A randomized trial of short psychotherapy versus sustained‐release bupropion for smoking cessation

Aims To compare the efficacy and safety of a novel psychological intervention for smoking cessation called psychodynamic model (PDM) training to an active control condition of sustained‐release bupropion. Design Randomized controlled clinical trial with allocation concealment. Setting Private psychiatric practice. Participants Seven hundred and seventy‐nine adult smokers recruited by advertising. Interventions PDM training (n = 366 participants) consisted of a very brief (1.5 days) psychoeducation and a supervised training in autosuggestion techniques (guided imageries) aimed at enhancing self‐management, decidedness, assertiveness, security and competence in relationships, natural functions of organs and awareness of bodily functions. Bupropion SR (n = 413) was increased to 150 mg twice daily over 1 week and given over a 8‐week period. Measurements Twelve‐month continuous abstinence confirmed by exhaled carbon monoxide (CO) of 9 parts per million (p.p.m.) or less at all interviews conducted at 3, 6 and 12 months. Findings Intention‐to‐treat analysis revealed Russell standard 12‐month continuous abstinence rates of 39.1% in the psychotherapy group versus 12.3% in the bupropion SR group (P < 0.001) with a relative benefit (RB) of 3.16 (2.38–4.26). Completer analysis revealed 12‐month continuous abstinence rates of 39.9% in the psychotherapy group versus 22.5% in the bupropion group [P < 0.001; RB 1.78 (1.35–2.34)]. Of note, bupropion abstinence rates were comparable to previous medications/placebo‐only comparisons in geographically different samples. Conclusions The 1.5‐day psychotherapy exceeded bupropion's efficacy, presenting an alternative to pharmacological smoking cessation aids, especially for smokers who reject drugs to treat their substance dependence, at a similar cost (€350) as the bupropion treatment (€355).