Combined Pharmacotherapy and Psychotherapy for Anxiety Disorders

Combined Pharmacotherapy and Psychotherapy for Anxiety Disorders: Is Efficacy Enhanced?
An Evidenced-Based Approach
By: Heide Klumpp, Ph.D.


Components of Evidence-Based Treatment include:
Chambless and Hollon (1998)
Comparison with a no-treatment control group, alternative treatment group, or placebo in a randomized control trial or equivalent time-samples design


Study must have been conducted with:

a) Treatment manual
b) Population, treated for specified problems
c) Reliable/valid outcome assessment measures
d) Appropriate data analysis

Clinical scenario

Family hx
Clinical questions:
Does she meet DSM-IV criteria for Social Phobia?
What’s your Evidenced-Based Treatment plan?
2) Psychotherapy (e.g., cognitive-behavioral treatment)?
3) Combined therapy?

Rationale for combined therapy:

Sources for evidence regarding combined therapy
Results consisted of:
Articles comparing treatment approaches
+ Provides details of research methods and analysis
- Difficult to compare results across different studies

Meta-analytic studies
Literature reviews
Efficacy of combined pharmacotherapy and psychotherapy for Social Phobia
Primary outcome measure:
Clinician rated: Clinic Global Impression Inventory-Social Phobia Scale (CGII-SPS)
Patient rated: CGII-SPS

Response defined as:

1) Overall severity score at final visit in the “no menta
Pharmacotherapy:
Exposure therapy:
Outcome after 24 weeks of treatment
Conclusions:
Points to consider:
Recruitment: two outpatient programs at medical centers
Response primarily via Clinical Global Impressions Improvement (CGII):
Pharmacotherapy: Double-blind administration
Cognitive-behavioral treatment:
Points to consider:
Recruitment: 133 participants from Cognitive behavioral treatment program at an Anxiety Disorders Clinic at a hospital
Pre Post Pre Post
Conclusion:
Points to consider:
Summary
Questions regarding clinical scenario

Combined Pharmacotherapy and Psychotherapy for Anxiety Disorders.ppt