Interaction of pharmacological and psychological treatments of anxiety

Abstract

Background Pharmacological and psychological treatments for anxiety are often combined in clinical practice but there is little research from which to predict the effects.Method The theoretical outcomes of combining treatments and methods of investigating these as well as methodological difficulties are described. Studies which have been completed in anxiety disorders are reviewed. A double-blind trial, using a factorial design, evaluated buspirone v. placebo and anxiety management training v. nondirective therapy in 60 patients with generalised anxiety disorder (GAD).Results Relatively few germane studies have been carried out in the anxiety disorders except for panic disorder with agoraphobia. There is some evidence that short-term, combined treatment does confer additional benefits which are evident both in speed of onset and lasting remission. All four treatment combinations proved effective in the short-term treatment of GAD.Conclusions More studies examining combined treatment are needed. Although differences may not be apparent at the end of the treatment period, psychological treatment appears to confer advantages at follow-up.

Escitalopram in the treatment of generalized anxiety disorder

“…Relapse rates are lower with cognitive behavioral therapy (CBT) than with other forms of psychologic treatment [29], but the comparative efficacy of drug and psychologic approaches over the long term is not established. It is uncertain whether combining drug and psychologic treatments is associated with greater overall efficacy than with either treatment given alone [30][31][32].…”

Combined medication and cognitive therapy for generalized anxiety disorder

“…However, this study is difficult to interpret because sample sizes were small, diagnosis was not established by structured interview, DSM-III diagnoses were used, and no assessment of adequacy of implementation of CBT was performed. In another study, 60 patients with GAD were randomized to receive buspirone plus anxiety management training; buspirone and non-directive therapy; placebo and anxiety management training; and placebo and non-directive therapy (Lader & Bond, 1998). There were no differences among the four groups, all of whom showed improvement.…”

Psychological features in panic disorder: a comparison with major depression

“…For instance, PD patients respond well to psychopharmacotherapy but responses are also good to nonpharmacological treatments 8,9 . Other types of psychotherapy using research techniques, such as focal psychotherapy 10 and client-centered psychotherapy 11 also have had their efficiency confirmed with the behavior-cognitive therapy 12 and recent trial 13 of brief psychodynamic psychotherapy. However, in a small percentage of cases (10-20%), PD is refractory to the combination of drugs and psychotherapy, at correct dosages and during adequate time 14 .…”