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What Works Best? CBT or Meds for Anxiety, Depression…

30 Apr

Researchers from the Puget Sound Health Care System in Seattle, Washington conducted a meta-analysis on whether cognitive behavioral therapy is more efficacious than medication for depressive disorders vs. anxiety disorders.
The investigators selected randomized controlled studies comparing CBT and pharmacotherapy, with or without placebo, in adults with major depressive or anxiety disorders.

Twenty-one anxiety studies (N = 1,266) and twenty-one depression studies (N = 2,027) comparing medication to CBT were included. Including all anxiety disorders, the overall effect size was .25 (95% CI: -0.02, 0.55, P =.07).  Effects for panic disorder significantly favored CBT over medications (.50, 95% CI: 0.02, 0.98). Obsessive-compulsive disorder showed similar effects-sizes, though not statistically significant (.49, 95% CI: -0.11, 1.09). Medications showed a nonsignificant advantage for social anxiety disorder (-.22, 95% CI: -0.50, 0.06).

The overall effect size for depression studies was .05 (95% CI: -0.09, 0.19), with no advantage for medications or CBT.

Pooling anxiety disorder and depression studies, the omnibus comparison of the relative difference between anxiety and depression in effectiveness for CBT versus pharmacotherapy pointed to a nonsignificant advantage for CBT in anxiety  disorders, as opposed to depression (B =.14, 95% CI: -0.14, 0.43).

On balance, the evidence indicates that there are at most very modest differences in the effects of CBT versus pharmacotherapy in the treatment of anxiety, as opposed to depressive disorders.  On the other hand, there seems to be larger differences between the anxiety disorders in terms of their relative responsiveness to pharmacotherapy versus CBT.

Citation: Roshanaei-Moghaddam B, Pauly MC, Atkins DC, Baldwin SA, Stein MB, Roy-Byrne PRelative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety? Depression and Anxiety. 2011 Jul; 28 (7):pages 560-7. Epub 2011 May 23. This email address is being protected from spambots. You need JavaScript enabled to view it.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award