title: Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy.
abstract: OBJECTIVE
  To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy.
  
  
  METHODS
  Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia.
  
  
  METHODS
  Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy.
  
  
  RESULTS
  There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change.
  
  
  CONCLUSIONS
  Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation.
authors: Ecole de Psychologie, Université Laval, Centre de Recherche Université Laval--Robert-Giffard, Québec, Canada.
authors: Geneviève
authors: G
authors: Belleville
authors: Charles M
authors: CM
authors: Morin
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001294:Attitude to Health; D053961:Azabicyclo Compounds / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D007206:Individuality; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology; D010555:Personality Inventory; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects; D012648:Self Care / Q000523:psychology; D020377:Self Efficacy; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy
chemical_list: D000081:Acetamides; D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D011743:Pyrimidines; C515050:zopiclone; D001569:Benzodiazepines; C085665:zaleplon