Open AccessCombined Pharmacotherapy and Cognitive‐Behavioral Therapy for Anxiety Disorders: Medication Effects, Glucocorticoids, and Attenuated Treatment Outcomes
Author(s) -
Otto Michael W.,
McHugh R. Kathryn,
Kantak Kathleen M.
Publication year - 2010
Publication title -
clinical psychology: science and practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 105
eISSN - 1468-2850
pISSN - 0969-5893
DOI - 10.1111/j.1468-2850.2010.01198.x
Subject(s) - anxiety , pharmacotherapy , extinction (optical mineralogy) , cognition , anxiolytic , cognitive behavioral therapy , psychological intervention , psychology , clinical psychology , exposure therapy , combination therapy , medicine , psychiatry , pharmacology , paleontology , biology
[Clin Psychol Sci Prac 17: 91–103, 2010] Despite the success of both pharmacologic and cognitive‐behavioral interventions for the treatment of anxiety disorders, the combination of these modalities in adults has not resulted in substantial improvements in outcome relative to either strategy alone, raising questions about whether there are interfering effects that attenuate the magnitude of combination treatment benefits. In this article, we introduce an accounting of potential interference effects that expands upon arguments asserting the necessity of arousal for successful fear exposure. Specifically, recent advances in the study of the effects of cortisol on memory—suggesting that glucocorticoids are crucial to the learning of emotional material—have led us to posit that the attenuation of glucocorticoid activity by anxiolytic medications may interfere with extinction learning in exposure‐based therapies. Implications for the efficacy of combination treatments for the anxiety disorders are discussed.