A Behavioral Activation Approach to Smoking Cessation for Depressed Smokers at VA Medical Centers.

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Depressed smokers experience greater difficulty in quitting, and patients who report improvement in depressive symptoms during smoking cessation treatment achieve higher rates of abstinence. Patients may benefit from a novel treatment approach that combines standard smoking cessation with behavioral activation treatment for depression (BA; Jacobson et al., 1996). Veterans Affairs (VA) Medical Center patients are a psychiatrically complex population with a smoking prevalence 10% higher than the general population. VA patients experience low cessation rates and may be underserved by standard treatments. The purpose of the present study was the development and initial investigation of a brief BA-based smoking intervention called the Life Enhancement Treatment for Smoking (LETS-Quit). A total of 21 VA patients with elevated (>12) Beck Depression Inventory-II scores (BDI-II; Beck, Steer, & Brown, 1996) received 3-sessions of LETS-Quit or a control treatment and were followed for 30 days. A small sample size limited treatment evaluation and no benefit of LETS-Quit on smoking outcome was noted. However, findings suggested a strong effect of LETS-Quit on depressive symptoms. Treatment of depression during smoking cessation may greatly improve long-term success rates for this difficult to treat population. The feasibility and potential effectiveness of LETS-Quit in outpatient medical settings is discussed to guide further treatment evaluation.