Posttraumatic stress disorder (
PTSD) is related to an increased risk of smoking cessation failure. In fact, the quit rate in smokers with
PTSD (23.2%) is one of the lowest of all
mental disorders. Features of
PTSD that contribute to smokers' progression to
nicotine dependence and cessation relapse include negative affect, fear, increased arousal, irritability, anger, distress intolerance, and anxiety sensitivity. Anxiety sensitivity is higher in people with
PTSD than in any other
anxiety disorder except for
panic disorder. High anxiety sensitivity is uniquely associated with greater odds of lapse and relapse during quit attempts. Distress intolerance, a perceived or behavioral tendency to not tolerate distress, is related to both the maintenance of
PTSD and problems in quitting smoking. Prolonged exposure (PE) and interoceptive exposure (IE) reduce
PTSD symptoms, distress intolerance, and anxiety sensitivity. Thus, they emerge as promising candidates to augment standard smoking cessation interventions for individuals with
PTSD. The present study tests a 12-session specialized treatment for smokers with
PTSD. This Integrated
PTSD and Smoking Treatment (IPST) combines cognitive-behavioral therapy and
nicotine replacement treatment for smoking cessation (standard care; SC) with PE to target
PTSD symptoms and IE to reduce anxiety sensitivity and distress intolerance. Adult smokers (N=80) with
PTSD will be randomly assigned to either: (1) IPST or (2) SC. Primary outcomes are assessed at weeks 0, 6, 8, 10, 14, 16, 22, and 30.