, 48-51.

Eisenthal, S., Emery, R., Lazare, A., & Udin, H. (1979). "Adherence" and the negotiated approach to patienthood. Archives of General Psychiatry, 36, 393-398.

Eng, W, Heimberg, R. G., Hart, T. A., Schneier, F R., & Liebowitz, M. R. (2001). Attachment in individuals with social anxiety disorder: The relationship among adult attachment styles, social anxiety, and depression. Emotion, 1, 365380.

Erwin, B. A., Heimberg, R. G., Juster, H., & Mindlin, M. (2002). Comorbid anxiety and mood disorders among persons with social anxiety disorder. Behaviour Research and Therapy, 40, 19-35.

Fava, M., Alpert, J. E., Carmin, C. N., Wisniewski, S. R., Trivedi, M. H., Biggs, M. M., et al. (2004). Clinical correlates and symptom patterns of anxious depres sion among patients with major depressive disorder in STAR*D. Psychological Medicine, 34, 1299-1308.

Foa, E. (1979). Failure in treating obsessive—compulsives. Behaviour Research and Therapy, 17, 169—176.

Frank, E., Cyranowski,J. M., Rucci, P., Shear, M. K., Fagiolini, A., Thase, M. E., et al. (2002). Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Archives of General Psychiatry, 59, 905— 911.

Frank, E., Shear, M. K., Rucci, P., Cyranowski, J. M., Endicott, J., Fagiolini, A., et al. (2000). Influence of panic—agoraphobic spectrum symptoms on treatment response in patients with recurrent major depression. American Journal of Psychiatry, 157, 1101-1107.

Gaynes, B. N., Magruder, K. M., Burns, B. J., Wagner, H. R., Yarnall, K. S., & Broadhead, W E. (1999). Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? General Hospital Psychiatry, 21(3), 158—167.

Glass, C. R., & Arnkoff, D. B. (1989). Behavioral assessment of social anxiety and social phobia. Clinical Psychology Review, 9, 75—90.

Grilo, C. M., Money, R., Barlow, D. H., Goddard, A. W, Gorman,J. M., et al. (1998). Pretreatment patient factors predicting attrition from a multicenter randomized controlled treatment study for panic disorder. Comprehensive Psychiatry, 39, 323-332.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford Press.

Henin, A., Otto, M. W, & Reilly-Harrington, N. A. (2001). Introducing flexibility in manualized treatment: Application of recommended strategies to the cognitive-behavioral treatment of bipolar disorder. Cognitive and Behavioral Practice, 8, 317-328.

Hofmann, S. G., & Barlow, D. H. (2002). Social phobia (social anxiety disorder). In D. H. Barlow (Ed.), Anxiety and its disorders: Second edition: The nature and treatment of anxiety and panic (pp. 454—476). New York: Guilford Press.

Hope, D. A., Heimberg, R. G., Juster, H. A., & Turk, C. L. (2000). Managing social anxiety: A cognitive-behavioral therapy approach. Oxford, UK: Oxford University Press.

Hopko, D. R., Lejuez, C. W, & Hopko, S. D. (2004). Behavioral activation as an intervention for co-existent depressive and anxiety symptoms. Clinical Case Studies, 3, 37-48.

Hopko, D. R., Lejuez, C. W, Ruggiero, K. J., & Eifert, G. H. (2003). Contemporary behavioral activation treatments for depression: Procedures, principles, and progress. Clinical Psychology Review, 23, 699—717.

Jansson, L., Ost, L.-G., & Jerremalm, A. (1987). Prognostic factors in the behavioral treatment of agoraphobia. Behavioral Psychotherapy, 15, 31—44.

Katzelnick, D. J., Kobak, K. A., DeLeire, T., Henk, H. J., Greist, J. H., Davidson, J. R., et al. (2001). Impact of generalized social anxiety disorder in managed care. American Journal of Psychiatry, 158, 1999—2007.

Keller, M. B., Lavori, P. W, Mueller, T. I., Endicott,J., Coryell, W, Hirschfeld, R. M., et al. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression: A 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry, 49, 809-816.

Kessler, R. C., Stang, P, Wittchen, H. U., Stein, M., & Walters, E. E. (1999). Lifetime comorbidities between social phobia and mood disorders in the U.S. National Comorbidity Survey. Psychological Medicine, 29, 555-567.

