What Are the Benefits of Therapy During Benzodiazepine Withdrawal?

Does therapy help with benzodiazepine withdrawal?

Therapy can make a long benzodiazepine taper easier to live with. It can teach skills for anxiety and panic, protect sleep, and take some of the fear out of the symptoms. It cannot treat the withdrawal itself.

Withdrawal symptoms are physical. They come from a nervous system that has adapted to a medication, and they are managed by the pace of a gradual, medically supervised taper over months, sometimes longer.

Unfortunately, patients are often sent to counseling because someone has decided that a person who cannot stop a medication must have a drug problem. Physical dependence is not addiction. It is the body’s expected adjustment to a medication taken as directed.

Why can therapy not treat the withdrawal itself?

Benzodiazepines strengthen the effect of gamma-aminobutyric acid (GABA), the brain’s main calming signal. In the first chapter of the Ashton Manual, Professor C. Heather Ashton explained that with steady use the GABA and benzodiazepine receptors “become less responsive.”

In its 2020 boxed warning update, the United States Food and Drug Administration (FDA) stated that physical dependence can occur “when benzodiazepines are taken steadily for several days to weeks, even as prescribed.” When the dose comes down, the anxiety, insomnia, tremor, and sweating are that adaptation unwinding. They are not thoughts, and no conversation resets a receptor.

The Maudsley Deprescribing Guidelines report that adding a psychological intervention to a gradual taper raised the rate of successfully stopping. Relaxation courses helped as well, they add. Still, the effect was far smaller than the effect of the taper itself. The same section turns to cognitive behavioral therapy (CBT). It does not improve longer-term results, the Guidelines note. Perhaps that is because the withdrawal process “has a large physiological component to it that can only be accommodated by gradual tapering.” So, the taper does the medical work, at a pace the patient controls.

Think of a long drive on a rough road. The patient is at the wheel, the taper is the speed they choose, and therapy is the suspension. It does not shorten the road, but the driver feels each bump less.

The road cannot be skipped. The FDA warns that stopping abruptly, or reducing the dose too quickly, can cause withdrawal reactions, including seizures, which can be life-threatening. Call 911 for a seizure or any other medical emergency, and call or text 988, the Suicide and Crisis Lifeline, for thoughts of suicide.

What can a therapist help with during a taper?

Fortunately, quite a lot, as long as the goal is coping and not cure. In Chapter II, Professor Ashton wrote that the help of a clinical psychologist, trained counselor, or other therapist is often “valuable, especially for teaching relaxation techniques, deep breathing, how to deal with a panic attack.”

Those skills matter because, in the words of Chapter III, “nearly all the acute symptoms of withdrawal are those of anxiety.” CBT, one of the techniques that chapter lists, teaches a person to understand their thinking patterns and react differently to situations that provoke anxiety.

Fear of the symptoms is the other target. In the same chapter, Professor Ashton observed that, for patients, a lack of explanation “has often added to their distress” and has introduced fears “which themselves magnify the symptoms.” A patient who can recognize a surge of dread as withdrawal, and not as losing their mind, has one less thing to fear.

A therapist can also help a patient pace work and family obligations on the bad days, and ease the strain a long taper puts on a household. The Guidelines add that learning skills to manage anxiety and insomnia “may have the dual benefit of making the withdrawal process easier, as well as preparing the person for life without medication.”

What should a patient look for in a therapist?

Knowledge of benzodiazepines comes first. Professor Ashton wrote in Chapter III that the outcome of psychological techniques “depends largely on the skill of the therapist, including his/her knowledge of benzodiazepines.”

In practice, that is a therapist who accepts that the symptoms are real and caused by the medication, and who leaves the dose to the patient and the prescribing physician. It is also a therapist who will not push an addiction curriculum.

Trigger lists, abstinence pledges, and 12-step meetings were built for a different problem, and they are not medical care. A patient who took a medication as directed is not helped by being treated as a person who misused it. A separate article covers whether talk therapy helps a benzodiazepine taper or gets in the way.

Can mindfulness help?

For some patients, it can. Mindfulness means paying attention to the present moment without arguing with it, and in practice it is slow breathing or a few minutes of meditation while a wave of symptoms passes.

The Guidelines list mindfulness among the coping skills worth building for a taper, and another article explains how mindfulness helps during a taper at home. Chapter III is more hopeful than the Guidelines on this point. Professor Ashton wrote that the psychological techniques have been formally tested and give the best long-term results, and that new stress-coping strategies are often the key to successful benzodiazepine withdrawal, though none of them is essential for everyone.

Why does a daily routine matter?

Withdrawal symptoms come and go, sometimes within a single day, so a patient cannot plan a week around how they expect to feel. A routine takes the decisions out of the bad days.

A regular wake time, regular meals, a short walk, and one or two tasks that matter are enough. The rest can wait.

What helps with sleep?

Insomnia is common during a taper, and it is physical too. Chapter III suggests attention to sleep hygiene, including avoiding tea, coffee, and other stimulants near bedtime, with relaxation techniques and physical exercise. The Guidelines add that people with insomnia may benefit from CBT for insomnia.

None of this forces sleep, and a separate article explains why insomnia gets worse during a taper and what helps. Yet, the Manual’s reassurance holds: “The need for sleep is so powerful that normal sleep will eventually reassert itself.”

Who belongs in the support network?

Anyone who believes the patient. Chapter II says that support can come from a spouse, partner, family member, or close friend, ideally someone “who understands about benzodiazepine withdrawal or is prepared to read about it and learn.”

People who have come through a taper can offer recognition that family cannot. However, Professor Ashton cautioned that those who had a bad experience “can frighten others by dwelling on their own symptoms.” There is more on what kind of support actually helps.

The taper does the medical work, and support makes the months livable.

Therapy, mindfulness, a routine, and better sleep do not shorten a taper, and none of them replaces one. What helps varies from person to person, and the evidence is stronger for some of these measures than for others. Yet, they can change what the months feel like.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, and his practice provides medically supervised benzodiazepine and z-drug tapering for patients in Florida. He counsels patients as part of their medical care, but the practice does not run a counseling program, and no patient is required to see a therapist or attend a group. Contact the office to ask about a taper plan.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.