The role of symptom reduction in improving health-related quality of life through brief cognitive behavioral therapy

Abstract

Objective

Brief cognitive behavior therapy (bCBT) is effective in reducing symptoms of depression and anxiety disorders and improving health-related quality of life (HRQoL). However, the mechanisms through which cognitive behavior therapy impact HRQoL are not well understood. This study evaluated whether anxiety and depression symptom reduction is a mechanism of treatment for HRQoL outcomes.

Method:

Using secondary data from a multisite, pragmatic, randomized trial, this study evaluated bCBT vs enhanced usual care in 16 VA community-based outpatient clinics. Ordinary least-squares path analysis testing multiple mediators was used to evaluate the role of change in depression and anxiety symptoms in the relationship between treatment condition and HRQoL.

Results:

Receiving bCBT (vs. enhanced usual care) was significantly negatively associated with change (reduction) in depression and anxiety scores. The indirect effect of treatment on mental HRQoL was significant with change in depression scores as mediator. A similar pattern was observed for physical HRQoL and change in anxiety scores as mediator.

Conclusion:

Findings suggest reduction of depression and anxiety symptoms as a mechanism through which bCBT for depression promoted improvements in HRQoL, with important implications for understanding how CBT impacts functioning, as well as the utility of bCBT in nontraditional mental health settings.

Trial registration:

ClinicalTrials.gov identifier: NCT02466126.

Keywords:

• cognitive behavioral therapy
• anxiety
• depression
• veterans
• health-related quality of

Acknowledgments

N/A

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Supplemental Data

Supplemental data for this article can be accessed at https://doi.org/10.1080/10503307.2024.2349992.

Additional information

Funding

This study was funded by Department of Veterans Affairs, Health Services Research & Development Grant # IIR 13–315 to Jeffrey A. Cully and use of the facilities and resources of the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN13-413) and the VA South Central Mental Illness Research, Education and Clinical Center. Preparation of the manuscript was in part supported by Award Number IK2 RX003520 from the United States (US) Department of Veterans Affairs Rehabilitation R&D (Rehab RD) Service to Anthony Ecker. Funders played no role in the design and conduct of the work; in the collection, analysis and interpretation of the data; or in the preparation, editing or censuring of the manuscript. The opinions expressed are those of the authors and not necessarily those of the Department of Veterans Affairs, the U. S. Government, or Baylor College of Medicine.