Extended cognitive behavior therapy for cigarette smoking cessation.
PRIMARY AIM: Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence.


METHODS
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.


METHODS
Community smoking cessation clinic.


METHODS
A total of 304 adult smokers (> or = 18 years of age; > or = 10 cigarettes/day).


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Stanford University School of Medicine, Stanford, CA 94305-5705, USA. jkillen@stanford.edu
Joel D
JD
Killen
Stephen P
SP
Fortmann
Alan F
AF
Schatzberg
Christina
C
Arredondo
Greer
G
Murphy
Chris
C
Hayward
Maria
M
Celio
Deann
D
Cromp
Dalea
D
Fong
Maya
M
Pandurangi
D000328:Adult; D016642:Bupropion / Q000008:administration & dosage*; D002248:Carbon Monoxide / Q000032:analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D010349:Patient Compliance; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy
D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine; D002248:Carbon Monoxide