# A novel mechanism for helping older adults discontinue use of sleeping pills

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2021 · $464,059

## Abstract

Project Summary
Use of hypnotics such as benzodiazepines and benzodiazepine receptor agonists is associated with adverse
health outcomes in older adults. Response rates to hypnotic discontinuation programs are often inadequate,
and many patients eventually resume use of hypnotics, suggesting that other mechanisms need to be targeted
to achieve and sustain high rates of non-use. Current programs focus on the tapering of hypnotics and/or the
treatment of insomnia symptoms. These programs employ strategies such as supervised gradual taper,
cognitive behavioral therapy targeting hypnotic withdrawal, and/or cognitive behavioral therapy for insomnia.
Evidence suggests that another mechanism involving “placebo” effects may be a viable target for achieving
and sustaining higher discontinuation rates. Cognitive expectancies play a key role in producing placebo
effects, which are characterized as real improvements in sleep arising from psychosocial aspects of treatment
rather than drug effects alone. The long-term goal of this research is to improve the health of older adults who
use hypnotics and have insomnia. This project's objectives are to determine whether a new program, entitled
Masked Taper plus cognitive behavioral therapy-augmented program (MTcap), which combines novel
cognitive exercises and masked tapering (described below), compared to an unmasked supervised gradual
taper plus cognitive behavioral therapy for insomnia (SGT+CBTI), reduces expectancies for hypnotics,
improves hypnotic discontinuation rates, and improves insomnia symptoms. The central hypothesis is that
cognitive expectancies that produce placebo effects are modifiable and that hypnotic discontinuation and
insomnia severity improve when cognitive expectancies for hypnotics are diminished. This hypothesis has
been formulated on our extensive preliminary data, which includes results from a “masked” tapering
intervention aimed at altering cognitive expectancies that produce placebo effects. Masking is achieved by
encapsulating hypnotics so the participant, who has consented to a gradual taper, is unaware of the actual
dose in each capsule until the end of the taper, when the tapering schedule is revealed to the participant. The
therapist uses masking as a tool to challenge expectancies about hypnotics that may be contributing to chronic
use and to augment cognitive behavioral therapy targeting hypnotic withdrawal (e.g., preparing for withdrawal).
The central hypothesis will be tested by pursing three specific aims in a 5-year randomized trial conducted
among 188 participants recruited from 2 sites: Determine whether MTcap improves 1) expectancies about
hypnotics more than SGT+CBTI, 2) hypnotic discontinuation more than SGT+CBTI, and 3) insomnia severity
more than SGT+CBTI at follow-up. This innovative approach targets a previously unaddressed mechanism—
the placebo effect—that may contribute to chronic hypnotic use. This highly significant research will improve
understanding of hypn...

## Key facts

- **NIH application ID:** 10160732
- **Project number:** 5R01AG057929-04
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** Constance Fung
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $464,059
- **Award type:** 5
- **Project period:** 2018-09-15 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10160732

## Citation

> US National Institutes of Health, RePORTER application 10160732, A novel mechanism for helping older adults discontinue use of sleeping pills (5R01AG057929-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10160732. Licensed CC0.

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