Chapter 4.Combined CBT and Psychopharmacology

Since the 1990s, the field of mental health has significantly expanded its knowledge base on the treatment of pediatric psychiatric disorders through empirical research, which informs everyday clinical practice. This is most evident in the area of pediatric psychopharmacology. Pharmacotherapy has become an important treatment tool for clinicians treating children and adolescents with psychiatric disorders. Another effective treatment modality for many of these disorders is cognitive-behavior therapy (CBT), a well-established psychosocial intervention. Empirical evidence now exists to support the combination of both pharmacotherapy and CBT in the pediatric mental health sector for optimal outcome. Although the evidence supporting the efficacy of both interventions is relatively comparable for many psychiatric disorders, most parents and children prefer psychotherapy as a first-line intervention. For example, parents of anxious children with no prior treatment history have been found to prefer CBT to medication for the treatment of their child’s anxiety disorder. CBT is often perceived to be more acceptable, believable, and effective than medication (Brown et al. 2007). Medication is often used in conjunction with CBT when symptoms are in the moderate to severe range or when treatment with CBT has not provided symptom resolution. However, given the lack of treatment guidelines, clinicians face challenges regarding the use of combined treatment (CBT plus pharmacotherapy), such as the indications for use of the combination approach versus monotherapy treatment.