Persistence-Targeted Smoking Cessation

Rbhs-Robert Wood Johnson Medical School, Piscataway NJ

Investigators

Linked publications & trials

Abstract

Project Summary / Abstract Tobacco use is the leading preventable cause of death in the United States1, and unfortunately, even in empirically supported multi-component tobacco dependence treatment2 trials, most smokers relapse within days of their quit attempt.3 One potentially modifiable relapse risk factor is task persistence - the tendency to persist in a difficult task. Because greater task persistence is associated with better smoking cessation treatment outcomes,4-7 an intervention which increases task persistence should result in higher quit rates. Cognitive theory8 indicates that automatic thoughts - such as those which may contribute to low task persistence (e.g., I can't take it any more!) - are modifiable. If we can train smokers to dispute automatic thoughts that contribute to their lack of persistence during a quit attempt, we may be able to improve cessation rates. In this Stage I Behavioral & Integrative Treatment Development (R34) project, we propose to develop a theory- based smoking cessation intervention (called Persistence Targeted Cognitive Behavioral Therapy; P-CBT), including treatment manual, therapist training materials, and therapy integrity scales. After writing a first draft of the P-CBT manual, we will use an innovative successive cohort design9,10 that allows for a more structured approach to therapy development than is traditionally used. We will recruit two successive cohorts of 5 smokers each to participate in an 8 session, individual, smoking cessation treatment (P-CBT + nicotine patch) to inform the development of the intervention and manual. After cohort 1, we will analyze data and feasibility, and will modify the treatment manual and protocol accordingly before treating cohort 2. We will again revise the manual based on data and clinical experience in treating cohort 2. Finally, we will conduct a pilot study where we will randomize smokers (N=50) to our Persistence-targeted CBT treatment plus patch (P-CBT) or a nicotine patch (NRT-Only) control group and assess prolonged abstinence outcomes at 1- and 3-months after the quit date. We will test the feasibility and preliminary efficacy of the intervention, and evaluate the relationship between changes in task persistence and smoking cessation success - including testing a mediational model as an experimental hypothesis. Our research team is particularly qualified to successfully conduct the proposed study. We have conducted multiple therapy development studies (including those of CBT) resulting in treatment manuals, developed and used therapy integrity scales, and treated hundreds of smokers in cessation clinics and in NIH clinical trials. This project has strong potential significance because if we can train smokers to dispute automatic thoughts contributing to their lack of persistence during a quit attempt, we may be able to improve cessation rates.