Behavioral activation for smoking cessation and mood management following a cardiac event: results of a pilot randomized controlled trial

Abstract

BackgroundSmoking cessation following hospitalization for Acute Coronary Syndrome (ACS) significantly reduces subsequent mortality. Depressed mood is a major barrier to cessation post-ACS. Although existing counseling treatments address smoking and depression independently in ACS patients, no integrated treatment addresses both. We developed an integrated treatment combining gold standard cessation counseling with behavioral activation-based mood management; Behavioral Activation Treatment for Cardiac Smokers (BAT-CS). The purpose of this pilot randomized controlled trial was to test feasibility, acceptability, and preliminary efficacy of BAT-CS vs. Standard of Care (SC).MethodsParticipants were recruited during hospitalization for ACS and were randomly assigned to BAT-CS or SC. The nicotine patch was offered in both conditions. Smoking, mood, and stress outcomes were collected at end-of-treatment and 24-week follow-up.ResultsFifty-nine participants (28 BAT-CS, 31 SC) were recruited over 42 weeks, and assessment completion was above 80% in both conditions. Treatment acceptability and fidelity were high. At 24 week follow-up adjusted odds ratios favoring BAT-CS were 1.27 (95% CI: 0.41–3.93) for 7-day point prevalence abstinence and 1.27 (95% CI: 0.42–3.82) for continuous abstinence. Time to first smoking lapse was significantly longer in BAT-CS (62.4 vs. 31.8 days, p = 0.03). At 24-weeks, effect sizes for mood and stress outcomes ranged from η2 partial of.07–.11, with significant between treatment effects for positive affect, negative affect, and stress.ConclusionsThe design of this study proved feasible and acceptable. Results provide preliminary evidence that combining behavioral activation with standard smoking cessation counseling could be efficacious for this high risk population. A larger trial with longer follow-up is warranted.Trial registration NCT01964898. First received by clinicaltrials.gov October 15, 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4250-7) contains supplementary material, which is available to authorized users.

Effects of behavioural activation on substance use and depression: a systematic review

“…1 ). Finally, a total of eight studies met inclusion criteria and were included in the review [ 43 – 50 ].…”

“…A complete description of study characteristics is provided in Table 1 . Of the eight included studies, six were conducted in the United States [ 43 – 45 , 47 – 49 ], one in the United Kingdom [ 46 ], and one in Spain [ 50 ]. Six were RCTs [ 43 , 45 – 47 ], and two were before-and-after studies [ 44 , 48 ].…”

“…Of the eight included studies, six were conducted in the United States [ 43 – 45 , 47 – 49 ], one in the United Kingdom [ 46 ], and one in Spain [ 50 ]. Six were RCTs [ 43 , 45 – 47 ], and two were before-and-after studies [ 44 , 48 ]. Regarding the type of substance assessed, three targeted smoking behaviour [ 43 , 47 , 50 ]; two targeted opiate dependence [ 44 , 45 ]; two focused on alcohol or drug dependence [ 46 , 49 ]; and finally, one on crystal methamphetamine abuse [ 48 ].…”

“…Six were RCTs [ 43 , 45 – 47 ], and two were before-and-after studies [ 44 , 48 ]. Regarding the type of substance assessed, three targeted smoking behaviour [ 43 , 47 , 50 ]; two targeted opiate dependence [ 44 , 45 ]; two focused on alcohol or drug dependence [ 46 , 49 ]; and finally, one on crystal methamphetamine abuse [ 48 ]. Six studies provided biochemical verification of substance use [ 43 – 45 , 47 , 49 , 50 ].…”

“… N = 263 (female 29.5%, mean age 42.7; SD = 11.8) African American 95.4% Gonzalez-Roz et al (2018) [ 50 ] RCT Clinical Unit of Addictive Behaviours of the University of Oviedo, Spain Tobacco To analyze if adding a CM component to CBT and BA would increase smoking cessation treatment adherence and decrease depressive symptoms (1) Age ≥ 18; (2) smoking ≥10 cigarettes per day within the last year; (3) meeting criteria for current unipolar major depression disorder (meeting DSM-IV-TR criteria or BDI score ≥ 14); and (4) meeting DSM-IV-TR criteria for nicotine dependence. N = 74 (females 82.4%) Busch et al (2017) [ 43 ] RCT Inpatient cardiac units at The Miriam and Rhode Island Hospitals. Providence, RI, USA Tobacco To compare BAT-CS to a Standard-of-Care control on smoking abstinence, mood, and stress related variables.…”