Abstract
Cognitive-behavioral therapy (CBT) and pharmacotherapy demonstrate efficacy across
the anxiety disorders, but recognition of their limitations has sparked interest in
combining modalities to maximize benefit. This article reviews the empirical literature
to examine whether combining treatments influences efficacy of either monotherapy.
We conducted a comprehensive literature search of published randomized trials that
compared combined treatment with pharmacologic or CBT monotherapies. Ten studies that
met our inclusion criteria were reviewed in detail, and within-subjects effect sizes
were calculated to compare treatment conditions within and across studies.
At posttreatment and follow-up, effect size and percentage responder data failed to
clearly demonstrate an advantage or disadvantage of combined treatment over CBT alone
for obsessive-compulsive disorder, social phobia, and generalized anxiety disorder.
Some advantage of combined treatment over pharmacotherapy alone emerged from the few
studies that allowed for such a direct comparison. In contrast, combined treatment
for panic disorder seems to provide an advantage over CBT alone at posttreatment,
but is associated with greater relapse after treatment discontinuation.
The advantage of combined treatment may vary across the anxiety disorders. The potential
differences in usefulness of combined treatment are discussed, directions for future
research are suggested, and implications for clinical practice are considered.
Keywords
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Article info
Publication history
Accepted:
July 16,
2002
Received in revised form:
July 12,
2002
Received:
March 18,
2002
Identification
Copyright
© 2002 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
