This month's issue of Psychiatric Annals is the first of two issues, guest edited by Dr. Naomi Simon and Dr. Mark Pollack, reviewing the current status of the treatment of anxiety disorders. This particular issue reviews the treatment of social phobia, panic disorder, and obsessive-compulsive disorder. Two generalizations can be made concerning our developing knowledge of the treatment of anxiety disorders:
1. It is clear that selective serotonin reuptake inhibitor medications have been shown to be the first-line preference medications for the treatment of anxiety disorders.
2. Less recognized in psychiatry is the demonstrated efficacy of cognitive-behavioral treatments for anxiety disorders (not to mention depression).
There is little question concerning the potential value of cognitive-behavioral techniques in the treatment of psychiatric disorders when the evidence is reviewed, but how many psychiatrists have obtained sufficient training to become proficient in the use of these techniques?
Up until the 1960s to 1970s, psychodynamic psychotherapy was the mainstay of psychiatric treatment. Almost 40 years later, a lot has changed in the field of psychiatry because of science and economics. Psychopharmacology has become the dominant treatment modality in psychiatry. Practice has come to a point where many psychiatrists are expected to diagnose a patient's disorder, prescribe an appropriate psychoactive medication, and refer to a psychotherapist, if indeed psychotherapy is ''required."
While these trends have been developing, a mass of studies demonstrating the efficacy of cognitive-behavioral therapies has built up following the dogged persistence of Aaron Beck, MD, in developing cogmtive-behavioral therapies for depression and anxiety disorders, followed by many psychologists who have continued to demonstrate the potential of these therapies. But unlike our (past?) relationship with psychoanalysis, how many psychiatrists have been trained to proficiency in the use of these powerful cognitive-behavioral techniques? Why is psychiatric practice becoming more and more unidimensional, as "split therapy" becomes the norm for practice? Why do patients tell me that their psychiatrists do not talk with them? Now there's a 180!
How does the contemporary psychiatrist prepare for being the most effective with patients? Besides becoming an absolute expert in diagnosis and psychopharmacologic treatment with a strong background in psychodynamic theory, be sure you learn or get specific instruction and supervised experience in the use of cognitive-behavioral therapies with your patients. If you want to be a true psychiatric expert, one who can earn his or her salt, learn to combine cognitive-behavioral treatment with psychqpharmacologic therapies. Learn to treat the difficult cases using a range of techniques, and do not let yourself be relegated to writing prescriptions after 15-minute "med checks."
It is becoming clear that cognitive-behavioral treatment is a very effective therapeutic weapon, so be sure you develop expertise in using it. The growing evidence supporting the effectiveness of cognitive-behavioral techniques should not be ignored or split off from psychiatric practice by default.