Smoking Cessation Intervention for Smokers With Depression Receiving Outpatient Psychiatric Treatment

The proposed study will develop a Mindfulness Smartphone Intervention with Contingency
Management (MSI-CM) for smoking cessation that can be readily available to depressed smokers
receiving outpatient psychiatric treatment. The intervention will involve a series of brief
mindfulness training that will be delivered via smartphone, that prompts patients to practice
a mindfulness exercise multiple times a day while abstinent: 1) 10-days prior to their target
quit date and 2) during the 2-week incentivized abstinence period (using CM) plus an
additional 2 weeks (without CM) following their target quit date. We will use CM as an
adjunct strategy to enhance the efficacy of mindfulness training due to its utility in
producing short-term abstinence, so as to provide opportunities to practice mindfulness
without smoking in one's natural environment. We will accomplish this objective by pursuing
the following specific aims (in 2 phases):

Phase 1: To develop the MSI-CM intervention intended to improve smoking cessation success
among depressed smokers receiving outpatient psychiatric treatment.

1a. We will collaborate with TelASK, Inc. to develop a prototype of a smartphone intervention
(MSI-CM).

1b. We will conduct preliminary pilot testing of MSI-CM, in an iterative fashion, with 10
smokers receiving outpatient psychiatric treatment for depression.

Phase 2: To conduct a preliminary, randomized controlled trial (RCT) with depressed 60
smokers receiving outpatient psychiatric treatment.

Inclusion Criteria:

- be 18 years of age

- be current daily smokers (i.e., at least 5 cigarettes for the past 6 months)

- English-speaking

- motivated to quit smoking (i.e., "intent to quit in the next 3 months")

- have a diagnosis of depressive or bipolar disorders

- engaged in outpatient psychiatric treatment (i.e., has been receiving outpatient
psychiatric treatment for at least 3 months AND has received counseling from social
worker at outpatient psychiatric treatment clinic at least 3 times in the past 3
months)

Exclusion Criteria:

- acute psychiatric symptomatology which precludes study participation including current
active suicidal ideation

- diagnosis of psychotic disorders

- current diagnosis of dementia or cognitive impairment sufficient to impair provision
of informed consent or study participation

- patient's inability to provide consent for study participation due to his/her
inability to demonstrate an understanding of study procedures as contained in the
statement of informed consent, after no more than two explanations

- current clinical diagnosis of intellectual development disorder or autistic disorder

- current (non-nicotine) substance use disorder with the exception of individuals
holding 6 months of sobriety and/or receiving treatment including counseling and
medications (i.e. methadone, suboxone)

- intention to quit smoking using pharmacotherapy other than transdermal nicotine
patches

- pregnant, breastfeeding, or planning to become pregnant within 6 months

- significant history of cardiovascular disease (a standard contraindication for
nicotine patch use),

- patient does not have a stable home address where the research team could reliably
reach patient, or

- regular (3 or more times in the past month) use of other tobacco products (i.e.,
cigars, cigarillos, chewing tobacco) or marijuana