(PS12-A7) Symptom Distress and Psychosocial Functioning Improve Bidirectionally During Cognitive Behavioral Therapy for Anxiety Disorders

The efficacy of cognitive-behavioral therapy (CBT) for reducing anxiety disorder symptoms is well documented. Contemporary work also highlights CBTs positive impact on quality of life and well-being for those with anxiety disorders. While it is often assumed that functioning improves as a consequence of symptom amelioration, little research has examined how symptom reduction is temporally associated with changes in psychosocial functioning during CBT. To test the hypothesis that symptom reduction translates to functional improvement during CBT, the present study examined associations between changes in symptom distress and psychosocial functioning in a naturalistic sample of 288 outpatients (M age = 37.00 [SD = 14.41]; 59.00% female; 69.00% White; 6.60% Hispanic/Latino) receiving CBT for anxiety disorders at a specialized hospital-based clinic. Participants completed the Outcome Questionnaire-45.2, a validated measure of symptom distress, social role performance, and interpersonal problems, at initial assessment and prior to each treatment session. Multilevel models including linear and quadratic time found that symptom distress (d = 1.74), interpersonal functioning (d = 1.69) and social role functioning (d = 1.58) significantly improved over the course of 25 sessions of CBT, though decelerating decreases in symptom distress plateaued around session 15. Additionally, symptom distress and psychosocial functioning indicators were robustly related during 25 sessions of CBT (i.e., within-subjects, change over time). Multivariate cross-lagged analyses revealed that reductions in symptom distress predicted improvements in social role functioning during treatment (b = 0.09, SE = .01, cr = 8.75, p < .001, pr = .46), and vice versa (b = 0.22, SE = .06, cr = 3.53, p</em> < .001, pr = .20). Similarly, reductions in symptom distress predicted improvements in interpersonal functioning (b = 0.11, SE = .01, cr = 9.67, p < .001, pr = .50), and vice versa (b = 0.16, SE = .06, cr = 2.73, p = .006, pr = .16). Notably, paths from symptom distress to subsequent psychosocial functioning evidenced larger effect sizes than the reverse. Regarding moderators of these effects, more severe impairment at intake and presence of comorbid depression attenuated the association between symptom reduction and social role performance improvement, respectively. In sum, findings suggest that anxiety symptoms and psychosocial functioning bidirectionally improve during CBT for anxiety disorders. Maximally effective treatments may be those that simultaneously ameliorate symptoms and focus on improving functioning in key domains.