Behavioral activation for smoking cessation may improve bodily pain in adults with lifetime major depressive disorder

Pain and major depressive disorder (MDD) are common and frequently co-occur among people who smoke cigarettes. Behavioral activation (BA) is standard treatment in MDD that may also reduce pain. This secondary analysis tested whether the effects of Behavioral Activation Smoking Cessation (BASC) was more effective than standard behavioral treatment (ST) in reducing pain during and after tobacco treatment among adults who smoked daily and had a history of MDD.

Participants (N = 244; 57% female; 53% Black; M_age = 50.1) received BASC or ST and varenicline or placebo, and reported on bodily pain at week 1 (baseline), 3 (target quit date, TQD), 7, 12 (end of treatment, EOT), and 27 (follow-up, FU) using the Short-Form Survey (SF-36). Repeated measures analyses examined changes in pain from baseline through FU by treatment condition.

There was a significant effect of BASC on change in pain across treatment (F(2.75) = 4.38, p = .006), with almost a 10-point decrease in SF-36 score from week 3 to week 12/EOT (M_BASC = 9.55 vs. M_ST = 0.86). While the BASC group reported significantly lower levels of pain at week 12/EOT compared to the ST group (M_BASC = 19.05 vs. M_ST = 28.83; p < .001), there was no differences between treatment groups at week 27/FU (M_BASC = 28.63 vs. M_ST = 31.14; p = .163).

BASC produced a clinically meaningful reduction in pain compared to ST during the 12-week intervention. These findings suggest that BA may be useful for addressing the comorbidity of pain, depression, and smoking. Future studies designed to test this transdiagnostic application of BASC are needed.