Question 1

Is therapy or medication more effective for anxiety, and which lasts longer after stopping?

Accepted Answer

A 2022 umbrella review synthesizing 102 meta-analyses and 3,782 RCTs found combined treatment superior to monotherapy, with an aggregate standardized mean difference of 0.31. A 2024 systematic review of relapse prevention showed that psychotherapy alone (RR=0.58) and combined treatment (RR=0.60) both outperform medication alone in preventing relapse after treatment cessation. The protective effect is mediated by cognitive and behavioral skills acquired during therapy. Both modalities converge in effect size when outcome is measured at 24-36 weeks in real-world practice, driven by monotherapy patients seeking additional treatment. Combined treatment from initiation remains the most evidence-supported approach.

Question 2

How do CBT and SSRI effect sizes compare?

Accepted Answer

A 2022 umbrella review synthesizing 102 meta-analyses and 3,782 RCTs found combined treatment superior to monotherapy, with an aggregate standardized mean difference of 0.31. A 2024 systematic review of relapse prevention showed that psychotherapy alone (RR=0.58) and combined treatment (RR=0.60) both outperform medication alone in preventing relapse after treatment cessation. The protective effect is mediated by cognitive and behavioral skills acquired during therapy. Both modalities converge in effect size when outcome is measured at 24-36 weeks in real-world practice, driven by monotherapy patients seeking additional treatment. Combined treatment from initiation remains the most evidence-supported approach.

Question 3

What's the relapse rate after stopping CBT vs stopping medication?

Accepted Answer

A 2022 umbrella review synthesizing 102 meta-analyses and 3,782 RCTs found combined treatment superior to monotherapy, with an aggregate standardized mean difference of 0.31. A 2024 systematic review of relapse prevention showed that psychotherapy alone (RR=0.58) and combined treatment (RR=0.60) both outperform medication alone in preventing relapse after treatment cessation. The protective effect is mediated by cognitive and behavioral skills acquired during therapy. Both modalities converge in effect size when outcome is measured at 24-36 weeks in real-world practice, driven by monotherapy patients seeking additional treatment. Combined treatment from initiation remains the most evidence-supported approach.

Question 4

Is CBT more cost-effective over 1-2 years due to durability?

Accepted Answer

A 2022 umbrella review synthesizing 102 meta-analyses and 3,782 RCTs found combined treatment superior to monotherapy, with an aggregate standardized mean difference of 0.31. A 2024 systematic review of relapse prevention showed that psychotherapy alone (RR=0.58) and combined treatment (RR=0.60) both outperform medication alone in preventing relapse after treatment cessation. The protective effect is mediated by cognitive and behavioral skills acquired during therapy. Both modalities converge in effect size when outcome is measured at 24-36 weeks in real-world practice, driven by monotherapy patients seeking additional treatment. Combined treatment from initiation remains the most evidence-supported approach.

Question 5

When does adding medication to CBT meaningfully improve outcomes?

Accepted Answer

A 2022 umbrella review synthesizing 102 meta-analyses and 3,782 RCTs found combined treatment superior to monotherapy, with an aggregate standardized mean difference of 0.31. A 2024 systematic review of relapse prevention showed that psychotherapy alone (RR=0.58) and combined treatment (RR=0.60) both outperform medication alone in preventing relapse after treatment cessation. The protective effect is mediated by cognitive and behavioral skills acquired during therapy. Both modalities converge in effect size when outcome is measured at 24-36 weeks in real-world practice, driven by monotherapy patients seeking additional treatment. Combined treatment from initiation remains the most evidence-supported approach.

PsychHQ

Therapy Versus Medication for Anxiety: Efficacy, Durability, and Cost-Effectiveness