Is Cognitive Behavioural Therapy More Effective Than Medication in Treating Anxiety?
The strong feelings of fear, unease and worry that are hallmarks of anxiety can have a very negative impact on your life. Making the decision to get help for anxiety is a positive step. At the same time, it merits the question: what treatment should you choose?
Two of the most popular treatments for anxiety are Cognitive Behavioural Therapy (CBT) and certain types of medication. This is due to the fact that both methods demonstrate good evidence in the successful treatment of anxiety.
However, is CBT more effective than medication in treating anxiety? How can you choose between the two, and when should you use both?
Cognitive Behavioural Therapy (CBT) for Anxiety
Cognitive Behavioural Therapy (CBT) is a short-term therapy usually lasting around 12 to 20 sessions. It shows people how to identify situations that might cause problems, understand their thoughts, identify any negative thinking patterns they engage in and then challenge such thoughts with more constructive alternatives. This helps people respond to their problems more effectively and learn new ways of coping that can be applied to future situations. As such, it can help alleviate anxiety symptoms on a long-term basis.
Some brain imaging studies have shown that there are actual physiological changes that take place in the brain when undergoing CBT. The amygdala, which is responsible for the fight-or-flight response appears to calm down.
Although studies have shown CBT to be an effective treatment for anxiety, the fact is, no singular treatment works for every single person. For some people, talking about their feelings or anxieties is something they just don’t feel comfortable with and this is a central part of the therapy. On the other hand other individuals might find that the homework based element of CBT is something that doesn’t appeal to them and other types of psychotherapy such as integrative, psychodynamic or humanistic psychotherapy may suit their learning style better. Then there are situations in which, due to practical or other concerns, individuals may have difficulty committing to regular sessions. In all these cases, CBT might not be the best solution.
Medications for Anxiety
From a medical perspective, the exact roots of anxiety are not known. The lack of a specific cause means that finding a medication that can completely cure it is difficult. However, certain medications have been shown to help relieve anxiety symptoms. Selective serotonin re-uptake inhibitors are one of the more common classes of medication used for anxiety. Benzodiazepines are also used in some cases for their relaxing effect.
That said, these medications do not work for everyone. They carry a number of side effects that some people find off putting such as weight gain, sexual dysfunction, gastrointestinal problems and sedation. In addition to this, it can sometimes be difficult to establish the right dosage. Nevertheless, people who have severe symptoms can find that the benefits outweigh the downfalls.
A lot of people have a GP they see regularly, but most people don’t have a psychotherapist. As a result, some people find it more convenient to seek medication for anxiety. This is of course better than not taking action, but the problem is that these drugs do not resolve a person’s underlying propensity to feel anxious. For this reason some GPs might be inclined to refer those with anxiety to a psychotherapist in addition to, or instead of, prescribing medicated drugs.
Quick Fix vs Long-Term Solution
Meta-analytic reviews in general find that CBT and medication both work similarly well in the short-term, but that after treatment ends CBT tends to yield better results. This is because the skills people learn during a course of CBT can enable them to maintain the progress made after the treatment ends.
Medications do however work faster than CBT. The difference is usually only a matter of weeks and for someone who is suffering from severe anxiety, a few weeks can feel like a lifetime. It should be noted that medications often only work during the duration that you take them, whereas CBT can continue to keep future anxiety issues at bay long after treatment has ended.
Another consideration is the fact that medication does not cure anxiety, so the symptoms might return shortly after stopping treatment. Many patients prefer to stop taking medication at some point. If symptoms of anxiety return, they may need CBT or another type of therapy to help them learn methods of dealing with the anxiety itself. On the other hand some people feel comfortable taking medication indefinitely.
Trial and Error
Because every individual is unique, it can be difficult to establish which treatment will work best without a bit of experimenting. Sometimes it is necessary to try a few different treatments or treatment combinations before finding one that works for you. Other factors which also require consideration is that some people with anxiety have coexisting conditions such as substance abuse or depression, which also need to be dealt with separately.
Even though trial and error is sometimes necessary, there are some predictors that can shed light on whether medication, therapy, or both is likely to work best for an individual. Generally speaking, the milder a person’s anxiety the better they typically respond to psychotherapy. Personality also plays a significant role; those who are more committed and insightful tend to benefit more from psychotherapy than medication. A certain level of motivation is needed to follow through with CBT. The fact that medication is sometimes cheaper than psychotherapy, or better covered by insurance, can make it a first treatment choice for some people. Furthermore, individuals who find it too uncomfortable to talk about their concerns may find medication is the preferred option. Individuals who are struggling with severe symptoms of anxiety could find the combination of therapy and medication works best for them.
The Combined Approach
A study in the Journal of the American Medical Association involving 321 adults found that a combination treatment of psychotherapy and medication worked better than either option individually. Another study in the New England Journal of Medicine found a similar effect in children with anxiety disorder; 80% of those who used both treatments improved, compared to 60% in psychotherapy alone, 55% taking medicine alone and 23% in the placebo group.
Medications treat the symptoms of anxiety, but they cannot help to cure anxiety itself. The things you can learn in CBT can help keep anxiety from reoccurring. Some people can benefit from the combined approach. On the one hand, in cases where CBT helps but anxiety is still present, some people find medication can help. On the other hand some people find that medication helps even out their mood, but therapy is what ultimately helps them solve their problems.