How Do Patience and Self-Compassion Help During a Benzodiazepine Taper?

Key Takeaways

• A slow benzodiazepine taper is measured in months and sometimes years, and much of the hardship comes from the calendar and from self-judgment rather than from the symptoms alone.
• Withdrawal symptoms are the nervous system readjusting after each reduction, and they say nothing about a patient’s character or strength.
• A patient who took a benzodiazepine as prescribed was following medical advice, and there is nothing in that to forgive.
• Stopping suddenly to get it over with is the one decision a taper exists to prevent, because abrupt stopping can bring on seizures and other life-threatening reactions.
• Symptoms come in windows and waves, and a hard stretch after a good one is a normal part of healing rather than evidence that progress has been lost.
• Holding at the current dose for a short stretch while symptoms settle, then making the next step smaller, is a normal part of the method, and a flare that does not settle during a hold is a reason to call the prescriber.
• Progress is counted in settled dose steps and steadier sleep, never in days without the medication or a date circled on a calendar.
• Self-compassion in practice means speaking to yourself as you would to a friend in the same taper, calling a bad night withdrawal rather than a breakdown, and letting a wave day shrink to the essentials.

Why is a slow taper hard in ways patients do not expect?

Coming off a benzodiazepine safely means a gradual taper, supervised by a physician, with the dose lowered in small steps and held steady whenever the nervous system needs more time. A taper like that is measured in months, and sometimes in years. Withdrawal symptoms come and go along the way, and they do not follow a straight line.

Most patients expect the symptoms. What they do not expect is how much of the suffering comes from the calendar and the mirror. A slow month feels like falling behind, and a bad day feels like a personal weakness.

Patience and self-compassion can sound like words from a greeting card. Yet, during a taper they are working skills, as practical as the schedule itself. So, what do they look like for a patient who is tired, anxious, and only three reductions into a long taper?

Withdrawal symptoms are not a sign of weakness.

Benzodiazepines strengthen the effect of gamma-aminobutyric acid (GABA), the chemical signal that quiets nerve cells. With daily use, the nervous system adapts to that extra quieting and comes to rely on it. This adaptation is called physical dependence, and it happens to patients who took the medication exactly as it was prescribed.

Physical dependence is not addiction. In fact, the 2020 boxed-warning update from the United States Food and Drug Administration (FDA) states that physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed.

Unfortunately, many patients have been told otherwise. A relative calls it a drug problem, or a doctor reads every symptom as the old anxiety coming back. Hearing it often enough, a patient begins to believe that a stronger person would handle this better.

The symptoms say nothing about character. Each reduction removes a little of the quieting the nervous system had come to rely on, and the insomnia, the anxiety, and the muscle tension are that system readjusting. Professor C. Heather Ashton wrote in Chapter III of the Ashton Manual that unexplained symptoms introduce fears, including the fear of going mad, “which themselves magnify the symptoms.” Self-blame works the same way.

Is there anything to forgive in taking a medication as prescribed?

Many patients carry guilt about ever having started. They replay the first appointment and ask why they did not question the prescription.

A patient who took a benzodiazepine as directed was following medical advice. Often, nobody explained that dependence could develop within weeks, and nobody offered a plan for coming off. Informed consent means hearing the risks first, then the alternatives and an exit plan, with the right to decline.

A decision made without that information is not a mistake to be forgiven. A reasonable person trusted a doctor. That is all that happened.

Why not just stop the medication and get it over with?

Impatience and self-blame push in the same direction. A patient who is angry at the medication, or at themselves, wants it gone by the weekend.

That is the one decision a taper exists to prevent. The FDA’s 2020 update warns that stopping a benzodiazepine abruptly, or reducing the dosage too quickly, can result in withdrawal reactions, including seizures, which can be life-threatening. Professor Ashton wrote that convulsions are extremely rare with slow dosage tapering.

A seizure or any other medical emergency is a reason to call 911, and thoughts of suicide are a reason to call or text the 988 Suicide and Crisis Lifeline.

How long does a slow taper take?

Longer than most patients are first told. Professor Ashton wrote in Chapter II that many people have taken a year or more, and that there is no need to hurry, because the body and brain may need time to readjust after years on a benzodiazepine.

The Ashton Manual describes reductions of up to one tenth of the dose at each step, with the person who is tapering in control of the pace. Where it helps, it also describes a crossover taper to diazepam (Valium), which the article on tapering off Valium explains.

The Maudsley Deprescribing Guidelines add hyperbolic reductions, in which each step gets smaller as the dose gets lower, and liquid or compounded formulations make those small steps possible. There is no deadline.

What are windows and waves?

Symptoms during a taper do not fade evenly. Professor Ashton wrote in Chapter III that they characteristically wax and wane, varying in severity and type from day to day and even during the course of a day.

Patients call the hard stretches waves and the good hours or days windows. She observed that windows typically appear after some weeks, then become more frequent and last longer, while the waves become less severe and less frequent as time passes.

