Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine.
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.
O'Connor
Kieron
K
Fernand-Seguin Research Centre, Louis-H. Lafontaine Hospital, University of Montreal. kieron.oconnor@umontreal.ca
Marchand
André
A
Brousseau
Lucie
L
Aardema
Frederick
F
Mainguy
Nicole
N
Landry
Pierre
P
Savard
Pierre
P
Léveillé
Cathy
C
Lafrance
Valérie
V
Boivin
Sonia
S
Pitre
Denise
D
Robillard
Sophie
S
Bouthillier
Donald
D
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
D014151:Anti-Anxiety Agents; D003975:Diazepam