Enhanced Smoking Cessation Intervention for Smokers Exposed to the World Trade Center (WTC) Disaster

Respiratory illness and post-traumatic stress disorder (PTSD) are the primary health
sequelae of the World Trade Center (WTC) disaster on September 11th 2001 and are often
comorbid. Cigarette smoking is a modifiable health behavior associated with both lower
respiratory symptoms (LRS) and PTSD. Smoking cessation programs are considered the crucial
front-line intervention for smokers with pulmonary problems. Unfortunately, trauma exposed
smokers with elevated PTSD symptoms have greater difficulty quitting, are more likely to
fail standard cessation programs, and are more likely to relapse than smokers with other
anxiety disorders and those without mental illness. Interventions that concurrently target
mechanisms thought to maintain the comorbidity between PTSD and LRS (e.g., anxious
reactivity to nicotine withdrawal, smoking to reduce negative affect) may offer a means of
improving smoking quit rates in trauma exposed populations. Thus, the purpose of this study
was to test the efficacy of a combined CBT smoking cessation treatment enhanced with
transdiagnostic skills for the management of anxiety and fear-based avoidance behaviors
(CBT-A). The investigators randomized 90 WTC disaster exposed daily smokers with elevated
PTSD symptoms to either CBT-A (N=44) or a standard CBT-based smoking cessation program
(CBT-S; N=46). Participants were followed up to six months post-treatment.

Inclusion Criteria:

- smoking at least five cigarettes per day

- reporting interest in smoking cessation treatment

- direct exposure to the WTC disaster (e.g., responding to the event or witnessing the
event in person)

- scoring >30 on the Posttraumatic Stress Disorder Checklist

Exclusion Criteria:

- current participation in another smoking cessation treatment

- alcohol dependence within the last six months

- serious mental illness (e.g., psychosis, mania)