--- title: "Psych News Alert: Masked Taper, Targeted CBT May Help Older Patients With Insomnia Discontinue Benzodiazepines" description: Implementing a masked taper along with targeted cognitive behavioral therapy (CBT) designed to address the placebo effect may help older pat... image: https://alert.psychnews.org/hubfs/Imported_Blog_Media/woman_sleeping-iStock-1461952154-Jun-24-2025-06-41-20-4066-PM.jpg --- 10/7/24 12:00 AM # Masked Taper, Targeted CBT May Help Older Patients With Insomnia Discontinue Benzodiazepines ![Picture of Psychiatric News Alert](https://alert.psychnews.org/hs-fs/hubfs/Psych%20News%20Email%20Banners/PN-Blue-Box_rgb.png?width=50&name=PN-Blue-Box_rgb.png) [ Psychiatric News Alert ](https://alert.psychnews.org/author/psychiatric-news-alert) Share: [facebook-f icon ](http://www.facebook.com/share.php?u=https://alert.psychnews.org/2024/10/masked-taper-targeted-cbt-may-help.html) [linkedin-in icon ](http://www.linkedin.com/shareArticle?mini=true&url=https://alert.psychnews.org/2024/10/masked-taper-targeted-cbt-may-help.html) [Twitter icon ](https://twitter.com/intent/tweet?url=https://alert.psychnews.org/2024/10/masked-taper-targeted-cbt-may-help.html) [pinterest-p icon ](http://pinterest.com/pin/create/link/?url=https://alert.psychnews.org/2024/10/masked-taper-targeted-cbt-may-help.html) [envelope icon ](mailto:?body=https://alert.psychnews.org/2024/10/masked-taper-targeted-cbt-may-help.html) ![](https://alert.psychnews.org/hs-fs/hubfs/Imported_Blog_Media/woman_sleeping-iStock-1461952154-Jun-24-2025-06-41-21-5831-PM.jpg?width=200&height=133&name=woman_sleeping-iStock-1461952154-Jun-24-2025-06-41-21-5831-PM.jpg) Implementing a masked taper along with targeted cognitive behavioral therapy (CBT) designed to address the placebo effect may help older patients discontinue benzodiazepine use for insomnia better than CBT and standard tapering alone, according to a [study](https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2824755) published today in *JAMA Internal Medicine*. Constance H. Fung, M.D., M.S.H.S., of the VA Greater Los Angeles Healthcare System, and colleagues enrolled 188 adults ages 55 years or older who had used benzodiazepines and/or zolpidem for insomnia at doses of less than 8 mg diazepam equivalent two or more nights per week for at least three months. One group, the supervised taper group, received a paper schedule for tapering their medication over nine weeks along with a pill cutter. They also received eight sessions of standard CBT for insomnia during the nine-week taper and had periodic withdrawal check-ins. The other group, the masked taper group, also received eight sessions of CBT for insomnia along with withdrawal check-ins. However, their CBT included additional exercises aimed at disrupting pathways thought to result in placebo effects. In essence, the exercises challenged any preconceived notions the participants may have had about whether benzodiazepines—which some [studies](https://academic.oup.com/sleep/article-abstract/38/6/925/2417000) have shown to have at least a moderate placebo effect for treating insomnia—actually helped them sleep and whether they would experience renewed insomnia or other discomfort upon discontinuing their medication. Further, this group received their medication capsules in seven-day blister packs that, unbeknownst to the participants, contained progressively larger amounts of inert filler over nine weeks. The participants in this group were instructed to take one pill per night, with no pill cutting. There were 179 participants at one-week posttreatment follow-up. Of those, 88.4% in the masked taper group had stopped taking their benzodiazepine, compared with 67.4% in the supervised taper group. There were 176 patients at six-month follow-up, and 73.4% in the masked taper group had stopped taking their benzodiazepine, compared with 58.6% in the supervised taper group. “Although the 14.8% difference between groups [at six months] fell short of the 20% threshold used for power calculations, the sustained and high percentage of discontinuation, which is statistically significant and not without merit, may be attributed to our novel approach,” Fung and colleagues wrote. “The results are most applicable to individuals who use (not misuse) benzodiazepine receptor agonists for chronic insomnia disorder, can attend weekly therapy sessions and engage in prescribed homework, and are not at high risk for complicated withdrawal.” For related information, see the *Psychiatric News* article “[To Improve Safety in Older Patients, Consider Deprescribing](https://psychiatryonline.org/doi/10.1176/appi.pn.2021.2.15).” (Image: Getty Images/iStock/Filmstax) --- **Don't miss out!** To learn about newly posted articles in *Psychiatric News,* please sign up [here](https://appi.org/pnpubalert). **[Follow *Psychiatric News* on X!](https://twitter.com/PsychiatricNews)** **[Follow *Psychiatric News* on LinkedIn!](https://www.linkedin.com/showcase/psychiatric-news)** [insomnia](https://alert.psychnews.org/tag/insomnia), [cognitive-behavioral therapy](https://alert.psychnews.org/tag/cognitive-behavioral-therapy), [CBT](https://alert.psychnews.org/tag/cbt), [placebo effect](https://alert.psychnews.org/tag/placebo-effect), [zolpidem](https://alert.psychnews.org/tag/zolpidem) ## Related posts [![](https://alert.psychnews.org/hs-fs/hubfs/Imported_Blog_Media/pharmacist_medications_iStock-692931318-Jun-24-2025-06-14-42-3011-PM.jpg?height=200&name=pharmacist_medications_iStock-692931318-Jun-24-2025-06-14-42-3011-PM.jpg) ](https://alert.psychnews.org/2019/02/tamoxifen-may-reduce-mania-in-patients.html) [mania](https://alert.psychnews.org/tag/mania), [depression](https://alert.psychnews.org/tag/depression), [bipolar disorder](https://alert.psychnews.org/tag/bipolar-disorder), [meta-analysis](https://alert.psychnews.org/tag/meta-analysis), [Journal of Psychopharmacology](https://alert.psychnews.org/tag/journal-of-psychopharmacology), [systematic review](https://alert.psychnews.org/tag/systematic-review) ## [Tamoxifen May Reduce Mania in Patients With Bipolar Disorder But Questions Remain](https://alert.psychnews.org/2019/02/tamoxifen-may-reduce-mania-in-patients.html) ![Picture of Psychiatric News Alert](https://alert.psychnews.org/hs-fs/hubfs/Psych%20News%20Email%20Banners/PN-Blue-Box_rgb.png?width=50&name=PN-Blue-Box_rgb.png) [Psychiatric News Alert](https://alert.psychnews.org/author/psychiatric-news-alert) 2/15/19 12:00 AM Tamoxifen, a medication commonly used to treat breast cancer, appears to hold some promise as a... 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