brand logo

Am Fam Physician. 2004;69(5):1223-1227

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 The patients who received combined treatment were more likely to have withdrawn from use of benzodiazepines at all three blood tests (70 versus 24 percent among patients who used gradual tapering alone;P 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–)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading


More in AFP

Copyright © 2004 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See https://www.aafp.org/about/this-site/permissions.html for copyright questions and/or permission requests.