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Treatment Options: CBT or Medication

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Research often shows that CBT or medications are the most effective treatments for a wide range of disorders and other problems. How do you decide between them, or when they should be combined?

This section offers information on:

CBT or Medication – What’s the evidence?

    • As a general rule, findings suggest that CBT and medication are equally effective for many disorders, including anxiety, obsessive-compulsive disorder (OCD), and depression; although, the effects of CBT may last longer overall.
    • Medications tend to work a little faster than CBT (by a matter of weeks) and there are sometimes benefits from using the two in combination or in sequence. However, research has shown that after discontinuing CBT or medication, people who received CBT are less likely to experience a return of symptoms compared to those who received medication.
    • CBT has been shown to be more effective than medication for a number of conditions, such as social anxiety disorder, phobias, and insomnia.
    • Research comparing medication, CBT, a combination of medication and CBT, and placebo has generally found that the medication/CBT combination is not necessarily more effective than either CBT or medication alone. There are some exceptions though, where the combination does seem to work somewhat better for conditions such as hypochondriasis, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and panic disorder in adults. In children, similar results have been found, with either CBT alone or CBT and medication being the most effective for anxiety disorders.

Limitations of Medication and CBT

    • One concern about medication is the potential for side effects. Side effects can range from none or mild to severe and often differ from person to person. These side effects can include symptoms such as dry mouth, fatigue, insomnia, weight gain, and sexual side effects, which can make some medications intolerable. However, many side effects do diminish after a period of time, so it is important to talk with your provider before stopping or changing a medication due to side effects.
    • It can be difficult to find a CBT therapist with the training and experience to address your specific concerns. ABCT maintains a searchable directory of providers who are members of ABCT (see our Find a Therapist pages). However, regardless of where you find a provider, you should always ask about their background and experience with CBT to ensure it is a good fit for your needs.
    • CBT requires some commitment to practice the skills you learn outside of sessions. It can take some time to change behaviors and habits. In some cases, adding medication will provide more immediate relief of symptoms. Your provider can also help you develop skills for managing symptoms if you want to stop taking medication.

Types of Medications

There are several different types of psychiatric medications.

    • Psychiatric medications such as selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine, citalopram, sertraline, etc.) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (e.g., duloxetine, venlafaxine, etc.) are commonly used for the treatment of anxiety and depression. Other types of medications known as anti-psychotics, such as risperidone or olanzapine are typically used to treat psychotic disorders (disorders with symptoms including hallucinations and/or delusions), while mood stabilizers such as carbamazepine or lamotrigine are used to treatment bipolar disorders (also known as “manic depression”). It is important to note that these medications are not exclusively used for specific conditions, and a provider may use different types of medication to treat different conditions.
    • Benzodiazepines (e.g., diazepam, clonazepam, alprazolam) work very quickly and are typically used on an “as needed” basis. They are widely prescribed for anxiety and provide very rapid symptom relief. However, there is more concern with using these types of medications due to their increased risk for addiction, potential medical risks when discontinuing use abruptly, and withdrawal symptoms of “rebound” anxiety and sleep difficulties. Any person wanting to use a benzodiazepine as part of their treatment plan or wanting to discontinue use of a benzodiazepine should speak with their medical provider about the risks and benefits of this approach before making any changes.
    • Stimulants like methylphenidate and dextroamphetamine are sometimes used in the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents or to augment other medications in the treatment of depression. Stimulants can be addictive and there are ongoing concerns about their effects on growth and development, but they appear to have a role in conjunction with behavior management in the treatment of more severe instances of ADHD.
    • Hypnotics include medications like zolpidem are widely used to treat insomnia but also can be addictive if taken for too long. These medications can also cause sleep disruption if someone stops taking them. CBT for insomnia has been shown to provide very effective and lasting relief for insomnia without the risks associated with medication.

