Outcomes from a Pilot Trial of a Dialectical Behavior Therapy (DBT) Tobacco Cessation Intervention for Veterans at Heightened Risk for Suicide.

Abstract

Tobacco use has consistently been linked to suicide risk, and some data suggest that tobacco cessation may reduce risk. However, higher risk individuals are typically excluded from clinical trials. Dialectical Behavior Therapy is a psychotherapy approach originally designed to reduce suicide risk that may also be beneficial in treating addiction by enhancing emotion regulation and distress tolerance skills. The present study was a randomized pilot trial comparing a standard tobacco cessation intervention to a DBT-based integrated intervention for tobacco cessation and suicide prevention. Veterans (n = 68) who were daily users of cigarettes and/or e-cigarettes were randomized to DBT for cessation (DBT-C) or to treatment as usual (TAU). Participants in both conditions attended 12 weekly group psychotherapy sessions and were followed for a total of 24 weeks to evaluate changes in tobacco use, suicidality, emotion regulation and overall satisfaction with the intervention. DBT-C and TAU participants did not differ in terms of abstinence at end-of-treatment or 24-week follow-up. There was a trend toward greater improvement in emotion regulation in DBT-C versus TAU. Participants generally were satisfied with the intervention. This pilot trial provides preliminary evidence that individuals who use tobacco and are at elevated suicide risk can be effectively engaged in tobacco cessation interventions, and that such interventions may benefit emotional functioning as well as reducing tobacco use. DBT-C appears to be a potentially effective approach but additional, larger-scale research is needed to enable a more thorough assessment.