Choosing the Best Anxiety Disorder Treatment: Medication or CBT?

For many people who are seeking help with an anxiety disorder it must be difficult to know where to turn to get effective treatment. In part due to advertising by pharmaceutical companies, people often think that medication is the only real way (or perhaps at least the best way) to treat anxiety. The anxiety is presumed to have a biological cause and thus a biological remedy is presumed to be the best solution.  Some recent research and a number of authors have started to challenge this assumption. Pharmaceutical companies have a vested interest in promoting and selling their products and from what I can tell they do a good job of doing just that. However, there is no “company” to sell and promote Cognitive Behavior Therapy (CBT) which has proven to be as effective as (and at times more effective than) medication. CBT seems to do especially better (compared to medication) at helping anxiety sufferers maintain the gains they have made in treatment. How many of us have seen a commercial on TV or a full page ad in a magazine or newspaper advertising the benefits of taking drug xyz for depression or anxiety compared to how often we may have seen any type of ad for CBT? Yet they are both well established treatments for anxiety and depression. I’m certainly not saying that CBT is always better than medication or that medication shouldn’t ever be considered, but an informed consumer should be aware that there are options. I often tell clients that there are three treatment options: medication, CBT and the combination. Another assumption that potential clients often make is that, since medication and CBT both work, then the combination should do better than either one alone – this assumption is also often not correct.

It can be difficult to decide which of the three options is best for any individual client. Clients often believe that if their anxiety is “severe” then they need the most powerful treatment – which they think is medication and CBT combined. I have treated many clients with “severe” anxiety who did just fine with CBT alone and I have also had clients who after a fair trial of CBT that seemed not to be progressing very well added medication to their treatment program and did better. I haven’t yet found a good formula for deciding who should start with CBT and who would benefit from starting with medication. At our clinic we generally suggest giving CBT a try and if we don’t see progress after reasonable period of time then we might add medication. Back to my original question – how is a potential client to choose treatment for their anxiety disorder? I would suggest considering all of the options and not just opting for medication right way. More and more primary care physicians are aware of the potential benefits of CBT and are often happy to make an appropriate referral. Consulting the web site for the Anxiety Disorders Association of America (www.adaa.org) and using their therapist locater service is a good idea as well. Finally, talking with your insurance company about who is on their panel of providers who uses CBT to treat anxiety. Once you have some names call and ask about the therapists training and experience with CBT for your particular anxiety disorder and ultimately choose the therapist who has the best combination of experience and with whom you felt the most comfortable over the telephone.