Kessler, R. C., Stang, P. E., Wittchen, H. U., Ustun, T. B., Roy-Burne, P. P., & Walters, E. E. (1998). Lifetime panic-depression comorbidity in the National Comorbidity Survey. Archives of General Psychiatry, 55, 801-808.

Laberge, B., Gauthier, J. G., Cote, G., Plamondon, J., & Cormier, H. J. (1993). Cognitive-behavioral therapy of panic disorder with secondary major depression: A preliminary investigation. Journal of Consulting and Clinical Psychology, 61, 1028-1037.

Liebowitz, M. R. (1987). Social phobia. Modern Problems in Pharmacopsychiatry, 22, 141-173.

Lincoln, T. M., & Rief, W (2004). How much do sample characteristics affect the effect size?: An investigation of studies testing the treatment effects for social phobia. Journal of Anxiety Disorders, 18(4), 515-529.

Maddock, R. J., & Blacker, K. H. (1991). Response to treatment in panic disorder with associated depression. Psychopathology, 24, 1-6.

Magee, W J., Eaton, W W, Wittchen, H. U., McGonagle, K. A., & Kessler, R. C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry, 53, 159-168.

Marks, I. M. (1987). Fears, phobias, and rituals. New York: Oxford University Press.

Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470.

McElroy, S. L., Altshuler, L. L., Suppes, T., Keck, P. E., Jr., Frye, M. A., Denicoff, K. D., et al. (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. American Journal of Psychiatry, 158, 420-426.

McLean, P. D., Woody, S., Taylor, S., & Koch, W J. (1998). Comorbid panic disorder and major depression: Implications for cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 66, 240-247.

Mennin, D. S., & Heimberg, R. G. (2000). The impact of comorbid mood and personality disorders in the cognitive-behavioral treatment ofpanic disorder. Clinical Psychology Review, 20, 339-357.

Mills, I., & Salkovskis, P (1988). Mood and habituation to phobic stimuli. Behaviour Research and Therapy, 26, 435-439.

Moscovitch, D. A., Hofmann, S. G., Suvak, M., & In-Albon, T. (2005). Mediation of changes in anxiety and depression during treatment for social phobia. Journal of Consulting and Clinical Psychology, 75, 945-952.

Ost, L.-G., Thulin, U., & Ramnero, J. (2004). Cognitive behavior therapy vs exposure in vivo in the treatment of panic disorder with agoraphobia. Behaviour Research and Therapy, 42, 1105-1127.

Otto, M. W., Fava, M., Penava, S. A., Bless, E., Muller, R. T., & Rosenbaum, J. F. (1997). Life event and cognitive predictors of perceived stress before and after treatment for major depression. Cognitive Therapy and Research, 21, 409-420.

Otto, M. W, & Gould, R. A. (1996). Maximizing treatment-outcome for panic disorder: Cognitive-behavioral strategies. In M. H. Pollack, M. W. Otto, & J. F. Rosenbaum (Eds.), Challenges in clinical practice: Pharmacologic and psychosocial strategies (pp. 113-140). New York: Guilford Press.

Otto, M. W,Jones,J. C., Craske, M. G., & Barlow, D. H. (1996). Stopping anxiety medication: Panic control therapy for benzodiazepine discontinuation (therapist guide). Oxford, UK: Oxford University Press.

Otto, M. W, Pollack, M. H., Fava, M., Uccello, R., & Rosenbaum, J. F. (1995). Elevated Anxiety Sensitivity Index scores in patients with major depression: Correlates and changes with antidepressant treatment. Journal ofAnxiety Disorders, 9, 117-123.

Otto, M. W, Powers, M. B., & Fischman, D. (2005). Emotional exposure in the treatment of substance use disorders: Conceptual model, evidence, and future directions. Clinical Psychology Review, 25, 824-839.

Otto, M. W, Simon, N. S., Wisniewski, S. R., Miklowitz, D. J., Kogan, J. N., Reilly-Harrington, N. A., et al. (2006). Prospective 12-month course of bipolar disorder in outpatients with and without comorbid anxiety disorders. British Journal of Psychiatry, 189, 20-25.

Persons, J. B., Roberts, N. A., & Zalecki, C. A. (2003). Anxiety and depression change together during treatment. Behavior Therapy, 34, 149-163.

