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Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy.

Abstract

OBJECTIVE

To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy.

DESIGN

Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia.

MAIN OUTCOME MEASURES

Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy.

RESULTS

There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change.

CONCLUSIONS

Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation.

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  • Authors+Show Affiliations

    ,

    Ecole de Psychologie, Université Laval, Centre de Recherche Université Laval--Robert-Giffard, Québec, Canada.

    Source

    MeSH

    Acetamides
    Adaptation, Psychological
    Adult
    Aged
    Anxiety
    Attitude to Health
    Azabicyclo Compounds
    Benzodiazepines
    Chronic Disease
    Cognitive Behavioral Therapy
    Combined Modality Therapy
    Depression
    Female
    Follow-Up Studies
    Humans
    Hypnotics and Sedatives
    Individuality
    Male
    Middle Aged
    Motivation
    Patient Compliance
    Personality Inventory
    Piperazines
    Pyrimidines
    Self Care
    Self Efficacy
    Sleep Initiation and Maintenance Disorders
    Stress, Psychological
    Substance Withdrawal Syndrome

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    18377143

    Citation

    Belleville, Geneviève, and Charles M. Morin. "Hypnotic Discontinuation in Chronic Insomnia: Impact of Psychological Distress, Readiness to Change, and Self-efficacy." Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, vol. 27, no. 2, 2008, pp. 239-48.
    Belleville G, Morin CM. Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy. Health Psychol. 2008;27(2):239-48.
    Belleville, G., & Morin, C. M. (2008). Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 27(2), pp. 239-48. doi:10.1037/0278-6133.27.2.239.
    Belleville G, Morin CM. Hypnotic Discontinuation in Chronic Insomnia: Impact of Psychological Distress, Readiness to Change, and Self-efficacy. Health Psychol. 2008;27(2):239-48. PubMed PMID: 18377143.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hypnotic discontinuation in chronic insomnia: impact of psychological distress, readiness to change, and self-efficacy. AU - Belleville,Geneviève, AU - Morin,Charles M, PY - 2008/4/2/pubmed PY - 2008/8/23/medline PY - 2008/4/2/entrez SP - 239 EP - 48 JF - Health psychology : official journal of the Division of Health Psychology, American Psychological Association JO - Health Psychol VL - 27 IS - 2 N2 - OBJECTIVE: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. DESIGN: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. MAIN OUTCOME MEASURES: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. RESULTS: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. CONCLUSIONS: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation. SN - 0278-6133 UR - https://www.unboundmedicine.com/medline/citation/18377143/Hypnotic_discontinuation_in_chronic_insomnia:_impact_of_psychological_distress_readiness_to_change_and_self_efficacy_ L2 - http://content.apa.org/journals/hea/27/2/239 DB - PRIME DP - Unbound Medicine ER -