# CPT-SMART for Treatment of PTSD and Cigarette Smoking

> **NIH VA I01** · DURHAM VA MEDICAL CENTER · 2021 · —

## Abstract

Smoking is the leading cause of preventable illness, disability, and death in the United States. The rate of
smoking is disproportionately higher among Veterans with posttraumatic stress disorder (PTSD).
Unfortunately, smoking cessation efforts that are effective in the general population have shown limited
effectiveness in smokers with PTSD. The high smoking rate and difficulty with achieving abstinence indicate a
critical need to develop effective interventions for PTSD smokers. Our data indicate that negative affect and
trauma reminders are a significant antecedent of relapse for PTSD smokers. Further, despite evidence that
nicotine may exacerbate PTSD symptoms, many smokers with PTSD expect that smoking helps manage their
symptoms. In this context, an ideal strategy may be to combine evidence-based PTSD treatment with intensive
smoking cessation treatment to maximize quit rates in this at-risk population.
Cognitive processing therapy (CPT) is a well-established evidenced-based treatment for PTSD. We have
successfully developed a treatment manual that integrates CPT with guideline-concordant cognitive-behavioral
counseling for smoking cessation and is well-tolerated among Veterans with PTSD who smoke cigarettes. The
addition of more intensive smoking cessation treatment is expected to maximize quit rates in this population.
Contingency management (CM) is an intensive behavioral treatment that has demonstrated efficacy for
reducing smoking in a range of difficult-to-treat populations, including individuals with psychiatric disorders. CM
provides positive reinforcers (e.g., vouchers, money) to individuals misusing substances contingent upon
bioverified abstinence from drug use. In combination with other treatment, CM may provide a potent initial
incentive in smokers who experience difficulties early in the quit attempt. The primary goal of the current study
is to evaluate the efficacy of an intervention that combines clinic-based CM using twice weekly monitoring with
salivary cotinine test strips, cognitive-behavioral smoking cessation counseling, smoking cessation medication,
and evidence-based PTSD treatment. Proposed is a randomized, two-arm clinical trial in which 120 Veteran
smokers with PTSD will be randomized to either: 1) COGNITIVE PROCESSING THERAPY with SMOKING
ABSTINENCE REINFORCEMENT THERAPY (CPT-SMART) – an intervention that combines evidenced-
based PTSD treatment with guideline-concordant cognitive-behavioral smoking cessation counseling,
bupropion, and intensive behavioral therapy through CM; or 2) COMBINED CONTACT CONTROL: an
intervention identical to CPT-SMART in PTSD and smoking treatment, except for using non-contingent
payment (i.e., yoked CM) to control for compensation and monitoring.
Specific aims include: AIM 1) To evaluate the efficacy of CPT-SMART on rates of short- and long-term
abstinence from cigarettes (assessed with multiple measures including bioverified abstinence) measured at 1-
week post-treatment, 3-months, a...

## Key facts

- **NIH application ID:** 10041693
- **Project number:** 5I01CX001757-02
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** Eric A Dedert
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10041693

## Citation

> US National Institutes of Health, RePORTER application 10041693, CPT-SMART for Treatment of PTSD and Cigarette Smoking (5I01CX001757-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10041693. Licensed CC0.

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