Although prescription rates may be declining, benzodiazepines (BZs) are still very commonly prescribed for the treatment of anxiety disorders. Because many anxiety patients require assistance in successfully discontinuing BZs, cognitive behavioral therapy (CBT) approaches have been specifically developed to target this issue, and an evidence base now exists to support their use in this manner. In this paper, we first provide the rationale for why BZ discontinuation is desirable. We then present a self-help handout that we have used productively in our cognitive-behavioral practice to assist patients in deciding whether they are ready to attempt discontinuation of their BZs, and to prepare them with strategies for successful discontinuation. The clinical use of this handout is discussed and suggestions offered for integrating it effectively into CBT for anxiety.
Although prescription rates may be declining in view of alternative, less problematic pharmacotherapies, benzodiazepines (BZs) are still commonly used for the treatment of anxiety disorders (Boixet et al., 1996 and Bruce et al., 2003). For example, recent population level data from Statistics Canada suggest that nearly 20% of individuals with a current anxiety disorder are taking BZs (Beck et al., 2005). Moreover, 50% of patients presenting for anxiety disorders treatment are already on BZs, with many unable to discontinue (Romach, Busto, Somer, Kaplan, & Sellers, 1995). Despite known difficulties with the use of BZs, they continue to be sanctioned by general physicians (Boixet et al., 1996 and Mant et al., 1995) and psychiatrists (Balter et al., 1993 and Uhlenhuth et al., 1995) for long-term use in clinical anxiety management.
Despite the continued widespread use of BZs for treatment of anxiety, research suggests several reasons for patients to consider discontinuation. BZ use has been associated with cognitive problems, dampens benefit from exposure-based treatments for anxiety disorders, and can be addictive (Michelini et al., 1996 and Westra et al., 2002). Other reasons for BZ discontinuation include limited long-term efficacy in anxiety management and patient preference for nonpharmacological treatments for anxiety (Banken and Wilson, 1992 and Otto et al., 1996).
Given that there is a withdrawal syndrome associated with BZ discontinuation (which can be serious), and most chronic BZ users have had one or more unsuccessful discontinuation efforts (Romach et al., 1995), patients require assistance in successfully discontinuing these medications (Otto, Hong, & Safren, 2002). The intent of this paper is to offer a patient self-help handout that can be used to facilitate successful BZ discontinuation (see Appendix A). The impetus to create the handout was based on observation in clinical practice of frequent and reoccurring concerns expressed by clients in the context of BZ discontinuation. As well, there was a need to integrate management of these common concerns with basic psychoeducation from research on BZ discontinuation (e.g., common withdrawal symptoms, appropriate taper schedule). To contextualize BZ discontinuation, we offer a brief elaboration of the reasons for considering such a course of action, particularly in the context of clients presenting for cognitive behavioral therapy (CBT).
