Telephone counseling with cognitive therapy for depression: Seven-month follow-up of effects on smokers with and without indicators of depression

Persons with depressive symptoms are nearly two times more likely to be current smokers than persons without those symptoms. During the course of operating a telephone counseling service for smoking cessation for the last eight years and conducting several related clinical trials, the American Cancer Society (ACS) has observed that 40-45% of clients seeking cessation assistance report having a symptom of depression at intake. Further ACS has observed that these clients have lower success rates than clients without this symptom, but a previous study suggests this deficit can be overcome by making additional relapse prevention sessions available. ACS partnered with the Beck Institute to create a telephone counseling protocol enhanced with cognitive therapy for depression. In this study, smokers (n=2,192) calling the American Cancer Society for cessation assistance were, after providing consent and meeting eligibility criteria, randomized to receive access to a standard telephone counseling protocol or the enhanced protocol with or without access to additional relapse prevention sessions. At intake 48% of the subjects reported having the symptom of depression. Women were significantly more likely to report the symptom than men (50% vs. 44%, p = 0.01). Follow-up surveys were conducted by telephone seven months following intake to assess quitting success (response rate=39%). Although power may be an issue, cessation rates were not significantly lower for the group reporting a symptom of depression (p=0.2) and no significant improvement was observed among those who had access to the enhanced protocol (p=0.1) or additional relapse prevention sessions (p=0.2).