(PS2-B28) Investigating the Role of Neuropsychological Functioning in Anxiety, Depression, and Therapy Outcomes

Generalized anxiety disorder (GAD) has a lifetime prevalence rate of 8% in the United States, which is the second highest prevalence rate globally. GAD is related to significant individual and socioeconomic burden. Importantly, only 40-60% of individuals with GAD see long-term improvements from gold-standard therapies. Various domains of neuropsychological functioning (e.g., attentional engagement, executive function, memory) are theoretically important for one’s ability to engage in behavioral therapy; for example, being able to learn information, being able to attend to the material presented, and so on. However, few studies have looked at how neuropsychological functioning relates to cognitive-behavioral therapy response.

Additionally, there are only a few studies documenting differences in cognitive function in relation to GAD. However, GAD frequently co-occurs with depression, which has consistently been associated with subtle deficits in processing speed, attention, and memory. The current study expands on prior literature by exploring how neurocognitive functioning relates to anxiety and depression symptom severity and exploring how individual differences in baseline executive functioning predict behavioral therapy treatment response.

Current analysis focused on a total of 102 adult participants who completed a randomized clinical trial focused on identifying neural and behavioral predictors of response to Behavioral Activation (BA) versus Exposure-based therapy (EXP). Participants were required to meet GAD criteria per the Mini International Neuropsychiatric Interview (MINI 6.0 and 7.0). At baseline, participants completed a battery of self-report measures (i.e., GAD-7, PROMIS Anxiety and Depression) as well as a neuropsychological battery that included: WRAT-4, D-KEFS, Wechsler Adult Intelligence Scale (WAIS-IV), and California Verbal Learning Test (CVLT-II).

An Exploratory Factor Analysis identified 4 overarching factors from the assessment battery (i.e., information retrieval, processing speed, response inhibition, and memory). We will also conduct and present results from regression analyses examining relationships between baseline neuropsychological factor scores and (1) baseline depression and anxiety symptom severity and (2) post-treatment depression and anxiety symptom severity (including pre-treatment symptoms as covariates). It is hypothesized that greater depression and anxiety symptom severity will relate to decreased performance on measures of attention and executive functioning and that worse scores on these measures will also predict worse symptom treatment outcomes. Results will inform our understanding of how cognitive functioning may relate to GAD and behavioral therapy response, which could be important to consider for individualizing or optimizing treatment.