Drug Treatments

Confronted with the increasingly favorable treatment outcomes associated with cognitive behavioral packages, there are three possible reasons why pharmacological interventions might be considered. First, it could be that pharmacological interventions achieve the same outcomes as the cognitive behavioral therapy packages but at a cheaper cost (financially to the patient or in terms of therapist time), with fewer dropouts, lower relapse rates, and with fewer associated difficulties (such as side-effects). Second, it could be that pharmacological treatments may be useful adjuncts to the cognitive behavioral therapy packages.

Panic disorder and agoraphobia

In 1988, Barlow examined the evidence from around the world and concluded that “with specifically targeted psychological treatments, panic is eliminated in close to 100% of all cases, and these results are maintained at follow-ups of over 1 year. If these results are confirmed by additional research and replication, it will be one of the most important and exciting developments in the history of psychotherapy”. The question facing researchers and clinicians alike is, with the benefit of more than a decade of subsequent research and replication, “Is it possible to concur with Barlow’s statement?”.

Nondrug Treatments

In vivo exposure has been one of the strongest and most consistently demonstrated treatments for agoraphobic avoidance. In fact, it has often been demonstrated to be superior to placebo interventions as well as other credible psychological treatments – a none too easy achievement in psychological research. Furthermore, when anti-exposure instructions are included in comparison therapies, the strength of exposure becomes even more evident.

Social Phobia

The aims of treatment are symptom reduction and improved function. Elimination of all anxiety is unlikely (and unnecessary), and the therapist has a role in helping the patient to set realistic goals for therapy. Psychological and pharmacological treatments are available for social phobia.

Obsessive-Compulsive Disorder

Although Obsessive-compulsive disorder has been recognized for centuries, effective treatment for this condition has been available only for the past four decades. The treatments of choice for Obsessive-compulsive disorder are behavior therapy, consisting of exposure and response prevention, and selective serotonin reuptake-inhibiting medications.

Generalized Anxiety Disorder

The goal of the treatment of Generalized anxiety disorder is the reduction of impairment that results from both cognitive and somatic symptoms of anxiety: the worry or anxious expectation, and the accompanying symptoms of tension and overarousal. This chapter aims to summarize the evidence for the effectiveness of psychological and pharmacological treatments for Generalized anxiety disorder. Since the first edition of this book was published, five reviews of the psychological treatment of Generalized anxiety disorder have been published.

Posttraumatic Stress Disorder

Survivors of trauma who do not recover independently, and who go on to develop longer-term problems as a result of their experiences, may require formal treatment. There is also a mounting body of research suggesting that early interventions with high risk survivors may facilitate the recovery process and reduce the prevalence of subsequent Posttraumatic stress disorder.

Prevention and Early Intervention

Posttraumatic stress disorder, it would seem, is potentially an ideal candidate for early intervention and prevention, since it is possible to accurately identify the precipitating event. In recent years, there has been considerable debate regarding the extent to which it may be possible to modify the course of traumatic stress reactions, and to facilitate recovery, by means of an early intervention.

Pharmacotherapy of Obsessive-Compulsive Disorder

Although a wide variety of medications have been utilized in the treatment of Obsessive-compulsive disorder, there is little doubt as to the consistent efficacy of serotonin reuptake inhibitors, of which clomipramine is the most widely researched. Placebo controlled trials have in general attested to its efficacy and comparison to other antidepressants have also demonstrated its superiority in decreasing obsessional symptoms.