Therapy helps some kick habit after heart attack

NEW YORK (Reuters Health) - Cognitive behavioral therapy (CBT) appears to help people who are depressed after suffering a heart attack to avoid smoking cigarettes, but only if they believe they have adequate social support, new research shows.

The findings suggest that most smokers will need more than CBT alone to give up the habit after a heart attack, but they also underscore the value of this therapy in treating depression in people with heart disease, Dr. Mickey Trockel of the Stanford University School of Medicine and colleagues report.

After a heart attack, smokers can substantially reduce their risk of dying if they quit, the researchers note in their study, published in the journal Psychosomatic Medicine. But people with heart disease frequently suffer from depression, which can make kicking the habit more difficult.

In the current study, the researchers looked at whether CBT had any effect on smoking behavior in 1,233 patients who had a heart attack and were participating in a trial investigating the effect of CBT on depression and low perceived social support. Study participants were randomly assigned to undergo at least six sessions of individual therapy or usual care.

Twelve percent of the study participants didn’t report smoking at the study’s outset, but picked up the habit again later on.

Overall, the researchers found, patients who had CBT were no less likely to report smoking than those who didn’t receive therapy. But when they limited their analysis to patients who believed they had adequate levels of social support, therapy cut their likelihood of smoking by 32 percent.

“Our findings suggest CBT may have little effect in reducing smoking behavior among a larger population of smokers outside a smoking cessation program,” Trockel and colleagues conclude. “More focused smoking cessation intervention is needed.”

Nevertheless, they add, the fact that the study wasn’t specifically designed to look at how CBT affected smoking behavior but did find a “beneficial side effect” of the treatment on smoking, “adds more support for the use of CBT, a well established evidence-based therapy, for the treatment of depression” among heart attack patients.

SOURCE: Psychosomatic Medicine, October 2008.

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