Anxiety disorders are among the most prevalent psychiatric conditions throughout the world, and they are responsible for considerable morbidity and functional impairment. Patients with these disorders make extensive use of medical resources, not only through their use of the mental health system but by frequent utilization of primary care and emergency medical services. Although it is common clinical practice to combine pharmacotherapy and psychotherapy, some researchers have argued that this has not been shown effective in practice and is an inefficient use of limited mental health resources. This article will examine the evidence supporting integrative therapy for the major Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision anxiety disorders and discuss clinical considerations surrounding the use of combined therapies for anxiety.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
References and Recommended Reading
Dupont RL, Rice DP, Miller LS, et al.: Economic costs of anxiety disorders. Anxiety 1996, 2:167–172.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Publishing; 2000.
Stein DJ: Clinical Manual of Anxiety Disorders. Washington, DC: American Psychiatric Publishing; 2004.
Hollander E, Simeon D: Anxiety disorders. In Textbook of Psychiatry, edn 4. Edited by Hales RE, Yudofsky SC, Talbott JA. Washington, DC: American Psychiatric Press; 2003:543–630.
Mattick RP, Andrews G, Hadzi-Pavolic D, et al.: Treatment of panic and agoraphobia: an integrative review. J Nerv Ment Dis 1990, 178:567–576.
Zitrin CM, Klein DF, Woerner MG, et al.: Treatment of phobias I: comparison of imipramine hydrochloride and placebo. Arch Gen Psychiatry 1980, 40:125–138. Although from 1980, this is a landmark study that helped open the current debate.
Gorman J, Shear K, March J, et al.: Practice guidelines for the treatment of patients with panic disorder. Am J Psychiatry 1998, 155(suppl):1–28.
Noyes RJ, Burrows GD, Reich JH, et al.: Diazepam versus alprazolam for the treatment of panic disorder. J Clin Psychiatry 1996, 57:349–355. This is an interesting example of how study findings are incorporated into clinical practice.
Foa EB, Franklin ME, Moser J: Context in clinic: how well do cognitive-behavioral therapies and medications work in combination? Biol Psychiatry 2002, 52:987–997. This is a comprehensive and articulate review.
Barlow DH, Gorman JM, Shear MK, et al.: Cognitive-behavioral therapy, imipramine or their combination for panic disorder. JAMA 2000, 283:2529–2536.
Westra HA, Stewart SH: Cognitive-behavioral therapy and pharmacotherapy: complementary or contradictory approaches to the treatment of anxiety. Clin Psychol Rev 1998, 18:307–340.
Otto MW, Pollack MH, Sabatino SA: Maintenance and remission following cognitive-behavior therapy for panic disorder: possible deleterious effects of concurrent medication treatment. Behav Ther 1996, 27:473–482.
Rosenbaum JF, Pollock RA, Otto MA, et al.: Integrated treatment of panic disorder. Bull Menninger Clin 1995, 59(suppl):A4-A26.
Rickles K, Rynn M: Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 2002, 63(suppl):9–16.
Ballenger JC, Davidson JRT, Lecrubier Y, et al.: Consensus statement on generalized anxiety disorder from the international consensus group on depression and anxiety. J Clin Psychiatry 2001, 62(suppl):53–58.
Power KG, Simpson MB, Swanson V, et al.: A controlled comparison of cognitive-behavioral therapy, diazepam, and placebo in the management of generalized anxiety disorder. J Anxiety Disord 1990, 4:267–292.
Bond AJ, Wingrove J, Curran HJ, et al.: Treatment of generalized anxiety disorder with a short course of psychological therapy, combined with buspirone or placebo. J Affect Disord 2002, 72:267–271.
Leckman JF, Grice DE, Boardman J, et al.: Symptoms of generalized anxiety disorder. Am J Psychiatry 1997, 154:911–917.
Sasson Y, Zohar J, Chopra M, et al.: Epidemiology of obsessive compulsive disorder: a world view. J Clin Psychiatry 1997, 58(suppl):7–10.
March JS, Frances A, Carpenter D, et al.: The expert consensus series: treatment of obsessive-compulsive disorder. J Clin Psychiatry 1997, 58(suppl):5–28.
Albert U, Aguglia E, Maina G, et al.: Venlafaxine versus clomipramine in the treatment of obsessive-compulsive disorder: a preliminary single-blind, 12-week, controlled study. J Clin Psychiatry 2002, 63:1004–1009.
McDougle CJ, Goodman WK, Leckman JF, et al.: A doubleblind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2000, 57:794–801.
Cottraux J, Mollard E, Bouvard M, et al.: A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder. Int Clin Psychopharmacology 1990, 5:17–30.
Hohagen F, Winkelman G, Rasche-Rauchle H, et al.: Combination of behavior therapy with fluvoxamine in comparison with behavior therapy and placebo. Br J Psychiatry 1998, 173(suppl):71–78.
van Balkom AJ, de Haan E, van Oppen P, et al.: Cognitive and behavioral therapies alone and in combination with fluvoxamine in the treatment of obsessive-compulsive disorder. J Nerv Ment Dis 1998, 186:492–499.
Van Ameringen MA, Lane RM, Walker JR, et al.: Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study. Am J Psychiatry 2001, 158:275–281.
Lipsitz JD, Markowitz JC, Cherry S, et al.: Open trial of interpersonal psychotherapy for the treatment of social phobia. Am J Psychiatry 1999, 156:1814–1816.
Gabbard GO: Psychodynamics of panic disorder and social phobia. Bull Menninger Clin 1992, 56(suppl):A3-A13.
Heimberg RG, Liebowitz MR, Hope DA, et al.: Cognitivebehavioral group treatment of social phobia: 12-week outcome. Arch Gen Psychiatry 1998, 55:1133–1141.
Blomhoff S, Haug TT, Hellstrom K, et al.: Randomised controlled general practice trial of sertraline, exposure therapy, and combined treatment in generalized social phobia. Br J Psychiatry 2001, 179:23–30.
Kessler RC, Sonnega A, Bromet E, et al.: Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 1995, 52:1048–1060.
Johnson DR, Rosenheck R, Fontana A, et al.: Outcome of intensive inpatient treatment for combat-related posttraumatic stress disorder. Am J Psychiatry 1996, 153:771–777.
Schnurr PP, Friedman MJ, Foy D: Randomized trial of traumafocused group therapy for posttraumatic stress disorder. Arch Gen Psychiatry 2003, 60:481–489.
Marshall RD, Carcamo JH, Blanco C, et al.: Trauma-focused psychotherapy after a partial response to medication in PTSD: pilot observations. Am J Psychother 2003, 57:374–383.
Otto MW, Hinton D, Korbly NB, et al.: Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behav Res Ther 2003, 41:1271–1276.
About this article
Cite this article
Kuzma, J.M., Black, D.W. Integrating pharmacotherapy and psychotherapy in the management of anxiety disorders. Curr Psychiatry Rep 6, 268–273 (2004). https://doi.org/10.1007/s11920-004-0076-y
- Anxiety Disorder
- Generalize Anxiety Disorder
- Social Phobia