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 (CBT) 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, CBT 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 CBT provides specific efficacy for the successful discontinuation from BZs, even when controlling for therapist contact and relaxation training.

Figure 1

Withdrawal checklist scores across the designated weeks of taper for each taper condition. Sample sizes decrease across the study weeks (from n = 16 to n = 11 for the CBT group, from n = 16 to n = 7 for the IRT group, from n = 15 to n = 8 for the TAU group), and WP0 represents the study week prior to reaching the lowest dose obtained. PWC is the Physician Withdrawal Checklist.