{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:55:05Z","timestamp":1793220905007,"version":"4.5.0"},"reference-count":53,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291722001556_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for depression and anxiety. However, most research has focused on the sum scores of symptoms. Relatively little is known about how individual symptoms respond.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291722001556_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Longitudinal models were used to explore how depression and generalised anxiety symptoms behave over the course of CBT in a retrospective, observational cohort of patients from primary care settings (<jats:italic>n<\/jats:italic> = 5306). Logistic mixed models were used to examine the probability of being symptom-free across CBT appointments, using the 9-item Patient Health Questionnaire and the 7-item Generalised Anxiety Disorder scale as measures.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291722001556_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>All symptoms improve across CBT treatment. The results suggest that <jats:italic>low mood\/hopelessness and guilt\/worthlessness<\/jats:italic> improved quickest relative to other depressive symptoms, <jats:italic>with sleeping problems, appetite changes,<\/jats:italic> and <jats:italic>psychomotor retardation\/agitation<\/jats:italic> improving relatively slower. <jats:italic>Uncontrollable worry<\/jats:italic> and <jats:italic>too much worry<\/jats:italic> were the anxiety symptoms that improved fastest; <jats:italic>irritability<\/jats:italic> and <jats:italic>restlessness<\/jats:italic> improved the slowest.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291722001556_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>This research suggests there is a benefit to examining symptoms rather than sum scores alone. Investigations of symptoms provide the potential for precision psychiatry and may explain some of the heterogeneity observed in clinical outcomes when only sum scores are considered.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291722001556","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T10:43:56Z","timestamp":1655376236000},"page":"4648-4656","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":7,"title":["Trajectories of depression and generalised anxiety symptoms over the course of cognitive behaviour therapy in primary care: an observational, retrospective cohort"],"prefix":"10.1017","volume":"53","author":[{"given":"Clarissa","family":"Bauer-Staeb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Griffith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian J.","family":"Faraway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-8789","authenticated-orcid":false,"given":"Katherine S.","family":"Button","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"S0033291722001556_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(03)00108-3"},{"key":"S0033291722001556_ref36","volume-title":"Generalised anxiety disorder and panic disorder in adults: Management\u2013 clinical guidelines [CG113]","year":"2011"},{"key":"S0033291722001556_ref46","doi-asserted-by":"publisher","DOI":"10.1017\/S1754470X20000173"},{"key":"S0033291722001556_ref4","doi-asserted-by":"publisher","DOI":"10.1159\/000486793"},{"key":"S0033291722001556_ref52","doi-asserted-by":"publisher","DOI":"10.1002\/wics.147"},{"key":"S0033291722001556_ref26","first-page":"137","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"11","year":"2022","journal-title":"The Lancet Psychiatry"},{"key":"S0033291722001556_ref22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0090311"},{"key":"S0033291722001556_ref12","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2017.1395922"},{"key":"S0033291722001556_ref35","volume-title":"Depression in adults: Recognition and management \u2013 clinical guidelines [CG90]","year":"2009"},{"key":"S0033291722001556_ref20","doi-asserted-by":"publisher","DOI":"10.1177\/1755738012471029"},{"key":"S0033291722001556_ref43","doi-asserted-by":"publisher","DOI":"10.1023\/A:1020363010465"},{"key":"S0033291722001556_ref32","volume-title":"The English indices of deprivation 2019: Technical report","author":"McLennan","year":"2019"},{"key":"S0033291722001556_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2016.02.003"},{"key":"S0033291722001556_ref1","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"S0033291722001556_ref9","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00291"},{"key":"S0033291722001556_ref30","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"S0033291722001556_ref37","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2020.20060845"},{"key":"S0033291722001556_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.10.010"},{"key":"S0033291722001556_ref47","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"S0033291722001556_ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-015-0325-4"},{"key":"S0033291722001556_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsaa223"},{"key":"S0033291722001556_ref50","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-002847"},{"key":"S0033291722001556_ref51","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-017-0816-4"},{"key":"S0033291722001556_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32133-5"},{"key":"S0033291722001556_ref2","unstructured":"Bates, D. , Maechler, M. , Bolker, B. , & Walker, S. 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