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

Gemma M.J. Taylor, Katherine Sawyer, Pamela Jacobsen, Tom P. Freeman, Anna Blackwell, Shadi Daryan, Chris Metcalfe, David Kessler, Marcus R. Munafò, Paul Aveyard

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Abstract

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.
Original languageEnglish
Pages (from-to)922-936
Number of pages15
JournalAddiction
Volume120
Issue number5
Early online date11 Mar 2025
DOIs
Publication statusPublished - 30 May 2025

Data Availability Statement

Data are available via request to the University of Bath’s Research
Data Archive (https://researchdata.bath.ac.uk/).

Acknowledgements

We sincerely thank all the participants, NHS staff, and Public Health commissioners for their invaluable contributions and support in this study. G. T. reports funding from a Cancer Research UK Population Researcher Postdoctoral Fellowship award (C56067/A21330), and project grant (PPRCPJT/100023). K. S. reports funding from CRUK (C56067/A21330) and in part by grant MR/N0137941/1 for the GW4 BIOMED DTP, awarded to the Universities of Bath, Bristol, Cardiff and Exeter from the Medical Research Council (MRC)/UKRI. D. K. is funded by The Centre for Primary Care at the University of Bristol. C. M. is funded by the Higher Education Funding Council for England. P. A. is an NIHR senior investigator and funded by NIHR Oxford Biomedical Research Centre, NIHR Oxford Health Biomedical Research Centre, and Oxford and Thames Valley Applied Research Collaboration. M. M. is supported by the MRC Integrative Epidemiology Unit at the University of Bristol is supported by the Medical Research Council and the University of Bristol (MC_UU_00032/7). The funders have no role in study design, conduct, data analysis and interpretation or manuscript writing. The funders may have a role in dissemination of the research findings.

Funding

We sincerely thank all the participants, NHS staff, and Public Health commissioners for their invaluable contributions and support in this study. G. T. reports funding from a Cancer Research UK Population Researcher Postdoctoral Fellowship award (C56067/A21330), and project grant (PPRCPJT/100023). K. S. reports funding from CRUK (C56067/A21330) and in part by grant MR/N0137941/1 for the GW4 BIOMED DTP, awarded to the Universities of Bath, Bristol, Cardiff and Exeter from the Medical Research Council (MRC)/UKRI. D. K. is funded by The Centre for Primary Care at the University of Bristol. C. M. is funded by the Higher Education Funding Council for England. P. A. is an NIHR senior investigator and funded by NIHR Oxford Biomedical Research Centre, NIHR Oxford Health Biomedical Research Centre, and Oxford and Thames Valley Applied Research Collaboration. M. M. is supported by the MRC Integrative Epidemiology Unit at the University of Bristol is supported by the Medical Research Council and the University of Bristol (MC_UU_00032/7). The funders have no role in study design, conduct, data analysis and interpretation or manuscript writing. The funders may have a role in dissemination of the research findings. M. M. and G.T. previously received funding from Pfizer, who manufacture smoking cessation products, for research unrelated to this study. All other authors have nothing to declare. G. T. previously worked at a scientific consultancy providing statistical and research support for pharmaceutical companies to medicines unrelated to this manuscript. Cancer Research UK. Grant Numbers: C56067/A21330, PPRCPJT/100023 Medical Research Council. Grant Numbers: MR/N0137941/1, MC_UU_00032/7 The Centre for Primary Care at the University of Bristol Higher Education Funding Council for England NIHR Oxford Biomedical Research Centre NIHR Oxford Health Biomedical Research Centre Oxford and Thames Valley Applied Research Collaboration

FundersFunder number
NIHR Oxford Biomedical Research Centre
Medical Research Council
Higher Education Funding Council for England
Population Researcher Postdoctoral Fellowship
National Institute for Health and Care Research
University of Bristol
Pfizer
UK Research and Innovation
Cancer Research UKMR/N0137941/1, PPRCPJT/100023, C56067/A21330
National Institute for Health and Care Research Applied Research Collaboration Oxford and Thames ValleyMC_UU_00032/7

Keywords

  • Anxiety
  • IAPT
  • behavioural intervention
  • depression
  • randomised controlled trial
  • smoking cessation
  • smoking treatment
  • talking therapies

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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