Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial

Carmela Martínez-Vispo, Rubén Rodríguez-Cano, Ana López-Durán, Carmen Senra, Elena Fernández Del Río, Elisardo Becoña, Carmela Martínez-Vispo, Rubén Rodríguez-Cano, Ana López-Durán, Carmen Senra, Elena Fernández Del Río, Elisardo Becoña

Abstract

Introduction: Behavioral Activation is a behavioral-based treatment that has been proposed as suitable for smoking cessation, as it simultaneously addresses reinforcement-related variables and also mood management. The aim of this study was to compare the effects of a cognitive-behavioral smoking cessation treatment with components of behavioral activation (SCBSCT-BA) with a standard cognitive-behavioral treatment (SCBSCT), and a wait-list control group (WL).

Method: The sample was comprised of 275 adults smokers (61.4% females, mean age = 45.36, SD = 10.96). After baseline assessment sessions, participants were randomized (ratio: 2.2.1.) to SCBSCT-BA, SCBSCT, or WL. Active groups received 8 weekly 1-hour face-to-face group sessions. Biochemically verified smoking abstinence and depressive symptoms were assessed at the end of treatment, and at 3-, 6-, and 12-month follow-ups.

Results: Significant treatment effects in 7-dayspoint prevalence abstinence rates were found for both active groups at the end of treatment. Abstinence rates at 12-months follow-up were 30% for SCBSCT-BA, and 18% for SCBSCT. Using Multiple Imputation for missing data, regression analysis showed significantly greater ORs for the SCBSCT-BA condition (vs. SCBSCT) at the end of treatment and at 3-months follow-up. At 6-, and 12-months follow-ups, ORs for the SCBSCT-BA condition, although greater, did not reach statistical significance. Multilevel analysis showed that abstinence was related to reductions in depressive symptoms.

Conclusions: SCBSCT-BA obtained positive results at short and medium term. Participants who quit smoking experienced a significant reduction in depressive symptoms. Findings support the benefit of adding BA to a cognitive-behavioral smoking cessation treatment.

Trial registration: www.clinicaltrials.gov NCT02844595.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Consort flow chart.
Fig 1. Consort flow chart.
Consolidated standards of reporting trials diagram for patient allocation. The randomization ratio was 2.2.1.
Fig 2. Depressive symptoms by smoking status…
Fig 2. Depressive symptoms by smoking status at the end of treatment, 3-, 6-, and 12-months follow-ups (n = 210).
Note. BDI-II: Beck Depression Inventory–Second edition. Included participants were those who attended at least the first treatment session.
Fig 3. Mediation model for treatment condition,…
Fig 3. Mediation model for treatment condition, number of sessions attended and 7-days point prevalence abstinence.
Direct and indirect effects at the end of treatment, and at 3-, 6-, and 12-months follow-ups.

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