Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms.

Abstract

Objective Depressive symptoms are associated with poor smoking cessation outcomes and there remains continued interest in behavioral interventions that simultaneously target smoking and depressive symptomatology. This pilot study examined whether a behavioral activation treatment for smoking can enhance cessation outcomes. Method A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years old, 48.5% female, 72.7% African-American) seeking smoking cessation treatment were randomized to receive either behavioral activation treatment for smoking (BATS) paired with standard smoking cessation strategies including nicotine replacement therapy (n = 35) or standard smoking cessation strategies (ST) alone including nicotine replacement therapy (n = 33). BATS and ST were matched for contact time and included 8 sessions of group-based treatment. Quit date was assigned to occur at session 4 for each treatment condition. Participants completed a baseline assessment, and measures of smoking cessation outcomes (7-day verified point prevalence abstinence), depressive symptoms (BDI-II), and enjoyment from daily activities (EROS) were obtained at 1, 4, 16, and 26 weeks post assigned quit date. Results Across the follow-ups over 26 weeks, participants in BATS reported greater smoking abstinence (adjusted odds ratio = 3.59; 95% confidence interval = 1.22, 10.53; p =.02) than did those in ST. Participants in BATS also reported a greater reduction in depressive symptoms (B = -1.99, SE = .86, p = .02) than did those in ST. Conclusions Results suggest BATS is a promising intervention that may promote smoking cessation and improve depressive symptoms among underserved smokers of diverse backgrounds.

Smoking cessation: Next steps for special populations research and innovative treatments.

“…At 6 months follow-up, women with higher levels of baseline depressive symptoms who had received CBASP had a higher probability of abstinence and greater improvements in depression than those treated with health and wellness. Both this study and the MacPherson et al (2010) study illustrate that EBTs in other areas of psychology can be effectively applied to smoking cessation.…”

Smoking Cessation Interventions for Patients with Depression: A Systematic Review and Meta-analysis

“…We identified 16 trials; only Hall (2006), MacPherson (2010), and Vickers (2009) recruited participants with current depression. 32,33,37 Most patients included in this review were historypositive for depression; findings best apply to this population.…”

“…38 Five of these studies, involving 402 smokers with depression, provided sufficient data to metaanalyze the added effect of mood management therapy to other smoking cessation cotreatments. 25,26,36,37,39 All studies included in the meta-analysis were in the expected direction, favoring behavioral mood management (RR = 1.41, 95% CI 1.01-1.96, Cochran Q=2.09, p = 0.71, I 2 = 0%). (Fig.…”

“…31 Ten studies were of good quality and only six trials used depression status as an inclusion criterion. [32][33][34][35][36][37] ( Table 2) Data from the remaining ten studies included in this review were from subgroup analysis of trials that recruited general populations of smokers; many of these trials cited current depression as an exclusion criteria. Thus, depressed participants included in this review from these ten studies were history positive for MDD or exceeded a screening threshold for significant depressive symptoms but were not recruited based on depression status.…”

“…38 Six studies included behavioral mood management. 25,26,[36][37][38][39] Behavioral mood management ranged from one-time mood management counseling to intensive multisession CBT. Of the studies that included antidepressants, four used bupropion, 33,34,38,40 and three tested sertraline, fluoxetine, or nortriptyline.…”