Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-27T13:30:33.132Z Has data issue: false hasContentIssue false
  • English
  • Français

Interaction of pharmacological and psychological treatments of anxiety

Published online by Cambridge University Press:  06 August 2018

M. H. Lader  and
A. J. Bond
Get access Rights & Permissions [Opens in a new window]

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.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S34: Recognition and management of anxiey syndromes , July 1998 , pp. 42 - 48
Copyright
Copyright © The Royal College of Psychiatrists, 1998 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bandura, A., Adams, N. E., Hardy, A. B., et al (1980) Tests of the generality of self-efficacy theory. Cognitive Therapy and Research, 4, 39–66.CrossRefGoogle Scholar
Borkovec, T. D. & Mathews, A. M. (1988) Treatment of nonphobic anxiety disorders: a comparison of nondirective, cognitive and coping desensitization therapy. Journal of Consulting and Clinical Psychology, 56, 877–884.CrossRefGoogle ScholarPubMed
Chiles, J. A., Carlin, A. S. & Beitman, B. D. (1984) A physician, a nonmedical therapist and a patient: The pharmacotherapy-psychotherapy triangle. In Combining Psychotherapy and Drug Therapy in Clinical Practice (eds B. D. Beitman & G. L. Klerman), pp. 89–101. New York: Spectrum.Google Scholar
Clum, G. A. (1989) Psychological interventions vs drugs in the treatment of panic. Behavior Therapy, 20, 429–457.CrossRefGoogle Scholar
Conte, H. R., Plutchik, R., Wild, K. V., et al (1986) Combined psychotherapy and pharmacotherapy for depression. Archives of General Psychiatry, 43, 471–479.Google Scholar
Cottraux, J., Mollard, E., Bouvard, M., et al (1990) A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. International Clinical Psychopharmacology, 5, 17–20.CrossRefGoogle ScholarPubMed
Zigmond, A. S. & Snaith, R. P., et al (1993) Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: one-year follow-up. Psychiatry Research, 49, 63–75.Google Scholar
Dubovsky, S. L. (1990) Generalized anxiety disorder: new concepts and psychopharmacologic therapies. Journal of Clinical Psychiatry, 51 (suppl. 1), 3–10.Google Scholar
Durham, R. C. & Turvey, A. A. (1987) Cognitive therapy vs behaviour therapy in the treatment of chronic general anxiety. Behaviour Research and Therapy, 25, 229–234.Google Scholar
Eckman, T. A., Wirshing, W. C., Marder, S. R., et al (1992) Technique for training patients in illness self-management: a controlled trial. American Journal of Psychiatry, 149, 1549–1555.Google ScholarPubMed
Elkin, I., Pilkonis, P. A., Docherty, J. P., et al (1988a) Conceptual and methodological issues in comparative studies of psychotherapy and pharmacotherapy: I. Active ingredients and mechanisms of change. American Journal of Psychiatry, 145, 909–917.Google Scholar
Elkin, I., Pilkonis, P. A., Docherty, J. P., et al (1988b) Conceptual and methodological issues in comparative studies of psychotherapy and pharmacotherapy: II. Nature and timing of treatment effects. American Journal of Psychiatry, 145, 1070–1076.Google ScholarPubMed
Fineberg, N. & Drummond, L. M. (1995) Anxiety disorders. Drug treatment or behavioural cognitive psychotherapy? CNS Drugs, 3, 448–466.Google Scholar
Fyer, A. J., Liebowitz, M. R., Gorman, J. M., et al (1987) Discontinuation of alprazolam treatment in panic patients. American Journal of Psychiatry, 144, 303–308.Google ScholarPubMed
Hamilton, M. (1959) The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.Google Scholar
Hollon, S. D., Shelton, R. C. & Loosen, P. T. (1991) Cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology, 59, 88–89.Google Scholar
Hollon, S. D., Shelton, R. C. & Davis, D. D. (1993) Cognitive therapy for depression: Conceptual issues and clinical efficacy. Journal of Consulting and Clinical Psychology, 61, 270–275.CrossRefGoogle ScholarPubMed
Karasu, T. B. (1993) Depression: the relative merits of pharmacotherapy and psychotherapy. Current Opinion in Psychiatry, 6, 184–190.Google Scholar
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: a randomized controlled trial. British Medical Journal, 312, 345–349.Google Scholar
Kendall, P. C. & Lipman, A. J. (1991) Psychological and pharmacological therapy: Methods and modes for comparative outcome research. Journal of Consulting and Clinical Psychology, 59, 78–87.CrossRefGoogle ScholarPubMed
