Exploring relapse through a network analysis of residual depression and anxiety symptoms after cognitive behavioural therapy: A proof-of-concept study

Abstract

Objective: Many patients relapse within one year of completing effective cognitive behavioural therapy (CBT) for depression and anxiety. Residual symptoms at treatment completion have been demonstrated to predict relapse, and so this study used network analyses to improve specificity regarding which residual anxiety and depression symptoms predict relapse. Method: A cohort study identified relapse cases following low-and high-intensity CBT in a stepped care psychological therapy service. The sample included N=867 'recovered' treatment completers that attended a six-month follow-up review. At follow-up, N=93 patients had relapsed and N=774 remained in-remission. Networks of final treatment session depression (PHQ-9) and anxiety (GAD-7) symptoms were estimated for both subgroups. Results: Qualitatively similar symptom networks were found. Difficulty concentrating was a highly central symptom in the relapse network, whilst of only average centrality in the remission network. In contrast, trouble relaxing was highly central in the remission network, whilst of only average centrality in the relapse network. Discussion: Identification of central residual symptoms holds promise in improving the specificity of prognostic models and the design of evidence-based relapse prevention strategies. The small sample of relapse cases limits this study's ability to draw firm conclusions.

A Systematic Review and Individual Patient Data Network Analysis of the Residual Symptom Structure Following Cognitive-Behavioral Therapy and Escitalopram, Mirtazapine and Venlafaxine for Depression

“…Nevertheless, the higher centrality and co-occurrence of these symptoms was not surprising given both, by DSM definition, are core MDD criteria (48). This result is also consistent with previous psychometric network models and prevalence statistics reporting up to 96% of patients experience these symptoms post-treatment (19,29,30,38,69,70).…”

“…Among psychotherapies, effects of CBT and Interpersonal Psychotherapy (IPT) on residual symptoms networks have been investigated. Following CBT, "trouble concentrating" was more central in individuals who relapse [vs. remitters (38)]. Conversely, "trouble relaxing" was more central for remitters (vs. relapse).…”

Characteristics associated with the discrepancy between subjective and objective executive functioning in depression

“…To date, there is no established approach to assess cognition in MDD, including EFs. A growing body of research has found that self-reported cognition is essential to several aspects of functioning, quality of life, and risk of relapse (Kim et al, 2016;Lorimer et al, 2020;Wang et al, 2019), and that subjective and objective measures contribute uniquely to disability (Naismith et al, 2007). However, our findings accord with previous research suggesting that subjective EF is a poor indicator of the neurocognitive status in MDD (Keilp et al, 2018).…”

Symptom-Specific Effects of Counselling for Depression compared to Cognitive Behavioural Therapy

“…32 CBT was also directly associated with trouble relaxing. Trouble relaxing has been identified as a central symptom within remission networks following CBT 33 and as a bridge between symptoms of anxiety and depression. 34 There is some evidence that these symptoms are associated with experiential avoidance so CBT might be bringing about symptom change by tackling this process.…”