Benzodiazepine Use, Cognitive Impairment, and Cognitive-Behavioral Therapy for Anxiety Disorders: Issues in the Treatment of a Patient in Need

Cognitive-behavioral therapy (CBT) is effective in the treatment of anxiety disorders when used inconjunction with benzodiazepine pharmacotherapy and when used as a monotherapy. Patients usingCBT alone have dropout rates similar to or lower than those patients undergoing other forms oftherapy, including benzodiazepines. CBT also works well with patients who do not respond adequatelyto pharmacotherapy. Combined CBT and benzodiazepine treatment has additive effects when comparedwith benzodiazepine monotherapy; however, patients receiving combined therapy who subsequentlydiscontinue benzodiazepine treatment experience a loss of efficacy compared with CBT andplacebo, perhaps due to fear extinction being context dependent. To avoid this loss of efficacy, CBTmay be administered alone or as a bridge between benzodiazepine use and discontinuation during amedication taper. The case report upon which this supplement is based questions the value of CBT forpatients experiencing cognitive impairment due to an anxiety disorder, benzodiazepine medication,substance abuse, or a combination of these factors. This article addresses this concern and asserts thatCBT is a valuable treatment option in these cases.