Telepsychology for Benzodiazepines Withdrawal in Adults Suffering From Hypnotic-dependent Insomnia

NCT ID: NCT04751851

Last Updated: 2025-05-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

128 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-03

Study Completion Date

2025-04-04

Brief Summary

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Long-term use of benzodiazepines is a long-standing problem, but the optimal withdrawal modalities are not known. The main objective of this study is to compare the effectiveness of a psychological support versus a psychotherapeutic intervention (Acceptance and Commitment Therapy, ACT) added to a withdrawal program on the reduction of benzodiazepines use in adults suffering from insomnia and hypnotic dependence.

Detailed Description

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Benzodiazepines and related drugs (BZDs) are effective for insomnia and anxiety in the short term. After few months (four weeks regarding insomnia), the benefit/risk ratio is considerably reduced. Nevertheless, between 2 and 5% of the general population uses them for more than 6 months. Prescribing recommendations are unanimous concerning the short-term use of these substances, but do not specify the optimal ways of reducing doses in a withdrawal programme.

Many factors influence the success of withdrawal, including the duration of withdrawal (how quickly doses are reduced), the half-life of the substance, and number of psychological factors. Studies on BZD withdrawal show that, on average, spontaneous cessation of treatment is 5-10%, withdrawal success is 30-40% following brief intervention and 60-80% following Behavioral and Cognitive Therapy (CBT). These are few, and only one study has tested the efficacy of Acceptance and Commitment Therapy (ACT) for benzodiazepine withdrawal. ACT is a contextual behavioral therapy which aims to increase acceptance of the full range of inner experiences including negative thoughts, emotions and sensations, in order to promote values-driven behavior change, leading to an improved quality of life. ACT is notably effective for the treatment of anxiety disorders, depression, psychosis and chronic pain, and some studies have shown the effectiveness of ACT for insomnia.

This study is a four-arms randomized controlled intervention which aims to evaluate the addition to a taper program of an ACT intervention versus a psychological support on one hand, and the duration of withdrawal on the other hand, in patients suffering from hypnotic-dependent insomnia. The entire protocol will be remotely delivered, which no randomized controlled trial has so far evaluated for benzodiazepine withdrawal.

Conditions

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Chronic Insomnia Hypnotic Dependence

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The participants will be randomly divided into four arms :

* Group A.1: Medium duration withdrawal programme with ACT
* Group A.2: Long duration withdrawal programme with ACT
* Group B.1: Medium duration withdrawal programme without ACT
* Group B.2: Long duration withdrawal programme without ACT
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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A.1: Medium duration withdrawal programme with ACT

Medium duration withdrawal programme with Acceptance and Commitment Therapy

Group Type EXPERIMENTAL

Medium duration withdrawal programme with ACT

Intervention Type BEHAVIORAL

* 10 interviews of withdrawal monitoring and psychological support during a taper programme of 6 weeks.
* 8 individual weekly ACT sessions. The ACT programme includes mindfulness, acceptance and thoughts defusion exercises, identification of personal values and promotion of actions committed to these values. It also includes sleep restriction, a component of CBT for insomnia, used in this protocol to carry out committed-actions, according to the principles of ACT.

A.2: Long duration withdrawal programme with ACT

Long duration withdrawal programme with Acceptance and Commitment Therapy

Group Type EXPERIMENTAL

Long duration withdrawal programme with ACT

Intervention Type BEHAVIORAL

* 10 interviews of withdrawal monitoring and psychological support during a taper programme of 18 weeks.
* 8 individual weekly ACT sessions. The ACT programme includes mindfulness, acceptance and thoughts defusion exercises, identification of personal values and promotion of actions committed to these values. It also includes sleep restriction, a component of CBT for insomnia, used in this protocol to carry out committed-actions, according to the principles of ACT.

B.1: Medium duration withdrawal programme without ACT

Medium duration withdrawal programme without Acceptance and Commitment Therapy

Group Type ACTIVE_COMPARATOR

Medium duration withdrawal programme without ACT

Intervention Type BEHAVIORAL

10 interviews of withdrawal monitoring and psychological support during a taper programme of 6 weeks.

B.2: Long duration withdrawal programme without ACT

Long duration withdrawal programme without Acceptance and Commitment Therapy

Group Type ACTIVE_COMPARATOR

Long duration withdrawal programme without ACT

Intervention Type BEHAVIORAL

10 interviews of withdrawal monitoring and psychological support during a taper programme of 18 weeks.

