Cognitive Therapy and Research

, Volume 28, Issue 2, pp 193–208 | Cite as

Benzodiazepine Use Associated with Decreased Memory for Psychoeducation Material in Cognitive Behavioral Therapy for Panic Disorder

  • Henny A. Westra
  • Sherry H. Stewart
  • Michael Teehan
  • Karen Johl
  • David J. A. Dozois
  • Todd Hill

Abstract

In laboratory studies with nonanxious participants, benzodiazepines (BZ) reliably induce anterograde amnesia. It remains unclear whether memory impairments exist for information presented in therapy among anxiety patients who are concomitantly taking BZs. This naturalistic study compared 16 panic disorder patients who were daily BZ users with 16 age- and education-matched, nonmedicated panic disorder patients. An incidental memory task assessed memory for psychoeducation material on the origins and management of somatic anxiety symptoms presented during group cognitive behavioral therapy (CBT). BZ users showed significantly poorer memory performance than controls although there were no group differences in anxiety symptoms, rates of psychiatric comorbidity, or sedation. Among BZ users, a higher number of minutes away from post peak drug-blood concentration when encoding began, was also associated with better incidental memory performance. Although causation cannot be inferred from this naturalistic study, the memory impairments observed among BZ users may contribute to the poorer efficacy of CBT previously documented in panic disorder patients receiving adjunctive BZs.

