scholarly journals Strategies for discontinuing long-term benzodiazepine use

2006 ◽  
Vol 189 (3) ◽  
pp. 213-220 ◽  
Author(s):  
Richard C. Oude Voshaar ◽  
Jaap E. Couvée ◽  
Anton J. L. M. Van Balkom ◽  
Paul G. H. Mulder ◽  
Frans G. Zitman
Keyword(s):  
Meta Analysis ◽  
Behavioural Therapy ◽  
Stepped Care ◽  
Success Rates ◽  
Treatment As Usual ◽  
Minimal Intervention ◽  
Group Cognitive Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Benzodiazepine Use

BackgroundThe prevalence of benzodiazepine consumption in European countries remains at 2–3% of the general population despite the well-documented disadvantages of long-term use.AimsTo review systematically the success rates of different benzodiazepine discontinuation strategies.MethodMeta-analysis of comparable intervention studies.ResultsTwenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6–5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0–18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1–9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3–14.2) was superior to systematic discontinuation alone.ConclusionsEvidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.

scholarly journals Tapering off long-term benzodiazepine use with or without group cognitive-behavioural therapy: three-condition, randomised controlled trial

2003 ◽  
Vol 182 (6) ◽  
pp. 498-504 ◽  
Author(s):  
Richard C. Oude Voshaar ◽  
Wim J. M. J. Gorgels ◽  
Audrey J. J. Mol ◽  
Anton J. L. M. Van Balkom ◽  
Eloy H. Van De Lisdonk ◽  
...  
Keyword(s):  
General Practice ◽  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Group Cognitive Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Benzodiazepine Use ◽  
Randomised Controlled ◽  
Group Cbt

BackgroundBenzodiazepine withdrawal programmes have never been experimentally compared with a nonintervention control condition.AimsTo evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use in general practice, and to evaluate the value of additional group cognitive–behavioural therapy (CBT).MethodA 3-month randomised, controlled trial was conducted in which 180 people attempting to discontinue long-term benzodiazepine use were assigned to tapering off plus group CBT, tapering off alone or usual care.ResultsTapering off led to a significantly higher proportion of successful discontinuations than usual care (62% v. 21%). Adding group CBT did not increase the success rate (58% v. 62%). Neither successful discontinuation nor intervention type affected psychological functioning. Both tapering strategies showed good feasibility in general practice.ConclusionsTapering off is a feasible and effective way of discontinuing long-term benzodiazepine use in general practice. The addition of group CBT is of limited value.

scholarly journals Group cognitive-behavioural therapy for schizophrenia

2006 ◽  
Vol 189 (6) ◽  
pp. 527-532 ◽  
Author(s):  
Christine Barrowclough ◽  
Gillian Haddock ◽  
Fiona Lobban ◽  
Steve Jones ◽  
Ron Siddle ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Treatment Method ◽  
Self Esteem ◽  
Behavioural Therapy ◽  
Positive Symptom ◽  
Secondary Outcome ◽  
Symptom Improvement ◽  
Treatment As Usual ◽  
Group Cognitive Behavioural Therapy ◽  
Cognitive Behavioural

BackgroundThe efficacy of cognitive–behavioural therapy for schizophrenia is established, but there is less evidence for a group format.AimsTo evaluate the effectiveness of group cognitive – behavioural therapy for schizophrenia.MethodIn all, 113 people with persistent positive symptoms of schizophrenia were assigned to receive group cognitive – behavioural therapy or treatment as usual. The primary outcome was positive symptom improvement on the Positive and Negative Syndrome Scales. Secondary outcome measures included symptoms, functioning, relapses, hopelessness and self-esteem.ResultsThere were no significant differences between the cognitive-behavioural therapy and treatment as usual on measures of symptoms or functioning or relapse, but group cognitive – behavioural therapy treatment resulted in reductions in feelings of hopelessness and in low self-esteem.ConclusionsAlthough group cognitive – behavioural therapy may not be the optimum treatment method for reducing hallucinations and delusions, it may have important benefits, including feeling less negative about oneself and less hopeless for the future.

