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. In this pilot study, we examined whether a behavioral activation treatment for smoking (BATS) can enhance cessation outcomes.

Method: A sample of 68 adult smokers with mildly elevated depressive symptoms (M = 43.8 years of age; 48.5% were women; 72.7% were African American) seeking smoking cessation treatment were randomized to receive either BATS paired with standard treatment (ST) smoking cessation strategies including nicotine replacement therapy (n = 35) or 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; furthermore, measures of smoking cessation outcomes (7-day verified point-prevalence abstinence), depressive symptoms (Beck Depression Inventory-II; Beck, Steer, & Brown, 1996), and enjoyment from daily activities (Environmental Reward Observation Scale; Armento & Hopko, 2007) 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% CI [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 = 0.86, 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.

Figures

Figure 1

CONSORT flowchart of study participants, randomization, treatment, follow-ups, and inclusion analyses. ST = standard smoking cessation treatment including nicotine replacement therapy (NRT); BATS = ST and NRT that integrates behavioral activation strategies.

Figure 2

Changes in BDI-II symptoms for BATS and ST Conditions in the Sub-sample (n = 42). Figure 2 Note: 1 week post quit day = week 4 of behavioral treatment; 4 weeks post quit day = week 8 and end of behavioral treatment; 16 weeks post quit day = 12 weeks from end of behavioral treatment; 26 weeks post quit day = 22 weeks from end of behavior treatment.