Combined Smoking Cessation and Cognitive Processing Therapy for PTSD

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DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and cigarette smoking are both associated with significant impairment in Veterans and cost to the Veterans' Affairs (VA) system. Though naturalistic and laboratory studies suggest smoking is linked with PTSD symptoms, existing smoking cessation treatments targeting PTSD smokers have not utilized standardized, evidence-based PTSD treatment. The most effective smoking cessation approach to date for PTSD smokers, Integrated Care for Smoking Cessation (ICSC), relies on delivery of smoking cessation treatment by the individual's PTSD treatment provider. In a recent trial comparing ICSC to VA specialty Smoking Cessation Clinic care, ICSC produced significantly better prolonged smoking abstinence. However, ICSC was associated with only modest improvements in PTSD symptoms, with no difference between ICSC and smoking cessation treatment alone, suggesting a likely avenue for improving ICSC. We have developed an intervention that combines evidence based treatment for PTSD [cognitive processing therapy (CPT-C)] with evidence based smoking cessation for PTSD [Integrated Care for Smoking Cessation (ICSC)] and interactive phone technology for maintaining smoking abstinence. The objectives of this Career Development Award are to: 1) Evaluate study feasibility and treatment delivery procedures of a randomized clinical trial (RCT) comparing CPT-C/ICSC to a comparison condition combining present-centered therapy (PCT) with ICSC; 2) Characterize the difference between the combined CPT-C intervention and a PCT/ICSC condition in effects on smoking and PTSD symptoms. Confidence intervals will be constructed around calculated effect sizes to reflect uncertainty regarding the reliability of the effect size; and 3) Use feasibility trial datato design a RCT combining evidence-based PTSD treatment and ICSC to improve smoking cessation in PTSD. PCT is a manualized, active treatment for PTSD with data supporting its effectiveness in reducing PTSD symptoms. PCT also controls for treatment time, supportive relationship, and instillation of hope in treatment, providing an ideal comparison condition. Fifty Veteran smokers with PTSD will be randomized to participate in fourteen study sessions, ending with the final follow-up session six months after the scheduled quit date. The development of a combined CPT-C/ICSC intervention with established empirical support would benefit the many Veterans with PTSD who smoke by providing them with treatment of two pervasive problems with significant associated impairment. In addition, this treatment could substantially reduce the cost of administering two individual treatments separately by administering them in combination.