Absence of definitive scientific evidence that benzodiazepines could hinder the efficacy of exposure-based interventions in adults with anxiety or posttraumatic stress disorders: A systematic review of randomized clinical trials

Depress Anxiety. 2020 Dec;37(12):1231-1242. doi: 10.1002/da.23078. Epub 2020 Aug 15.


Background and objectives: Exposure-based interventions (EBIs) are the first-line treatment for anxiety disorders and posttraumatic stress disorder. Although common, the association between EBIs and benzodiazepines is controversial. Therefore, we systematically reviewed the literature to evaluate if benzodiazepines could undermine the efficacy of EBIs in treating these disorders.

Methods: We conducted a systematic review aiming for randomized clinical trials (RCTs) in ISI Web of Science, Scopus, PubMed/MEDLINE, and PsycINFO databases. We scrutinized the reference list of selected papers and other systematic reviews. Finally, we evaluated the methodological quality and the scientific evidence of the studies.

Results: We screened 1,529 studies and included 12 RCTs in this review (all showing some concerns or high risk of bias). Benzodiazepines did not impact the efficacy of EBIs in nine studies at posttreatment, improved efficacy in two, and reduced it in one. In the follow-up, benzodiazepines (after its discontinuation) did not impact the efficacy in six studies and reduced it in five. The scientific level of evidence achieved was B for both phases.

Conclusions: Until now there is no definitive evidence that benzodiazepines could hinder the EBIs' efficacy for treating posttraumatic stress disorder and anxiety disorders.

Keywords: anxiety disorders; benzodiazepines; cognitive behavioral therapy; exposure; posttraumatic stress disorder; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Anxiety
  • Anxiety Disorders / drug therapy
  • Benzodiazepines* / therapeutic use
  • Humans
  • Randomized Controlled Trials as Topic
  • Stress Disorders, Post-Traumatic* / drug therapy


  • Benzodiazepines