Integrating Psychotherapy and Psychopharmacology: A Handbook for Clinicians

315 Pages·2013·2.798 MB·English

by  Irismar Reis de Oliveira, Thomas Schwartz, Stephen M. Stahl

Integrating Psychotherapy
and Psychopharmacology
Integrating Psychotherapy and Psychopharmacology: A Handbook for Clinicians is a practical
guide for the growing number of mental health practitioners searching for information on
treatments that combine psychopharmacology, psychotherapy, and psychosocial rehabilita-
tion. Research shows that combined approaches are among the most effective ways to treat
an increasing number of psychiatric disorders. However, though these combined treatments
are becoming the everyday practice of psychiatrists, psychologists, and other mental health
professionals, identifying the right treatment plan can be notoriously diffi cult, and clinicians
are often left scrambling to answer questions about how to design and customize their treat-
ment strategies. In Integrating Psychotherapy and Psychopharmacology , readers will fi nd these
questions fully addressed and the answers explained, and they’ll come away from the book
with a toolbox full of strategies for helping their patients improve symptoms, achieve remis-
sion, and stay well using a combination of drug and psychological treatments.
Irismar Reis de Oliveira, MD, PhD, is a professor of psychiatry in the department of neu-
rosciences and mental health at the Federal University of Bahia, Brazil. He is the creator of
trial-based cognitive therapy and has trained therapists in Brazil and other countries in this
model. Dr. de Oliveira also maintains a private practice and is the editor of Standard and In-
novative Strategies in Cognitive Behavior Therapy .
Thomas Schwartz, MD, is a professor in the department of psychiatry at SUNY Upstate
Medical University in Syracuse, New York, where he is also director of adult psychiatric clini-
cal services, assistant director for psychiatric medical students, and director of the Depression
and Anxiety Disorders Research Program. Dr. Schwartz also maintains a private practice and
consults for the Indian Health Service, the Neuroscience Education Institute, pharmaceuti-
cal companies, and associated industries as well. He is the coeditor of Depression: Treatment
Strategies and Management , 2nd edition.
Stephen M. Stahl, MD, PhD, is an adjunct professor of psychiatry at the University of
California–San Diego, chairman of the Neuroscience Education Institute, and an honorary
visiting senior fellow at the University of Cambridge. He is the author of over 450 articles
and chapters; more than 1,200 scientifi c presentations and abstracts; and the author of many
books, including the best-selling and award-winning Stahl’s Essential Psychopharmacology ,
and The Prescriber’s Guide, both now in their fourth editions, and the recently published
series of clinical cases, C ase Studies: Stahl’s Essential Psychopharmacology.
Psychopharmacology and Psychotherapy in Clinical Practice
Bret A. Moore, PsyD, ABPP, Series Editor
Anxiety Disorders: A Guide for Integrating Psychopharmacology and Psychotherapy
by Stephen M. Stahl and Bret A. Moore
Integrating Psychotherapy and Psychopharmacology: A Handbook for Clinicians
by Irismar Reis de Oliveira, Thomas Schwartz, and Stephen M. Stahl
Integrating Psychotherapy
and Psychopharmacology
A Handbook for Clinicians
Edited by
Irismar Reis de Oliveira, Thomas Schwartz, and
Stephen M. Stahl
First published 2014
by Routledge
711 Third Avenue, New York, NY 10017
Simultaneously published in the UK
by Routledge
27 Church Road, Hove, East Sussex BN3 2FA
© 2014 Taylor & Francis
Routledge is an imprint of the Taylor & Francis Group, an informa business
The right of the editors to be identifi ed as the authors of the editorial material, and of the
authors for their individual chapters, has been asserted in accordance with sections 77 and 78
of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval system,
without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identifi cation and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Integrating psychotherapy and psychopharmacology : a handbook for clinicians / edited by
Irismar Reis de Oliveira, Thomas Schwartz and Stephen M. Stahl.
pages cm
Includes bibliographical references and index.
1. Psychology, Pathological. 2. Mental illness—Treatment. 3. Psychotherapy.
4. Psychopharmacology. I. Oliveira, Irismar Reis de, editor of compilation. II. Schwartz,
Thomas L., editor of compilation. III. Stahl, Stephen M., 1951– editor of compilation.
RC454.I53 2014
616.8914—dc23
2013021464
ISBN: 978-0-415-52997-6 (hbk)
ISBN: 978-0-415-83857-3 (pbk)
ISBN: 978-0-203-11732-3 (ebk)
Typeset in Minion
by Apex CoVantage, LLC
Contents
List of Figures vii
List of Tables ix
List of Contributors xi
Foreword xiii
STEPHEN HOLLON
Preface xv
STEPHEN M. STAHL
Series Editor Introduction xvii
BRET A. MOORE
1 Integrating Psychotherapy and Psychopharmacology: Outcomes,
Endophenotypes, and Theoretical Underpinnings Regarding Effectiveness 1
THOMAS L. SCHWARTZ AND SHILPA SACHDEVA
2 Trial-Based Cognitive Therapy (TBCT): A New Cognitive-Behavior
Therapy Approach 24
IRISMAR REIS DE OLIVEIRA
3 Integrating Psychopharmacology and Psychotherapy in Mood Disorders:
Major Depression 66
AARON M. KOENIG, EDWARD S. FRIEDMAN, AND MICHAEL E. THASE
4 Integrating Psychopharmacology and Psychotherapy in Mood Disorders:
