Psychotherapy vs. Medication

Large scale, long term studies reveal that psychotherapy is as effective as medications, lasts longer than drug treatments, and avoids the harmful side effects. Despite growing evidence for the efficacy of psychotherapy, the use of therapy has decreased in the last decade while the use of medications has been on the rise (APA, 2012). This is due in part to the billions of dollars allocated to “direct to consumer” advertising by pharmaceutical companies. Psychotherapy simply can’t compete for marketing airtime and the results are misleading to those suffering with mental health conditions.

“We are all vulnerable when we experience anxiety, panic, or despair and in these times we are especially dependent upon the experts around us to provide sound medical and psychological care.”
-Dr. Arielle Schwartz

Medications on the Rise

The use of medications for mental health is on the rise. As a culture we tend to uphold an imbalanced focus on short-term vs. long term goals and aim towards the quick fix (Gaudiano & Miller, 2013). The use of antidepressants has multiplied almost fiftyfold in the last twenty years and it has been estimated that one in eight Americans, including children and toddlers, is now taking a psychotropic medication.

Friedman (2012) asserts that within the military the number of Ritalin and Adderall prescriptions written for active-duty troops had increased nearly 1,000 percent in five years from 3,000 to 32,000. The military has used these stimulants to help fatigue and sleep-deprived troops stay alert and awake.  Military services have also traditionally relied on prescription drugs (primarily benzodiazepines such as Valium, Xanax, Ativan, and Klonopin) to help troops manage Post Traumatic Stress Disorder (PTSD). In 2010 over 200,000 (20%) of active-duty troops were taking some form of psychotropic drug (Brewin, 2012).

Waking Up to the Problem

Yehuda (2008), a researcher in trauma and PTSD, reveals that use of benzodiazepine medications suppresses physiological and psychological processes necessary to adapt effectively to trauma exposure. She indicates that benzodiazepines increases the likelihood of the development of PTSD and prolongs the healing process.

In 2012, the Army Surgeon General changed the military’s policy around prescribing benzodiazepines concluding the harm outweighs the benefits, they are contraindicated for both acute stress and PTSD, and they should be avoided. This same memorandum provides recommendations for evidence based trauma treatment that includes the use of trauma-informed therapies, EMDR, and supports adjunctive integration of mind-body therapies (Brewin, 2012).

ADHD drugs are also possibly contraindicated for individuals with recent trauma exposure.  Stimulant medications, such as Ritalin and Adderall, cause the direct release of norepinephrine in the brain which facilitates the formation of vivid, long-lasting memories. In short, taking stimulant medications during a time of acute trauma exposure may increase your risk of becoming fear-conditioned and developing PTSD. (See Friedman, 2012).

Be an Informed Consumer

I recognize the importance of medications when your symptoms are preventing you from effectively managing daily tasks such as parenting children or keeping your job. There are times when drugs play an essential role in the treatment of mental health. Unfortunately, sometimes they are taken much longer than necessary. Additionally, insurance companies may be hesitant to cover psychotherapy preferring the idea of a cost effective quick fix. However, the field of psychology is realizing that the “costs” of medicalizing mental health has a far more expensive long-term impact on both mental and physical health.

In my experience treating trauma for the past 15 years I have seen the negative impact of medical mismanagement of PTSD. I have witnessed clients suffer trying to recover from their psychopharmacological treatments and painfully try and rebuild their lives from the impact of physiological and psychological dependence upon medicine; conditions that are sometimes equally painful or worse than the initial traumatic events.

We are all vulnerable when we experience anxiety, panic, or despair and in these times we are especially dependent upon the experts around us to provide sound medical and psychological care. When possible I recommend the following:

• Find a therapist who is trained in the treatment of trauma. Look for exposure therapies, somatic trauma treatment models, and EMDR. Ask potential therapists what modalities they utilize and whether there is evidence of their efficacy. Find a clinician who you feel comfortable working with and who you connect to. Be willing to get uncomfortable (i.e. turn towards the painful memories) within the supportive, therapeutic environment.

• Coordinate your medical and psychological care. Should you need medications, aim towards short-term use in conjunction with and not in lieu of psychotherapy. Give permission for you psychotherapist and prescribing doctor to communicate so that you have a team to facilitate your healing process.

• Explore mind-body interventions as adjunct to your psychotherapy. When treating PTSD I have seen clients have great success when we develop an integrative wellness team. Mind-body therapies such as acupuncture, massage, and craniosacral therapy, and yoga have been particularly helpful. Perhaps explore how developing a mindfulness practice such as meditation or yoga might serve you as a natural ways to manage anxiety. I highly recommend taking a Mindfulness Based Stress Reduction course to support your overall health.

Finding comprehensive trauma treatment is not always accessible or affordable. However, the field of psychology is developing an increasing understanding of what comprises good trauma-informed psychotherapy and creating excellent training programs for clinicians in this specialized area of care. As an informed consumer, knowing what to look for in your treatment providers is a significant part of the process and increases your likelihood of finding the treatments that will best serve you.

Further reading:

• Avoid the downward spiral of untreated PTSD
• Polyvagal theory and healing PTSD
• The impact of untreated PTSD on your health

About Dr. Arielle Schwartz

Dr. Arielle Schwartz is a licensed clinical psychologist, wife, and mother in Boulder, CO. She offers trainings for therapists, maintains a private practice, and has passions for the outdoors, yoga, and writing. Dr. Schwartz is the author of The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole. She is the developer of Resilience-Informed Therapy which applies research on trauma recovery to form a strength-based, trauma treatment model that includes Eye Movement Desensitization and Reprocessing (EMDR), somatic (body-centered) psychology and time-tested relational psychotherapy. Like Dr. Arielle Schwartz on Facebook, follow her on Linkedin and sign up for email updates to stay up to date with all her posts.