title: Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine.
abstract: Eighty-six participants wishing to stop benzodiazepine and who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychological Association, 1994) criteria for anxiety disorder or insomnia were assessed pre- and post-taper on clinical, pharmacological and psychosocial measures. An initial cohort of 41 participants received treatment as usual (taper only) plus physician counselling in the same clinic setting. A second cohort of 45 participants were randomly allocated to group cognitive-behavioural therapy (CBT) plus taper, or group support (GS) plus taper. At 3 months follow-up, the outcomes in both the CBT and the GS subgroups were equivalent. Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self-efficacy post-taper.Over all 86 participants, a high-baseline level of psychological distress, anxiety and dosage predicted a poor outcome, but increase in self-efficacy contributed to a successful outcome particularly in those with initially poor baseline predictors. Although there was a decrease in positive affect during preliminary stages of tapered discontinuation compared to baseline, there was no significant overall increase in negative affect.
authors.affiliation: Fernand-Seguin Research Centre, Louis-H. Lafontaine Hospital, University of Montreal. kieron.oconnor@umontreal.ca
authors.forename: Kieron
authors.initials: K
authors.lastname: O'Connor
authors.forename: André
authors.initials: A
authors.lastname: Marchand
authors.forename: Lucie
authors.initials: L
authors.lastname: Brousseau
authors.forename: Frederick
authors.initials: F
authors.lastname: Aardema
authors.forename: Nicole
authors.initials: N
authors.lastname: Mainguy
authors.forename: Pierre
authors.initials: P
authors.lastname: Landry
authors.forename: Pierre
authors.initials: P
authors.lastname: Savard
authors.forename: Cathy
authors.initials: C
authors.lastname: Léveillé
authors.forename: Valérie
authors.initials: V
authors.lastname: Lafrance
authors.forename: Sonia
authors.initials: S
authors.lastname: Boivin
authors.forename: Denise
authors.initials: D
authors.lastname: Pitre
authors.forename: Sophie
authors.initials: S
authors.lastname: Robillard
authors.forename: Donald
authors.initials: D
authors.lastname: Bouthillier
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000139:chemically induced / Q000188:drug therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015331:Cohort Studies; D003975:Diazepam / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence / Q000187:drug effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011615:Psychotherapy, Group / Q000379:methods; D020377:Self Efficacy; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced / Q000188:drug therapy*; D013315:Stress, Psychological / Q000139:chemically induced; D013375:Substance Withdrawal Syndrome; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D003975:Diazepam