Department of Medicine, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center
Behavior and Behavior Mechanisms | Health Psychology | Psychoanalysis and Psychotherapy | Public Health | Substance Abuse and Addiction
BACKGROUND: Smoking 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).
METHODS: Participants 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.
RESULTS: Fifty-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 eta2partial of.07-.11, with significant between treatment effects for positive affect, negative affect, and stress.
CONCLUSIONS: The 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.
Acute coronary syndrome, Behavioral activation, Cessation, Depression, Mood, Smoking
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DOI of Published Version
BMC Public Health. 2017 Apr 17;17(1):323. doi: 10.1186/s12889-017-4250-7. Link to article on publisher's site
BMC public health
Busch A, Tooley EM, Dunsiger S, Chattillion EA, Srour JF, Pagoto SL, Kahler CW, Borrelli B. (2017). Behavioral activation for smoking cessation and mood management following a cardiac event: results of a pilot randomized controlled trial. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1186/s12889-017-4250-7. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/1288
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