Combined therapy in anxiety disorders: Current data and recommendations for the clinical practice

Method. Over the past couple of years there has been a definite increase in studies on the effects of combined behavioral and pharmacological treatmen ts of anxiety disorders. But their results have been partially contradictor y and the interpretation of outcomes has sometimes been controversial. This article reviews the results of controlled studies for the different subtyp es of anxiety disorders. Results: Although a few studies with patients with panic disorder and agoraphobia show an earlier response to combined treatm ent compared to behavior therapy alone, altogether the results are inconsis tent. The combination of an initial pharmacotherapy alone with additional b ehavior therapy before drug discontinuation is helpful to reduce the otherw ise high relapse-rates. Sometimes, the subsequent treatment of nonresponder s in behavior therapy or psychopharmacotherapy with the alternative method is helpful. Conclusions: No convincing evidence was found that the parallel combination is generally more effective in any of the anxiety disorders th an the single treatment. In the individual case, the decision for or agains t a combined treatment is dependent on several factors which are only partl y investigated in controlled clinical trials. Especially the severity of th e anxiety symptoms, comorbid symptomatology and the number of treatment ref users and dropouts have to be mentioned in this context. These factors, the results of naturalistic studies and 'clinical experience' have influenced our conclusions for clinical practice from the controlled studies.