Clinical Question: Does cognitive behavior therapy improve the likelihood of successful withdrawal from benzodiazepines taken for sleep therapy in older adults?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Investigators compared two approaches to withdrawal of benzodiazepines after long-term use by older adults: gradual tapering or gradual tapering plus cognitive behavior therapy in eight weekly 90-minute small-group sessions. Randomization of the 65 patients was appropriate, and allocation appears to have been adequately concealed. The average patient had used benzodiazepines for more than 12 years, with an average diazepam-equivalent daily dosage of 6.3 mg per day. The primary outcome was a blood level of benzodiazepine measured at eight weeks, three months, and 12 months.

The study results showed that cognitive behavior therapy was successful. The patients who received combined treatment were more likely to have withdrawn from use of benzodiazepines at all three blood tests (70 versus 24 percent among patients who used gradual tapering alone;P <.05; absolute risk reduction = 46 percent; number needed to treat = 2.2).

Bottom Line: In motivated older patients, cognitive behavior therapy significantly improves the ability to successfully withdraw from the use of benzodiazepines for sleep. (Level of Evidence: 1b–)