Is a full psychotherapy program necessary to reduce benzodiazepine dependence for insomnia? A Randomized Controlled Trial Comparing Drug Tapering with Single-Session CBT vs. Full Acceptance and Commitment Therapy.

OBJECTIVE: Benzodiazepines and Z-drugs (BZs) are known to present a high-risk for chronic dependence when patients do not adhere to duration of use guidelines. Cognitive Behavioral Therapy for Insomnia (CBT-I) has shown effectiveness to reduce dependence, but is not frequently sought by consumers due to being costly and time intensive. A single session of CBT-I may show promise as a compromise. The efficacy of these two approaches is herein compared in the context of a drug tapering program.

METHOD: In this randomized controlled trial, the latest generation of CBT-I, Acceptance and Commitment Therapy for Insomnia (ACT-I), was compared to a single session of CBT-I in the context of a tapering program assessing two tapering speeds (rapid-6 weeks vs. long-18 weeks), and short vs. long BZs drug half-lives. The taper program consisted of 10-min phone guided sessions with a psychologist. Participants were evaluated pre-treatment, and at 1, 3, and 12 months post-treatment.

RESULTS: Across all experimental groups, by 12 months, 58.6 % of the 87 participants achieved successful abstinence, and 29.9 % reduced their daily dosage by more than 50 %. No significant difference was observed between ACT-I and the single session of CBT-I. The rapid taper condition led to cumulative withdrawal symptoms in long BZ half-life consumers.

CONCLUSION: Both ACT-I and the single session of CBT-I are associated with similar success rates when combined with a drug tapering program consisting of periodic telephone consultations. Clinical practice may be reevaluated to propose slow tapering for long BZ half-lives. The data show this program to be effective to a broad population.