While no comparison is perfect, a falling tide comes close. Each wave still runs up the sand, and some run higher than the one before, yet the waterline keeps moving out. Progress is judged by the tide, never by a single wave.

A common pattern is the patient who enjoys three good weeks, makes a reduction, has four hard days, and concludes that everything gained has been lost. Nothing has been lost. A wave after a window is what healing looks like.

How long do symptoms last after the last dose?

Professor Ashton was plain that it is impossible to give an exact time. On a slow taper there is no single acute phase to get through, because symptoms tend to rise after a reduction and then ease. For some patients they continue after the taper ends, which is called protracted withdrawal or benzodiazepine-induced neurological dysfunction (BIND).

Her table of protracted symptoms (Chapter III, Table 3) describes anxiety as gradually diminishing over a year and insomnia over six to twelve months. Other symptoms, such as tingling and tinnitus, may last at least a year and occasionally several years.

Yet, she also wrote that most people experience a definite improvement over time, and that a steady decline in symptoms almost invariably continues. The direction is toward healing.

Holding or slowing down is not failure.

Patience is more than an attitude. In a taper it is a clinical tool called the hold.

When symptoms flare after a reduction, a common answer is a short hold, staying at the current dose for a stretch while they settle and then making the next step smaller, and a flare that does not settle within a few weeks is a reason to talk with the prescriber about the next step rather than to wait indefinitely. Professor Ashton wrote in Chapter II that a person who reaches a difficult point can stop there for a few weeks if necessary. She also advised against becoming obsessed with the schedule.

Does a hard week mean the patient has done something wrong? No. It is information about the pace, and a flare that does not settle during a hold, or a new symptom that does not fit the pattern, is a reason to call the prescriber.

What does progress look like during a taper?

Progress in a taper is never counted in days without the medication. A patient who is tapering takes the medication every day for months, on purpose.

The real milestones are a completed dose step, a hold that feels stable, and a reduction that passes without a spike in symptoms. A useful goal is the next small step, taken once the last one has settled, and never a date circled on a calendar.

Between steps the signs are quieter. Sleep gets a little steadier, the baseline level of anxiety drops, energy and appetite return, thinking clears, and the waves grow shorter or arrive further apart. A short taper log of the date, the dose, and a few words about sleep shows the trend that memory hides, and the article on keeping a journal during withdrawal explains how.

Of course, a milestone deserves to be marked. A better night, an errand finished, or ten minutes of laughing at something all count, and none of them has to be earned first.

What helps on an ordinary day?

None of what follows replaces a slow taper, and the evidence for most comfort measures is limited. Still, they can make the days more tolerable, and patients differ in what helps.

Routine comes first. Fixed times for waking and going to bed, regular meals, daylight in the morning, and a quiet hour before sleep take some of the unpredictability out of a day. Gentle movement belongs there too, and Professor Ashton, who recommended regular moderate exercise during withdrawal, saw no point in slavishly doing exercises a person hates.

Sleep takes patience as well. Professor Ashton suggested avoiding tea, coffee, other stimulants, and alcohol near bedtime, and some patients find they do better with no caffeine at all. She also wrote that the need for sleep is so powerful that normal sleep will eventually reassert itself.

Professor Ashton warned against substituting increasing doses of alcohol for decreasing doses of benzodiazepines. Because alcohol acts on the same GABA receptors as the medication, it is best left out during a taper altogether.

For the minutes when a wave peaks, slow breathing with a longer breath out, or naming five things in the room, gives the mind a smaller task than the fear. A person or two who understand what a taper is can help as well. Professor Ashton noted that supporters should be prepared to repeat their encouragement again and again, because the words are soon forgotten.

What does self-compassion look like in practice?

It is less mysterious than it sounds. The simplest exercise is for a patient to notice the sentence they say to themselves on a bad day, and to ask whether they would say it to a friend in the middle of the same taper. Almost nobody would.

A second exercise is to call the symptom by its name. Calling a bad night withdrawal, and remembering that it passes, is more accurate than calling it a breakdown. Professor Ashton wrote that a proper understanding of the symptoms can do much to allay the bewilderment and fear.

A third is permission. On a wave day the plan can shrink to the essentials, a rest in the afternoon counts as care and not as laziness, and a cancelled commitment is not a moral event. While none of this shortens a taper, it makes a long one easier to live through.

The pace of a taper belongs to the patient.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. In his practice the patient sets the pace of the taper, a hold is part of the plan, and no reduction is made to meet a deadline. While Professor Ashton advised patients to try to avoid going back up in dose, Dr. Leeds treats a small step back up, after a cut that proved too large, as a legitimate choice.

Fortunately, with time and a taper the nervous system can follow, most patients improve. Dr. Leeds’ practice offers medically supervised tapering of benzodiazepines and z-drugs to patients in Florida. Contact the office to ask about a taper that moves at the patient’s pace.

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.