Review Of Efficacy Research

There are a number of reasons to expect poorer outcomes among patients with depression and comorbid anxiety disorders. Indeed, investigators have suggested that comorbid depression may reduce patient motivation to conduct self-directed exposures (Marks, 1987), may affect habituation patterns (Abramowitz, Franklin, Street, Kozak, & Foa, 2000; Abramowitz & Foa, 2000; Foa, 1979; Mills & Salkovskis, 1988), and may lead patients to minimize new (safety) learning from exposure interventions (Telch, 1988). Fortunately, there is some evidence that anxiety treatment effects may be more robust than expected. Indeed, early indications that severe depression may interfere with within- or between-session extinction in the treatment of obsessive-compulsive disorder (Foa, 1979) have not been particularly evident in later studies. As Abramowitz et al. (2000) and Abramowitz and Foa

(2000) noted, depressed patients with obsessive-compulsive disorder achieve treatment gains in exposure-based CBT, albeit at a lower magnitude than less depressed patients. Studies of the efficacy of CBT for other anxiety disorders provide an expanded account of the resilience of treatment when depression comorbidity is confronted.

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