Targets of Psychotherapy for Patients with Anxiety Disorders (Episodic and Generalized Anxiety) and Comorbid Subdepressive Symptoms at Risk of Hazardous Alcohol Consumption

In a cross-sectional study, 120 patients with anxiety disorders (episodic anxiety [EA]: F40, F41.0; generalized anxiety: F41.1) and comorbid subdepressive symptomatology participated and were divided into two equal groups. The aim was to identify specific psychotherapy targets for patients with risky alcohol consumption levels. Patients with generalized anxiety disorder (GAD) showed significantly higher anxiety levels on the HAM-A scale (p<0.001) and higher rates of risky alcohol consumption (41.6% vs. 13.4% in the episodic anxiety group). Episodic anxiety is characterized by symptomatic targets (muscle tension, sleep disturbances, somatovegetative dysfunctions). In GAD, emotional-cognitive targets predominate (high anxiety, catastrophizing, low tolerance for uncertainty, hypercontrol, using alcohol as an anxiolytic). Patients with GAD demonstrate predominantly avoidant behavior and deficits in problem-solving skills; individuals with EA tend toward excessive preventive coping. Factor analysis identified three aspects of dysfunction correlating with alcohol use: neuroticism - strong correlation with alcohol consumption in both groups (p<0.001); anankastic traits - significant correlation, especially in the episodic anxiety group; sensitivity - very strong correlation in the episodic anxiety group (p<0.001), noticeable also in the GAD group. Significant correlations between personality components (agreeableness, neuroticism, openness, extraversion, conscientiousness) and alcohol consumption level were identified, specific to each group. Based on these findings, priority therapy targets were defined across domains: symptomatic - relaxation training, normalization of sleep, management of hyperventilation; emotional - reducing anxiety and fears, correcting anhedonia, substituting alcohol with adaptive regulation strategies; cognitive - correcting catastrophizing thinking, increasing tolerance for uncertainty, addressing dysfunctional beliefs about the usefulness of worry/hypercontrol; behavioral - overcoming avoidance, developing problem- solving skills, modifying coping strategies, assertiveness training; personality - building adequate self-esteem, reducing neuroticism and sensitivity. For subdepressive symptoms, additional targets from interpersonal therapy were added (loss experiences, role conflicts, deficits).

1. Vasileva A.V., Karavaeva T.A., Neznanov N.G. Psikhoterapiya : uchebnik pod red. A.V. Vasil'evoi, T.A. Karavaevoi, N.G. Neznanova. Moskva: GEOTAR-Media, 2022. (In Russ.). https://doi.org/10.33029/9704-6485-4-VKN-2022-1-864.

2. Emyasheva ZhV, Rozanov VA, Midko AA. Some psychological characteristics of individuals who attempted suicide against the background of alcohol dependence. Suitsidologiya. 2012;3(8):29–37. (In Russ.).

3. Karavaeva TA, Vasileva AV, Radionov DS et al. Clinical and etiopathogenetic aspects of comorbidity of depressive and anxiety disorders: towards the problem of achieving stable remission. Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 2024;(4-1(58)):23–33. (In Russ.). https://doi.org/10.31363/2313-7053-2024-975

4. Karavaeva TA, Vasileva AV, Radionov DS. Alcohol abuse in patients with social phobias: problems of comorbidity, diagnosis, etiopathogenesis, and approaches to psychotherapy. Voprosy Narkologii. 2022;(7-8(211)):27–53. (In Russ.). https://doi.org/10.47877/0234-0623_2022_7-8_27

5. Klimanova SG, Berezina AA, Trusova AV et al. The relationship between clinical characteristics of patients with alcohol dependence and the dominant motivation for alcohol use. Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 2022;56(4):63–76. (In Russ.). https://doi.org/10.31363/2313-7053-2022-4-63-76

6. Minyacheva MV, Rubaylova VE, Pugovkina OD. Rumination, perfectionism, and stress coping strategies as targets of metacognitive training in patients with depression. Konsul'tativnaya psihologiya i psihoterapiya. 2024;32(2):127–149. (In Russ.). https://doi.org/10.17759/cpp.2024320207

7. Radionov DS, Karavaeva TA, Vasileva AV et al. Features of alcohol abuse in individuals with anxiety disorders of the neurotic spectrum: clinical aspects and psychotherapy issues. Voprosy Narkologii. 2023;35(3):27–50. (In Russ.).

8. Pugovkina OD, Syrokvashina AD, Istomin MA, Kholmogorova AB. Rumination as a cognitive factor in the chronicity of depression: conceptualization and validation of assessment tools. Konsul'tativnaya psihologiya i psihoterapiya. 2021;29(3):88–115. (In Russ.). https://doi.org/10.17759/cpp.2021290307

9. Radionov DS, Tverdokhlebova AM, Karavaeva TA. Analysis of psychological characteristics in patients with anxiety disorders and varying levels of alcohol consumption. Voprosy Narkologii. 2024;36(6):29–54. (In Russ.).

