Cognitive Behavioral Therapy and Medications

If you have an anxiety disorder, a basic question that you may ask yourself is: “How do I get better?” If you happen to bring this up to your doctor, they are very likely to prescribe you a drug without even mentioning the most effective, scientifically validated treatment around: Cognitive Behavioral Therapy or CBT for short. Over the past 20 or 30 years or so, scientists have discovered several principles that help people overcome their fears. These principles have to do with how thinking affects or colors emotional responses and how specific behaviors contribute either to helpful and adaptive emotional responses or painful and difficult ones. These principles contributed to the formation of a new type of therapy called Cognitive-Behavioral Therapy.

The Cognitive part (which means thinking) works by teaching people to change harmful, overly fearful, and non-realistic anxious thinking into more positive and realistic ways of thinking. The underlying assumption is: If you change the way you think, you will change the way you feel. The Behavioral part works by teaching people to engage in behaviors that have a calming effect to reduce anxious arousal, and by learning new behavior to face, rather than avoid fears through a process of Therapeutic Exposure to the fears. Cognitive Behavioral approaches for Anxiety Disorders are superior to medication in reducing anxiety and preventing relapse. Still most Americans have rarely heard of it and since many medical doctors do not have ready access to this approach, medication is often prescribed for anxiety disorders.
Lets take a look at the major classes of drugs used to “treat” anxiety disorders. There are two main classes of medication most commonly prescribed to treat anxiety: Tranquilizers (a class or grouping of Benzodiazepine based medicines like Xanax, Ativan, and Valium) and anti-depressants (like Prozac, Paxil, Zoloft, and Welbutrin). There are many, many more as well. The most recent research suggests that while Benzodiazepine medications work faster, there are many problems associated with their usage (including addiction and anxiety rebound when they are discontinued). The plain truth is that drugs are also associated with a variety of unpleasant side effects: weight gain, sexual dysfunction (like difficulty achieving orgasm and loss of desire), dry mouth, headaches, gastrointestinal distress and many others. Weight gain and sexual dysfunction are particularly common. Another significant problem with all classes of drug treatment for anxiety disorders is that once the drug is removed, the chances of a relapse are much greater then after a successful course of Cognitive Behavioral Therapy. The simple truth is that drugs only work while you take them! If you learn specific coping skills through CBT, they become a part of you for the rest of your life resulting in significantly reduced anxiety even after treatment has ended.
Cognitive Behavioral approaches to emotional problems, have been shown repeatedly by rigorous scientific studies to significantly reduce panic, anxiety, worry, and fear in a variety of well controlled studies. It has now been demonstrated that for certain Anxiety Disorders (including Panic Disorder and Agoraphobia), that these approaches have better outcomes and far less relapse then medication (again, when you go off the drug, the symptoms at some point usually come back). Most people are unaware of these findings because medication is by far still the most common treatment for anxiety problems. Unfortunately, per above, medication does not teach skills! Brain imaging studies have shown that after people underwent a course of Cognitive Behavioral Therapy they experienced a decrease in the fear center of the brain!