Got a problem? Should you take something for it or do something about it?

Anxious? Depressed? Should you take something or do something?

Posted Aug 03, 2010

Sometimes the single most important intervention a therapist can make is convincing a client to try a course of psychotropic medication. Alternatively, it can sometimes be just as crucial to discourage some clients from seeking medical solutions to their emotional problems. How is one to know which direction to take when faced with this fork in the therapy road?

The good news is that neither decision is irreversible. If adequate trials of medication don't do the trick, serious effort in cognitive-behavioral therapy (CBT) usually leads to positive results. Conversely, if a considerable commitment to working in CBT doesn't yield sufficient results, augmenting psychosocial therapy with appropriate medication can produce an excellent outcome. Indeed, the synergy of CBT combined with medication can result in some of the most rapid and durable progress possible.

Still, how does one know if a problem requires the "take something for it" or the "do something about it" approach, or, as suggested above, the combined treatment? First, let me clarify that by "do something about it," I specifically mean undergo CBT because there is an impressive body of scientific research validating the efficacy of CBT and indicating it's the non-medical treatment of choice for most psychological problems. In fact, a lot of recent neuroimaging research has demonstrated that the changes in brain metabolism that are produced by medications are also produced by CBT.

Nevertheless, if someone is suffering from severe Bipolar Disorder, psychotic illness, incapacitating or suicidal depression, crippling OCD, or extreme panic it is usually necessary to "jump start" therapy with appropriate medication. Once symptoms have subsided sufficiently, the work of CBT can be meaningfully undertaken. In many cases, medication can then be reduced and sometimes discontinued completely.

If a person is suffering from the stress of daily living, having trouble managing a significant life event, or struggling with relationship problems, however, medication should not be an immediate consideration. Rather, learning adaptive coping strategies, problem solving skills, and/or emotional regulation techniques should be the first line of treatment.

Many people fall within the middle of this spectrum of psychological distress. In most cases, the more they're willing to do about their problems (i.e., meaningfully engage in CBT) the less they'll need to take for them.

Remember, think well, act well, feel well, be well!

Copyrighyt by Clifford N. Lazarus, Ph.D.