10. Radionov DS, Karavaeva TA. Clinical characteristics of patients with anxiety disorders and specific levels of alcohol use. Voprosy Narkologii. 2024;36(3):56–71. (In Russ.).

11. Brambila-Tapia AJL, Macías-Espinoza F, Reyes-Domínguez YA et al. Association of Depression, Anxiety, Stress and Stress-Coping Strategies with Somatization and Number of Diseases According to Sex in the Mexican General Population. Healthcare (Basel). 2022;10(6):1048. https://doi.org/10.3390/healthcare10061048

12. Buckner JD, Lewis EM, Terlecki MA et al. Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing. Addictive Behaviors. 2020;102:106184. https://doi.org/10.1016/j.addbeh.2019.106184

13. Dong M, Lu W, Zeng X et al. Prevalence and correlates of generalized anxiety disorder and subthreshold anxiety symptoms in south China: A network perspective. Journal of Affective Disorders. 2025;340. https://doi.org/10.1016/j.jad.2025.03.026

14. Huang K, Li M, You S et al. The effectiveness of an exergame intervention for college students with subthreshold depression: protocol for a mixed methods study. Frontiers in Public Health. 2024;12:1390806. https://doi.org/10.3389/fpubh.2024.1390806

15. Johnson JCS, Byrne GJ, Pelecanos AM. The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults. BMC Psychiatry. 2022;22:270. https://doi.org/10.1186/s12888-022-03834-1

16. Khosravani V, Sharifi Bastan F, Kolubinski DC et al. Distress tolerance and special alcohol metacognitions behave differently in the association of negative affect with alcohol-related patterns in men with problematic alcohol use in the abstinence phase. Clinical Psychology & Psychotherapy. 2021;28(2):345–354. https://doi.org/10.1002/cpp.2514

17. Klimanova S, Radionov D, Shova N et al. The Use of Melatoninergic Antidepressants for Stabilization of Remission in Depression Comorbid with Alcohol Abuse, Anxiety or Neuropsychiatric Disorders: A Systematic Review. Consortium Psychiatricum. 2024;5(4):40–62. https://doi.org/10.17816/CP15560

18. Leclercq S, Le Roy T, Furgiuele S et al. Gut Microbiota-Induced Changes in β-Hydroxybutyrate Metabolism Are Linked to Altered Sociability and Depression in Alcohol Use Disorder. Cell Reports. 2020;33(2):108238. https://doi.org/10.1016/j.celrep.2020.108238

19. Li J, Wang H, Li M et al. Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta-analysis of cohort studies. Addiction. 2020;115(7):1224–1243. https://doi.org/10.1111/add.14935

20. McCabe CJ, Brumback T, Brown SA et al. Assessing cross-lagged associations between depression, anxiety, and binge drinking in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study. Drug and Alcohol Dependence. 2023;243:109761. https://doi.org/10.1016/j.drugalcdep.2022.109761

21. Savenkova V, Zorkina Y, Ochneva A et al. Prevalence of Anxiety and Depressive Disorders in a Sample of Moscow Residents: Comparison of the GAD-7 and HADS Results with a Clinical Assessment. Consortium Psychiatricum. 2024;5(4):5–15. https://doi.org/10.17816/CP15487

22. Smirnova D, Morozov P, Neznanov N et al. Interpersonal Psychotherapy in Russia: Remembering Past Losses of the Heart, Keeping Mindful of the Culture of Melancholy, and Reconnecting with a Supportive Social Environment. Psychiatria Danubina. 2024;36(Suppl 2):332–337.

23. Witlox M, Garnefski N, Kraaij V et al. Prevalence of anxiety disorders and subthreshold anxiety throughout later life: Systematic review and meta-analysis. Psychology and Aging. 2021;36(2):268–287. https://doi.org/10.1037/pag0000529

24. Wołyńczyk-Gmaj D, Jakubczyk A, Trucco EM et al. Emotional Dysregulation, Anxiety Symptoms and Insomnia in Individuals with Alcohol Use Disorder. International Journal of Environmental Research and Public Health. 2022;19(5):2700. https://doi.org/10.3390/ijerph19052700

25. Wycoff AM, Carpenter RW, Hepp J et al. Real-time reports of drinking to cope: Associations with subjective relief from alcohol and changes in negative affect. Journal of Abnormal Psychology. 2021;130(6):641–650. https://doi.org/10.1037/abn0000684

26. Xu C, Xiong Q, Tian X et al. Alcohol Exposure Induces Depressive and Anxiety-like Behaviors via Activating Ferroptosis in Mice. International Journal of Molecular Sciences. 2022;23(22):13828. https://doi.org/10.3390/ijms232213828