scholarly journals Balneotherapy Together with a Psychoeducation Program for Benzodiazepine Withdrawal: A Feasibility Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
P. De Maricourt ◽  
P. Gorwood ◽  
Th. Hergueta ◽  
A. Galinowski ◽  
R. Salamon ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Behavioural Therapy ◽  
Public Health Issue ◽  
Depression Symptoms ◽  
Cognitive Behavioural ◽  
Efficacy Outcome ◽  
Benzodiazepine Use ◽  
Benzodiazepine Withdrawal ◽  
The Impact

Benzodiazepines should be prescribed on a short-term basis, but a significant proportion of patients (%) use them for more than 6 months, constituting a serious public health issue. Indeed, few strategies are effective in helping patients to discontinue long-term benzodiazepine treatments. The aim of this study was to assess the feasibility and the impact of a program including cognitive behavioural therapy, psychoeducation, and balneotherapy in a spa resort to facilitate long-term discontinuation of benzodiazepines. We conducted a prospective multicentre cohort study. Patients with long-term benzodiazepine use were recruited with the aim of anxiolytic withdrawal by means of a psychoeducational program and daily balneotherapy during 3 weeks. The primary efficacy outcome measure was benzodiazepine use 6 months after the program, compared to use at baseline. A total of 70 subjects were enrolled. At 6 months, overall benzodiazepine intake had decreased by 75.3%, with 41.4% of patients completely stopping benzodiazepine use. The results also suggest a significantly greater improvement in anxiety and depression symptoms among patients who discontinued benzodiazepines compared to patients who only reduced their use. Our findings suggest that balneotherapy in association with a psychoeducative program is efficient in subjects with benzodiazepine addiction.

scholarly journals Psychological interventions for people with psychotic experiences: A systematic review and meta-analysis of controlled and uncontrolled effectiveness and economic studies

2020 ◽  
Vol 54 (7) ◽  
pp. 673-695
Author(s):  
Emma Soneson ◽  
Debra Russo ◽  
Jan Stochl ◽  
Margaret Heslin ◽  
Julieta Galante ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Psychotic Disorders ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Economic Evaluations ◽  
Psychological Interventions ◽  
Psychotic Experiences ◽  
Treatment As Usual ◽  
Cognitive Behavioural

Objective: Many people with psychotic experiences do not develop psychotic disorders, yet those who seek help demonstrate high clinical complexity and poor outcomes. In this systematic review and meta-analysis, we evaluated the effectiveness and cost-effectiveness of psychological interventions for people with psychotic experiences. Method: We searched 13 databases for studies of psychological interventions for adults with psychotic experiences, but not psychotic disorders. Our outcomes were the proportion of participants remitting from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, and quality of life; and economic outcomes (secondary). We analysed results using multilevel random-effects meta-analysis and narrative synthesis. Results: A total of 27 reports met inclusion criteria. In general, there was no strong evidence for the superiority of any one intervention. Five studies reported on our primary outcome, though only two reports provided randomised controlled trial evidence that psychological intervention (specifically, cognitive behavioural therapy) promoted remission from psychotic experiences. For secondary outcomes, we could only meta-analyse trials of cognitive behavioural therapy. We found that cognitive behavioural therapy was more effective than treatment as usual for reducing distress (pooled standardised mean difference: −0.24; 95% confidence interval = [−0.37, −0.10]), but no more effective than the control treatment for improving any other outcome. Individual reports indicated that cognitive behavioural therapy, mindfulness-based cognitive therapy, sleep cognitive behavioural therapy, systemic therapy, cognitive remediation therapy, and supportive treatments improved at least one clinical or functional outcome. Four reports included economic evaluations, which suggested cognitive behavioural therapy may be cost-effective compared with treatment as usual. Conclusion: Our meta-analytic findings were primarily null, with the exception that cognitive behavioural therapy may reduce the distress associated with psychotic experiences. Our analyses were limited by scarcity of studies, small samples and variable study quality. Several intervention frameworks showed preliminary evidence of positive outcomes; however, the paucity of consistent evidence for clinical and functional improvement highlights a need for further research into psychological treatments for psychotic experiences. PROSPERO protocol registration number: CRD42016033869

scholarly journals Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Harry Banyard ◽  
Alex J. Behn ◽  
Jaime Delgadillo
Keyword(s):  
Systematic Review ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Behavioural Therapy ◽  
Risk Of Bias ◽  
Cognitive Behavioural ◽  
Primary Focus ◽  
Effect Of Pd ◽  
Evidence Based Care

