Skip to main content
SpringerLink
Log in

Comparison of combined psycho- and pharmacotherapy with monotherapy in anxiety disorders: controversial viewpoints and clinical perspectives

  • Biological Psychiatry - Review Article
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

Anxiety disorders are among the most frequent psychiatric disorders. Experimental evidence supports both psychotherapy as well as pharmacotherapy as effective treatments. There is, however, a controversy concerning the efficacy of a combination of both approaches. While some studies suggest that combined treatment enhances efficacy, others report conflicting results. This article traces the positions in this debate. We present the results from two recent meta-analyses and discuss implications for clinical practice and further research. We suggest that a research strategy that strives to establish differential indications based on patient characteristics should be preferred over attempts to reach a global judgement of the question, which appears too simplistic given the complexity of the issue.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ballenger JC, Burrows GD, DuPont RL Jr, Lesser IM, Noyes R Jr, Pecknold JC, Rifkin A, Swinson RP (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry 45:413–422

    PubMed  CAS  Google Scholar 

  • Bandelow B, Zohar J, Hollander E, Kasper S, Moller HJ (2002) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 3:171–199

    Article  PubMed  Google Scholar 

  • Bandelow B, Seidler-Brandler U, Becker A, Wedekind D, Ruther E (2007) Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. World J Biol Psychiatry 8:175–187

    Article  PubMed  Google Scholar 

  • Barlow DH (2002) Anxiety and its disorders: the nature and treatment of anxiety and panic. The Guilford Press, New York

    Google Scholar 

  • Barlow DH, Gorman JM, Shear MK, Woods SW (2000) Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA 283:2529–2536

    Article  PubMed  CAS  Google Scholar 

  • Blanco C, Schneier FR, Schmidt A, Blanco-Jerez CR, Marshall RD, Sanchez-Lacay A, Liebowitz MR (2003) Pharmacological treatment of social anxiety disorder: a meta-analysis. Depress Anxiety 18:29–40

    Article  PubMed  CAS  Google Scholar 

  • Falls WA, Miserendino MJ, Davis M (1992) Extinction of fear-potentiated startle: blockade by infusion of an NMDA antagonist into the amygdala. J Neurosci 12:854–863

    PubMed  CAS  Google Scholar 

  • Feske U, Chambless D (1995) Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behav Ther 26:695–720

    Article  Google Scholar 

  • Foa EB, Franklin ME, Moser J (2002) Context in the clinic: how well do cognitive-behavioral therapies and medications work in combination? Biol Psychiatry 52:987–997

    Article  PubMed  Google Scholar 

  • Furukawa TA, Watanabe N, Churchill R (2007) Combined psychotherapy plus antidepressants for panic disorder with or without agoraphobia. Cochrane Database Syst Rev CD004364

  • Gould R, Buckminster S, Pollack M, Otto M, Yap L (1997a) Cognitive-behavioral and pharmacological treatment for social phobia: a meta-analysis. Clin Psychol Sci Practice 4:291–306

    Article  Google Scholar 

  • Gould R, Otto M, Pollack M (1995) A meta-analysis of treatment outcome for panic disorder. Clin Psychol Rev 15:819–844

    Article  Google Scholar 

  • Gould RA, Otto M, Pollack M, Yap L (1997b) Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: a preliminary meta-analysis. Behav Ther 28:285–305

    Article  Google Scholar 

  • Greist JH (1992) An integrated approach to treatment of obsessive compulsive disorder. J Clin Psychiatry 53 Suppl(38–41):38–41

    PubMed  CAS  Google Scholar 

  • Guastella AJ, Richardson R, Lovibond PF, Rapee RM, Gaston JE, Mitchell P, Dadds MR (2008) A randomized controlled trial of d-cycloserine enhancement of exposure therapy for social anxiety disorder. Biol Psychiatry 63:544–549

    Article  PubMed  CAS  Google Scholar 

  • Heimberg RG (2001) Current status of psychotherapeutic interventions for social phobia. J Clin Psychiatry 62 Suppl 1(36–42):36–42

    PubMed  CAS  Google Scholar 

  • Hidalgo RB, Tupler LA, Davidson JR (2007) An effect-size analysis of pharmacologic treatments for generalized anxiety disorder. J Psychopharmacol 21:864–872

