Psychological Treatment of Hypnotic-Dependent Insomnia in a Primarily Older Adult Sample

Lichstein, Kenneth L.; Nau, Sidney D.; Wilson, Nancy M.; Aguillard, R. Neal; Lester, Kristin W.; Bush, Andrew J.; McCrae, Christina S.

doi:10.1016/j.brat.2013.09.006

Cited by 55Sleep and related disordersObstructive Sleep Apnea ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Psychological Treatment of Hypnotic-Dependent Insomnia in a Primarily Older Adult Sample

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Lichstein, Kenneth L., Nau, Sidney D., Wilson, Nancy M., Aguillard, R. Neal, Lester, Kristin W., Bush, Andrew J., McCrae, Christina S.·2013·Behaviour Research and Therapy

DOI 10.1016/j.brat.2013.09.006PMC PMC3838504

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Abstract

Objective This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.Method Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.Results Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.Conclusions Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.

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The CBT used in these protocols, except in one study, principally targeted the conditions that initially led to BZD misuse: insomnia in people over 50, panic disorders, or generalized anxiety disorder.
“The CBT used in these protocols, with the exception of one study [121], principally targeted the conditions that initially led to the misuse of BZD: insomnia in people over 50 years old [33,122,123], panic disorders [118,119,120], or generalized anxiety disorder (GAD) [108,124].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [123]
The Abstract (Method) reports a CBT-and-drug-withdrawal trial in volunteers aged 50 and older, and Methods (Treatments) shows that the CBT targeted insomnia. The paper does not establish that insomnia initially led to benzodiazepine misuse in these participants; Results (Participants) says only 45% used benzodiazepines, with others using different hypnotics. The panic-disorder and GAD studies are attributed to other citations in the citing sentence, not this paper. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Only two studies propose a stepwise increase in drug-free days/nights.
“Only two studies propose a stepwise increase in drug-free days/nights [33,123].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [123]
To date, eight RCTs comparing taper alone versus taper plus CBT and two publications reporting long-term outcomes (>24 months) have been published.
“To date, eight RCTs (see Table 1) comparing the effectiveness of a taper program alone versus a taper program associated with CBT [33,112,118,119,120,121,122,123] and two publications reporting their long-term outcomes (>24 months) have been published [124,125].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [123]
The first study showing no added value of CBT for withdrawal (50% versus 43%) provided CBT-I without the main therapeutic component of sleep restriction.
“The first (50% versus 43%) provided CBT-I without the main therapeutic component of sleep restriction [123].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [123]

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Psychological treatment of insomnia in hypnotic-dependant older adults
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Authors: Lichstein, K. L., Nau, S. D., Wilson, N. M., Aguillard, R. N., Lester, K. W., Bush, A. J., & McCrae, C. S.
Affiliations: University of Alabama (US)
University of Memphis (US)
Methodist Healthcare (US)
University of Tennessee at Knoxville (US)
University of Florida (US)
Corresponding author: Lichstein, Kenneth L.
ORCID: Wilson, Nancy M.
McCrae, Christina S.
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2013-12
Volume: 51
Issue: 12
Pages: 787-796
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2013.09.006
PMC: PMC3838504
OpenAlex: W1978251941
Cited by: 54
References: 69
Citations by year: 2026: 1 · 2025: 7 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 7 · 2017: 1 · 2016: 3 · 2015: 6 · 2014: 3
FWCI: 5.41
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Behaviour Research and Therapy (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Aging (AG14738)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: cognitive behavioral therapy, gradual tapering, older adults, late middle age, biofeedback, sleep latency, daytime functioning, anxiety and depression
MeSH terms: Activities of Daily Living, Aged, Analysis of Variance, Biofeedback, Psychology, Female, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Medical Records, Middle Aged, Relaxation Therapy, Cognitive Behavioral Therapy, Treatment Outcome, Polysomnography

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Psychological Treatment of Hypnotic-Dependent Insomnia in a Primarily Older Adult Sample

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