Acceptance and Commitment Therapy and nicotine patch for smokers with bipolar disorder: preliminary evaluation of in‐person and telephone‐delivered treatment

Abstract

Objectives People with bipolar disorder are two to three times more likely to smoke and 50% less likely to quit than the general population. New treatments are needed to improve smoking cessation outcomes in this group. The study aim was to develop and pilot test a novel cessation intervention for smokers with bipolar disorder using Acceptance and Commitment Therapy (ACT) combined with nicotine patch. Methods The 10-session ACT intervention was initially evaluated as in-person, individual counseling (n = 10), then as telephone-delivered counseling (n = 6). Participants were adult smokers with no more than mild current symptoms of bipolar disorder. Results For the in-person protocol, end-of-treatment outcomes were: 80% retention, 40% of participants with carbon monoxide (CO)-verified seven-day point prevalence abstinence (PPA), 90% satisfied with treatment, 8.3 of 10 sessions attended, and 54% increase in acceptance of cravings to smoke (i.e., ACT’s theory-based change process) from baseline. The seven-day PPA at one-month follow-up was 30%. For the telephone protocol, end-of-treatment outcomes were: 67% retention, 33% reporting seven-day PPA, 100% satisfied with treatment, 6.7 of 10 treatment calls completed, and 55% increase in acceptance from baseline. At one-month follow up, seven-day PPA was 17%. The proportion of treatment completers who used at least 80% of the nicotine patches was 62.5% for the in-person protocol and 0% for the telephone protocol. Conclusions Both in-person and telephone-delivered ACT were feasible. Despite low adherence to nicotine patch, the intervention showed preliminary evidence of facilitating quitting and impacting ACT’s change mechanism. A randomized, controlled trial of this targeted ACT intervention is now needed.

Telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder: systematic review

“…Studies typically included one or more measures to assess the impact on symptoms, service utilisation and attitudes (including self-efficacy and insight), but only two assessed the impact on quality of life and/or functioning (Salzer et al , 2004 ; Montes et al , 2010 ). In studies of CVD/health risk behaviours, primary outcomes typically included an index of smoking (Baker et al , 2015 ; Heffner et al , 2015 ) or CVD risk (Kilbourne et al , 2012 ; Baker et al , 2015 ). One study (Baker et al , 2014 ) focused on sedentary activity and intake of fruit and vegetables.…”

“…There were four studies reporting smoking or CVD risk behaviour outcomes (Kilbourne et al , 2012 ; Baker et al , 2014 ; Baker et al , 2015 ; Heffner et al , 2015 ), with two RCTs (Kilbourne et al , 2012 ; Baker et al , 2015 ) – one of those a pilot trial (Kilbourne et al , 2012 ). Both RCTs utilised an active comparison condition and neither demonstrated at least 50% of outcomes in favour of the telephone condition.…”

“…Further, for individuals at greater risk (BMI⩾30 or systolic BP>140), post hoc analyses demonstrated superior improvement in functioning and depressive symptoms for the telephone condition (Kilbourne et al , 2012 ). For the single-arm studies, results from Heffner et al ( 2015 ) suggest largely equivalent performance of the phone and face-to-face delivery for a smoking cessation intervention, although between groups comparisons were not performed. Finally, in a single-group pre-post design Baker et al ( 2014 ) demonstrated clinically important change across a range of health behaviours following an intervention delivered entirely by telephone.…”

Safety and efficacy of first-line smoking cessation pharmacotherapies in bipolar disorders: Subgroup analysis of a randomized clinical trial

“…Improved understanding of mechanisms underlying greater cessation difficulty and NPSAE occurrence among smokers with BD can help to inform new treatment approaches to address disparities in treatment outcomes. Although this remains a nascent area of research, a novel behavioral treatment (Acceptance and Commitment Therapy) that targets barriers to quitting among smokers with BD has been piloted, with promising results (Heffner et al, 2015). Longer courses of pharmacotherapy and abstinence-contingent monetary incentives (Brunette et al, 2018; Evins et al, 2014) may also improve cessation outcomes for smokers with BD, as well as those with other forms of serious mental illness.…”

“I Smoke Like This to Suppress These Issues That Are Flaws of My Character”: Challenges and Facilitators of Cessation Among Smokers With Bipolar Disorder

“…Furthermore, an estimated 70% of people with BD have smoked cigarettes and only 16% successfully stop smoking—a quit rate that is 60% lower than smokers without mental health conditions (Lasser et al, 2000). Despite this evidence suggesting that smokers with BD have more difficulty quitting, very few cessation studies have targeted this group (Chengappa et al, 2014; Evins, Cather, Pratt, & et al, 2014; Frye et al, 2013; Heffner, Anthenelli, DelBello, Stahl, & Strakowski, 2013; Heffner, McClure, Mull, Anthenelli, & Bricker, 2015; Weinberger et al, 2008; Wu et al, 2012), and even fewer studies have attempted to gain an in-depth understanding of their quitting experiences. The perceived challenges of quitting for smokers with BD may differ from smokers without mental health conditions (Heffner, Strawn, DelBello, Strakowski, & Anthenelli, 2011; Twyman, Bonevski, Paul, & Bryant, 2014); thus, knowledge regarding this process could facilitate development of more effective interventions for this group.…”