Extended cognitive behavior therapy for cigarette smoking cessation

Abstract

Primary aim Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer‐term smoking abstinence. Design Open‐label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open‐label treatment phase; analysis based on intention‐to‐treat to avoid threat of selection bias. Setting Community smoking cessation clinic. Participants A total of 304 adult smokers (≥18 years of age; ≥10 cigarettes/day). Intervention Open‐label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone‐based general support. Measurements Seven‐day point prevalence abstinence, expired‐air carbon monoxide. Results At week 20 follow‐up, CBT produced a higher 7‐day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05). Conclusion The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non‐smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown.