CPT-SMART for Treatment of PTSD and Cigarette Smoking
Status:
Recruiting
Trial end date:
2024-04-01
Target enrollment:
Participant gender:
Summary
Smoking is the leading cause of preventable illness, disability, and death in the United
States. The rate of smoking is disproportionately higher among Veterans with posttraumatic
stress disorder (PTSD). Unfortunately, smoking cessation efforts that are effective in the
general population have shown limited effectiveness in smokers with PTSD. The high smoking
rate and difficulty with achieving abstinence indicate a critical need to develop effective
interventions for Veterans who smoke and have PTSD. The investigators' data indicate that
negative emotions and trauma reminders are associated with relapse for smokers with PTSD. In
this context, an ideal strategy may be to combine evidence-based PTSD treatment with
intensive smoking cessation treatment to maximize quit rates.
Cognitive processing therapy (CPT) is a well-established evidence-based treatment for PTSD.
The investigators have successfully developed a treatment manual that combines CPT with
cognitive-behavioral counseling for smoking cessation. Contingency management (CM) is another
intensive behavioral treatment that has been shown to help with reducing smoking. CM provides
positive reinforcers such as money to individuals misusing substances contingent upon
abstinence from use. The primary goal of this study is to evaluate the efficacy of a
treatment that combines CM with cognitive-behavioral smoking cessation counseling, smoking
cessation medication, and CPT. Proposed is a randomized, two-arm clinical trial in which 120
Veteran smokers with PTSD will be randomized to either: 1) COGNITIVE PROCESSING THERAPY with
SMOKING ABSTINENCE REINFORCEMENT THERAPY (CPT-SMART) or 2) COMBINED CONTACT CONTROL, an
intervention identical to CPT-SMART in PTSD and smoking treatment, except for using payment
that is not contingent on abstinence.
Specific aims include: AIM 1) To evaluate the efficacy of CPT-SMART on rates of short- and
long-term abstinence from cigarettes; AIM 2) To evaluate the impact of CPT-SMART on treatment
engagement and utilization; and an EXPLORATORY AIM) To explore mechanisms of CPT-SMART on
long-term smoking abstinence. The positive public health impact of reducing smoking among
Veterans with PTSD could be enormous as it would prevent significant smoking-related
morbidity and mortality.