Using cognitive-behavioral case formulations to increase relevance and tailor treatment for African American and Hispanic adults experiencing Comorbid Depression and Anxiety
Cognitive-behavioral therapy (CBT) has been found to be an effective and efficacious treatment for depression and anxiety. However, there is little in the way of empirically supported treatments for comorbid depression and anxiety or for ethnically and racially diverse populations experiencing either depression and/or anxiety. One approach to treating comorbid Major Depressive Disorder and Generalized Anxiety Disorder is tailored treatment guided by a cognitive-behavioral case formulation (CBCF) which include unique issues that can be important in developing a treatment plan for complex and comorbid cases. The primary purposes of the present study were to determine if a valid CBCF could be established and used in the treatment of African American and Hispanic adults experiencing comorbid depressive and anxiety disorders. The study used ecological momentary assessment within a replicated, single-subject design to evaluate the validity of the CBCF developed by the clinician. Additionally, the study evaluated how well the CBCF and idiographic measures addressed culturally specific treatment barriers, and if tailored CBT guided by the CBCF contributed to reductions in depression and anxiety. For three of the four participants, results of the EMA data indicated valid and reliable CBCFs had been developed. All four participants had significant decreases in levels of distress and severity of negative cognitions. Although therapeutic alliance was established and maintained throughout treatment and the treatment was amenable to the participants, this variable had little effect on level of distress or cognitions. The research and clinical implications of these findings, as well as the limitations and future directions are discussed.