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Treatment Options: CBT or Medication
Cognitive Behavior Therapy (CBT) has been shown to be effective for reducing symptoms across a broad range of emotional and behavioral disorders, as well as for non-psychiatric problems in both children and adults (e.g., procrastination, weight loss, etc.). Psychiatric medications are also used to address emotional and behavioral issues either alone or in combination with CBT. Understanding these treatment options will help you and your provider determine the best treatment plan to address your issues.
This section offers information on:
- CBT or medication – What’s the evidence?
- Limitations of medication and CBT
- Types of medications
CBT or Medication – What’s the evidence?
- As a general rule, findings suggest that CBT and medication are equally effective for many disorders, including anxiety, obsessive-compulsive disorder (OCD), and depression; although, the effects of CBT may last longer overall.
- Medications tend to work a little faster than CBT (by a matter of weeks) and there are sometimes benefits from using the two in combination or in sequence. However, research has shown that after discontinuing CBT or medication, people who received CBT are less likely to experience a return of symptoms compared to those who received medication.
- CBT has been shown to be more effective than medication for a number of conditions, such as social anxiety disorder, phobias, and insomnia.
- Research comparing medication, CBT, a combination of medication and CBT, and placebo has generally found that the medication/CBT combination is not necessarily more effective than either CBT or medication alone. There are some exceptions though, where the combination does seem to work somewhat better for conditions such as hypochondriasis, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and panic disorder in adults. In children, similar results have been found, with either CBT alone or CBT and medication being the most effective for anxiety
Limitations of Medication and CBT
- One concern about medication is the potential for side effects. Side effects can range from none or mild to severe and often differ from person to person. These side effects can include symptoms such as dry mouth, fatigue, insomnia, weight gain, and sexual side effects, which can make some medications intolerable. However, many side effects do diminish after a period of time, so it is important to talk with your provider before stopping or changing a medication due to side effects.
- It can be difficult to find a CBT therapist with the training and experience to address your specific concerns. ABCT maintains a searchable directory of providers who are members of ABCT (see our Find a Therapist pages). However, regardless of where you find a provider, you should always ask about their background and experience with CBT to ensure it is a good fit for your needs.
- CBT requires some commitment to practice the skills you learn outside of sessions. It can take some time to change behaviors and habits. In some cases, adding medication will provide more immediate relief of symptoms. Your provider can also help you develop skills for managing symptoms if you want to stop taking medication.
Types of Medications
There are several different types of psychiatric medications.
- Psychiatric medications such as selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine, citalopram, sertraline, etc.) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., duloxetine, venlafaxine, etc.) are commonly used for the treatment of anxiety and depression. Other types of medications known as anti-psychotics, such as risperidone or olanzapine are typically used to treat psychotic disorders (disorders with symptoms including hallucinations and/or delusions), while mood stabilizers such as carbamazepine or lamotrigine are used to treatment bipolar disorders (also known as “manic depression”). It is important to note that these medications are not exclusively used for specific conditions, and a provider may use different types of medication to treat different conditions.
- Benzodiazepines (e.g., diazepam, clonazepam, alprazolam) work very quickly and are typically used on an “as needed” basis. They are widely prescribed for anxiety and provide very rapid symptom relief. However, there is more concern with using these types of medications due to their increased risk for addiction, potential medical risks when discontinuing use abruptly, and withdrawal symptoms of “rebound” anxiety and sleep difficulties. Any person wanting to use a benzodiazepine as part of their treatment plan or wanting to discontinue use of a benzodiazepine should speak with their medical provider about the risks and benefits of this approach before making any changes.
- Stimulants like methylphenidate and dextroamphetamine are sometimes used in the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents or to augment other medications in the treatment of depression. Stimulants can be addictive and there are ongoing concerns about their effects on growth and development, but they appear to have a role in conjunction with behavior management in the treatment of more severe instances of ADHD.
- Hypnotics include medications like zolpidem are widely used to treat insomnia but also can be addictive if taken for too long. These medications can also cause sleep disruption if someone stops taking them. CBT for insomnia has been shown to provide very effective and lasting relief for insomnia without the risks associated with medication.
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