Use of a blinded hypnotic tapering strategy to promote hypnotic discontinuation
Bibliographic record
Abstract
Abstract Study Objectives Cognitive behavioral insomnia therapy (CBT-I) combined with supervised open-label tapering is effective for helping hypnotic-dependent patients discontinue their hypnotics. This study tested whether slowing the tapering pace and blinding the tapering process enhance outcomes. Methods Seventy-eight benzodiazepines (BZD) or benzodiazepine receptor agonists (BZRA) users completed 4 CBT-I sessions, followed by a randomly assigned blinded tapering protocol wherein hypnotic dosage was: held constant, reduced by 10% every two weeks, or reduced by 25% every two weeks. After 20 weeks those who did not have their medications reduced were offered an open-label tapering protocol. Participants completed assessments 3 months after completing their respective tapering protocols. Outcomes included discontinuation rates, hypnotic withdrawal effects, and responder and remission rates determined by Insomnia Severity Index (ISI) scores. Results No differences were observed between the two tapering paces (10% vs. 25%). Blinded tapering had a consistent association with better outcomes that did not reach statistical significance. At 3-month follow-up the number of patients needed to be treated with blinded taper instead of open-label tapering in order for one additional individual to achieve desired endpoints was 7.7 for BZD/BZRA discontinuation, 3.4 for hypnotic withdrawal effects, 4.4 for ISI responder status, and 5.0 for insomnia remission. One-third (32.3%) of the sample was using benzo-related hypnotics at 3-month follow-up. Twice as many individuals (64.6%) were using some type of medication or substance for sleep at this time point. Conclusions Blinding tapering may enhance hypnotic discontinuation rates and insomnia treatment response and remission rates. Trial Registration: Clinicaltrials.gov Identifier: NCT02831894, “The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation;” URL:https://clinicaltrials.gov/ct2/show/NCT02831894?term=hypnotics&cond=Insomnia&cntry=US&state=US%3ACO&city=Denver&draw=2&rank=2
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".