Psychotherapy for Benzodiazepine Dependence & Mental Health by Dr. Rebecca Wang-Harris

As a Mental Health Therapist and Developmental Psychologist with 28 years of experience in the field, I have worked predominantly with clients diagnosed and conducted psychotherapy on various Substance Dependence Disorders, Generalized Anxiety Disorder, Major Depressive Disorder, Bipolar Disorder, Post-Traumatic Stress Disorder, Borderline Personality Disorder, Obsessive-Compulsive Disorder, Attention Deficit Disorder, and Attention Deficit Hyperactivity Disorder.  I am extremely passionate about teaching my clients daily coping skills and assisting them in identifying and working through the cognitive triggers which create and perpetuate the symptoms related to their disorders.  Tapering off of benzodiazepines causes intense anxiety, and I provide a highly structured, supportive, and educational cognitive behavioral therapeutic approach which teaches my clients the daily skills necessary for controlling anxiety and dealing with the triggers related to the desire for benzodiazepine usage by providing psychotherapy for benzodiazepine dependence.

After obtaining my Master’s degree in Mental Health Counseling from the University of Miami in 1994, I have worked with many substance dependent clients and understand the cravings which can occur at any second of any given day.  The physiological discomfort and intense anxiety during the withdrawal period are the causes of relapse.  These clients require much emotional support, empathy, and assistance with working through their personal history as it has contributed to their substance dependence.  They also require assistance with developing and adhering to a structured daily cognitive and behavioral plan.  During the first 30 to 60 days of the withdrawal process, clients are advised to attend weekly counseling sessions to get help and support in managing the intense physical, mental, and emotional distress which can lead to relapse.  I am committed to empowering clients while tapering down their benzodiazepine usage with skilled psychotherapy.  I do so by first evaluating the client’s personal and familial history and any previous therapeutic experiences and then teaching the client necessary and effective daily coping skills for managing the inevitable anxiety symptoms which occur during the reduction of benzodiazepines.

Benzodiazepine Use and Withdrawal

Benzodiazepines, such as Ativan, Xanax, and Klonipin, are frequently prescribed to treat anxiety disorders.  These medications in the prescribed dosages can be an effective treatment for Panic Disorder, Post-Traumatic Stress Disorder, and Generalized Anxiety Disorder.  Benzodiazepines are a class of the most widely prescribed medications in the United States.  However, patients become dependent on these medications to induce a relaxed state, to deal with insomnia, and to reduce anxiety.  Because benzodiazepines are prescribed medications, many clients believe that they are not addictive and may chose not to receive Psychotherapy for Benzodiazepine Dependence.       Doctors often prescribe these medications to those who are experiencing stressful life circumstances and just want to feel relaxed and to sleep through the night.  These medications are not intended to be used as a lifelong solution to their anxiety symptoms.  Tolerance, dependence, and interactions with other substances are all important considerations.  However, numerous research studies have shown that benzodiazepine withdrawal symptoms can occur after even one month of daily usage.  These withdrawal symptoms include rebound anxiety, insomnia, headaches, agitation, and various physical pains.  With large dosages or abuse of benzodiazepines, any person can experience these withdrawal symptoms and even more severe symptoms, such as hallucinations and seizures.

I have observed clients, close friends, and even family members who cannot sleep or feel calm without benzodiazepines.  I have worked with clients who admit to abusing their benzodiazepines and combining them with other substances, such as alcohol, opiates, and stimulants.  Furthermore, I have been personally and deeply affected by helping significant people in my life through the benzodiazepine withdrawal process.  I have had to go to the emergency room after two close family members had withdrawal grand mal seizures, and both of these loved ones had no idea that this could ever be the outcome from this medication.  The central nervous system and the specific neurotransmitter, GABA, rely heavily upon the benzodiazepine dosage to induce slower functioning and a relaxed bodily and mental state.  Unfortunately, a person cannot just stop taking this type of medication in a “cold turkey” manner and must have medical monitoring through the detox and taper down process.  It is a very difficult and daily path to reduce the dosages and to eventually stop these medications. 

How Cognitive Behavioral Therapy Can Help

Cognitive behavioral therapy (CBT) is a type of psychotherapy for benzodiazepine dependence which helps a client to identify and then to change or control the disturbing thoughts which create the anxiety symptoms which had been reduced or stopped by benzodiazepines.  Anxiety is the root of the need for benzodiazepines.  CBT is a blend of cognitive therapy and behavioral therapy.  Cognitive therapy focuses on thoughts, and behavioral therapy focuses on the actions caused by the thoughts.  I use cognitive behavioral therapy to help clients identify specific negative, fear-inducing, or repetitive thoughts.  After this process, which may take a few sessions or many sessions, I teach the client how to recognize when these thoughts appear and how to replace these thoughts with more rational thoughts or how to redirect their focus, in order to prevent or decrease the desire for anti-anxiety medications and to decrease the uncomfortable physiological symptoms.  By teaching the client how to manage one’s thoughts, the client gradually becomes able to control behavioral responses to challenging or stressful situations.  The ability to gain control over one’s thoughts results in greater control over one’s emotions and behaviors.

