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Helping Veterans Quit Smoking by Improving Their Sleep (ISCWCBTI)

This study has been terminated.
(Terminated after two years by CSRD)
Information provided by (Responsible Party):
VA Office of Research and Development Identifier:
First received: December 23, 2010
Last updated: December 1, 2014
Last verified: December 2014
This project is designed to determine whether an efficacious behavioral intervention for insomnia can improve the quit rates achieved by an efficacious smoking cessation program aimed at PTSD patients ("Integrated Care"). A second aim is to deepen our understanding of the mechanisms relating sleep and smoking in PTSD.

Condition Intervention Phase
Behavioral: Integrated Care
Behavioral: Cognitive-Behavioral Treatment for Insomnia
Behavioral: Desensitization Treatment for Insomnia
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Improving Smoking Cessation Outcomes in PTSD With CBT for Insomnia

Resource links provided by NLM:

Further study details as provided by VA Office of Research and Development:

Primary Outcome Measures:
  • seven-day point prevalence abstinence [ Time Frame: 21 days post-quit-day ]

Enrollment: 142
Study Start Date: October 2011
Study Completion Date: June 2013
Primary Completion Date: June 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
Integrated Care + Cognitive-Behavioral Treatment for Insomnia
Behavioral: Integrated Care
A PTSD-aware smoking cessation intervention developed by Miles McFall, PhD.
Behavioral: Cognitive-Behavioral Treatment for Insomnia
A behavioral treatment aimed at improving sleep continuity and subjective sleep through stimulus control, sleep restriction, and attenuation of maladaptive sleep-related cognitions.
Sham Comparator: Arm 2
Integrated Care + Desensitization Treatment for Insomnia
Behavioral: Integrated Care
A PTSD-aware smoking cessation intervention developed by Miles McFall, PhD.
Behavioral: Desensitization Treatment for Insomnia
A credible sham treatment for insomnia matching CBTI in treatment time, patient expectations, therapist expectations, etc.

Detailed Description:

In summary, participation will involve a screening period of approximately one week, six weeks of temporally aligned IC ("Integrated Care" - manualized smoking cessation treatment integrating components of behavioral treatment for PTSD) and behavioral sleep treatments (Cognitive-Behavioral Treatment for Insomnia or CBTI), and follow-up telephone interviews at two months and six months.

Screening: Patients in the VA Palo Alto inpatient psychiatry and domiciliary programs indicating interest in quitting cigarette smoking will be pre-screened by the Medical Director to determine whether an individual's psychiatric conditions contraindicates use of bupropion or NRT (Nicoderm). Patients interested in quitting will be referred to the study coordinator. Coordinator will be notified whether medication or NRT is contraindicated for participant and/or of a diagnosed sleep disorder (treated or untreated) other than insomnia.

Continuing participants will be consented and then complete 24 hours of cued symptom reporting using a personal digital assistant (PDA) to verify their capacity to adhere to this component of the study protocol. Continuing participants will undergo a research psychodiagnostic assessment followed by an ambulatory screening polysomnogram (PSG) to exclude undiagnosed sleep disorders. (Participants exhibiting evidence of sleep disorder will be referred for a clinical sleep study.) Screening assessments and psychodiagnostics have been sequenced with the aim of minimizing burden for those excluded.

Participants meeting all inclusion and exclusion criteria will be randomized to IC+CBTI or IC+Desensitization Treatment for Insomnia (DTI: a manualized placebo control intervention). They will meet twice with the IC therapist to complete IC sessions 1 and 2. Over the course of these sessions, they will negotiate a quit date at least three weeks from that time and at least four weeks prior to their projected discharge from inpatient treatment. (Inpatient stays in both of these programs average thirteen weeks.) IC sessions 3 and 4 will be evenly spaced between IC session 2 and the planned quit date. Three weeks prior to their quit date, they will initiate sleep treatment (sessions 1 and 2) and nightly mattress actigraphy. Two weeks prior to their quit date they will begin PDA-based EMA. One to two weeks prior to their quit date, they will commence bupropion and receive sleep treatment session 3. One week prior to their quit date they will receive sleep treatment session 4. On their quit date they will begin NRT. Thereafter, for weeks four through six, they will receive IC sessions five through eight and sleep treatment session five through seven, respectively. At the end of week six, they will receive IC session eight which will also serve as the 3 week assessment of smoking status (the primary outcome assessment of the study). (Note that the first planned assessment of cessation status will occur prior to the expected discharge date for all participants.) The final research interventions will be telephone interviews at two months and six months. Salivary cotinine samples will be obtained at the end of each post-quit week (only if the participant is not using NRT) the last corresponding to the primary outcome assessment, at both telephone follow-up smoking status assessments (by mail).


Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Potential participants will be smokers who have smoked at least 10 cigarettes per day for the past year,
  • are motivated to make a smoking cessation attempt,
  • are na ve to behavioral sleep treatment and are willing to be randomly assigned to either one of the sleep treatment arms.
  • Participants must meet the criteria for PTSD and or partial PTSD.
  • They will indicate a willingness to forgo the use of all alternative tobacco products during their attempt to quit cigarettes.
  • They will be fluent in English.

Exclusion Criteria:

  • Candidates who meet DSM-IV criteria for schizophrenia,
  • current manic syndrome,
  • lifetime but not current PTSD or partial PTSD,
  • or current substance abuse/dependence will be excluded.
  • positive Brain Injury Screen will not result in exclusion from the study.
  • subjects reporting a prior diagnosis of severe obstructive sleep apnea will be excluded unless they have been successfully treated via weight loss, surgery, or continuous positive airway pressure to which they are reliably adherent.
  • We expect these criteria to exclude 15 to 20% of potential participants.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01267032

United States, California
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, California, United States, 94304-1290
Sponsors and Collaborators
VA Office of Research and Development
Principal Investigator: Steven H. Woodward, PhD VA Palo Alto Health Care System, Palo Alto, CA
  More Information

Responsible Party: VA Office of Research and Development Identifier: NCT01267032     History of Changes
Other Study ID Numbers: SPLA-09-S09
1I01CX000301-01 ( Other Grant/Funding Number: DVA )
Study First Received: December 23, 2010
Last Updated: December 1, 2014 processed this record on May 25, 2017