Jennifer R Laude1,2, Steffani R Bailey3, Erin Crew1, Ann Varady1, Anna Lembke4, Danielle McFall5, Anna Jeon6, Diana Killen1, Joel D Killen1,7, Sean P David1. 1. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. 2. Department of Psychology, Stanford University, Stanford, CA, USA. 3. Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA. 4. Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA. 5. Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA. 6. Community Health Partnership, San Jose, CA, USA. 7. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Abstract
AIM: To test the potential benefit of extending cognitive-behavioral therapy (CBT) relative to not extending CBT on long-term abstinence from smoking. DESIGN: Two-group parallel randomized controlled trial. Patients were randomized to receive non-extended CBT (n = 111) or extended CBT (n = 112) following a 26-week open-label treatment. SETTING: Community clinic in the United States. PARTICIPANTS: A total of 219 smokers (mean age: 43 years; mean cigarettes/day: 18). INTERVENTION: All participants received 10 weeks of combined CBT + bupropion sustained release (bupropion SR) + nicotine patch and were continued on CBT and either no medications if abstinent, continued bupropion + nicotine replacement therapy (NRT) if increased craving or depression scores, or varenicline if still smoking at 10 weeks. Half the participants were randomized at 26 weeks to extended CBT (E-CBT) to week 48 and half to non-extended CBT (no additional CBT sessions). MEASUREMENTS: The primary outcome was expired CO-confirmed, 7-day point-prevalence (PP) at 52- and 104-week follow-up. Analyses were based on intention-to-treat. FINDINGS:PP abstinence rates at the 52-week follow-up were comparable across non-extended CBT (40%) and E-CBT (39%) groups [odds ratio (OR) = 0.99; 95% confidence interval (CI) = 0.55, 1.78]. A similar pattern was observed across non-extended CBT (39%) and E-CBT (33%) groups at the 104-week follow-up (OR = 0.79; 95% CI= 0.44, 1.40). CONCLUSION: Prolonging cognitive-behavioral therapy from 26 to 48 weeks does not appear to improve long-term abstinence from smoking.
RCT Entities:
AIM: To test the potential benefit of extending cognitive-behavioral therapy (CBT) relative to not extending CBT on long-term abstinence from smoking. DESIGN: Two-group parallel randomized controlled trial. Patients were randomized to receive non-extended CBT (n = 111) or extended CBT (n = 112) following a 26-week open-label treatment. SETTING: Community clinic in the United States. PARTICIPANTS: A total of 219 smokers (mean age: 43 years; mean cigarettes/day: 18). INTERVENTION: All participants received 10 weeks of combined CBT + bupropion sustained release (bupropion SR) + nicotine patch and were continued on CBT and either no medications if abstinent, continued bupropion + nicotine replacement therapy (NRT) if increased craving or depression scores, or varenicline if still smoking at 10 weeks. Half the participants were randomized at 26 weeks to extended CBT (E-CBT) to week 48 and half to non-extended CBT (no additional CBT sessions). MEASUREMENTS: The primary outcome was expired CO-confirmed, 7-day point-prevalence (PP) at 52- and 104-week follow-up. Analyses were based on intention-to-treat. FINDINGS: PP abstinence rates at the 52-week follow-up were comparable across non-extended CBT (40%) and E-CBT (39%) groups [odds ratio (OR) = 0.99; 95% confidence interval (CI) = 0.55, 1.78]. A similar pattern was observed across non-extended CBT (39%) and E-CBT (33%) groups at the 104-week follow-up (OR = 0.79; 95% CI= 0.44, 1.40). CONCLUSION: Prolonging cognitive-behavioral therapy from 26 to 48 weeks does not appear to improve long-term abstinence from smoking.
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