benzodiazepines memory cognitive behavioral therapy psychoeducation 

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REFERENCES

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Bacon, E., Danion, J. M., Kauffmann-Muller, F., Schelstraete, M. A., Bruant, A., Sellal, F., et al. (1998). Confidence and feelings of knowing for episodic and semantic memory: An investigation of lorazepam effects on meta-memory. Psychopharmacology, 138, 318-325.Google Scholar
  3. Barbee, J. G. (1993). Memory, benzodiazepines, and anxiety: Integration of theoretical and clinical perspectives. Journal of Clinical Psychiatry, 54, 86-97.Google Scholar
  4. Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford.Google Scholar
  5. Barlow, D. H., & Craske, M. G. (1989). Mastery of your anxiety and panic. New York: Graywind.Google Scholar
  6. Beck, A. T. (1990). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893-897.Google Scholar
  7. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.Google Scholar
  8. Bishop, K. I., Curran, H. V., & Lader, M. (1996). Do scopolamine and lorazepam have dissociable effects on human memory systems? A dose-response study with normal volunteers. Experimental and Clinical Psychopharmacology, 4, 292-299.Google Scholar
  9. Bond, A., & Lader, M. (1974). The use of analogue scales in rating subjective feelings. British Journal of Medical Psychology, 47, 211-218.Google Scholar
  10. Buffett-Jerrott, S. E., & Stewart, S. H. (2002). Cognitive and sedative effects of benzodiazepine use. Current Pharmaceutical Design, 8, 45-58.Google Scholar
  11. Buffett-Jerrott, S. E., Stewart, S. H., Bird, S., & Teehan, M. D. (1998). An examination of differences in the time course of oxazepam's effects on implicit and explicit memory. Journal of Psychopharmacology, 12, 338-347.Google Scholar
  12. Buffett-Jerrott, S., Stewart, S. H., & Teehan, M. D. (1998). Further evidence for time course influences on the effects of oxazepam and lorazepam on implicit and explicit memory. Psychopharmacology, 138, 344-353.Google Scholar
  13. Chambless, D. L., Sanderson, W. C., Shohma, V., Johnson, S. B., Pope, K. S., Crits-Christoph, P., et al. (1996). An update on empirically validated therapies. The Clinical Psychologist, 49, 5-18.Google Scholar
  14. Clum, G. A., Clum, G. A., & Surls, R. (1993). A meta-analysis of treatments for panic disorder. Journal of Consulting and Clinical Psychology, 61, 317-326.Google Scholar
  15. Cooper, A. J. (1982). Benzodiazepines: Towards more logical use. Scottish Medical Journal, 27, 297-304.Google Scholar
  16. Cox, B. J., Norton, G. R., & Swinson, R. P. (1992). The Panic Attack Questionnaire revised. Unpublished questionnaire. Clarke Institute of Psychiatry, Toronto, Canada.Google Scholar
  17. Curran, H. V. (1986). Tranquilizing memories: A review of the effects of benzodiazepines on human memory. Biological Psychiatry, 23, 179-213.Google Scholar
  18. Curran, H. V. (1991). Benzodiazepines, memory and mood: A review. Psychopharmacology, 105, 1-18.Google Scholar
  19. Curran, H. V. (1992). Memory functions, alertness and mood of long-term benzodiazepine users: A preliminary investigation of the effects of a normal daily dose. Psychopharmacology, 6, 69-75.Google Scholar
  20. Curran, H. V., & Gorenstein, C. (1993). Differential effects of lorazepam and oxazepam on priming. International Clinical Psychopharmacology, 8, 37-42.Google Scholar
  21. Curran, H. V., Schiwy, W., & Lader, M. (1987). Differential amnesic properties of benzodiazepines: A dose-response comparison of two drugs with similar plasma elimination half-lives. Psychopharmacology, 92, 358-364.Google Scholar
  22. Danion, J. M., Zimmerman, M. A., Willard-Schroeder, D., Grange, D., & Singer, L. (1989). Diazepam induces a dissociation between explicit and implicit memory. Psychopharmacology, 99, 238-243.Google Scholar
  23. Echeburua, E., DeCorral, P., Bajos, E. G., & Borda, M. (1993). Interactions between self-exposure and alprazolam in the treatment of agoraphobia without current panic: An exploratory study. behavioral and Cognitive Psychotherapy, 21, 219-238.Google Scholar
  24. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.Google Scholar
  25. Ghoneim, M. M., Mewaldt, S. P., Berie, J. L., & Hinrichs, J. V. (1983). Memory performance and effects of single-and three-week administration of diazepam. Psychopharmacology, 73, 147-151.Google Scholar
  26. Gladsjo, J. A., Rapaport, M. H., McKinney, R., Auerbach, M., Hahn, T., Rabin, A., et al. (2001). Absence of neuropsychologic deficits in patients receiving long-term treatment with alprazolam-XR for panic disorder. Journal of Clinical Psychopharmacology, 21, 131-138.Google Scholar
  27. Gorissen, M. E. E., Curran, H. V., & Eling, P. A. T. M. (1998). Proactive interference and temporal context encoding after diazepam intake. Psychopharmacology, 138, 334-343.Google Scholar
  28. Hommer, D. (1991). Benzodiazepines: Cognitive and psychomotor effects. In P. P. Roy-Byrne & D. S. Cowley (Eds.), Benzodiazepines in clinical practice: Risks and benefits (pp. 113-130). Washington, DC: American Psychiatric Press.Google Scholar
  29. Legrand, F., Vidaihet, P., Danion, J.M., Grange, D., Giersch, A., Van Der Linden, M., et al. (1995). Time course of the effects of diazepam and lorazepam on perceptual priming and explicit memory. Psychopharmacology, 118, 475-479.Google Scholar
  30. Leng, N. R., & Copello, A. G. (1990). Rehabilitation of memory after brain injury: Is there an effective technique? Clinical Rehabilitation, 4, 63-69.Google Scholar
  31. Marks, I. M., & Mathews, A. (1979). Brief standard rating scale for phobias. Behaviour Research and Therapy, 17, 263-267.Google Scholar
  32. Marks, I. M., Swinson, R. P., Basoglu, M., Kuch, K., Noshirvani, H., O'Sullivan, G., et al. (1993). Alprazolam and exposure alone and combined in panic disorder with agoraphobia: A controlled study in London and Toronto. British Journal of Psychiatry, 162, 776-787.Google Scholar
  33. Maxmen, J. S., & Ward, N. G. (1995). Psychotropic drugs: Fast facts (2nd ed.). New York: Norton.Google Scholar
