Cognitive Therapy and Research

, Volume 43, Issue 5, pp 803–818 | Cite as

Cognitive Moderation of CBT: Disorder-Specific or Transdiagnostic Predictors of Treatment Response

  • Danielle E. Katz
  • Judith M. Laposa
  • Lance L. Hawley
  • Leanne Quigley
  • Neil A. RectorEmail author
Original Article


Cognitive vulnerability research has focused on cognitive variables that are hypothesized to confer risk to specific disorders within the mood and anxiety spectrum, while transdiagnostic research has emphasized common risk factors across disorders. The purpose of the present study was to test specific versus common cognitive predictors of treatment response across three treatment groups. Participants (N = 373) with major depressive disorder (MDD; N = 187, panic disorder with/without agoraphobia (PD/A; N = 85), and obsessive compulsive disorder (OCD; N = 101) completed measures of cognitive vulnerability (performance-oriented dysfunctional attitudes, anxiety sensitivity, and obsessive beliefs) and disorder-specific symptom measures at pre- and post CBT treatment. Based on latent difference score analysis, pre-treatment performance-oriented dysfunctional attitudes alone predicted improvement in depressive symptoms in the MDD group; pre-treatment anxiety sensitivity alone predicted reductions in anxious arousal symptoms in the PD/A group; and pre-treatment obsessive beliefs alone predicted change in OCD symptoms in the OCD group. These findings provide support for disorder-specific cognitive factors in the prediction of CBT treatment outcomes and provide guidance towards ways in which current CBT approaches may benefit from augmentation or adjustment.


Anxiety-sensitivity Obsessive beliefs Dysfunctional attitudes Depression Panic disorder Obsessive–compulsive disorder Cognitive behavioural therapy 


Compliance with Ethical Standards

Conflict of interest

Danielle Katz, Judith Laposa, Lance Hawley, Leanne Quigley, and Neil Rector declare that they have no conflict of interest.

