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Impact of Cognitive Behaviour Therapy Via Mail for Cessation of Benzodiazepine Use: A Series of Case Reports

Published online by Cambridge University Press:  11 April 2013

Jannette M. Parr ,
David J. Kavanagh ,
Ross McD. Young ,
Barbara Stubbs  and
Nick Bradizza
Jannette M. Parr
Affiliation:
The University of Queensland, School of Medicine, Discipline of Psychiatry, Brisbane, Queensland, Australia
David J. Kavanagh*
Affiliation:
Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
Ross McD. Young
Affiliation:
Faculty of Health Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
Barbara Stubbs
Affiliation:
Queensland Health, Cairns Health Service District, Cairns, Queensland, Australia
Nick Bradizza
Affiliation:
Queensland Health, Cairns Health Service District, Cairns, Queensland, Australia
*
Address for correspondence: Professor David Kavanagh, Institute of Health & Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane QLD 4001, Australia. Email: david.kavanagh@qut.edu.au
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Abstract

Benzodiazepines are widely prescribed to manage sleep disorders, anxiety and muscular tension. While providing short-term relief, continued use induces tolerance and withdrawal, and in older users, increases the risk of falls. However, long-term prescription remains common, and effective interventions are not widely available. This study developed a self-managed cognitive behaviour therapy package for cessation of benzodiazepine use delivered to participants via mail (M-CBT) and trialled its effectiveness as an adjunct to a general practitioner (GP)-managed dose reduction schedule. In the pilot trial, participants were randomly assigned to GP management with immediate or delayed M-CBT. Significant recruitment and engagement problems were experienced, and only three participants were allocated to each condition. After immediate M-CBT, two participants ceased use, while none receiving delayed treatment reduced daily intake by more than 50%. Across the sample, doses at 12 months remained significantly lower than baseline, and qualitative feedback from participants was positive. While M-CBT may have promise, improved engagement of GPs and participants is needed for this approach to substantially impact on community-wide benzodiazepine use.

Keywords

benzodiazepinescorrespondencecognitive-behaviour therapygeneral practitionermailed interventionself-managed
Type
Standard Papers
Information
Behaviour Change , Volume 30 , Issue 2 , June 2013 , pp. 74 - 83
Copyright
Copyright © The Authors 2013