  34. McGaugh, J. L. (1992). Affect, neuromodulatory systems and memory storage. In S. I. Christianson (Ed.), The handbook of emotion and memory research and theory (pp. 245-269). Hillsdale, NJ: Erlbaum.Google Scholar
  35. Otto, M. W., Hong, J. J., & Safren, S. A. (2002). Benzodiazpine discontinuation difficulties in panic disorder: Conceptual model and outcomes for cognitive-behaviour therapy. Current Pharmaceutical Design, 8, 99-106.Google Scholar
  36. Otto, M. W., Pollack, M. H., Penava, S. J., & Zucker, B. G. (1999). Group cognitive behavioral therapy for patients failing to respond to pharmacotherapy for panic disorder: A clinical case series. Behaviour Research and Therapy, 37, 763-770.Google Scholar
  37. Parente', F. J., & Anderson, J. K. (1983). Techniques for improving cognitive rehabilitation: Teaching organization and encoding skills. Cognitive Rehabilitation, 1, 20-22.Google Scholar
  38. Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.Google Scholar
  39. Rachman, S. J., & Wilson, G. T. (1980). The effects of psychological therapy. Oxford, UK: Permagon.Google Scholar
  40. Romach, M. K., Busto, U. E., Sobell, L. C., Sobell, M. B., Somer, G. R., & Sellers, E. M. (1991). Long-term alprazolam use: Abuse, dependence or treatment? Psychopharmacology Bulletin, 271, 391-395.Google Scholar
  41. Schmitt, J. A. J., Kruizinga, M. J., & Riedel, W. J. (2001). Non-serotonergic pharmacological profiles and associated cognitive effects of serotonin reuptake inhibitors. Journal of Psychopharmacology, 15, 173-179.Google Scholar
  42. Schotte, D. E., Cools, J., & McNally, R. J. (1990). Film-induced negative affect triggers overeating in restrained eaters. Journal of Abnormal Psychology, 99, 317-320.Google Scholar
  43. Schwarz, H. J. (1979). Pharmacokinetics and metabolism of temazepam in man and several animal species. British Journal of Clinical Pharmacology, 8, 23S-29S.Google Scholar
  44. Sellal, F., Danion, J. M., Kauffmann-Muller, F., Grange, D., Imbs, J. L., VanDerLinden, M., et al. (1992). Differential effects of diazepam and lorazepam on repetition priming in health volunteers. Psychopharmacology, 108, 371-379.Google Scholar
  45. Shear, M. K., & Maser, J. D. (1994). Standardized assessment for panic disorder research: A conference report. Archives of General Psychiatry, 51, 346-354.Google Scholar
  46. Spitzer, R. L., Williams, J. B. W., & Gibbon, M. (1994). Structured Clinical Interview for DSM-IV. New York: New York State Psychiatric Institute, Biometrics Research Department.Google Scholar
  47. Stewart, S. H., Rioux, G. F., Connolly, J. F., Dunphy, S., & Teehan, M. D. (1996). Effects of oxazepam and lorazepam on implicit and explicit memory: Evidence for possible influences of time course. Psychopharmacology, 128, 139-149.Google Scholar
  48. Stewart, S. H., & Westra, H. A. (2002). Introduction to the special issue on: Benzodiazepine side effects: From the bench to the clinic. Current Pharmaceutical Design, 8, 1-3.Google Scholar
  49. Stewart, S. H., Westra, H. A., Thompson, C., & Conrad, B. E. (2000). Effects of naturalistic benzodiazepine use on selective attention to threat cues among anxiety disorder patients. Cognitive Therapy and Research, 24, 67-85.Google Scholar
  50. Van der Linden, M. (1989). Reorganization therapy for memory impairments. In X. Seron & G. Deloche (Eds.), Cognitive approaches in neuropsychological rehabilitation: Neuropsychology and neurolinguistics (pp. 105-158). Hillsdale, NJ: Erlbaum.Google Scholar
  51. Vidailhet, P., Danion, J. M., Kauffmann-Muller, F., Grange, D., Giersch, A., & VanDerLinden, M. (1994). Lorazepam and diazepam effects on memory acquisition in priming tasks. Psychopharmacology, 115, 163-168.Google Scholar
  52. Wardle, J. (1990). Behaviour therapy and benzodiazepine: Allies or antagonists? British Journal of Psychiatry, 156, 163-168.Google Scholar
  53. Weingartner, H. J., Hommer, D., Lister, R. G., Thompson, K., & Wolkowitz, O. (1992). Selective effects of triazolam on memory. Psychopharmacology, 106, 341-345.Google Scholar
  54. Weingartner, H. J., Sirocco, K., Curran, H. V., & Wolkowitz, O. (1995). Memory facilitation following the administration of the benzodiazepine triazolam. Experimental and Clinical Psychopharmacology, 3, 298-303.Google Scholar
  55. Woods, B. (1996). Cognitive approaches to the management of dementia. In R.G. Morris (Ed.), The cognitive neuropsychology of Alzheimer-type dementia (pp. 310-326). New York: Oxford University Press.Google Scholar
  56. Westra, H. A., & Stewart, S. H. (1998). Cognitive behavioral therapy and pharmacotherapy: Complementary or contradictory approaches to the treatment of anxiety? Clinical Psychology Review, 18, 307-340.Google Scholar
  57. Westra, H. A., & Stewart, S. H. (2002). As-needed use of benzodiazepines: Incidence and implications. Current Pharmaceutical Design, 8, 59-74.Google Scholar
  58. Westra, H. A., Stewart, S. H., & Conrad, B. E. (2002). Naturalistic manner of benzodiazepine use and cognitive behavioral therapy outcome in panic disorder with agoraphobia. Journal of Anxiety Disorders, 36, 1-14.Google Scholar
  59. Williams, S. L., & Falbo, J. (1996). Cognitive versus performance-based treatment of panic and agoraphobia. Behaviour Research and Therapy, 34, 253-263.Google Scholar

Copyright information

© Plenum Publishing Corporation 2004

Authors and Affiliations

  • Henny A. Westra
    • 1
  • Sherry H. Stewart
    • 2
  • Michael Teehan
    • 1
    • 3
  • Karen Johl
    • 3
  • David J. A. Dozois
    • 4
  • Todd Hill
    • 5
  1. 1.Anxiety and Affective Disorders ServiceLondon Health Sciences CentreLondon
  2. 2.Departments of Psychology, Psychiatry, and Community Health and EpidemiologyDalhousie UniversityHalifax, Nova Scotia
  3. 3.Queen Elizabeth II Health Sciences CentreHalifax, Nova Scotia
  4. 4.Departments of Psychology and PsychiatryUniversity of Western OntarioLondon
  5. 5.Halifax County East Mental Health ServicesDartmouth, Nova Scotia

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