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.
Killen
Joel D
JD
Stanford University School of Medicine, Stanford, CA 94305-5705, USA. jkillen@stanford.edu
Fortmann
Stephen P
SP
Schatzberg
Alan F
AF
Arredondo
Christina
C
Murphy
Greer
G
Hayward
Chris
C
Celio
Maria
M
Cromp
Deann
D
Fong
Dalea
D
Pandurangi
Maya
M
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