Research Involving Animal Rights

No animal studies were carried out by the authors for this article.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. Abela, J. R., & D’Alessandro, D. U. (2002). Beck’s cognitive theory of depression: A test of the diathesis-stress and causal mediation components. British Journal of Clinical Psychology, 41, 111–128. Scholar
  2. Abramowitz, J. S. (2009). Getting over OCD: a 10-step workbook for taking back your life. New York: Guilford Press.Google Scholar
  3. Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J., & Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive–compulsive symptoms: A prospective study. Behaviour Research and Therapy, 44, 1361–1374. Scholar
  4. Abramowitz, J. S., Nelson, C. A., Rygwall, R., & Khandker, M. (2007). The cognitive mediation of obsessive-compulsive symptoms: A longitudinal study. Journal of Anxiety Disorders, 21, 91–104. Scholar
  5. Adams, T. G., Riemann, B. C., Wetterneck, C. T., & Cisler, J. M. (2012). Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder. Cognitive Behaviour Therapy, 41, 203–211. Scholar
  6. Akaike, H. (1973). Information theory and an extension of the maximum likelihood principle. In Proceedings of the 2nd International Symposium on Information Theory (pp. 267–281). Budepest: Akademiai Kiado.Google Scholar
  7. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181. Scholar
  8. Arbuckle, J. L. (2011). Amos (Version 20.0) [Computer Program]. Chicago: SPSS.Google Scholar
  9. Baer, R. A. (2007). Commentaries: Mindfulness, assessment, and transdiagnostic processes. Psychological Inquiry, 18, 238–242. Scholar
  10. Beck, A. T. (1967). Depression: clinical, experimental, and theoretical aspects. Philadelphia: University of Pennsylvania Press.Google Scholar
  11. Beck, A. T. (1983). Cognitive therapy of depression: New perspectives. In P. J. Clayton & J. E. Barnett (Eds.), Treatment for depression: Old controversies and new approaches (pp. 265–290). New York: Raven Press.Google Scholar
  12. Beck, A. T., Brown, G., Steer, R. A., Eidelson, J. I., & Riskind, J. H. (1987). Differentiating anxiety and depression: a test of the cognitive content-specificity hypothesis. Journal of Abnormal Psychology, 96, 179–183. Scholar
  13. Beck, R., & Perkins, T. S. (2001). Cognitive content-specificity for anxiety and depression: a meta-analysis. Cognitive Therapy and Research, 25, 651–663. Scholar
  14. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246. Scholar
  15. Blakey, S. M., Abramowitz, J. S., Reuman, L., Leonard, R. C., & Riemann, B. C. (2017). Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 57, 113–117. Scholar
  16. Blatt, S. J., Quinlan, D. M., Pilkonis, P. A., & Shea, M. T. (1995). Impact of perfectionism and need for approval on the brief treatment of depression: The National Institute of Mental Health Treatment of Depression Collaborative Research Program revisited. Journal of Consulting and Clinical Psychology, 63, 125–132. Scholar
  17. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park: Sage.Google Scholar
  18. Byrne, B. M. (2004). Testing for multigroup invariance using AMOS graphics: a road less traveled. Structural Equation Modeling: A Multidisciplinary Journal, 11, 272–300. Scholar
  19. Calvete, E., Orue, I., & Hankin, B. (2013). Transactional relationships among cognitive vulnerabilities, stressors, and depressive symptoms in adolescence. Journal of Abnormal Child Psychology, 41, 399–410. Scholar
  20. Calvete, E., Riskind, J. H., Orue, I., & Gonzalez-Diez, Z. (2016). Recursive associations among maladaptive cognitions and symptoms of social anxiety and depression: Implications for sex differences. Journal of Social and Clinical Psychology, 35, 807–821. Scholar
  21. Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. Scholar
  22. Clark, D. A., Beck, A. T., & Brown, G. (1989). Cognitive mediation in general psychiatric outpatients: A test of the content-specificity hypothesis. Journal of Personality and Social Psychology, 56, 958–964. Scholar
  23. Coles, M. E., & Horng, B. (2006). A prospective test of cognitive vulnerability to obsessive-compulsive disorder. Cognitive Therapy and Research, 30, 723–734. Scholar
  24. Craske, M. G., & Barlow, D. H. (2006). Mastery of your anxiety and worry. New York; Oxford: Oxford University Press.CrossRefGoogle Scholar
  25. Dobson, K. S., & Breiter, H. J. (1983). Cognitive assessment of depression: Reliability and validity of three measures. Journal of Abnormal Psychology, 92, 107–109. Scholar
  26. Dowling, N., Thomas, N., Blair-West, S., Bousman, C., Yap, K., Smith, D. J., & Ng, C. H. (2016). Intensive residential treatment for obsessive-compulsive disorder: Outcomes and predictors of patient adherence to cognitive-behavioural therapy. Journal of Obsessive-Compulsive and Related Disorders, 9, 82–89. Scholar
  27. Dunkley, D. M., Sanislow, C. A., Grilo, C. M., & McGlashan, T. H. (2006). Perfectionism and depressive symptoms 3 years later: Negative social interactions, avoidant coping, and perceived social support as mediators. Comprehensive Psychiatry; New York, 47, 106–115. Scholar
  28. Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192–205. Scholar
  29. Fergus, T., & Carmin, C. (2014). The validity and specificity of the short-form of the Obsessive Beliefs Questionnaire (OBQ). Journal of Psychopathology and Behavioral Assessment, 36, 318–328. Scholar
  30. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., & Charney, D. S. (1989a). The Yale-Brown Obsessive Compulsive Scale. II. Validity. Archives of General Psychiatry, 46, 1012–1016. Scholar
  31. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., … Charney, D. S. (1989b). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011. Scholar
