Cognitive-Behavioral Therapy Enhancement Strategies.

We review the literature on various strategies to augment cognitive-behavioral therapy (CBT). Although traditional pharmacotherapy has only a small additive effect, research demonstrates that it is possible to select interventions that potentiate known mechanisms of CBT. D-cycloserine appears to potentiate activity at the N-methyl D-ethyl aspartate receptor and thereby facilitates fear extinction. Exercise may increase neural plasticity and thereby increase the efficacy of CBT for depression and anxiety. Noninvasive brain stimulation is thought to target the specific cortical regions needed for CBT response, but results have been mixed. Several other compounds appear promising but await controlled research before their efficacy as an augmentation strategy can be determined.

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Disclosure Dr D.F. Tolin receives royalties from Guilford Press, John Wiley and Sons, New Harbinger Publications, Oxford University Press, Cambridge University Press, and PsychWire. He is a consultant for Oui Therapeutics and Mindyra LLC. Drs K.A. Lord and K.A. Knowles have no potential conflicts to declare.