Cognitive-behavioral therapy combined with

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Anton RF, Moak DH, Latham PK, et al Posttreatment results of combining naltrexone with cognitive-behavior therapy for the treatment of alcoholism. J Clin Psycho-pharmacol 21 72—77, 2001... 

Interpersonal therapy and cognitive behavioral therapy are types of psychotherapy that have well-documented efficacy for the treatment of MDD. Psychotherapy alone is an initial treatment option for mild to moderate cases of depression, and it may be useful when combined with pharmacotherapy in the treatment of more severe cases of depression. In fact, the combination of psychotherapy and pharmacotherapy can be more effective than either treatment modality alone in cases of severe or recurrent MDD. Psychotherapy can be especially helpful for patients with significant psychosocial stressors, interpersonal difficulties, or comorbid personality disorders.16... 

Empirically validated cognitive behavioral therapy for couples can be quite helpful if relationship problems are an issue. Cognitive behavioral couples therapy combines the best of cognitive behavioral and family therapy techniques in order to help couples. The research suggests that use of this type of therapy can be quite helpful in mediating and resolving problems involving couples. Counselors may want to make a referral for this therapy if clients have relationship issues that interfere with aftercare. 

The type of psychotherapy that has been shown to help people with anxiety problems is called cognitive-behavioral therapy. Cognitive-behavioral therapy is the combination of two distinct kinds of psychotherapy—cognitive therapy and behavior therapy. 

Comorbid personality disorders have long been associated with TRD and a poor response to antidepressant treatment. For example, Pfohl et al. (1984) observed only a 16% response rate in inpatients with comorbid depression and personality disorder compared with a 50% response rate in patients with pure depression. Similar results were reported from a study by D. W. Black et al. (1987), in which, with the use of ECT in addition to a TCA, the response rate among those with a comorbid Axis II disorder was lower, 42% compared with a 60% recovery in those without Axis II pathology. The best approach for these patients may be a combination of psychotherapy and medication. This approach was recently borne out by the Treatment of Depression Collaborative Research Project (Shea et al. 1990), which found that cognitive-behavioral therapy yielded a better response than either imipra-... 

Loerch B, Graf-Morgenstern M, Hautzineger M, et al. Randomised placebo-controlled trial of moclobemide, cognitive-behavioral therapy and their combination in panic disorder with agoraphobia. Br J Psychiatry 1999 174 205-212. 

A recent review also finds that cognitive-behavioral therapy may be beneficial for older depressed patients either as the sole treatment or in combination with an antidepressant (295). 

The promising findings of the trials already mentioned, as well as the possible benefits of opiate antagonists in treating symptoms of schizophrenia or bipolar disorder without alcohol dependence or co-morbid alcohol and cocaine dependence, however, warrant studies in these difficult-to-treat populations ( 419, 420, 421 and 422). Furthermore, some data support a synergistic therapeutic effect when naltrexone is combined with cognitive-behavioral therapy ( 423). 

In clinical practice, it is not rare to find chronic insomniacs taking a hypnotic for years. In this population, a progressive 15-day withdrawal, may not help avoiding an immediate worsening of sleep parameters [61]. Furthermore, discontinuation of the hypnotic has been demonstrated to be a very difficult task for prolonged users of benzodiazepines, even when their medication taper was combined with cognitive-behavior therapy [62],... 

March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J., et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression Treatment for Adolescents with Depression Study (TADS) team. Journal of the American Medical Association, 292, 807-820. 

Balldin J, Berglund M, Borg S, Mansson M, Bendtsen P, Franck J, Gustafsson L, Halldin J, Nilsson LH, Stolt G, Willander A (2003) A 6-month controlled naltrexone study combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence. Alcohol Clin Exp Res 27 1142-1149... 

In general, patients who seek treatment acutely after a trauma and are in intense distress should receive therapy based on their presenting symptoms (e.g., a nonbenzodiazepine hypnotic for difficulty sleeping). Short courses of cognitive behavioral therapy (CBT) can be helpful. If symptoms (e.g., hyperarousal, avoidance, dissociation, sleep difficulties, or depressed mood) persist for 3 to 4 weeks and the patient experiences marked social, occupational, and/or interpersonal impairment, they should be treated with pharmacotherapy, psychotherapy, or both. Many patients with PTSD will improve substantially with pharmacotherapy but retain some symptoms. Treatment regimens usually combine psychoeducation, psychosocial support and/or treatment, and pharmacotherapy."... 

Naltrexone 100 mg/day-I-sertraline 200 mg/day was more effective than either drug alone in depression and alcohol abstinence/ delay before relapse. Alcohol-dependent depressed patients (n = 170) were randomly assigned to four groups naltrexone only, sertraline only, naltrexone-I-sertraline, and placebo. All received weekly cognitive behavioral therapy. The rate of adverse events was lower in the combination treatment group (12%) than in the other groups (naltrexone 27%, sertraline 38%, placebo 28%) however, more subjects withdrew seven patients compared with two, four, and one in the naltrexone, sertraline, and placebo groups respectively [213. ... 

Results have been reported from the Treatment of Adolescents with Depression Study (TADS) 6 ], in which 439 adolescents were randomly allocated to 12 weeks of fluoxetine, cognitive behavioral therapy, the combination of these, or clinical... 

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