intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods.
Study Goal
The researchers aimed to assess the feasibility and acceptability of integrating a smoking cessation intervention within cognitive behavioral therapy (CBT) for adults with depression or anxiety.
Results Summary
The intervention increased smoking abstinence rates without negatively affecting mental health outcomes or study completion rates. Recruitment was acceptable, and stakeholders were satisfied with the intervention.
Population
Adult daily smokers receiving CBT for depression or anxiety in UK NHS-funded services (mean age 35.6 years, 89.6% white).
Effective Dosage
Up to 12 sessions of integrated smoking cessation support.
Duration
Follow-up at 3 and 6 months.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
smoking cessation | increase | depression and anxiety symptoms | - | - | may improve | #1 |
smoking cessation intervention | no change | study completion | adult daily smokers starting CBT for depression or anxiety | OR=0.81, 95% CI=0.31 to 2.09 | did not affect | #2 |
smoking cessation intervention | no change | mental health (PHQ-9) | adult daily smokers starting CBT for depression or anxiety | coefficient 0.01, 95% CI=-2.19 to 2.22 | did not harm | #3 |
smoking cessation intervention | no change | mental health (GAD-7) | adult daily smokers starting CBT for depression or anxiety | coefficient 0.65, 95% CI=-1.59 to 2.90 | did not harm | #4 |
smoking cessation intervention | increase | abstinence rates | adult daily smokers starting CBT for depression or anxiety | OR=8.69, 95% CI=1.11 to 396.26 | increased | #5 |
smoking cessation intervention | neutral | - | UK adult smokers receiving CBT treatment for depression or anxiety | - | was well received | #6 |
smoking cessation intervention | no change | primary treatment goals | UK adult smokers receiving CBT treatment for depression or anxiety | - | did not interfere with | #7 |
smoking cessation intervention | increase | smoking cessation | UK adult smokers receiving CBT treatment for depression or anxiety | - | increased | #8 |
BACKGROUND AND AIM: There is evidence that smoking cessation may improve depression and anxiety symptoms. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness. DESIGN, SETTING AND PARTICIPANTS: This study was a pragmatic, two-armed, randomised, multi-centre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779) involving United Kingdom National Health Service (NHS)-funded services treating depression or anxiety among four NHS Trusts. Participants comprised adult daily smokers starting CBT for depression or anxiety [mean age 35.6 years, standard deviation (SD) = 12.7, 89.6% white] who smoked 14.3 (SD = 8.2) cigarettes/day with mean Generalised Anxiety Disorder Questionnaire-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores of 13.1 (SD = 4.9) and 14.5 (SD = 6.0). Sixty-eight participants were allocated to the treatment group and 67 to control. INTERVENTION AND CONTROL: Both groups received CBT for depression or anxiety. The treatment group also received up to 12 sessions of integrated smoking cessation support. The control group was signposted to smoking cessation services post-treatment. MEASUREMENTS: Follow-up was at 3 and 6 months. The primary outcome was 'study completion' by 3 months. Other outcomes included acceptability, satisfaction, feasibility, data completeness and mental health. FINDINGS: At 3 months, treatment did not affect study completion [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.31 to 2.09], did not harm mental health (PHQ-9 difference: coefficient 0.01, 95% CI = -2.19 to 2.22); GAD-7: coefficient 0.65, 95% CI = -1.59 to 2.90), but increased abstinence rates (OR = 8.69, 95% CI = 1.11 to 396.26). Recruitment was acceptable and key stakeholders were satisfied with the intervention. CONCLUSIONS: Among UK adult smokers receiving CBT treatment for depression or anxiety, a smoking cessation intervention within the CBT treatment was well received, did not interfere with the primary treatment goals and increased smoking cessation.