Interventions

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Medium duration withdrawal programme with ACT

* 10 interviews of withdrawal monitoring and psychological support during a taper programme of 6 weeks.
* 8 individual weekly ACT sessions. The ACT programme includes mindfulness, acceptance and thoughts defusion exercises, identification of personal values and promotion of actions committed to these values. It also includes sleep restriction, a component of CBT for insomnia, used in this protocol to carry out committed-actions, according to the principles of ACT.

Intervention Type BEHAVIORAL

Long duration withdrawal programme with ACT

* 10 interviews of withdrawal monitoring and psychological support during a taper programme of 18 weeks.
* 8 individual weekly ACT sessions. The ACT programme includes mindfulness, acceptance and thoughts defusion exercises, identification of personal values and promotion of actions committed to these values. It also includes sleep restriction, a component of CBT for insomnia, used in this protocol to carry out committed-actions, according to the principles of ACT.

Intervention Type BEHAVIORAL

Medium duration withdrawal programme without ACT

10 interviews of withdrawal monitoring and psychological support during a taper programme of 6 weeks.

Intervention Type BEHAVIORAL

Long duration withdrawal programme without ACT

10 interviews of withdrawal monitoring and psychological support during a taper programme of 18 weeks.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* French speaker
* Had benzodiazepines and related drugs prescribed to improving sleep, for a minimum of 4 nights per week and for at least 6 months
* Pathological Benzodiazepine Dependence Questionnaire (BDEPQ) score (\>34).
* Motivated to stop hypnotic treatment (score \>5 on a 1 to 10 degrees VAS)
* Subjective complaints of difficulties initiating and/or maintaining sleep for a minimum of 3 nights per week and for at least 6 months, and 4) presence of marked distress or impaired daytime functioning (fatigue, impaired attention and/or concentration). Because hypnotic medications may mask an underlying insomnia problem, participants should meet these criteria either currently (while taking medication) or after previous attempts to discontinue the medication. These criteria are consistent with those for primary insomnia and hypnotic-dependent insomnia.
* Present the diagnoses of insomnia (307.42) and sedative, hypnotic and anxiolytic use disorder (304.10) from the DSM V.
* Having e-literacy (being familiar with emails, videoconferencing, online questionnaires and Internet use)

Exclusion Criteria

* In acute treatment for psychological or psychiatric problems (e.g., current participation in psychotherapy)
* Be participating in a tapering BZD protocol, or similar
* Currently receiving an active prescription for any antipsychotic medication
* Using non-BZRA sedative-hypnotics for treating insomnia or related sleep problems (e.g., trazodone, quetiapine, tricyclic antidepressant, mirtazapine, diphenhydramine, dimenhydrinate)
* Met criteria for a substance use disorder in the last six months (other than nicotine and hypnotics)
* Use of alcohol or cannabis 3 or more nights a week for sleep problems
* Drinking more than 3 alcoholic beverages per day
* Presence of another untreated sleep disorder (e.g., obstructive sleep apnea or periodic limb movements during sleep)
* Presence of major depression or other severe unstabilized psychopathology (e.g., bipolar disorder, psychosis, panic disorder, generalized anxiety disorder, posttraumatic stress disorder, specific phobia, social phobia, or obsessive-compulsive disorder)
* Had a history of psychosis
* Currently suicidal
* Current crisis or with an illness for which the benzodiazepine were required at the time (e.g. acute pain)
* Presence of terminal illness (e.g. cancer, receiving palliative care)
* Unstable cardiovascular, respiratory or endocrinological diseases (clinical interview)
* Had a history of severe cognitive impairment, dementia, seizure disorder (epilepsy either in themselves or in their family), spinal injury
* Pregnant or lactating
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Association Nationale de Promotion des Connaissances sur le Sommeil

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Benjamin Putois, MD, Ph.D

Role: PRINCIPAL_INVESTIGATOR

Lyon Neuroscience Research Centre, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, France

Laure Peter-Derex, MD, Ph.D

Role: PRINCIPAL_INVESTIGATOR

Lyon Neuroscience Research Centre, CNRS UMR 5292 - INSERM U1028 - Lyon 1 University, France

Locations

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PROSOM

Lausanne, , Switzerland

Site Status

Countries

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Switzerland

Other Identifiers

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BENZOSTOP

Identifier Type: -

Identifier Source: org_study_id

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