Pushback from other clinicians with benzo tapers

[Fan_of_Meehl]

Often times benzodiazepines are worsening the anxiety disorder through avoidance and reinforcement. I believe anxiety is more commonly rooted in the principles that CBT attempts to address moreso than just low serotonin, if that makes sense. SSRIs themselves dont decrease anxiety with the tapering of a benzo and trying to find an SSRI or medication that works is an important term...What does a medication that works mean to the patient? What should they feel? Because how they think they should feel may be based on their experience with xanax. Also one issue is that patients associate anxiety as a "bad" emotion that they shouldnt feel and forget that anxiety is sometimes the appropriate response in the right context of the situation. if you lose your car keys, anxiety is the appropriate response to this in many people. Ultimately exposure to anxiety to some degree is likely the best treatment to overcoming it, ideally without flooding the patient.

All too often, clinicians and patients alike fail to emphasize the absolutely CRITICAL distinction between:

(a) 'feeling safe' and
(b) actually BEING safe (or unsafe)

To the extent where there is a significant gulf between (a) and (b), then you have a clinical anxiety disorder. It's okay, under the auspices of an exposure paradigm to 'feel unsafe' as long as you're not objectively in danger. In fact, it's essential for recovery that your nervous system builds up an entirely new learning history of you 'feeling unsafe' while actually being safe (i.e., not coming under attack, not being harmed).

To the extent that there is no gulf between (a) and (b) (sometimes claimed by veterans) then, by definition, there is no clinical anxiety disorder and therefore nothing to diagnose, nothing to treat.

---

Members don't see this ad.