What is the effect of regular smoking on the efficacy of Cognitive Behavioral Therapy (CBT)?

From the Guidelines

Cognitive Behavioral Therapy (CBT) is highly recommended for individuals looking to quit regular smoking, as it addresses both the psychological dependence and behavioral patterns associated with tobacco use. CBT for smoking cessation typically involves 8 or more sessions, as interventions that provided this number of sessions have been shown to have the largest effect on tobacco smoking cessation rates compared with either usual care/brief cessation interventions alone or pharmacotherapy alone 1. The therapy works by teaching smokers to recognize situations that prompt them to smoke, challenge irrational beliefs about smoking benefits, and replace smoking behaviors with healthier alternatives. For optimal results, CBT should be combined with pharmacological treatments such as nicotine replacement therapy, bupropion, or varenicline. This combination approach addresses both the physical addiction to nicotine and the psychological aspects of smoking dependence. Some key points to consider when using CBT for smoking cessation include:

• The importance of a trained therapist to help identify smoking triggers and develop coping strategies for cravings
• The need for patients to actively participate in therapy by completing homework assignments and practicing new coping skills
• The potential benefits of combining CBT with pharmacological treatments, as this approach has been shown to increase tobacco smoking cessation rates compared with either usual care/brief cessation interventions alone or pharmacotherapy alone 1
• The strong evidence base for brief interventions, with a combination of behavioural support and pharmacotherapies, including nicotine replacement therapy, bupropion, and varenicline, as well as the potential benefits of electronic cigarettes in achieving smoking cessation 1.

From the Research

Regular Smoking and CBT

• Regular smoking is a significant source of preventable morbidity and premature mortality worldwide, with approximately 100 million deaths caused by tobacco use in the 20th century 2.
• Tobacco dependence is a chronic condition that often requires repeated intervention for success, and just informing a patient about health risks is usually not sufficient for a decision to change 2.
• Cognitive Behavioral Therapy (CBT) is not explicitly mentioned in the provided studies as a standalone treatment for smoking cessation, but behavioral interventions are recommended as part of a comprehensive approach to smoking cessation 2, 3.
• Behavioral interventions, including counseling and support, can increase quit rates, with a success rate of 7% to 16% compared to 3% to 5% for unassisted quit attempts 2.

Nicotine Replacement Therapy (NRT)

• NRT is a effective strategy for smoking cessation, increasing quit rates by 50% to 60% regardless of setting 4, 5, 6.
• Different forms of NRT, including gum, transdermal patches, nasal spray, inhalers, and tablets, are effective in achieving abstinence from cigarettes 4, 5, 6.
• The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker, but provision of more intense levels of support can be beneficial in facilitating the likelihood of quitting 4, 5, 6.

Combination Therapies

• Combination pharmacotherapy, including NRT and other medications such as bupropion and varenicline, may be indicated for highly nicotine-dependent smokers or those who have failed with monotherapy 2.
• There is promising evidence that bupropion may be more effective than NRT, either alone or in combination, but further study is needed to determine its most appropriate place in the therapeutic armamentarium 4, 5.