# The Efficacy of Masked Tapering on Discontinuation of Hypnotics in Older Veterans

> **NIH VA I01** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2021 · —

## Abstract

Hypnotics such as benzodiazepines and benzodiazepine receptor agonists are often prescribed for
insomnia. Among Veterans attending outpatient clinics, approximately one-quarter use hypnotics (or bedtime
alcohol). Hypnotics use is associated with an increased risk of falls and worse cognition in older adults.
Discontinuing hypnotics often attenuates or reverses these negative effects, and the Department of Veterans
Affairs (VA) has initiatives to reduce hypnotic use among older adults. Current discontinuation strategies focus
on tapering off the hypnotic and/or treating insomnia symptoms. Common strategies include supervised
gradual taper (SGT), cognitive behavioral therapy targeting hypnotic withdrawal (CBT-HW), cognitive
behavioral therapy for insomnia (CBTI), and combination therapy (SGT+CBTI). Yet up to 40% of patients
eventually resume use of hypnotics with these strategies, suggesting that other mechanisms need to be
targeted to achieve and sustain high rates of non-use.
 Another mechanism that may be a viable target for achieving hypnotic discontinuation and sustaining long-
term non-use is the placebo effect, which is characterized by real improvements in sleep arising from
psychosocial aspects of treatment rather than drug effects alone. We recently developed and tested the
feasibility of an intervention that targets the placebo effect. Our intervention retains core components tested in
prior studies for achieving hypnotic discontinuation (i.e., SGT+CBTI), but adds a novel feature—“masked”
tapering. Masking is achieved by encapsulating hypnotics (prepared by a compounding pharmacy) so the
patient, 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 patient. Towards the end of the taper, placebo
capsules are used. Through novel cognitive exercises, the therapist uses masking as a tool to challenge
expectancies about hypnotics, which may be contributing to chronic use, and to augment CBT-HW (e.g.,
preparing for withdrawal). Coupled with CBTI (i.e., stimulus control, sleep restriction, cognitive therapy for
insomnia, and relaxation), the intervention targets the placebo effect and the factors contributing to insomnia
symptoms and helps patients safely taper off their hypnotic.
 Objectives: 1) To assess the efficacy of Masked Taper plus cognitive behavioral therapy-augmented
program (MTcap) on hypnotic discontinuation among older Veterans, 2) to determine the impact of the MTcap
intervention on insomnia severity, 3) to assess the impact of the MTcap intervention on participants' beliefs and
expectancies for using hypnotics to improve sleep quality and daytime function, and 4) to assess the efficacy of
MTcap on balance and cognition.
 To achieve these objectives, we propose to conduct a randomized clinical trial in older Veterans recruited
from a single VA site. Veterans will undergo a 3-step screening process (letter with opt-out card, te...

## Key facts

- **NIH application ID:** 10197053
- **Project number:** 5I01HX002166-03
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Constance Fung
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10197053

## Citation

> US National Institutes of Health, RePORTER application 10197053, The Efficacy of Masked Tapering on Discontinuation of Hypnotics in Older Veterans (5I01HX002166-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10197053. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*