Raffa, S. D., White, K. S., & Barlow, D. H. (2004). Feared consequences of panic attacks in panic disorder: A qualitative and quantitative analysis. Cognitive and Behavioral Therapy, 33, 199-207.

Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R.J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8.

Roy-Byrne, P. P., Stang, P., Wittchen, H. U., Ustun, B., Walters, E. E., & Kessler, R. C. (2000). Lifetime panic-depression comorbidity in the National Comorbidity Survey: Association with symptoms, impairment, course and help-seeking. British Journal of Psychiatry, 176, 229-235.

Rubin, H. C., Rapaport, M. H., Levine, B., Gladsjo, J. K., Rabin, A., Auerbach, M., et al. (2000). Quality of well being in panic disorder: The assessment of psychiatric and general disability. Journal of Affective Disorders, 57, 217-221.

Rush, J. A., Zimmerman, M., Wisniewski, S. R., Fava, M., Hollon, S. D., Warden, D., et al. (2005). Comorbid psychiatric disorders in depressed outpatients: Demographic and clinical features. Journal of Affective Disorders, 87, 43-55.

Schneier, E R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia: Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282—288. Scholing, A., & Emmelkamp, P. M. G. (1999). Prediction of treatment outcome in social phobia: A cross-validation. Behaviour Research and Therapy, 37, 659—670. Schulberg, H. C., Block, M. R., Madonia, M. J., Scott, C. P., Rodriguez, E., Imber, S. D., et al. (1996). Treating major depression in primary care practice: Eight-month clinical outcomes. Archives of General Psychiatry, 53, 913—919. Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W, et al. (1997). Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154, 1571—1575. Simon, N. S., Otto, M. W, Wisniewski, S. R., Eossey, M., Sagdayu, K., Frank, E., et al. (2004). Anxiety disorder comorbidity in bipolar disorder: Data from the first 500 STEP-BD participants. American Journal of Psychiatry, 161, 2222—2229. Stein, M. B., Euetsch, M., Müller, N., Höfler, M., Lieb, R., & Wittchen, H.-U.

(2001). Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry, 58, 251-256.

Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in the cognitive-behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894-904. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V.

(2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70, 275-287.

Telch, M. J. (1988). Combined pharmacological and psychological treatments for panic sufferers. In S. Rachman & J. D. Maser (Eds.), Panic: Psychological perspectives (pp. 167-187). Hillsdale, NJ: Erlbaum. Tsao, J. C. I., Mystkowski, J. L., Zucker, B. G., & Craske, M. G. (2002). Effects of cognitive-behavioral therapy for panic disorder on comorbid conditions: Replication and extension. Behavior Therapy, 33, 493-509. Turner, S. M., Beidel, D. C., Dancu, C. V, & Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory. Psychological Assessment, 1, 35-40. Turner, S. M., Beidel, D. C., Wolff, P. L., Spaulding, S., & Jacob, R. G. (1996). Clinical features affecting treatment outcome in social phobia. Behaviour Research and Therapy, 34, 795-804. Van Ameringen, M., Mancini, C., Styan, G., & Donison, D. (1991). Relationship of social phobia with other psychiatric illness. Journal of Affective Disorders, 21, 9399.

Van Velzen, C. J., Emmelkamp, P. M., & Scholing, A. (1997). The impact of personality disorders on behavioral treatment outcome for social phobia. Behaviour Research and Therapy, 35, 889-900. Vickers, K., & McNally, R. J. (2004) Panic disorder and sucide attempt in the National Comorbidity Survey. Journal of Abnormal Psychology, 113, 582-591.

Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448—457.

Wilson, J. K., & Rapee, R. M. (2005). The interpretation of negative social events in social phobia with versus without comorbid mood disorder. Journal of Anxiety Disorders, 19, 245-274.

Woody, S., McLean, P. D., Taylor, S., & Koch, W (1999). Treatment of major depression in the context of panic disorder..Journal of Affective Disorders, 53, 163-174.

The 10 Keys To Happiness

The 10 Keys To Happiness

Simple Ways to Be Happy and Enjoy Your Life Regardless of Circumstances. Happiness is the underlying foundation that influences the quality of life. Have you ever seen someone who lives in a small house and has an older car? They may not be rich in terms of material things, but they are beyond rich in their happiness.

Get My Free Ebook

Post a comment