Bipolar Disorder 87
DONNA M. SUDAK AND WEI DU
5 Integrating Psychopharmacology and Cognitive Remediation to Treat Cognitive
Dysfunction in the Psychotic Disorders 106
ALICE MEDALIA, LEWIS A. OPLER, AND MARK G. OPLER
6 Integrating Psychopharmacology and Psychotherapy in Anxiety Disorders 125
DAVID S. SHEARER, CHRISTOPHER S. BROWN, S. CORY HARMON, AND BRET A. MOORE
7 Integrating Psychopharmacology and Psychotherapy in Eating Disorders 147
PHILLIPA J. HAY, JOSUÉ BACALTCHUK, AND STEPHEN TOUYZ
vi CONTENTS
8 Integrating Psychopharmacology and Psychotherapy to Treat Children
with ADHD 161
TAIS S. MORIYAMA, GUILHERME V. POLANCZYK, FERNANDA S. TERZI, KAUY M. FARIA,
MANFRED DÖPFNER, AND LUIS A. ROHDE
9 Integrating Psychopharmacology and Psychotherapy in Insomnia 186
KARL DOGHRAMJI AND DIMITRI MARKOV
10 Integrating Psychotherapy and Medication for Addicted Patients 204
DIANE ST. FLEUR AND BRIAN JOHNSON
11 Integrating Pharmacotherapy and Psychotherapy in Perinatal Distress 224
AMY WENZEL
12 Integrating Psychotherapy and Psychopharmacology in Sexual Disorders 242
MEHMET Z. SUNGUR AND ANIL GÜNDÜZ
13 Integrating Psychopharmacology and Computer-Based Psychotherapy 266
JOHN GREIST
14 A Delicate Balance: The Contribution of Psychosocial Factors to Biological
Treatments of Mental Disorders 277
ROGER P. GREENBERG AND MANTOSH J. DEWAN
Index 289
Figures
2.1 Interactions between cognitions and responses to cognitions. 25
2.2 Conceptualization diagram showing an activated negative core belief. 26
2.3 Mary-Ann’s conceptualization diagram showing ATs, UAs, and an activated
negative core belief. 29
2.4 Mary-Ann’s Intra-TR. 30
2.5 Color-coded symptom hierarchy (CCSH) card to facilitate exposure
implementation. 32
2.6 Mary-Ann’s chart showing weekly progress (total score and the number
of things she wasn’t able to do), based on the CCSH. 34
2.7 Mary-Ann’s consensual role-play (CRP) to help her understand and make the
decision to take the elevator. 35
2.8 Mary-Ann’s action plan (step 7 of CRP) to help her gather information to
make the decision to take the elevator in the future. 36
2.9 Ida’s Evidence-Based Meaning Card, derived from the defense attorney’s
pleas, copied by the patient from columns 3 and 6 of the TBTR in
Table 2.4, in the fi rst person, to help her remember the conclusions
she reached role-playing the defense attorney. 53
10.1 Craving/Dreaming Pathways: Neurop = neuropeptides, GABA = gamma
amino butyric acid, CB = cannabinoid. 206
10.2 Cumulative response to DDP treatment as measured by the proportion of
participants achieving at least 25% improvement in Borderline
Improvement of Severity Over Time score; primary outcome measure. 212
13.1 Adult and pediatric OCD effi cacy of SRIs and CBT alone and in combination. 267
13.2 Change in Beck Depression Inventory scores with computer versus therapist
CBT and wait control. 269
13.3 Completer analysis mean improvement in total Y-BOCS. 269
13.4 Mean reduction in rituals and obsessions hours/day. 270
13.5 Dose-response relationship between exposure and ritual
prevention sessions with BT STEPS and reduction in Y-BOCS score. 270
13.6 Effect of CBT and SMT as augmentation of SRI treatment. 272
13.7 D-Cycloserine versus placebo in CBT for OCD. 273
13.8 OCD treatment preferences. 274
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Tables
2.1 Cognitive distortions, defi nitions, and examples. 28
2.2 Questions to be answered by the patients when they fi ll in the Intra-TR. 30
2.3 Mary-Ann’s symptom scores (0–5) assessed according to
the color-coded symptom hierarchy (CCSH) card in Fig. 2.5. 33
2.4 Illustration of the trial-based thought record in a patient with OCD. 38
2.5 Ida’s appeal preparation—one-belief form . 51
2.6 Ida’s appeal preparation—two or more–belief form . 52
4.1 DSM-IV criteria for bipolar disorder. 88
7.1 Selected fi ndings from meta-analyses of randomized controlled trials
of antidepressant or topiramate versus placebo or no treatment control
in bulimia nervosa and binge eating disorder. (AD = antidepressants,
MAOI = monoaminooxidase inhibitor). 150
7.2 Randomized controlled trials for bulimia nervosa (BN) or binge eating
disorder (BED) comparing cognitive-behavior therapy (CBT) combined
with either antidepressant drug or psychotherapy alone: Outcomes at end
of therapy and follow-up. 155
8.1 Meta-analyses reporting ES of stimulants and nonstimulants for ADHD. 164
8.2 Meta-analyses comparing stimulants with nonstimulants for ADHD. 167
8.3 Meta-analyses reporting effect size of psychosocial interventions for ADHD. 170
9.1 Impact of receptor systems on sleep continuity. 190
9.2 Effects of antidepressants on sleep continuity. 190
9.3 Effects of antipsychotics on sleep continuity. 191
9.4 FDA-approved hypnotic agents. 192
9.5 P sychological and behavioral therapies for insomnia. 195
9 .6 E lements of sleep hygiene education. 195
9 .7 R ules of stimulus control therapy. 195
9.8 Sleep restriction therapy. 196
9.9 Factors favoring the initiation of treatment with CBT or pharmacotherapy. 198
9.10 Studies examining the combination of pharmacologic agents and CBT in
the initial management of primary insomnia. 199
10.1 Summary of pharmacotherapies of common addictive drugs. 208
12.1 Comparison of effi cacy and side effects of 5PDEI (studies which use
the same primary effi cacy measures are chosen for comparative reasons). 245