CPT-SMART for Treatment of PTSD and Cigarette Smoking
Key facts
- Who runs it
- VA Office of Research and Development
- Where
- Durham, United StatesSee the site
- Trial code
- Status
- Completed
- Phase
- Phase 4
- People taking part
- 115 people enrolled
- Started
- 7 Nov 2019
- Ended
- 8 Oct 2025
- Type of study
- Interventional, 2 groupsOne group gets an existing treatment, for comparison.
- Treatments tested
- Smoking Cessation Cognitive Behavioral Therapy (CBT)
- Bupropion
- Cognitive Processing Therapy
- Smoking Abstinence Reinforcement Therapy
- Yoked Contingency Management
- Record updated
- 2 July 2026
Who can take part
- Age
- 18 years to 80 years
- Sex
- Women and men
- Healthy volunteers
- Cannot take part
The registry criteria, word for word
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Who can take part
- Is Veteran
- Is between the ages of 18 and 80
- Smokes ten or more cigarettes per day for the past year
- Has been smoking for at least the past year
- Meets criteria for current PTSD
- Speaks and writes English
- Is willing to attempt smoking cessation and trauma-focused psychotherapy
Who cannot take part
- Is receiving other behavioral smoking counseling or trauma-focused therapy or plans to do so during the study period
- Has had myocardial infarction in the past 6 months
- Has a primary psychotic disorder
- Has a current substance use disorder other than tobacco use disorder
- Is currently imprisoned or in psychiatric hospitalization
- Has a contraindication to bupropion use with no medical clearance to use it
- Uses other forms of nicotine that he/she is unwilling to stop
- Is pregnant
- Is unwilling to use bupropion
Where in United States
- Durham VA Medical Center, Durham, NCDurham, United States
About the trial
What the trial wants to find out
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 Veterans who smoke and have PTSD. The investigators' data indicate that negative emotions and trauma reminders are associated with relapse for smokers with PTSD. In this context, an ideal strategy may be to combine evidence-based PTSD treatment with intensive smoking cessation treatment to maximize quit rates.
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Cognitive processing therapy (CPT) is a well-established evidence-based treatment for PTSD. The investigators have successfully developed a treatment manual that combines CPT with cognitive-behavioral counseling for smoking cessation. Contingency management (CM) is another intensive behavioral treatment that has been shown to help with reducing smoking. CM provides positive reinforcers such as money to individuals misusing substances contingent upon abstinence from use. The primary goal of this study is to evaluate the efficacy of a treatment that combines CM with cognitive-behavioral smoking cessation counseling, smoking cessation medication, and CPT. 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) or 2) COMBINED CONTACT CONTROL, an intervention identical to CPT-SMART in PTSD and smoking treatment, except for using payment that is not contingent on abstinence.
Specific aims include: AIM 1) To evaluate the efficacy of CPT-SMART on rates of short- and long-term abstinence from cigarettes; AIM 2) To evaluate the impact of CPT-SMART on treatment engagement and utilization; and an EXPLORATORY AIM) To explore mechanisms of CPT-SMART on long-term smoking abstinence. The positive public health impact of reducing smoking among Veterans with PTSD could be enormous as it would prevent significant smoking-related morbidity and mortality.
The 2 groups in the trial
- CPT-SMARTTreatment being tested
COGNITIVE PROCESSING THERAPY with SMOKING ABSTINENCE REINFORCEMENT THERAPY (CPT-SMART) - an intervention that combines evidence-based PTSD treatment with guideline-concordant cognitive-behavioral smoking cessation counseling, bupropion, and intensive behavioral therapy through CM.
Treatment: Smoking Cessation Cognitive Behavioral Therapy (CBT), Bupropion, Cognitive Processing Therapy, and Smoking Abstinence Reinforcement Therapy
- Combined Contact Yoked ControlExisting treatment, for comparison
COMBINED CONTACT YOKED CONTROL (CCYC) - an intervention that is identical to CPT-SMART for PTSD and smoking treatment, except for using non-contingent payment (i.e., yoked CM) to control for compensation and monitoring.
Treatment: Smoking Cessation Cognitive Behavioral Therapy (CBT), Bupropion, Cognitive Processing Therapy, and Yoked Contingency Management
Data and sources
- Registry record
- Listed on ClinicalTrials.gov.
- Record updated
- 2 July 2026