THE RELEVANCE OF PSYCHOTHERAPEUTIC-PHARMACOLOGICAL COMBINATION THERAPIES IN ANXIETY DISORDERS

A number of empirical studies document the growing clinical and scient ific interest in combining cognitive-behavioral therapy (CBT) and psyc hopharmacologic treatment in anxiety disorders. Potential advantages a nd disadvantages of combined therapies are described. A review of exis ting studies with combined treatments for the different subtypes of an xiety disorders is given. There are no empirical data showing that com pared with CBT alone combinations are superior in specific and social phobia or generalized anxiety disorder. In panic disorder and agorapho bia some studies show better results (an earlier response to treatment ) for CBT plus medication compared to CBT plus placebo in the short ru n. In follow-up studies success rates are independent from the former treatment groups. Several studies show that CBT methods are necessary for long-term stabilization after drug discontinuation and for the pre vention of relapses. Taken together CBT is shown to be helpful as an a djunct to psychopharmacotherapy, necessary for successful drug discont inuation, long-term stabilization, and an alternative treatment to psy chopharmacotherapy. Considering the long-term results, CBT should be t he treatment of choice if the patient is motivated for this active for m of therapy and no practical constraints limit this option. Parallel combinations of CBT and medication in anxiety disorders should be limi ted to special indications, e.g. very severe comorbidity or the need f or an immediate symptom relief. Sequential therapy strategies for CBT non-responders need further investigation.