Book contents
- Frontmatter
- Dedication
- Contents
- List of tables, boxes, figures and case examples
- Foreword
- Preface
- Structure of the book
- List of abbreviations
- 1 Introduction
- 2 Assessment
- 3 Rules of reinforcement and practical examples
- 4 Social skills training
- 5 Relationship, communication and sexual skills training
- 6 Phobic and social anxiety
- 7 Treatment of obsessive–compulsive disorders
- 8 Depression
- 9 Generalised anxiety disorder and panic
- 10 Body dysmorphic disorder and the somatic symptom and related disorders
- 11 Eating disorders
- 12 Addictive behaviour
- 13 Schizophrenia and the psychoses
- 14 Personality disorder
- 15 CBT in combination with other therapy
- Glossary
- Index
15 - CBT in combination with other therapy
Published online by Cambridge University Press: 01 January 2018
- Frontmatter
- Dedication
- Contents
- List of tables, boxes, figures and case examples
- Foreword
- Preface
- Structure of the book
- List of abbreviations
- 1 Introduction
- 2 Assessment
- 3 Rules of reinforcement and practical examples
- 4 Social skills training
- 5 Relationship, communication and sexual skills training
- 6 Phobic and social anxiety
- 7 Treatment of obsessive–compulsive disorders
- 8 Depression
- 9 Generalised anxiety disorder and panic
- 10 Body dysmorphic disorder and the somatic symptom and related disorders
- 11 Eating disorders
- 12 Addictive behaviour
- 13 Schizophrenia and the psychoses
- 14 Personality disorder
- 15 CBT in combination with other therapy
- Glossary
- Index
Summary
Overview
Many books on CBT fail to take account of the fact that most patients with mental health problems are receiving psychotropic medication. Such medication may be unhelpful, as with long-term benzodiazepine treatment of anxiety disorders, or helpful and indeed essential, as with treatment of schizophrenia, moderate to severe depression or severe, refractory OCD. The interactive effect of medication and CBT will be discussed in this chapter. Sometimes other non-pharmacological treatments will also be necessary to effect meaningful change. Examples such as the use of EMDR for post-traumatic stress disorder (PTSD) will be described. In addition, the pitfalls of combining CBT with more analytical approaches will be evaluated as well as a brief examination of CAT and systemic family therapy.
Medication and CBT
CBT therapists have not always been accepting of the role of medication in treatment. It remains a fact, despite this, that the majority of patients who are treated by CBT in a psychiatric hospital and a significant minority treated by CBT in general practice will be on at least one psychopharmacological agent.
In 2012, an international panel of experts reported some guidelines on the psychopharmacological treatment of anxiety disorders, OCD and PTSD in primary care (Bandelow et al, 2012). This group of eminent psychiatrists and others concluded that selective serotonin reuptake inhibitors (SSRIs) were useful in all conditions; serotonin-noradrenaline reuptake inhibitors (SNRIs) for anxiety disorders (not OCD) and pregabalin for generalised anxiety disorder only. A combination of medication and CBT including exposure therapy was shown to be a clinically desired treatment strategy.
The benzodiazepine experience
The first benzodiazepine, chlordiazepoxide, was introduced for the treatment of anxiety in the late 1950s. Thereafter a large number of similar compounds came on the market. Unlike their predecessors, the barbiturates, these were considered to be safe and not to produce dependency and withdrawal syndromes. Throughout the 1960s and 1970s they were widely prescribed in general practice and hospitals for mild anxiety, bereavement, insomnia as well as all psychiatric disorders.
- Type
- Chapter
- Information
- CBT for AdultsA Practical Guide for Clinicians, pp. 232 - 243Publisher: Royal College of PsychiatristsPrint publication year: 2014