intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods

Gemma M J Taylor; Katherine Sawyer; Pamela Jacobsen; Tom P Freeman; Anna Blackwell; Shadi Daryan; Chris Metcalfe; David Kessler; Marcus R Munafò; 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, multi-centre, acceptability and feasibility trial with nested qualitative methods

Gemma M J Taylor, Katherine Sawyer, Pamela Jacobsen, Tom P Freeman, Anna Blackwell, Shadi Daryan, Chris Metcalfe, David Kessler, Marcus R Munafò, Paul Aveyard

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 symptoms. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.

Design, setting and participants
This study was a pragmatic, two-armed, randomised, multi-centre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779) involving United Kingdom National Health Service (NHS)-funded services treating depression or anxiety among four NHS Trusts. Participants comprised adult daily smokers starting CBT for depression or 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-7 (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 and control
Both groups received CBT for depression or anxiety. The treatment group also received up to 12 sessions of integrated smoking cessation support. The control group was signposted to smoking 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 to 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 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	E-pub ahead of print - 11 Mar 2025

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Taylor, G. M. J., Sawyer, K., Jacobsen, P., Freeman, T. P., Blackwell, A., Daryan, S., Metcalfe, C., Kessler, D., Munafò, M. R., & Aveyard, P. (2025). intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods. Addiction, 120(5), 922-936. Advance online publication. https://doi.org/10.1111/add.16718

@article{391ef112a818410a8a8abe820603a3f4,

title = "intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods",

abstract = "Background and aimThere is evidence that smoking cessation may improve depression and anxiety symptoms. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.Design, setting and participantsThis study was a pragmatic, two-armed, randomised, multi-centre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779) involving United Kingdom National Health Service (NHS)-funded services treating depression or anxiety among four NHS Trusts. Participants comprised adult daily smokers starting CBT for depression or 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-7 (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 and controlBoth groups received CBT for depression or anxiety. The treatment group also received up to 12 sessions of integrated smoking cessation support. The control group was signposted to smoking cessation services post-treatment.MeasurementsFollow-up was at 3 and 6 months. The primary outcome was {\textquoteleft}study completion{\textquoteright} by 3 months. Other outcomes included acceptability, satisfaction, feasibility, data completeness and mental health.FindingsAt 3 months, treatment did not affect study completion [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.31 to 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.ConclusionsAmong UK adult smokers receiving 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 = "Taylor, {Gemma M J} and Katherine Sawyer and Pamela Jacobsen and Freeman, {Tom P} and Anna Blackwell and Shadi Daryan and Chris Metcalfe and David Kessler and Munaf{\`o}, {Marcus R} and Paul Aveyard",

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

year = "2025",

month = mar,

day = "11",

doi = "10.1111/add.16718",

language = "English",

volume = "120",

pages = "922--936",

journal = "Addiction",

issn = "0965-2140",

publisher = "Wiley",

number = "5",

}

Taylor, GMJ, Sawyer, K, Jacobsen, P, Freeman, TP, Blackwell, A, Daryan, S, Metcalfe, C , Kessler, D , Munafò, MR & Aveyard, P 2025, 'intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, 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, multi-centre, acceptability and feasibility trial with nested qualitative methods. / Taylor, Gemma M J; Sawyer, Katherine; Jacobsen, Pamela et al.
In: Addiction, Vol. 120, No. 5, 11.03.2025, 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, multi-centre, acceptability and feasibility trial with nested qualitative methods

AU - Taylor, Gemma M J

AU - Sawyer, Katherine

AU - Jacobsen, Pamela

AU - Freeman, Tom P

AU - Blackwell, Anna

AU - Daryan, Shadi

AU - Metcalfe, Chris

AU - Kessler, David

AU - Munafò, Marcus R

AU - Aveyard, Paul

PY - 2025/3/11

Y1 - 2025/3/11

N2 - Background and aimThere is evidence that smoking cessation may improve depression and anxiety symptoms. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.Design, setting and participantsThis study was a pragmatic, two-armed, randomised, multi-centre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779) involving United Kingdom National Health Service (NHS)-funded services treating depression or anxiety among four NHS Trusts. Participants comprised adult daily smokers starting CBT for depression or 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-7 (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 and controlBoth groups received CBT for depression or anxiety. The treatment group also received up to 12 sessions of integrated smoking cessation support. The control group was signposted to smoking cessation services post-treatment.MeasurementsFollow-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.FindingsAt 3 months, treatment did not affect study completion [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.31 to 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.ConclusionsAmong UK adult smokers receiving 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 aimThere is evidence that smoking cessation may improve depression and anxiety symptoms. We assessed the feasibility of implementing and trialling a smoking cessation intervention in services providing cognitive behavioural therapy (CBT) for common mental illness.Design, setting and participantsThis study was a pragmatic, two-armed, randomised, multi-centre, acceptability and feasibility trial of a co-designed smoking cessation intervention (ISRCTN99531779) involving United Kingdom National Health Service (NHS)-funded services treating depression or anxiety among four NHS Trusts. Participants comprised adult daily smokers starting CBT for depression or 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-7 (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 and controlBoth groups received CBT for depression or anxiety. The treatment group also received up to 12 sessions of integrated smoking cessation support. The control group was signposted to smoking cessation services post-treatment.MeasurementsFollow-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.FindingsAt 3 months, treatment did not affect study completion [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.31 to 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.ConclusionsAmong UK adult smokers receiving 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

ER -

Taylor GMJ, Sawyer K, Jacobsen P, Freeman TP, Blackwell A, Daryan S et al. intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): A randomised and controlled, multi-centre, acceptability and feasibility trial with nested qualitative methods. Addiction. 2025 Mar 11;120(5):922-936. Epub 2025 Mar 11. doi: 10.1111/add.16718