Am J Psychiatry 1997; 154:773-781
Copyright © 1997 by American Psychiatric Association
Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: conclusions from combined treatment trials
DA Spiegel and TJ Bruce
Center for Anxiety and Related Disorders, Boston University, MA 02215- 2015, USA.
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. METHOD: 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.
