Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: conclusions from combined treatment trials.
OBJECTIVE
Concurrent use of benzodiazepines and psychotherapy for panic disorder is a prevalent but highly controversial practice. Although there are many rationales for that approach, critics contend that benzodiazepines foster drug abuse and dependence and undermine psychosocial treatments in various ways. The authors examine that controversy in the light of recent empirical findings and offer some tentative conclusions and recommendations.


METHODS
Data from studies combining benzodiazepines and the leading psychosocial treatment for panic disorder, exposure-based cognitive behavior therapy, are reviewed, and their application to clinical practice is discussed.


RESULTS
The strongest support for combined treatment is for the addition of cognitive behavior therapy to pharmacotherapy for patients with agoraphobia and for those whose benzodiazepine treatment is being discontinued. The greatest problem with combined treatment is relapse after drug discontinuance.


CONCLUSIONS
Combined treatment may be advantageous for some patients, but it must be carefully designed to avoid potential problems. Suggestions for that are given.
Spiegel
D A
DA
Center for Anxiety and Related Disorders, Boston University, MA 02215-2015, USA.
Bruce
T J
TJ
D000379:Agoraphobia / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D000818:Animals; D001569:Benzodiazepines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003975:Diazepam / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005239:Fear / Q000187:drug effects; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D051381:Rats; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D016896:Treatment Outcome
D001569:Benzodiazepines; D003975:Diazepam