Abstract Background Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on studies of Cognitive Behavioural Therapy (CBT) for depression examining the influence of comorbid PD on post-treatment depression outcomes. Methods This was a systematic review and meta-analysis of studies identified through PubMed, PsychINFO, Web of Science, and Scopus. A review protocol was pre-registered in the PROSPERO database (CRD42019128590). Results Eleven eligible studies (N = 769) were included in a narrative synthesis, and ten (N = 690) provided sufficient data for inclusion in random effects meta-analysis. All studies were rated as having “low” or “moderate” risk of bias and there was no significant evidence of publication bias. A small pooled effect size indicated that patients with PD had marginally higher depression severity after CBT compared to patients without PD (g = 0.26, [95% CI: 0.10, 0.43], p = .002), but the effect was not significant in controlled trials (p = .075), studies with low risk of bias (p = .107) and studies that adjusted for intake severity (p = .827). Furthermore, PD cases showed symptomatic improvements across studies, particularly those with longer treatment durations (16–20 sessions). Conclusions The apparent effect of PD on depression outcomes is likely explained by higher intake severity rather than treatment resistance. Excluding these patients from evidence-based care for depression is unjustified, and adequately lengthy CBT should be routinely offered.

scholarly journals Efficacy and moderators of efficacy of trauma-focused cognitive behavioural therapies in children and adolescents: protocol for an individual participant data meta-analysis from randomised trials

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e047212
Author(s):  
Anke de Haan ◽  
Caitlin Hitchcock ◽  
Richard Meiser-Stedman ◽  
Markus A Landolt ◽  
Isla Kuhn ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Risk Of Bias ◽  
Randomised Trials ◽  
First Line ◽  
Cognitive Behavioural ◽  
Individual Participant ◽  
Behavioural Therapies ◽  
First Line Treatment

IntroductionTrauma-focused cognitive behavioural therapies are the first-line treatment for posttraumatic stress disorder (PTSD) in children and adolescents. Nevertheless, open questions remain with respect to efficacy: why does this first-line treatment not work for everyone? For whom does it work best? Individual clinical trials often do not provide sufficient statistical power to examine and substantiate moderating factors. To overcome the issue of limited power, an individual participant data meta-analysis of randomised trials evaluating forms of trauma-focused cognitive behavioural therapy in children and adolescents aged 6–18 years will be conducted.Methods and analysisWe will update the National Institute for Health and Care Excellence guideline literature search from 2018 with an electronic search in the databases PsycINFO, MEDLINE, Embase, Cochrane Central Register of Controlled Trials and CINAHL with the terms (trauma* OR stress*) AND (cognitive therap* OR psychotherap*) AND (trial* OR review*). Electronic searches will be supplemented by a comprehensive grey literature search in archives and trial registries. Only randomised trials that used any manualised psychological treatment—that is a trauma-focused cognitive behavioural therapy for children and adolescents—will be included. The primary outcome variable will be child-reported posttraumatic stress symptoms (PTSS) post-treatment. Proxy-reports (teacher, parent and caregiver) will be analysed separately. Secondary outcomes will include follow-up assessments of PTSS, PTSD diagnosis and symptoms of comorbid disorders such as depression, anxiety-related and externalising problems. Random-effects models applying restricted maximum likelihood estimation will be used for all analyses. We will use the Revised Cochrane Risk of Bias tool to measure risk of bias.Ethics and disseminationContributing study authors need to have permission to share anonymised data. Contributing studies will be required to remove patient identifiers before providing their data. Results will be published in a peer-reviewed journal and presented at international conferences.PROSPERO registration numberCRD42019151954.

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