Masked Taper Plus CBT for Insomnia Effective in Benzodiazepine Discontinuation
A masked drug taper combined with cognitive behavioral therapy for insomnia (CBTI) were associated with improved benzodiazepine receptor agonist discontinuation in patients receiving treatment for insomnia. Results from the randomized control trial were published in JAMA Internal Medicine.
“Hypnotics such as benzodiazepine receptor agonists are often prescribed for insomnia. In older adults, benzodiazepine receptor agonists[…]are associated with an increased fall risk,” observed Constance H. Fung, MD, MSHS, geriatric research, VA Greater Los Angeles Healthcare System, and co-authors in the study introduction. “Guidelines recommend discontinuing benzodiazepine receptor agonists in this population, which is attempted in clinical care with varying success.”
Authors aimed to assess the efficacy of 2 interventions: a discontinuation program combining a masked taper with “augmented” CBTI (MTcap), which included “novel cognitive and behavioral exercises targeting placebo mechanisms” against an unmasked taper with standard CBTI (SGT). The primary outcome was percentage of patients who achieved benzodiazepine receptor agonist discontinuation 6 months after treatment ended. Secondary outcomes included Insomnia Index and Dysfunctional Beliefs About Sleep-Medication scores at week 1 and at month 6 after treatment conclusion.
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Study participants comprised 188 people aged 55 years or older (mean [SD] age, 69.8 [8.3] years, 123 male [65.4%] and 65 female [35.6%]) recruited from an academic medical center and/or a Department of Veterans Affairs medical center. Participants were randomly assigned to MTcap (n=92) or SGT (n=96).
Compared with SGT, MTcap resulted in greater benzodiazepine receptor agonist discontinuation at 6 months (MTcap = 64 [73.4%], SGT = 52 [58.6%]; odds ratio [OR], 1.95; 95% CI 1.03-3.70; P = .04) and 1 week posttreatment (MTcap = 76 [88.4%], SGT = 62 [67.4%]; OR, 3.68; 95% CI, 1.67-8.12; P = .001) and reduced frequency of benzodiazepine receptor agonist use (nights/week) at 1 week posttreatment (−1.31; 95% CI, −2.05 to −0.57; P < .001). Insomnia Severity Index improved with no significant between-group difference at follow-up (baseline to 1 week posttreatment, 1.38; P = .16; baseline to 6 months, 0.16; P = .88).
“[We] demonstrated that a novel program that combined masked tapering with exercises targeting expectancies for benzodiazepine receptor agonists and conditioned responses resulted in a higher percentage of sustained benzodiazepine receptor agonist discontinuation,” the authors wrote in the study conclusion.
“Future studies are needed to examine methods for implementing the MTcap program in clinical settings and for reproducing the results in other cultural contexts.”
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