Acceptance and Commitment Therapy and nicotine patch for smokers with bipolar disorder: preliminary evaluation of in-person and telephone-delivered treatment.
OBJECTIVE
People with bipolar disorder are two to three times more likely to smoke and 50% less likely to quit than the general population. New treatments are needed to improve smoking cessation outcomes in this group. The study aim was to develop and pilot test a novel cessation intervention for smokers with bipolar disorder using Acceptance and Commitment Therapy (ACT) combined with nicotine patches.


METHODS
The ten-session ACT intervention was initially evaluated as in-person, individual counseling (n = 10), then as telephone-delivered counseling (n = 6). Participants were adult smokers with no more than mild current symptoms of bipolar disorder.


RESULTS
For the in-person protocol, end-of-treatment outcomes were: 80% retention, 40% of participants with carbon monoxide (CO)-verified seven-day point prevalence abstinence (PPA), 90% satisfied with treatment, 8.3 of ten sessions attended, and 54% increase in acceptance of cravings to smoke (i.e., ACT's theory-based change process) from baseline. The seven-day PPA at one-month follow-up was 30%. For the telephone protocol, end-of-treatment outcomes were: 67% retention, 33% reporting seven-day PPA, 100% satisfied with treatment, 6.7 of ten treatment calls completed, and 55% increase in acceptance from baseline. At one-month follow-up, seven-day PPA was 17%. The proportion of treatment completers who used at least 80% of the nicotine patches was 62.5% for the in-person protocol and 0% for the telephone protocol.


CONCLUSIONS
Both in-person and telephone-delivered ACT were feasible. Despite low adherence to nicotine patches, the intervention showed preliminary evidence of facilitating quitting and impacting ACT's change mechanism. A randomized, controlled trial of this targeted ACT intervention is now needed.
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Jaimee L
JL
Heffner
Group Health Research Institute, Seattle, WA, USA.
Jennifer B
JB
McClure
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Kristin E
KE
Mull
Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, CA, USA.
Robert M
RM
Anthenelli
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.|Department of Psychology, University of Washington, Seattle, WA, USA.
Jonathan B
JB
Bricker
D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D013689:Telephone; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy; D016896:Treatment Outcome
depression; mania; nicotine; smoking cessation; tobacco