You likely started using benzodiazepines or Z drugs (like Ambien, etc.) for a good reason. But after a while, what used to make sense no longer does - as the negative consequences of long-term sedative use start to outweigh any of their diminishing benefits.
And when side effects and other adverse effects start to add-up and the medication gets less and less effective, you might be wise to consider breaking free from your habit.
But unfortunately, these drugs cause powerful physical dependencies and quitting often causes rebound withdrawal symptoms (a temporary return of your original problem) as well as a host of new unpleasant withdrawal symptoms – and these withdrawal symptoms can persist for a weeks or months.
You can minimize your withdrawal symptoms by tapering slowly (never quit cold turkey) but when rebound withdrawal symptoms mean a return to panic attacks, severe GAD or endless sleepless nights, it can be very tough to persist with tapering for long enough to get to zero.
Fortunately, you can minimize the discomfort of rebound withdrawal symptoms and greatly increase your odds of a success by signing up for a couple of months of cognitive behavioral therapy (CBT) during the tapering process.
What Is CBT?
CBT is a form of talk therapy. CBT therapists help you understand that how you think affects how you act and that how you act affects how you feel. Once you have a better understanding of this interplay, you make small changes to your thinking patterns or behaviors to cause significant changes to how you feel.
- CBT won‘t have you on a couch with a therapist for ever and ever. It’s considered a brief and directed therapy, and in many cases between 8 and 12 sessions are all that’s needed to bring substantial benefits.
- CBT teaches you specific skills that you can practice at home and techniques that you can use to manage things like distress over not sleeping or worry about feelings of impending panic.
Learn more about CBT and its benefits.
So tapering off benzos is a big deal and a tough thing to do. Would you be willing to see a therapist once a week for a couple of months if it meant a substantial increase in your likelihood of success?
It’s definitely something to think about – to learn more about the difference it can make, read the brief research summaries below that illustrate just how dramatically CBT can help.
Panic Disorder: CBT Helps during Benzo Tapering
If you’ve got panic disorder, tapering off benzos is pretty scary and recurring panic or other symptoms can easily derail a good intentioned attempt to quit.
Fortunately, research suggests CBT can help a lot.
In one study, researchers at Boston University compared a group of panic patients who were trying to end long-term dependencies on either Xanax or clonazepam.
The patients were divided into two groups. One group received instructions on slow tapering, and members of the other group received instruction on slow tapering and also 10 weeks of group CBT.
- 76% of patients receiving CBT while tapering were able to discontinue benzos completely
- Only 25% of people in the taper-only group successfully discontinued their benzo use
- At a 3 month follow-up, 77% of those in the tapering + CBT group remained abstinent1
Benzodiazepine withdrawal symptoms feel very similar to symptoms of panic. Exposure-based CBT helps you manage the fear and worry that you experience as you start feeling withdrawal symptoms. By managing your fears and worries you decrease the likelihood of panic relapse and you increase the likelihood that you’ll be able to finish your tapering.2
Agoraphobia: CBT Helps after Benzo Tapering
Researchers at The University of Illinois College of Medicine at Peoria investigated how CBT might influence the tapering and abstinence-maintenance success rates of people with agoraphobia.
The study subjects were all patients with agoraphobia who had become panic-free through the use of alprazolam. All subjects wished to taper down off the medication. The subjects were divided into 2 groups – one group received tapering support only and subjects in the other group received tapering support and 12 weeks of individual CBT.
- A high percentage of subjects in both experimental groups achieved tapering success – 80% of those in the tapering advice only and 90% of those in the tapering advice plus CBT group.
- However, at a 6 month follow-up point, half of those who had successfully tapered with tapering advice only had relapsed back to benzodiazepine use while none of those who had received CBT and tapering advice had relapsed.3
GAD: CBT Helps during Benzo Tapering
Researchers at University de Sherbrooke in Quebec, Canada, evaluated the efficacy of CBT in helping patient with generalized anxiety disorder (GAD) taper off benzodiazepines.
For their study, they enlisted a group of GAD patients who were also long-time benzodiazepine users (12 months or longer). Study subjects were assigned to either a group that received group CBT and tapering advice or to a group that received tapering advice only.
- 75% of the patients in the CBT group successfully tapered off benzodiazepines.
- Only 37% of those who did not get CBT were able to successfully taper off
- More subjects in the CBT group also recovered to a point where they no longer met the diagnostic criteria for GAD4
Based on the study results, the researchers suggest that CBT helps facilitate tapering for patients with GAD
Insomnia: CBT Helps during Benzo Tapering
Rebound insomnia is a common feature of benzodiazepine withdrawal. Does CBT help patients to manage this withdrawal symptom and achieve a successful taper?
To find out, doctors at Quebec University compared the tapering success rates of two different groups of chronic benzodiazepine using insomniacs. Subjects in the first group received medical tapering advice and support and subjects in the second group received tapering support and advice plus 8 weeks of small-group cognitive behavioral therapy.
Subjects receiving CBT were about twice as likely to achieve a successful taper, 77% vs. 38%5
- 1. Discontinuation of Benzodiazepine Treatment: Efficacy of Cognitive-Behavioral Therapy for Patients with Panic Disorder
- 2. Efficacy of CBT for Benzodiazepine Discontinuation in Patients with Panic Disorder: Further Evaluation
- 3. Does Cognitive Behavior Therapy Assist Slow-Taper Alprazolam Discontinuation in Panic Disorder
Page last updated May 27, 2013