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References

Ashton, H. (1987). Benzodiazepine withdrawal: Outcome in 50 patients. British Journal of Addiction, 82 (6), 665–671.CrossRefGoogle ScholarPubMed
Australian Bureau of Statistics. (1996). National health survey, first results, Australia, 1995. Canberra, Australia: Author.Google Scholar
Barker, M.J., Greenwood, K.M., Jackson, M., & Crowe, S.F. (2004) Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: A meta-analysis. Archives of Clinical Neuropsychology, 19 (3), 437–454.CrossRefGoogle ScholarPubMed
Barter, G., & Cormack, M. (1996). The long-term use of benzodiazepines: Patients’ views, accounts and experiences. Family Practice, 13 (6), 491–497.CrossRefGoogle ScholarPubMed
Clarke, G., Kelleher, C., Hornbrook, M., Debar, L., Dickerson, J., & Gullion, C. (2009). Randomized effectiveness trial of an Internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults. Cognitive Behavioral Therapy, 38 (4), 222–234.CrossRefGoogle ScholarPubMed
Cumming, R.G., & Le Couteur, D.G. (2003) Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs, 17 (11), 825–837.CrossRefGoogle ScholarPubMed
D'Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behaviour modification. Journal of Abnormal Psychology, 78, 107–126.CrossRefGoogle Scholar
Department of Health and Ageing. (2010). Expenditure and prescriptions twelve months to 30 June 2010. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/pbs-stats-pbexp-jun10Google Scholar
Ghosh, A., Marks, I.M., & Carr, A.C. (1988). Therapist contact and outcome of self-exposure treatment for phobias: A controlled study. British Journal of Psychiatry, 152, 234–238.CrossRefGoogle ScholarPubMed
Glasgow, R. E., & Rosen, G. M. (1978). Behavioral bibliotherapy: A review of self-help behavior therapy manuals. Psychological Bulletin, 85 (1), 1–23.CrossRefGoogle ScholarPubMed
Hallstrom, C., & Lader, M. (1981). Benzodiazepine withdrawal phenomena. International Pharmacopsychiatry, 16 (4), 235–244.CrossRefGoogle ScholarPubMed
Holbrook, A.M., Crowther, R., Lotter, A., Cheng, C., & King, D. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. Canadian Medical Association Journal, 162 (2), 225–233.Google ScholarPubMed
Iliffe, S., Curran, H.V., Collins, R., Yuen Kee, S.C., Fletcher, S., & Woods, B. (2004). Attitudes to long-term use of benzodiazepine hypnotics by older people in general practice: Findings from interviews with service users and providers. Aging & Mental Health, 8 (3), 242–248.CrossRefGoogle ScholarPubMed
Kavanagh, D., & Connolly, J.M. (2009) Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial. Drug and Alcohol Review, 28 (1), 73–80.CrossRefGoogle ScholarPubMed
Lader, M.H. (1983). Dependence on benzodiazepines. Journal of Clinical Psychiatry, 44 (4), 121–127.Google ScholarPubMed
Lader, M.H., Tylee, A., & Donoghue, J. (2009). Withdrawing benzodiazepines in primary care. CNS Drugs, 23 (1), 19–34.CrossRefGoogle ScholarPubMed
Leipzig, R.M., Cumming, R.G., & Tinetti, M.E. (1999) Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs. Journal of the American Geriatrics Society, 47 (1), 30–39.CrossRefGoogle ScholarPubMed
Lidren, D.M., Watkins, P. L., Gould, R.A., Clum, G.A., Asterino, M., & Tulloch, H.L. (1994). A comparison of bibliotherapy and group therapy in the treatment of panic disorder. Journal of Consulting and Clinical Psychology, 62 (4), 865–869.CrossRefGoogle ScholarPubMed
MacKinnon, G.L., & Parker, W.A. (1982). Benzodiazepine withdrawal syndrome: A literature review and evaluation. The American Journal Of Drug and Alcohol Abuse, 9 (1), 19–33.CrossRefGoogle ScholarPubMed
Marlatt, G.A., & George, W.H. (1984). Relapse prevention: Introduction and overview of the model. Addiction Biology, 79 (3), 261–273.Google ScholarPubMed
Martin, J.L., Sainz-Pardo, M., Furukawa, T.A., Martin-Sanchez, E., Seoane, T., & Galan, C. (2007). Benzodiazepines in generalized anxiety disorder: Heterogeneity of outcomes based on a systematic review and meta-analysis of clinical trials. Journal of Psychopharmacology, 21 (7), 774–782.CrossRefGoogle ScholarPubMed
Miller, W.R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: The Guilford Press.Google Scholar
Olkkola, K.T., & Ahonen, J. (2008). Midazolam and other benzodiazepines. Handbook of Experimental Pharmacology (182), 335–360.CrossRefGoogle Scholar
Oude Voshaar, R.C., Couvee, J.E., van Balkom, A.J., Mulder, P.G., & Zitman, F.G. (2006). Strategies for discontinuing long-term benzodiazepine use: Meta-analysis. British Journal of Psychiatry, 189, 213–220.CrossRefGoogle Scholar
Parr, J.M., Kavanagh, D.J., Cahill, L., Mitchell, G., & Young, R.M. (2009). Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction, 104 (1), 13–24.CrossRefGoogle ScholarPubMed
Parr, J.M., Kavanagh, D.J., & Young, R.M. (2011). Acceptability of CBT via the internet for cessation benzodiazepine use. Drug and Alcohol Review, 30, 306–314.CrossRefGoogle Scholar
Parr, J.M., Kavanagh, D.J., Young, R.M., & McCafferty, K. (2006). Views of general practitioners and benzodiazepine users on benzodiazepines: A qualitative analysis. Social Science and Medicine, 62 (5), 1237–1249.CrossRefGoogle ScholarPubMed
Petursson, H., & Lader, M.H. (1981). Withdrawal from long-term benzodiazepine treatment. British Medical Journal, 283 (6292), 643–645.CrossRefGoogle ScholarPubMed
Ray, W.A., Griffin, M.R., & Downey, W. (1989) Benzodiazepines of long and short elimination half-life and the risk of hip fracture. Journal of the American Medical Association, 262 (23), 3303–3307.CrossRefGoogle ScholarPubMed
Ray, W.A., Griffin, M.R., Schaffner, W., Baugh, D.K., & Melton, L.J.3rd. (1987) Psychotropic drug use and the risk of hip fracture. New England Journal of Medicine, 316 (7), 363–369.CrossRefGoogle ScholarPubMed
Ray, W.A., Thapa, P.B., & Gideon, P. (2000) Benzodiazepines and the risk of falls in nursing home residents. Journal of the American Geriatrics Society, 48 (6), 682–685.CrossRefGoogle ScholarPubMed
Sitharthan, T., Kavanagh, D.J., & Sayer, G. (1996). Moderating drinking by correspondence: An evaluation of a new method of intervention. Addiction, 91 (3), 345–355.CrossRefGoogle ScholarPubMed
Tranquiliser Recovery and New Existence. (2004). Benzodiazepine reduction guidelines for doctors. Melbourne, Australia: Author.Google Scholar
Tyrer, P. (1980). Dependence on benzodiazepines. British Journal of Psychiatry, 137, 576–577.CrossRefGoogle ScholarPubMed
Vicens, C., Fiol, F., Llobera, J., Campoamor, F., Mateu, C., Alegret, S., & Socías, I. (2006). Withdrawal from long-term benzodiazepine use: Randomised trial in family practice. British Journal of General Practice, 56 (533), 958–963.Google ScholarPubMed
Wagner, A.K., Zhang, F., Soumerai, S.B., Walker, A.M., Gurwitz, J.H., Glynn, R.J., & Ross-Degnan, D. (2004). Benzodiazepine use and hip fractures in the elderly: Who is at greatest risk? Archives of Internal Medicine, 164 (14), 1567–1572.CrossRefGoogle ScholarPubMed