Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods

Gemma Taylor; Katherine Sawyer; Pamela Jacobsen; Anna K M Blackwell; Shadi Daryan; Tom Freeman; Chris Metcalfe; David S Kessler; Marcus R Munafo; Paul Aveyard

doi:10.1111/add.16718

Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods

Gemma Taylor^*, Katherine Sawyer, Pamela Jacobsen, Anna K M Blackwell, Shadi Daryan, Tom Freeman, Chris Metcalfe, David S Kessler, Marcus R Munafo, Paul Aveyard

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Background and aim:
There is evidence that smoking cessation may improve depression and anxiety. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.

Design:
Pragmatic, two-armed, randomised, multicentre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779).

Setting:
United Kingdom National Health Service (NHS)-funded services treating depression/anxiety across 4 NHS trusts.

Participants:
Adult daily smokers starting CBT for depression/anxiety (mean age 35.6 years (standard deviation [SD]=12.7), 89.6% white) who smoked 14.3 (SD=8.2) cigarettes/day with mean Generalised Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) scores of 13.1 (SD=4.9) and 14.5 (SD=6.0). Sixty-eight participants were allocated to the treatment group and 67 to control.

Intervention/Control:
Both groups received CBT for depression/anxiety. The treatment group also received 12 sessions of integrated smoking cessation support. The control group was signposted to cessation services post-treatment.

Measurements:
Follow-up was at 3 and 6 months. The primary outcome was “study completion” by 3 months. Other outcomes included acceptability, satisfaction, feasibility, data completeness, and mental health.

Findings:
At 3 months, treatment did not affect study completion (odds ratio [OR] 0.81, 95% confidence interval [CI]: 0.31—2.09), did not harm mental health (PHQ-9 difference: coefficient 0.01, 95% CI: -2.19 to 2.22); GAD-7: coefficient 0.65, 95% CI: -1.59 to 2.90), but increased abstinence rates (OR 8.69, 95% CI: 1.11 to 396.26). Recruitment was acceptable, and key stakeholders were satisfied with the intervention.

Conclusions:
Among UK adult smokers receiving cognitive behavioural therapy (CBT) treatment for depression or anxiety, a smoking cessation intervention within the CBT treatment was well received, did not interfere with the primary treatment goals, and increased smoking cessation.

Original language	English
Pages (from-to)	922-936
Number of pages	15
Journal	Addiction
Volume	120
Issue number	5
Early online date	11 Mar 2025
DOIs	https://doi.org/10.1111/add.16718
Publication status	Published - 1 May 2025

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Publisher Copyright:
© 2025 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

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Taylor, G., Sawyer, K., Jacobsen, P., Blackwell, A. K. M., Daryan, S., Freeman, T., Metcalfe, C., Kessler, D. S., Munafo, M. R., & Aveyard, P. (2025). Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods. Addiction, 120(5), 922-936. https://doi.org/10.1111/add.16718

@article{cd14bc5b66984322b8f9b9814f415f02,

title = "Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods",

abstract = "Background and aim: There is evidence that smoking cessation may improve depression and anxiety. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.Design:Pragmatic, two-armed, randomised, multicentre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779).Setting:United Kingdom National Health Service (NHS)-funded services treating depression/anxiety across 4 NHS trusts.Participants:Adult daily smokers starting CBT for depression/anxiety (mean age 35.6 years (standard deviation [SD]=12.7), 89.6\% white) who smoked 14.3 (SD=8.2) cigarettes/day with mean Generalised Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) scores of 13.1 (SD=4.9) and 14.5 (SD=6.0). Sixty-eight participants were allocated to the treatment group and 67 to control.Intervention/Control:Both groups received CBT for depression/anxiety. The treatment group also received 12 sessions of integrated smoking cessation support. The control group was signposted to cessation services post-treatment.Measurements:Follow-up was at 3 and 6 months. The primary outcome was “study completion” by 3 months. Other outcomes included acceptability, satisfaction, feasibility, data completeness, and mental health.Findings: At 3 months, treatment did not affect study completion (odds ratio [OR] 0.81, 95\% confidence interval [CI]: 0.31—2.09), did not harm mental health (PHQ-9 difference: coefficient 0.01, 95\% CI: -2.19 to 2.22); GAD-7: coefficient 0.65, 95\% CI: -1.59 to 2.90), but increased abstinence rates (OR 8.69, 95\% CI: 1.11 to 396.26). Recruitment was acceptable, and key stakeholders were satisfied with the intervention.Conclusions:Among UK adult smokers receiving cognitive behavioural therapy (CBT) treatment for depression or anxiety, a smoking cessation intervention within the CBT treatment was well received, did not interfere with the primary treatment goals, and increased smoking cessation.",

author = "Gemma Taylor and Katherine Sawyer and Pamela Jacobsen and Blackwell, \{Anna K M\} and Shadi Daryan and Tom Freeman and Chris Metcalfe and Kessler, \{David S\} and Munafo, \{Marcus R\} and Paul Aveyard",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Addiction published by John Wiley \& Sons Ltd on behalf of Society for the Study of Addiction.",

year = "2025",

month = may,

day = "1",

doi = "10.1111/add.16718",

language = "English",

volume = "120",

pages = "922--936",

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Taylor, G, Sawyer, K, Jacobsen, P, Blackwell, AKM, Daryan, S, Freeman, T, Metcalfe, C , Kessler, DS, Munafo, MR & Aveyard, P 2025, 'Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods', Addiction, vol. 120, no. 5, pp. 922-936. https://doi.org/10.1111/add.16718

Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods. / Taylor, Gemma; Sawyer, Katherine; Jacobsen, Pamela et al.
In: Addiction, Vol. 120, No. 5, 01.05.2025, p. 922-936.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE)

T2 - A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods

AU - Taylor, Gemma

AU - Sawyer, Katherine

AU - Jacobsen, Pamela

AU - Blackwell, Anna K M

AU - Daryan, Shadi

AU - Freeman, Tom

AU - Metcalfe, Chris

AU - Kessler, David S

AU - Munafo, Marcus R

AU - Aveyard, Paul

PY - 2025/5/1

Y1 - 2025/5/1

N2 - Background and aim: There is evidence that smoking cessation may improve depression and anxiety. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.Design:Pragmatic, two-armed, randomised, multicentre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779).Setting:United Kingdom National Health Service (NHS)-funded services treating depression/anxiety across 4 NHS trusts.Participants:Adult daily smokers starting CBT for depression/anxiety (mean age 35.6 years (standard deviation [SD]=12.7), 89.6% white) who smoked 14.3 (SD=8.2) cigarettes/day with mean Generalised Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) scores of 13.1 (SD=4.9) and 14.5 (SD=6.0). Sixty-eight participants were allocated to the treatment group and 67 to control.Intervention/Control:Both groups received CBT for depression/anxiety. The treatment group also received 12 sessions of integrated smoking cessation support. The control group was signposted to cessation services post-treatment.Measurements:Follow-up was at 3 and 6 months. The primary outcome was “study completion” by 3 months. Other outcomes included acceptability, satisfaction, feasibility, data completeness, and mental health.Findings: At 3 months, treatment did not affect study completion (odds ratio [OR] 0.81, 95% confidence interval [CI]: 0.31—2.09), did not harm mental health (PHQ-9 difference: coefficient 0.01, 95% CI: -2.19 to 2.22); GAD-7: coefficient 0.65, 95% CI: -1.59 to 2.90), but increased abstinence rates (OR 8.69, 95% CI: 1.11 to 396.26). Recruitment was acceptable, and key stakeholders were satisfied with the intervention.Conclusions:Among UK adult smokers receiving cognitive behavioural therapy (CBT) treatment for depression or anxiety, a smoking cessation intervention within the CBT treatment was well received, did not interfere with the primary treatment goals, and increased smoking cessation.

AB - Background and aim: There is evidence that smoking cessation may improve depression and anxiety. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.Design:Pragmatic, two-armed, randomised, multicentre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779).Setting:United Kingdom National Health Service (NHS)-funded services treating depression/anxiety across 4 NHS trusts.Participants:Adult daily smokers starting CBT for depression/anxiety (mean age 35.6 years (standard deviation [SD]=12.7), 89.6% white) who smoked 14.3 (SD=8.2) cigarettes/day with mean Generalised Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) scores of 13.1 (SD=4.9) and 14.5 (SD=6.0). Sixty-eight participants were allocated to the treatment group and 67 to control.Intervention/Control:Both groups received CBT for depression/anxiety. The treatment group also received 12 sessions of integrated smoking cessation support. The control group was signposted to cessation services post-treatment.Measurements:Follow-up was at 3 and 6 months. The primary outcome was “study completion” by 3 months. Other outcomes included acceptability, satisfaction, feasibility, data completeness, and mental health.Findings: At 3 months, treatment did not affect study completion (odds ratio [OR] 0.81, 95% confidence interval [CI]: 0.31—2.09), did not harm mental health (PHQ-9 difference: coefficient 0.01, 95% CI: -2.19 to 2.22); GAD-7: coefficient 0.65, 95% CI: -1.59 to 2.90), but increased abstinence rates (OR 8.69, 95% CI: 1.11 to 396.26). Recruitment was acceptable, and key stakeholders were satisfied with the intervention.Conclusions:Among UK adult smokers receiving cognitive behavioural therapy (CBT) treatment for depression or anxiety, a smoking cessation intervention within the CBT treatment was well received, did not interfere with the primary treatment goals, and increased smoking cessation.

U2 - 10.1111/add.16718

DO - 10.1111/add.16718

M3 - Article (Academic Journal)

C2 - 40068701

SN - 0965-2140

VL - 120

SP - 922

EP - 936

JO - Addiction

JF - Addiction

IS - 5

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Taylor G, Sawyer K, Jacobsen P, Blackwell AKM, Daryan S, Freeman T et al. Integrating smoking cessation treatment as part of usual psychological care for depression and anxiety (ESCAPE): A randomised and controlled, multicentre, acceptability and feasibility trial with nested qualitative methods. Addiction. 2025 May 1;120(5):922-936. Epub 2025 Mar 11. doi: 10.1111/add.16718