    Fallon, B. A., Ahern, D. K., Pavlicova, M., Slavov, I., Skritskya, N., & Barsky, A. J. (2017). A Randomized Controlled Trial of Medication and Cognitive-Behavioral Therapy for Hypochondriasis. The American journal of psychiatry, 174(8), 756–764. https://doi.org/10.1176/appi.ajp.2017.16020189

     Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB, Tu X. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 2005 Jan;162(1):151-61. doi: 10.1176/appi.ajp.162.1.151. PMID: 15625214.

    Simpson HB, Foa EB, Liebowitz MR, Ledley DR, Huppert JD, Cahill S, Vermes D, Schmidt AB, Hembree E, Franklin M, Campeas R, Hahn CG, Petkova E. A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. Am J Psychiatry. 2008 May;165(5):621-30. doi: 10.1176/appi.ajp.2007.07091440.

     Barlow DH, Gorman JM, Shear MK, Woods SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA. 2000 May 17;283(19):2529-36. doi: 10.1001/jama.283.19.2529. Erratum in: JAMA 2000 Nov 15;284(19):2450. Erratum in: JAMA 2001 Nov 22-29;284(20):2597.

     Ginsburg GS, Becker-Haimes EM, Keeton C, Kendall PC, Iyengar S, Sakolsky D, Albano AM, Peris T, Compton SN, Piacentini J. Results From the Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes. J Am Acad Child Adolesc Psychiatry. 2018 Jul;57(7):471-480. doi: 10.1016/j.jaac.2018.03.017. Epub 2018 May 9. PMID: 29960692.

     Piacentini J, Bennett S, Compton SN, Kendall PC, Birmaher B, Albano AM, March J, Sherrill J, Sakolsky D, Ginsburg G, Rynn M, Bergman RL, Gosch E, Waslick B, Iyengar S, McCracken J, Walkup J. 24- and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). J Am Acad Child Adolesc Psychiatry. 2014 Mar;53(3):297-310. doi: 10.1016/j.jaac.2013.11.010.

     Swan AJ, Kendall PC, Olino T, Ginsburg G, Keeton C, Compton S, Piacentini J, Peris T, Sakolsky D, Birmaher B, Albano AM. Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes. J Consult Clin Psychol. 2018 Sep;86(9):738-750. doi: 10.1037/ccp0000334.

    Wang Z, Whiteside SPH, Sim L, Farah W, Morrow AS, Alsawas M, Barrionuevo P, Tello M, Asi N, Beuschel B, Daraz L, Almasri J, Zaiem F, Larrea-Mantilla L, Ponce OJ, LeBlanc A, Prokop LJ, Murad MH. Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017 Nov 1;171(11):1049-1056. doi: 10.1001/jamapediatrics.2017.3036. Erratum in: JAMA Pediatr. 2018 Oct 1;172(10):992.

    Williams T, Hattingh CJ, Kariuki CM, Tromp SA, van Balkom AJ, Ipser JC, Stein DJ. Pharmacotherapy for social anxiety disorder (SAnD). Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD001206. DOI: 10.1002/14651858.CD001206.pub3

Related Information

Suggested Resources

What Is Cognitive Behavior Therapy?

Cognitive Behavioral Therapy is a type of treatment that is based firmly on research findings.  It places emphasis on changing your cognitions (thoughts) or behaviors (actions) in order to effect change in how you feel. These approaches help people in achieving specific changes or goals.

Changes or goals might involve:

A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like reducing back pain or helping a person stick to a doctor’s suggestions.

Cognitive behavioral therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on a person’s views and beliefs about their life. CBT is an effective treatment for individuals, parents, children, couples, and families. The goal of CBT is to help people improve and gain more control over their lives by changing behaviors that don’t work well to ones that do.

How to Get Help

If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist. It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association. Of course, they should be licensed to practice in your state. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. You may, of course, visit our website (www.abct.org) and click on “Find a CBT Therapist”

The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.