Prospective Evaluation of Cognitive Reframing and Thought-Challenging Techniques in Reducing Symptom Severity Among Adults with Dual Anxiety–Depression Diagnosis

Muhammad Numair Kashif; Eisha Maryam; Harmain Fatima; Seema Habib Bhutto; Bushra Waheed; Najma Syed Ghulam

doi:10.61919/3p18wr83

Authors

Muhammad Numair Kashif Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan Author
Eisha Maryam Baghdad-ul-Jadeed Campus, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Author
Harmain Fatima Baghdad-ul-Jadeed Campus, The Islamia University of Bahawalpur, Bahawalpur, Pakistan Author
Seema Habib Bhutto NEST, Islamabad, Pakistan Author
Bushra Waheed Department of Pharmacy, University of Swabi, Swabi, Pakistan Author
Najma Syed Ghulam Department of Clinical Psychology, IISAAT University, Gujranwala, Pakistan Author

DOI:

https://doi.org/10.61919/3p18wr83

Keywords:

Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Cognitive Reframing; Comorbidity; Depression; Pakistan; Prospective Studies; Thought-Challenging; Treatment Outcome.

Abstract

Background: Anxiety and depression frequently co-occur, creating compounded symptom burden and reduced responsiveness to conventional pharmacotherapy. Cognitive reframing and thought-challenging, core components of cognitive-behavioral therapy, target the shared maladaptive cognitive processes that maintain both conditions, yet their effectiveness as an isolated structured intervention in adults with confirmed dual diagnoses of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in low-to-middle-income settings remains inadequately characterized. Objective: To evaluate the effectiveness of a structured 12-week cognitive reframing and thought-challenging intervention in reducing anxiety and depressive symptom severity, improving cognitive emotion regulation, and enhancing quality of life among adults with comorbid GAD and MDD over a 24-week prospective follow-up. Methods: A prospective single-arm interventional study was conducted among 80 adults with DSM-5-confirmed comorbid GAD and MDD at three tertiary care hospitals in Lahore, Pakistan. Participants received 12 weekly individual sessions derived from validated CBT manuals, culturally adapted for local context. Primary outcomes were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline, week 12, and week 24. Secondary outcomes included the Cognitive Emotion Regulation Questionnaire (CERQ) and WHOQOL-BREF. Repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons and ANCOVA adjusting for medication class were performed. Results: Per-protocol retention was 93.75% (n = 75). BAI scores declined from 28.4 ± 7.1 to 14.9 ± 5.8 (Δ = −13.5; 95% CI: −16.0 to −11.0; Cohen's d = 1.34; p < 0.001) and BDI-II from 30.6 ± 8.2 to 16.1 ± 6.4 (Δ = −14.5; 95% CI: −16.9 to −12.1; d = 1.34; p < 0.001) by week 24. CERQ adaptive composite scores increased by +16.7 points and WHOQOL-BREF total scores by +17.8 points at week 24 (both p < 0.001). ANCOVA confirmed independence of effects from medication class. Conclusion: Structured cognitive reframing and thought-challenging were associated with large, sustained reductions in anxiety and depressive symptoms and improvements in cognitive regulation and quality of life among Pakistani adults with comorbid GAD and MDD. Randomized controlled trials are warranted to confirm efficacy against active comparators.

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