  32. Greenberger, D., & Padesky, C. A. (1995). Mind over mood: a cognitive therapy treatment manual for clients. New York: Guilford Press.Google Scholar
  33. Hamagami, F., & McArdle, J. J. (2001). Advanced studies for individual differences in linear dynamic models for longitudinal data analysis. In G. A. Marcoulides & R. E. Schumacker (Eds.), New developments and techniques in structural equation modeling (pp. 203–246). Mahwah: Erlbaum.Google Scholar
  34. Hamilton, K. E., & Dobson, K. S. (2002). Cognitive therapy of depression: Pretreatment patient predictors of outcome. Clinical Psychology Review, 22, 875–893. Scholar
  35. Hankin, B. L., Fraley, R. C., & Abela, J. R. Z. (2005). Daily depression and cognitions about stress: Evidence for a traitlike depressogenic cognitive style and the prediction of depressive symptoms in a prospective daily diary study. Journal of Personality and Social Psychology, 88, 673–685. Scholar
  36. Hawley, L. L., Ho, M.-H. R., Zuroff, D. C., & Blatt, S. J. (2006). The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: Latent difference score analysis. Journal of Consulting and Clinical Psychology, 74, 930–942. Scholar
  37. Hill, C., Oei, T., & Hill, M. (1989). An empirical investigation of the specificity and sensitivity of the Automatic Thoughts Questionnaire and Dysfunctional Attitudes Scale. Journal of Psychopathology and Behavioral Assessment, 11, 291–311. Scholar
  38. Houck, P. R., Spiegel, D. A., Shear, M. K., & Rucci, P. (2002). Reliability of the self-report version of the panic disorder severity scale. Depression and Anxiety, 15, 183–185. Scholar
  39. Iacoviello, B. M., Alloy, L. B., Abramson, L. Y., Whitehouse, W. G., & Hogan, M. E. (2006). The course of depression in individuals at high and low cognitive risk for depression: A prospective study. Journal of Affective Disorders, 93, 61–69. Scholar
  40. Imber, S. D., Pilkonis, P. A., Sotsky, S. M., Elkin, I., Watkins, J. T., Collins, J. F., … Glass, D. R. (1990). Mode-specific effects among three treatments for depression. Journal of Consulting and Clinical Psychology, 58, 352–359. Scholar
  41. Ingram, R. E. (1990). Self-focused attention in clinical disorders: Review and a conceptual model. Psychological Bulletin, 107, 156–176. Scholar
  42. Jacobs, R. H., Silva, S. G., Reinecke, M. A., Curry, J. F., Ginsburg, G. S., Kratochvil, C. J., & March, J. S. (2009). Dysfunctional attitudes scale perfectionism: A predictor and partial mediator of acute treatment outcome among clinically depressed adolescents. Journal of Clinical Child and Adolescent Psychology, 38, 803–813. Scholar
  43. Jarrett, R. B., Eaves, G. G., Grannemann, B. D., & Rush, A. J. (1991). Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: A preliminary report. Psychiatry Research, 37, 245–260. Scholar
  44. Jöreskog, K. G., & Sörbom, D. (1979). Advances in factor analysis and structural equation models. Cambridge: Abt Books.Google Scholar
  45. Katz, D., Laposa, J. M., & Rector, N. A. (2018). Anxiety sensitivity, obsessive beliefs, and the prediction of CBT treatment outcome for OCD. International Journal of Cognitive Therapy, 11, 31–43. Scholar
  46. Kemper, C., Lutz, J., Bähr, T., Rüddel, H., & Hock, M. (2012). Construct validity of the Anxiety Sensitivity Index–3 in clinical samples. Assessment, 19, 89–100. Scholar
  47. Kyrios, M., Hordern, C., & Fassnacht, D. B. (2015). Predictors of response to cognitive behaviour therapy for obsessive-compulsive disorder. International Journal of Clinical and Health Psychology, 15, 181–190. Scholar
  48. Laposa, J. M., Collimore, K. C., Hawley, L. L., & Rector, N. A. (2015). Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of Anxiety Disorders, 33, 8–14. Scholar
  49. Li, W., & Zinbarg, R. (2007). Anxiety sensitivity and panic attacks. Behavior Modification, 31, 145–161. Scholar
  50. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: The Psychology Foundation of Australia.Google Scholar
  51. MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1, 130–149. Scholar
  52. McArdle, J. J. (2001). A latent difference score approach to longitudinal dynamic analysis. In R. Cudeck, S. Du Toit & D. Sörbom (Eds.), Structural equation modeling: Present and future (pp. 341–380). Lincolnwood: Scientific Software International.Google Scholar
  53. McArdle, J. J., & Hamagami, F. (2001). Latent difference score structural models for linear dynamic analyses with incomplete longitudinal data. In L. M. Collins & A. G. Sayer (Eds.), New methods for the analysis of change (pp. 139–175). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  54. McArdle, J. J., & Nesselroade, J. R. (2002). Growth curve analysis in contemporary psychological research. In J. Schinka & W. Velicer (Eds.), Comprehensive handbook of psychology: Vol. 2. Research methods in psychology. Hoboken: Wiley.Google Scholar
  55. McLean, P. D., Whittal, M. L., Thordarson, D. S., Taylor, S., Söchting, I., Koch, W. J., … Anderson, K. W. (2001). Cognitive versus behavior therapy in the group treatment of obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 69, 205–214. Scholar
  56. McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological Psychiatry, 52, 938–946. Scholar
  57. Meredith, W., & Tisak, J. (1990). Latent curve analysis. Psychometrika, 55(1), 107–122. Scholar
  58. Michelson, D., Lydiard, R. B., Pollack, M. H., Tamura, R. N., Hoog, S. L., Tepner, R., … Tollefson, G. D. (1998). Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. The American Journal of Psychiatry, 155, 1570–1577. Scholar
  59. Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136, 128–150. Scholar
  60. Nelson, L., Stern, S., & Cicchetti, D. (1992). The Dysfunctional Attitude Scale: How well can it measure depressive thinking? Journal of Psychopathology and Behavioral Assessment, 14, 217–223. Scholar
