Can we integrate cognitive-behavioural and pharmacological theories of anxiety?

Lead Research Organisation: University of Oxford
Department Name: Experimental Psychology


Anxiety disorders are very common, affecting about 20% of the population. Current treatment fall into two broad areas - either involving drug treatment or with psychological therapy (particularly Cognitive Behavioural Therapy: CBT). Although patients often receive a combination of these treatments, the research on each treatment type is typically carried out separately.

The current proposal explores how both treatments affect responses to emotional information in patients suffering from panic disorder, using both behavioural measures like facial expression recognition and brain scanning methods. By exploring the effects of both treatment types together we can gain information about their similarities and differences and also how these treatments may affect each other (i.e. perhaps drug treatments improving the effects of CBT, or vice-versa).

It is predicted that both treatments will decrease automatic brain responses to threat and reduce dysfunctional beliefs relevant to panic. However, it is hypothesised that the drug treatment will first affect automatic processing of threatening cues with effects on these beliefs emerging later. By contrast, CBT is predicted to directly target beliefs and behaviour which take time to unravel automatic processing biases. This proposal therefore aims to understand the mechanisms underlying two different successful treatments for anxiety disorders. Such an approach may help develop more optimal combinations of drug and psychological therapy.

Technical Summary

Cognitive-Behavioural Therapy (CBT) and drug treatment with selective serotonin reuptake inhibitors (SSRIs) are both effective in the treatment of anxiety disorders but have traditionally been considered within separate theoretical frameworks. While pharmacological treatment aims to normalise aberrant neurotransmitter function, cognitive accounts emphasise the importance of correcting biased thinking and information processing in these disorders. In contrast to this traditional division, my recent work suggests that SSRI administration also reduces threat-relevant processing across a number of different cognitive paradigms. These effects can be seen in healthy volunteers and occur earlier in treatment than subjective changes in mood and anxiety. Such cognitive changes could therefore be important in the actions of anxiolytic drugs as well as in CBT. This application will explore the extent to which neuropsychological mechanisms overlap following SSRI treatment and CBT in patients suffering from panic disorder. It is hypothesised that these treatments will have similar effects on threat-relevant processing by the end of treatment, but these effects will be dissociable early in treatment. Critically, drug treatments will affect the processing of threat-relevant information prior to a change in mood and behaviour, but the effect of CBT on this kind of information processing will only be observed following changes in beliefs and safety behaviours. These differences in mode and timescale of action are hypothesized to tap into partly dissociable neural substrates involved in fear and anxiety, including the amygdala and medial prefrontal cortex. This approach aims to improve our understanding of the processes involved in the successful treatment of anxiety and facilitate the integration between pharmacological and psychological strategies.


10 25 50
Description MQ fellowship award
Amount £225,000 (GBP)
Organisation MQ Transforming Mental Health 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2015 
End 01/2018
Description MRC Experimental Medicine
Amount £220,000 (GBP)
Funding ID MR/J011878/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 06/2012 
End 06/2014
Description UCL collaboration 
Organisation University College London
Department Institute of Neurology
Country United Kingdom 
Sector Academic/University 
PI Contribution Integration of work on emotional processing (Oxford) with expertise on neurocardiology and emotional regulation (Neurocardiology Research Unit, UCL)
Collaborator Contribution Expertise on role of heart rate varaibility during emotional processing including analysis of ECG recordings
Impact Publication: see Di Simplicio et al (2011). Multi-disciplinary: integration between cognitive neuroscience and cardiology
Start Year 2008
Description Newspaper editorial 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact An article about this study appeared in the local press.

This increased awareness of our work and volunteer recruitment.
Year(s) Of Engagement Activity 2008,2009
Description Press Briefing 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Press Briefing in science media centre.

Article appeared in BBC news online
Year(s) Of Engagement Activity 2009