Combined CBT and medications with anxiety disorders

One study in which CBT without meds was more effective in the long run than CBT with meds and in which CBT plus placebo was a bit more effective than CBT alone is summarized earlier in this forum. To Jump directly to that post Click Here. I've seen other studies with similar results but can't recall the references.

There are two problems with combining meds and CBT with anxiety disorders. First, if you combine CBT with benzodiazepines or other meds that give immediate anxiety relief, many clients rely on the meds for quick relief and don't do a very good job of following through on in-vivo exposure. When this is the case, there is a very high relapse rate when meds are eventually discontinued. Second, even if you are using meds that don't provide immediate anxiety reduction (such as SSRIs or Buspar) clients have a strong tendency to attribute their improvement to the meds, not to their own efforts. This results in less motivation for following through on in-vivo exposure and less of an increase in self-efficacy. When this is the case, the relapse rate isn't as dramatic as with benzodiazepines but it is significantly higher than with CBT alone.

There doesn't appear to be a problem with combining SSRIs with CBT in the treatment of OCD, in fact the meds often facilitate CBT. This may be because the meds only provide partial relief with OCD (about a 50% reduction in symptomatology). This means that the individual still has an incentive to follow through on CBT and can easily see that their efforts really do make a difference.

Some clients are dependent on benzodiazepines at the time when they enter CBT. Barlow has developed a treatment protocol for the discontinuation of benzodiazepines which is published by the Psychological Corporation, I believe.

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