  61. Nishikawa, Y., Laposa, J. M., Regev, R., & Rector, N. A. (2017). Social anxiety and fear of causing discomfort to others: Diagnostic specificity, symptom correlates and CBT treatment outcome. Behavioural and Cognitive Psychotherapy, 45, 382–400. Scholar
  62. Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116, 198–207. Scholar
  63. Nowakowski, M. E., Rowa, K., Antony, M. M., & McCabe, R. (2016). Changes in anxiety sensitivity following group cognitive-behavior therapy for social anxiety disorder and panic disorder. Cognitive Therapy and Research, 40, 468–478. Scholar
  64. Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681. Scholar
  65. Obsessive Compulsive Cognitions Working Group. (2001). Development and initial validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory. Behaviour Research and Therapy, 39, 987–1006. Scholar
  66. Obsessive Compulsive Cognitions Working Group. (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I. Behaviour Research and Therapy, 41, 863–878. Scholar
  67. Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the Obsessive Belief Questionnaire and Interpretation of Intrusions Inventory–Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542. Scholar
  68. Plehn, K., & Peterson, R. A. (2002). Anxiety sensitivity as a predictor of the development of panic symptoms, panic attacks, and panic disorder: A prospective study. Journal of Anxiety Disorders, 16, 455–474. Scholar
  69. Porter, E., & Chambless, D. L. (2015). A systematic review of predictors and moderators of improvement in cognitive-behavioral therapy for panic disorder and agoraphobia. Clinical Psychology Review, 42, 179–192. Scholar
  70. Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793–802. Scholar
  71. Rachman, S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy, 36, 385–401. Scholar
  72. Rector, N. A., Szacun-Shimizu, K., & Leybman, M. (2007). Anxiety sensitivity within the anxiety disorders: Disorder-specific sensitivities and depression comorbidity. Behaviour Research and Therapy, 45, 1967–1975. Scholar
  73. Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153. Scholar
  74. Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8. Scholar
  75. Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., … Keller, M. B. (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry, 54, 573–583. Scholar
  76. Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23, 571–583. Scholar
  77. Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: Replication and extension. Journal of Abnormal Psychology, 108, 532–537. Scholar
  78. Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … Papp, L. A. (1997). Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154, 1571–1575. Scholar
  79. Sica, C., Coradeschi, D., Sanavio, E., Dorz, S., Manchisi, D., & Novara, C. (2004). A study of the psychometric properties of the Obsessive Beliefs Inventory and Interpretations of Intrusions Inventory on clinical Italian individuals. Journal of Anxiety Disorders, 18, 291–307. Scholar
  80. Smits, J. A. J., Powers, M. B., Cho, Y., & Telch, M. J. (2004). Mechanism of change in cognitive-behavioral treatment of panic disorder: Evidence for the fear of fear mediational hypothesis. Journal of Consulting and Clinical Psychology, 72, 646–652. Scholar
  81. Sotsky, S. M., Glass, D. R., & al, et (1991). Patient predictors of response to psychotherapy and pharmacotherapy: Findings in the NIMH treatment of depression collaborative research program. The American Journal of Psychiatry; Washington, 148, 997–1008. Scholar
  82. Steiger, J. H., & Lind, J. C. (1980, June). Statistically-based tests for the number of factors. Iowa City: Presented at the meeting of the Psychometric Society.Google Scholar
  83. Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., … Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176–188. Scholar
  84. Tolin, D. F., Woods, C. M., & Abramowitz, J. S. (2003). Relationship between obsessive beliefs and obsessive–compulsive symptoms. Cognitive Therapy and Research, 27, 657–669. Scholar
  85. Tolin, D. F., Worhunsky, P., & Maltby, N. (2006). Are “obsessive” beliefs specific to OCD?: A comparison across anxiety disorders. Behaviour Research and Therapy, 44, 469–480. Scholar
  86. Viar, M., Bilsky, S., Armstrong, T., & Olatunji, B. (2011). Obsessive beliefs and dimensions of obsessive-compulsive disorder: an examination of specific associations. Cognitive Therapy and Research, 35, 108–117. Scholar
  87. Weissman, A. N., & Beck, A. T. (1978). Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Poster presented at the 86th annual convention of the American Psychological Association. Toronto, Ontario, Canada.Google Scholar
  88. Wheaton, M. G., Abramowitz, J. S., Berman, N. C., Riemann, B. C., & Hale, L. R. (2010). The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder. Behaviour Research and Therapy, 48, 949–954. Scholar
  89. Wilhelm, S., & Steketee, G. (2006). Cognitive therapy for obsessive-compulsive disorder: a guide for professionals. Oakland: New Harbinger Publications.Google Scholar
  90. Zinbarg, R. E., Barlow, D. H., & Brown, T. A. (1997). Hierarchical structure and general factor saturation of the Anxiety Sensitivity Index: Evidence and implications. Psychological Assessment, 9, 277–284. Scholar
  91. Zuroff, D., Igreja, I., & Mongrain, M. (1990). Dysfunctional attitudes, dependency, and self-criticism as predictors of depressive mood states: A 12-month longitudinal study. Cognitive Therapy and Research, 14, 315–326. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
  2. 2.Centre for Addiction and Mental HealthTorontoCanada
  3. 3.Department of PsychiatryUniversity of TorontoTorontoCanada

Personalised recommendations