Efficacy of CBT for benzodiazepine discontinuation in patients with panic disorder: Further evaluation

Abstract

Despite its acute efficacy for the treatment of panic disorder, benzodiazepines (BZs) are associated with a withdrawal syndrome that closely mimics anxiety sensations, leading to difficulty with treatment discontinuation and often disorder relapse. An exposure-based cognitive-behavioral treatment for BZ discontinuation, Panic Control Treatment for BZ Discontinuation (PCT-BD) targets the fear of these sensations and has demonstrated efficacy in preventing disorder relapse and facilitating successful BZ discontinuation among patients with panic disorder. In this randomized controlled trial, PCT-BD was compared to taper-alone and a taper plus a relaxation condition to control for the effect of therapist contact and support among 47 patients with panic disorder seeking taper from BZs. Based on the primary outcome of successful discontinuation of BZ use, results indicate that adjunctive CBT provided additive benefits above both taper alone and taper plus relaxation, with consistently medium and large effect sizes over time that reached significance at the six month follow-up evaluation. The efficacy of CBT relative to either of the other taper conditions reflected very large and significant effect sizes at that time. These findings suggest that PCT-BD provides specific efficacy for the successful discontinuation from BZs, even when controlling for therapist contact and relaxation training.

A Randomized, Controlled Trial of the Efficacy of an Interoceptive Exposure-Based CBT for Treatment-Refractory Outpatients with Opioid Dependence

“…This outcome reflects a failure to change one of the specific instrumental outcomes under study. Given ample evidence for the efficacy of interoceptive exposure for reducing anxiety sensitivity and aiding medication discontinuation in other populations (Otto et al 2010; Smits et al 2008), there may be factors unique to this population that prevented therapeutic learning from occurring. Our therapist adherence data indicated adequate differentiation of the two treatment conditions and that, in general, component interventions for CBT-IC were provided to patients.…”

Randomized Trial of D-Cycloserine Enhancement of Cognitive-Behavioral Therapy for Panic Disorder

“…We did find that CBT may be less effective in individuals taking benzodiazepines, consistent with clinical trial and observation data 11; 12; 34 . As such, prior to considering augmentation of CBT with these patients, strategies for treatment in the context of benzodiazepine discontinuation should be considered 35 .…”

Panic Disorder: Assessment and Treatment

“…In general, a duration of 1 year or more after acute response is suggested in order to maintain or improve upon gains and prevent relapse (Rapaport et al, 2001). In addition, panic disorder patients may need cognitive-behavioral skills to address the discontinuation of psychiatric medications for panic disorder (Otto, Hong, & Safren, 2002;Otto, McHugh, Simon, et al, 2010;Whittal, Otto, & Hong, 2001).…”

“…Because of this, benzodiazepines are not preferable for the treatment of panic disorder in patients with comorbid depression or substance abuse (APA, 2009). Physiological dependence may also make discontinuation more difficult, but this seems to vary across types of benzodiazepines (Michelini, Cassano, Frare, & Perugi, 1996;Rosenbaum et al, 1997;Salzman, 1993) and can be mitigated with the use of CBT in the discontinuation process (Otto et al, 2002;Otto, McHugh, Simon, et al, 2010). Another common concern about benzodiazepines is that tolerance may necessitate increased dosages over time.…”

“…The short-term CBT often focuses on interoceptive exposure and other techniques to help patients cope with withdrawal symptoms and signs of relapse (Otto, McHugh, Simon, et al, 2010;Otto et al, 1993;Spiegel et al, 1994). This seems to be effective given that Otto, McHugh, Simon, and colleagues (2010) found that patients who were administered CBT during benzodiazepine taper were more successful at maintaining benzodiazepine discontinuation as compared to both taper alone and taper plus relaxation training conditions.…”