COMBINATION OF BENZODIAZEPINES WITH PSYCHOTHERAPY IN THE OUTCOME OF ANXIETY: A SYSTEMATIC REVIEW

Abstract

Introduction: Benzodiazepines have been widely used since the 1960s to treat anxiety and insomnia, acting on the central nervous system. However, prolonged use can be harmful, masking underlying issues and requiring a more careful therapeutic approach. The combination of benzodiazepines with psychotherapy emerges as a promising alternative in the management of anxiety disorders. Objective: To review the literature on the efficacy of the combination of benzodiazepines and psychotherapy in the treatment of anxiety disorders. Methodology: This systematic review used searches in databases such as PubMed, Cochrane Library, PsycINFO, Embase and Scopus, focusing on articles published between 2012 and 2022, in Portuguese and English, that evaluated adults with anxiety disorders treated with the combination of benzodiazepines and psychotherapy. Results: The combination of benzodiazepines with psychotherapy has been shown to be more effective than either treatment alone in several anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder. Studies indicate that benzodiazepines provide rapid symptom relief, which may facilitate initial adherence to psychotherapy, especially in patients with high levels of anxiety. In addition, psychotherapy, especially Cognitive Behavioral Therapy (CBT), has a lasting effect on reducing anxiety and preventing relapses in the long term, which decreases dependence on benzodiazepines. However, some studies suggest that prolonged use of benzodiazepines may impair progress in psychotherapy by attenuating the emotional distress necessary for the therapeutic process. Significant adverse effects associated with prolonged use of benzodiazepines, such as dependence and cognitive effects, have also been observed, highlighting the importance of careful administration. The analysis revealed that the combination is most beneficial at the beginning of treatment, but gradual withdrawal of benzodiazepines is recommended to avoid long-term dependence. Conclusion: The review indicates that the combination of benzodiazepines with psychotherapy offers significant benefits in the management of anxiety disorders, especially in terms of immediate symptom relief and sustainable behavioral changes. However, long-term use of benzodiazepines should be carefully monitored due to the risk of adverse effects. The integrated approach may be particularly useful in severe cases of anxiety, but focusing on long-term strategies, such as psychotherapy, is crucial to maintain results and reduce drug dependence.