Integrating Psychotherapy and Psychopharmacology for Treatment of Mood, Psychotic, Anxiety Disorders and Insomnia

Developed by Julia M. DiFilippo, Ph.D., Chapters from the Routledge book collection

Course content available in chapters.

Content from this course is also included in the 15-hour course on Psychopharmacology

This intermediate-level course focuses on the benefits, limitations, and challenges of integrating psychotherapy with psychopharmacological treatment for depression, bipolar disorder, psychotic disorders, anxiety disorders, and insomnia. For some conditions (e.g., bipolar disorder, schizophrenia), pharmacologic interventions are generally considered to be the primary mode of treatment, with psychotherapy providing added benefit. For other conditions, (e.g., anxiety disorders), psychotherapy is generally considered to be the more effective approach, with medication at times enhancing or hindering the therapeutic work. And for some conditions (e.g., major depression, insomnia), patient preference and symptom severity can influence decision making for optimal care.

This course contains five chapters from the Routledge book, Integrating Psychotherapy and Psychopharmacology: A Handbook for Clinicians. The first chapter provides an overview of the use of antidepressant medications and then addresses how antidepressant medications can be combined with cognitive-behavioral, interpersonal, and psychodynamic psychotherapies. The second chapter on bipolar disorder highlights psychopharmacology as the cornerstone of treatment and then provides evidence for combined biological and psychological treatments. The third chapter on treating psychotic disorders reviews pharmacological treatments, explains the importance of cognitive remediation, and concludes with promising new areas of research in the combination of pharmacotherapy and cognitive remediation.

The fourth and fifth chapters focus on treating anxiety disorders and insomnia respectively. The benefits of psychological treatments, as well as limitations of pharmacologic treatments, are discussed. The literature addressing generalized anxiety disorder, specific phobia, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder with and without agoraphobia, are reviewed independently. Finally, the importance of a thorough evaluation of insomnia, including the etiology of the sleep difficulties and management of comorbid conditions, is highlighted. Pharmacologic and nonpharmacologic approaches are reviewed, with consideration of the patient’s specific needs in determining the optimal treatment approach.

Educational Objectives

This course will teach the participant to:

Explain the ways in which antidepressant medication can be combined with cognitive-behavioral, interpersonal, and psychodynamic approaches for the treatment of depression
Identify how cognitive-behavioral and other psychological approaches can enhance the effectiveness of pharmacologic treatment of bipolar disorder
Discuss the strengths and benefits of using a combined approach for the treatment of cognitive dysfunction in psychotic disorders
Identify the benefits of psychotherapy in the treatment of anxiety disorders and the specific diagnoses for which medication and/or its combination with psychotherapy have little or mixed benefit
Explain the clinical issues involved in the combination of psychotherapy and medication for the treatment of insomnia

Syllabus

Part one: Integrating psychopharmacology and psychotherapy for major depression

Historical perspective on the use of antidepressants
Measuring the efficacy of antidepressants and psychotherapy
Combining antidepressants with modern psychotherapies
- Cognitive-behavioral therapy (CBT)
- Interpersonal therapy (IPT)
- Psychodynamic psychotherapy
Clinical models of combining medications and psychotherapy in depression
- Split treatment
- Integrated treatment

Part two: Integrating psychopharmacology and psychotherapy for bipolar disorder

Psychopharmacology as the cornerstone of treatment for bipolar disorder
- Acute manic episodes
- Acute depressive episodes
- Mixed episodes and rapid cycling
Evidence base for combined biological and psychological treatment
- Cognitive-behavioral therapy (CBT)
- Family-focused treatment (FFT)
- Interpersonal social rhythm therapy (IPSRT)
- Psychoeducation

Part three: Integrating psychopharmacology and psychotherapy for psychotic disorders

Cognitive dysfunction in schizophrenia
Psychopharmacological treatment of cognitive symptoms in schizophrenia
Cognitive remediation
- Impact on neurocognitive symptoms
- Impact on social cognitive symptoms
- Strengths/benefits and weaknesses/limitations of using cognitive remediation as the sole approach
Combining pharmacological and psychosocial treatment
- Review of randomized controlled studies
- Strengths and benefits of using a combined approach

Part four: Integrating psychopharmacology and psychotherapy for anxiety disorders

Psychological and pharmacological treatments separately and in combination
- Generalized anxiety disorder (GAD)
- Specific phobia
- Social phobia
- Obsessive-compulsive disorder (OCD)
- Posttraumatic stress disorder (PTSD)
- Panic disorder with and without agoraphobia

Part five: Integrating psychopharmacology and psychotherapy for insomnia

Classification
Pathophysiology
Evaluation and management of comorbid conditions
Pharmacological agents
Nonpharmacological methods
- Sleep hygiene education
- Stimulus control therapy
- Sleep restriction therapy
- Cognitive therapy
- Relaxation therapy
Integrating pharmacotherapy with cognitive-behavioral approaches
- Cognitive-behavioral therapy versus pharmacotherapy
- Factors favoring the initiation of treatment with cognitive-behavioral therapy or pharmacotherapy
- Combination strategies

IPPT101

June 6, 2023