    Article  PubMed  CAS  Google Scholar 

  • Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, Shiekh M, Otto MW (2006) Augmentation of exposure therapy with d-cycloserine for social anxiety disorder. Arch Gen Psychiatry 63:298–304

    Article  PubMed  CAS  Google Scholar 

  • Hunot V, Churchill R, Silva de LM, Teixeira V (2007) Psychological therapies for generalised anxiety disorder. Cochrane Database Syst Rev CD001848

  • Ipser JC, Kariuki CM, Stein DJ (2008) Pharmacotherapy for social anxiety disorder: a systematic review. Expert Rev Neurother 8:235–257

    Article  PubMed  CAS  Google Scholar 

  • Marcus SM, Gorman J, Shear MK, Lewin D, Martinez J, Ray S, Goetz R, Mosovich S, Gorman L, Barlow D, Woods S (2007) A comparison of medication side effect reports by panic disorder patients with and without concomitant cognitive behavior therapy. Am J Psychiatry 164:273–275

    Article  PubMed  Google Scholar 

  • Mitte K (2005) A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. J Affect Disord 88:27–45

    Article  PubMed  Google Scholar 

  • Mula M, Pini S, Cassano GB (2007) The role of anticonvulsant drugs in anxiety disorders: a critical review of the evidence. J Clin Psychopharmacol 27:263–272

    Article  PubMed  CAS  Google Scholar 

  • Otto MW, Tuby KS, Gould RA, McLean RY, Pollack MH (2001) An effect-size analysis of the relative efficacy and tolerability of serotonin selective reuptake inhibitors for panic disorder. Am J Psychiatry 158:1989–1992

    Article  PubMed  CAS  Google Scholar 

  • Parnas AS, Weber M, Richardson R (2005) Effects of multiple exposures to d-cycloserine on extinction of conditioned fear in rats. Neurobiol Learn Mem 83:224–231

    Article  PubMed  CAS  Google Scholar 

  • Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, Hodges L, Davis M (2004) Cognitive enhancers as adjuncts to psychotherapy: use of d-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 61:1136–1144

    Article  PubMed  Google Scholar 

  • Santini E, Muller RU, Quirk GJ (2001) Consolidation of extinction learning involves transfer from NMDA-independent to NMDA-dependent memory. J Neurosci 21:9009–9017

    PubMed  CAS  Google Scholar 

  • Stein DJ, Ipser JC, Balkom AJ (2004) Pharmacotherapy for social phobia. Cochrane Database Syst Rev CD001206

  • Stern R, Marks I (1973) Brief and prolonged flooding. A comparison in agoraphobic patients. Arch Gen Psychiatry 28:270–276

    PubMed  CAS  Google Scholar 

  • Taylor S (1996) Meta-analysis of cognitive-behavioral treatments for social phobia. J Behav Ther Exp Psychiatry 27:1–9

    Article  PubMed  CAS  Google Scholar 

  • van Balkom AJ, Bakker A, Spinhoven P, Blaauw BM, Smeenk S, Ruesink B (1997) A meta-analysis of the treatment of panic disorder with or without agoraphobia: a comparison of psychopharmacological, cognitive-behavioural, and combination treatments. J Nerv Ment Dis 185:510–516

    Article  PubMed  Google Scholar 

  • Zwanzger P, Deckert J (2007) Anxiety disorders. Causes, clinical picture and treatment. [Angsterkrankungen. Ursachen, Klinik, Therapie] Nervenarzt 78:349–359

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University of Munster, Albert-Schweitzer-Strasse 11, 49149, Munster, Germany

    P. Zwanzger & J. Diemer

  2. Department of Psychiatry, Psychotherapy and Psychosomatics, University of Wurzburg, Wurzburg, Germany

    B. Jabs

Authors
  1. P. Zwanzger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Diemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Jabs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Zwanzger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zwanzger, P., Diemer, J. & Jabs, B. Comparison of combined psycho- and pharmacotherapy with monotherapy in anxiety disorders: controversial viewpoints and clinical perspectives. J Neural Transm 116, 759–765 (2009). https://doi.org/10.1007/s00702-008-0116-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-008-0116-6

Keywords

Search

Navigation