Telephone counseling with cognitive therapy for depression, proactive enrollment of social support and relapse prevention sessions: Effects on smokers with and without indicators of depression

During the course of operating a telephone counseling service for smoking cessation for the last seven 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. They answer yes to the question: Have you felt sad or blue every day for the last two weeks? Further ACS has observed that these clients have lower success rates than clients without this symptom, but that results of a previous study suggest this deficit can be overcome by making relapse prevention sessions available after the completion of regular counseling sessions. ACS partnered with the Beck Institute to create a telephone counseling protocol enhanced with cognitive therapy for depression and training for proactive enrollment of social support. 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 four and eight weeks after the completion of counseling. At intake 48% of the subjects reported having the symptom of depression. Follow-up surveys were conducted by telephone four months following intake to assess quitting success (response rate=45%). Cessation rates were significantly lower for the group reporting a symptom of depression (p=0.01) and no significant improvement was observed among those who had access to the enhanced protocol or additional relapse prevention sessions.