title: Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?
abstract: OBJECTIVE
  Benzodiazepines, other anxiolytics, or sedative hypnotics are prescribed for 30%-50% of posttraumatic stress disorder (PTSD) patients. Prior data and theory suggest that these medications may inhibit response to exposure therapy, one of the most effective PTSD treatments. The present post hoc study reanalyzed results from a psychotherapy trial to assess whether benzodiazepine use was associated with reduced response to exposure therapy.
  
  
  METHODS
  Between August 2002 and October 2005, 283 female veterans and soldiers meeting DSM-IV criteria for PTSD were randomly assigned to 10 weekly 90-minute sessions of either prolonged exposure (n = 140) or present-centered psychotherapy (n = 143). Benzodiazepine use (n = 57) or non-use (n = 226) at intake was not randomly assigned. Multilevel modeling was used to assess the effects of benzodiazepine status, psychotherapy condition, and their interaction on changes on the Clinician-Administered PTSD Scale and the PTSD Checklist during the treatment and 6-month follow-up periods.
  
  
  RESULTS
  Consistent with prior reports from these data, prolonged exposure psychotherapy produced greater reductions per week in PTSD symptoms than did present-centered psychotherapy (b = -0.48, P = .02). Patients prescribed benzodiazepines did not have weaker response to prolonged exposure, but demonstrated poorer posttreatment maintenance of gains from present-centered psychotherapy (b = -0.78, P < .001).
  
  
  CONCLUSIONS
  Prolonged exposure is a sufficiently robust treatment that patients who are taking benzodiazepines can benefit from it. It is unclear whether benzodiazepine use or other patient factors accounted for benzodiazepine recipients' poorer maintenance of gains in present-centered psychotherapy.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00032617.
authors.affiliation: VA Palo Alto Health Care System, 795 Willow Rd (334-PTSD), Menlo Park, CA 94025 craig.rosen@va.gov.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenbaum
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
authors.forename: Tyson H
authors.initials: TH
authors.lastname: Holmes
authors.forename: Penny L
authors.initials: PL
authors.lastname: Brennan
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines