Combined cognitive behavioral therapy (CBT) and pharmacotherapy to improve treatment outcomes

Combined cognitive behavioral therapy (CBT) and pharmacotherapy was found in a systematic review with meta-analysis (Ray et al., 2020, 30 RCTs) to have:

• increased benefits compared with usual care and pharmacotherapy
  • the effect for CBT on posttreatment frequency outcomes was small, homogeneous, and statistically significant (g=0.18 [95%CI, 0.01-0.35]; P = .04; τ2=0.00, Q > 0.05, I2 = 0%)
  • for quantity outcomes effects were small to moderate, homogenous, and significant (g=0.28 [95% CI, 0.03-0.54]; P = .03; τ2=0.03; Q > 0.05; I2 = 31%).

Outcomes included the following in the decisional hierarchy established by the authors: (1) biological assay measures, (2) measures of frequency or quantity in the form of means (SDs), (3) sample proportions, and (4) other outcomes (eg, diagnostic measures).

CBT did not perform better than another evidence-based modality (eg. contingency management, motivation enhancement therapy, 12-step facilitation, and interpersonal therapy) in this context or as an add-on to combined usual care and pharmacotherapy.