During my counseling sessions, I use in-depth cognitive restructuring exercises.  These exercises prompt the client to make specific “I” statements, which reveal one’s self-talk and which can assist the client in identifying irrational, negative, or unproductive thoughts.  Some of these types of thoughts include (1) all-or-nothing thinking, which is the tendency to view events in black-and-white terms, (2) repetitive negative thoughts, (3) magnifying the importance of events by getting caught up in ruminating thoughts, and (4) taking things too personally.  The main therapeutic goals in cognitive behavioral therapy are learning how to identify and control thoughts which are rooted in past negative experiences, practicing more positive and rational self-talk, and using self-evaluation to respond appropriately to stressful and emotionally painful life experiences.  However, this learning process depends upon the client’s motivation for change and improved self-awareness.  If a client is resistant to this process, the prognosis for stopping benzodiazepine usage is very poor.

How Mindfulness Training Can Help

Being mindful means that you focus only on the present moment and not on past-oriented or future-oriented thoughts or emotions.  Using the mindfulness process is a learned skill, and you will often get so caught up in a stressful situation or in ruminating thoughts that you will forget to practice this skill as an adjunct with psychotherapy for benzodiazepine dependence.  When you stay in the moment, every second, you will appreciate each task or experience in your daily life.  These tasks and experiences include cooking, cleaning, eating, exercising, performing necessary actions at your job, talking to significant people in your life, and being alone with your thoughts.  Regarding your daily thoughts, you CAN sit in the moment with each thought, if only you are willing to acknowledge and embrace these thoughts.  Some thoughts may cause feelings of insecurity, pain, anger, frustration, anxiety, sadness, or fear.  Your thoughts navigate, in each and every moment, your feelings.  If you can “catch” your thoughts in any given moment, you can take that opportunity to own these thoughts but then to redirect these thoughts to what you are doing at that moment.  Often, your thoughts come into your consciousness or are less clear memories, due to being more in the subconscious, and can create very uncomfortable emotions.  That is OK!  The main point of being mindful is staying in each moment and understanding that you cannot change the past or predict the future.  Each moment of your life is a learning experience.  If you go through the day ruminating about past events or worrying about what may happen, you are not truly living in each moment.  Not living in the moment is the root of anxiety, depression, and many other mental health disorders.  All that you can do is to try diligently each day to stop in any given moment, to observe a thought or several thoughts, to determine what emotions are related to the thought or thoughts, and to then refocus on what you are actually doing or saying at that particular moment.  What does this do for you?  It keeps you mentally and emotionally grounded.  It decreases the anxiety caused by irrational or negative thoughts which may be triggers for escapes through substances. Try this in addition to psychotherapy for benzodiazepine dependence or other mental health disorders.

Anxiety is Manageable

Anxiety can be genetic, learned through repeated dysfunctional experiences with family members or other significant people in one’s life, or caused by one or more traumatic events.  Anxiety takes many forms.  For instance, Post-Traumatic Disorder and Generalized Anxiety Disorder result from emotionally painful experiences which alter one’s brain chemistry and cause various physiological symptoms, such as insomnia, gastrointestinal distress, migraines, and panic attacks.  Taking a prescribed or unprescribed anti-anxiety medication is very tempting for someone who cannot sleep, who experiences discomfort throughout the day, who has difficulty with work or academics, and who cannot control ruminating, negative, and/or traumatizing thoughts.  After a prescribed anti-anxiety medication is taken for even a few months, a person’s brain functioning becomes dependent on that medication for relaxation and relief of other anxiety symptoms.

The techniques which I have described in this blog CAN be very effective if a client is receptive to them.  If a client is not receptive to these techniques, it is more likely that the dependence to prescribed anti-anxiety medications will continue.  My approach, in these cases, is to continue to support the client emotionally, mentally, and behaviorally and to try my best to empower a client toward increased self-awareness.  I value the opportunity to learn about each client’s history and to assist each client with the development and maintenance of daily coping skills, increased self-awareness, and personal growth.  Anxiety can be a lifelong struggle for many people, and prescribed medications are very desirable in reducing or erasing anxiety.  However, these medications are physically addictive.  Tapering off or stopping these medications causes mild to severe withdrawal symptoms, depending on the level of daily dosages taken.  The ability to confront and revise one’s thoughts is necessary in the process of anxiety management with the help of psychotherapy.  Thoughts and life circumstances are the causes of anxiety.  Although we often cannot control circumstances, we can control our thoughts and behavioral responses in every moment.

Reach out to our office today to receive psychotherapy for benzodiazepine dependence or other mental health conditions. Want to learn more on anxiety? Read our anxiety disorder blog here!