The problem of relapse continues to plague public health efforts to reduce the prevalence of cigarette smoking. Relapse is of particular concern for individuals with depression-related vulnerabilities. Previous research has examined the addition of elaborate cognitive-behavioral strategies into standard smoking cessation protocols, focusing on individuals who have a past history of major depressive disorders. However, limited success suggests that (a) individuals with current elevated depressive symptoms might be a better target for negative affect reduction strategies than individuals with a past history of a depressive episode, and (b) typical cognitive-behavioral approaches may be too complicated for effective integration into smoking cessation protocols. Considering the first issue, converging evidence suggests that depressive symptoms may interfere with smoking cessation in a variety of ways and therefore individuals with such concerns represent a particular high-risk group of smokers who would benefit from specialized smoking cessation treatments that address their unique needs. Regarding the second issue, recent evidence suggests that behavioral activation strategies might be equally effective in reducing depressive symptoms as more elaborate cognitive-behavioral approaches, but can do so in a considerably less complicated and briefer format. Taken together, the overall objective of this research program is to utilize behavioral activation strategies in the development of a novel, uncomplicated approach to smoking cessation treatment for smokers with elevated depressive symptoms, with a focus on reducing depressive symptoms in order to facilitate successful cessation. This project will take place in two phases. In the first phase, we will complete the development of a specialized protocol for the treatment of nicotine dependence for smokers with elevated depressive symptoms (BDI-II = or >= 13), which integrates behavioral activation strategies developed for the treatment of depression with standard smoking cessation strategies and nicotine replacement therapy. During this phase, 20 smokers with elevated depressive symptoms will complete the protocol, which will be modified and refined based upon feedback from participants and clinicians. Clinician and participant manuals also will be developed for use in the next phase. In the second phase, 60 smokers with elevated depressive symptoms will be recruited and randomly assigned to either: 1) standard smoking cessation treatment and nicotine replacement therapy (ST) or 2) a behavioral activation treatment for smoking (BAT-S), comprised of ST and behavioral activation strategies aimed at reducing elevated depressive symptoms. Based on the outcome of this preliminary trial, the BAT-S protocol will be further refined and readied for larger-scale clinical trials.
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