Augmentation of Cognitive Behavioral Therapy with Pharmacotherapy

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Combining CBT and medication

The introduction of CBT as an effective treatment of a range of psychiatric disorders raised the question of whether CBT and pharmacotherapy could be successfully combined.7 In clinical practice, CBT and pharmacotherapy are each effective for only a subset of patients, and it is possible that CBT and pharmacotherapy achieve their effects via different mechanisms.8 Thus, an early hypothesis was that combined treatment would be more effective than either modality.2 Here, the authors briefly

The neurobiology of DCS and psychotherapy

A particularly important set of studies on the neurobiology of psychotherapy emerged not from imaging research but from animal studies on the neurobiology of fear extinction in rodent models. It was found that fear extinction involved the lateral and basolateral amygdaloid nuclei.45 A second finding was that agents that acted on NMDA receptors in these circuits could enhance fear extinction.46 NMDA antagonists, for example, were shown to prevent the acquisition and extinction of conditioned

OCD

Wilhelm and colleagues54 used DCS to augment CBT in the treatment of OCD. This was a randomized, double-blind, placebo-controlled augmentation trial of 23 participants with OCD. The participants received 10 behavior therapy sessions twice a week. One hour before each of the sessions, the participants received 100 mg of either DCS or a placebo pill. The study included a mid-treatment assessment after session 5, a posttreatment session after session 10, and a 1-month follow-up assessment after

Substance Use Disorders

Exposure therapy has been used to treat individuals with substance use disorders.78 Such therapies aim to reduce drug-seeking behavior and relapse by desensitizing patients to certain cues from the environment and from drug paraphernalia. To date, these treatments have been at most, moderately successful, depending on the substance of abuse.78 Given the ability of DCS to facilitate extinction learning via the NMDA receptor, this agent may prove useful in augmenting CBT for substance use

Summary

It may seem intuitively correct to combine psychotherapy and pharmacotherapy, and in depression there is some evidence for the value of combined treatment.81 In studies of anxiety disorders, however, the data on combined use of CBT and standard medications are mixed.7, 82, 83 Nevertheless, several consistent findings emerge. First, there is preliminary evidence that simultaneous prescription of certain agents, such as benzodiazepines, may interfere with the positive effects of exposure. Second,

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