smoking Cessation Integrated With mental Health Care: A Feasible and Effective Approach
A new study suggests integrating smoking cessation treatment into psychological care for depression and anxiety is not only feasible but also well-received, leading to higher quit rates without worsening mental health symptoms.
Key Findings at a Glance
- Feasibility: Integrating smoking cessation support into cognitive behavioral therapy (CBT) is feasible within the UK’s National Health Service (NHS) psychological care programs.
- Acceptability: Both participants and practitioners positively received the integrated intervention.
- Quit Rates: The treatment group, receiving integrated support, showed considerably higher smoking cessation rates compared to the control group.
- Mental Health: Integrated intervention did not negatively impact mental health outcomes; no notable differences in anxiety or depression symptoms were observed.
The ESCAPE Trial: A Closer Look
The ESCAPE trial, a randomized, multi-center feasibility study published in Addiction, evaluated the integration of smoking cessation treatment into psychological care for individuals with depression and anxiety. Researchers conducted a 2-arm randomized controlled trial within the UK’s National Health Service (NHS) to assess the acceptability and feasibility of this integrated approach.
Study Design
- Participants: 135 adults who smoked daily and were beginning NHS-funded psychological therapy for depression or anxiety. The mean age of participants was 35.6 years, and 89.6% were White, smoking an average of 14.3 cigarettes per day.
- Randomization: Participants were randomly assigned to either a treatment group receiving integrated smoking cessation support alongside CBT or a control group receiving standard CBT with a referral to smoking cessation services at the end of therapy.
- Outcomes: The primary outcome was retention in psychological therapy at 3 months. Secondary outcomes included intervention acceptability, smoking abstinence, and effects on mental health, assessed using the Generalized Anxiety Disorder Questionnaire-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9).
- Follow-up: Assessments were conducted at 3 and 6 months.
Positive Outcomes and Key Results
The study revealed encouraging results regarding the integration of smoking cessation support into mental health treatment.
- Therapy Completion: at 3 months, there was no significant difference in therapy completion between the treatment and control groups (odds ratio [OR], 0.81, 95% CI, 0.31 to 2.09).
- Smoking Cessation Rates: The treatment group demonstrated a significant increase in smoking cessation rates compared to the control group at 3 months (OR, 8.69, 95% CI, 1.11 to 396.26). At 6 months, abstinence rates remained higher in the treatment group (OR, 2.70, 95% CI, 0.73 to 12.43).
- Mental Health Impact: Mental health outcomes were not negatively impacted by the integrated smoking cessation intervention. The mean PHQ-9 and GAD-7 scores showed no significant differences between groups at either follow-up point (PHQ-9 difference: β=0.01, 95% CI, −2.19 to 2.22; GAD-7 difference: β=0.65, 95% CI, −1.59 to 2.90).
Voices From the Study
The intervention was well-received by both participants and practitioners. Here’s what they had to say:
The intervention was well received by both participants and IAPT practitioners and the intervention arm achieved higher quit rates, with no evidence of worsening depression or anxiety symptoms compared to control.
Researchers of the ESCAPE Trial
Participant satisfaction was high, with 90% expressing satisfaction and 76% willing to reccommend the intervention. Practitioners also responded positively, with 83% willing to continue delivering the intervention.
Challenges and Considerations
Despite the positive outcomes, the study identified challenges:
- The additional time required for smoking cessation counseling within CBT sessions.
- Variations in access to pharmacological support for quitting smoking.
Pro tip
Combining behavioral therapy with pharmacological support, such as nicotine replacement therapy, can significantly improve smoking cessation outcomes. Consult with a healthcare professional to determine the best approach for your individual needs.
Looking Ahead
The researchers recommend further large-scale trials to assess the effectiveness of integrated smoking cessation interventions and explore implementation strategies within routine mental healthcare.
Limitations of the Study
The study had several limitations:
- Inability to assess adherence or participant reaction to treatment.
- Bias due to unblinded trials.
- A smaller recruitment target due to the COVID-19 pandemic.
Did You Know?
Smoking cessation is associated with reduced depression, anxiety, and stress, and improved positive mood and quality of life compared to continuing to smoke [1].
FAQ: Smoking cessation and Mental Health
- Will quitting smoking worsen my anxiety or depression?
- No, studies suggest that smoking cessation is associated with reduced depression, anxiety, and stress [1].
- How manny attempts dose it take to quit smoking?
- On average, it takes an estimated 30 attempts to successfully quit smoking for longer then 1 year [2].
- Is integrating smoking cessation into mental health treatment effective?
- Yes, the ESCAPE trial showed that integrating smoking cessation support into CBT led to higher quit rates without worsening mental health symptoms.
