Cognitive-Behavioral Therapy Targeted to the Successful Discontinuation of Benzodiazepine Medication

This chapter presents an overview of the status of cognitive-behavioral therapy (CBT) for benzodiazepine discontinuation. A conceptual model for treatment and elemental interventions are discussed and exemplified. Although benzodiazepine medications are efficacious for treating anxiety disorders, short-term treatment is generally recommended given the potential for concerning side effects, dependence, and misuse. Nonetheless, many patients undergo long-term treatment with benzodiazepines and face challenges discontinuing this medication due to withdrawal symptoms, rebound anxiety, and relapse, which can make abstinence difficult to achieve even with gradual dose reduction. The empirical literature suggests that exposure-based CBT paired with gradual tapering has engendered greater success with benzodiazepine discontinuation compared to either a slow taper alone or a slow taper combined with relaxation training. CBT treatment involves a systematic program of interoceptive exposure to prepare patients for the withdrawal symptoms they may experience, as to teach non-anxiogenic responses to these sensations and emotional distress more generally. These skills are then applied to management of the underlying anxiety disorders once the benzodiazepine medications are successfully tapered. New applications of these strategies to patients taking the combination of opioid and benzodiazepine medications are also discussed.