Klerman, G. L. (1984) Ideological conflicts in combined treatment. In Combining Psychotherapy and Drug Therapy in Clinical Practice (eds B. D. Beitman & G. L. Klerman), pp. 17–34. New York: Spectrum.Google Scholar
Klerman, G. L. (1986) Drugs and psychotherapy. In Handbook of Psychotherapy and Behavior Change (eds S. L. Garfield & A. E. Bergin), pp. 777–818. New York: Wiley.Google Scholar
Lakshman, M., Fernando, D. & Kazarian, S. S. (1995) Patient education in the drug treatment of psychiatric disorders. Effect on compliance and outcome. CNS Drugs, 3, 291–304.Google Scholar
Lindsay, W. R., Gamsu, C. V., McLaughlin, E., et al (1987) A controlled trial of treatments for generalized anxiety. British Journal of Clinical Psychology, 26, 3–15.Google Scholar
Marks, I. & O'Sullivan, G. (1988) Drugs and psychological treatments for agoraphobia/panic and obsessive-compulsive disorders: A review. British Journal of Psychiatry, 153, 650–658.Google Scholar
Michelson, L. K. & Marchione, K. (1991) Behavioral, cognitive, and pharmacological treatments of panic disorder with agoraphobia: Critique and synthesis. Journal of Consulting and Clinical Psychology, 59, 100–114.Google Scholar
Miller, E. (1986) Benzodiazepines and the behaviour therapist: managing withdrawal and the problems of concurrent treatment with these drugs. Behavioural Psychotherapy, 14, 1–12.Google Scholar
Nagy, L. M., Krystal, J. H., Woods, S. W., et al (1989) Clinical and medical outcome after short-term alprazolam and behavioral group treatment in panic disorder. 2.5-year naturalistic follow-up study. Archives of General Psychiatry, 46, 993–999.Google Scholar
Oehrberg, S., Christiansen, P. E., Behnke, K., et al (1995) Paroxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study. British Journal of Psychiatry, 167, 374–379.CrossRefGoogle ScholarPubMed
Otto, M. W., Pollack, M. H., Sachs, G. S., et al (1993) Discontinuation of benzodiazepine treatment: efficacy of cognitive-behavioral therapy for patients with panic disorder. American Journal of Psychiatry, 150, 1485–1490.Google ScholarPubMed
Petursson, H. & Lader, M. (1984) Dependence on Tranquillizers. Maudsley Monograph No. 28. Oxford: Oxford University Press.Google Scholar
Power, K. G. & Sharp, D. M. (1995) Keep taking the tablets? Inadequate controls for concurrent psychotropic medication in studies of psychological treatments for panic disorder. Journal of Psychopharmacology, 9, 71–72.Google Scholar
Power, K. G., Jerrom, D. W. A., Simpson, R. J., et al (1989) A controlled comparison of cognitive behaviour therapy, diazepam and placebo in the management of generalised anxiety. Behavioural Psychotherapy, 17, 1–14.Google Scholar
Power, K. G., Simpson, R. J., Swanson, V., et al (1990) A controlled comparison of cognitive–behaviour therapy, diazepam and placebo, alone and in combination, for the treatment of generalised anxiety disorder. Journal of Anxiety Disorders, 4, 267–292.Google Scholar
Shapiro, A. K., Struening, E. L., Shapiro, E., et al (1983) Diazepam: how much better than placebo? Journal of Psychiatric Research, 17, 51–73.CrossRefGoogle Scholar
Shear, M. K., Pilkonis, P. A., Cloitre, M., et al (1994) Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder. Archives of General Psychiatry, 51, 395–401.Google Scholar
Spiegel, D. A., Bruce, T. J., Gregg, S. F., et al (1994) Does cognitive behaviour therapy assist slow-taper alprazolam discontinuation in panic disorder. American Journal of Psychiatry, 151, 876–881.Google Scholar
Swinson, R. P., Kuch, K. & Antony, M. M. (1991) Combining pharmacotherapy and behavioral therapy for panic disorder and agoraphobia. In Panic Disorder and Agoraphobia (eds J. R. Walker, G. R. Norton & C. A. Ross), pp. 306–334. Belmont, CA: Wadsworth.Google Scholar
Tyrer, P., Seivewright, N., Murphy, S., et al (1988) The Nottingham study of neurotic disorder: comparison of drug and psychological treatments. Lancet, ii, 235–240.CrossRefGoogle Scholar
Uhlenhuth, E. H., Lipman, R. S. & Covi, L. (1969) Combined pharmacotherapy and psychotherapy. Controlled studies. Journal of Nervous and Mental Disease, 148, 52–64.CrossRefGoogle Scholar
Wardle, J. (1990) Behaviour therapy and benzodiazepines: Allies or antagonists? British Journal of Psychiatry, 156, 163–168.Google Scholar
Weissman, M. M. (1979) The psychological treatment of depression: Evidence for the efficacy of psychotherapy alone, in comparison with, and in combination with, pharmacotherapy. Archives of General Psychiatry, 36, 1261–1269.Google Scholar
Zigmond, A. S. & Snaith, R. P. (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.