Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders

ObjectiveTo compare a mindfulness-based intervention with cognitive behavioral therapy (CBT) for the group treatment of anxiety disorders.MethodOne hundred five veterans (83% male, mean age = 46 years, 30% minority) with one or more DSM-IV anxiety disorders began group treatment following randomization to adapted mindfulness-based stress reduction (MBSR) or CBT.ResultsBoth groups showed large and equivalent improvements on principal disorder severity thru 3-month follow up (ps < .001, d = ?4.08 for adapted MBSR; d = ?3.52 for CBT). CBT outperformed adapted MBSR on anxious arousal outcomes at follow up (p < .01, d = .49) whereas adapted MBSR reduced worry at a greater rate than CBT (p < .05, d = .64) and resulted in greater reduction of comorbid emotional disorders (p < .05, d = .49). The adapted MBSR group evidenced greater mood disorders and worry at Pre, however. Groups showed equivalent treatment credibility, therapist adherence and competency, and reliable improvement.ConclusionsCBT and adapted MBSR were both effective at reducing principal diagnosis severity and somewhat effective at reducing self-reported anxiety symptoms within a complex sample. CBT was more effective at reducing anxious arousal, whereas adapted MBSR may be more effective at reducing worry and comorbid disorders.     

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial

Background/ObjectiveFibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia.MethodWe compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models.ResultsParticipants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β = -0.47, t = -0.49, p = .63) and at follow-up (β = -1.12, t = -1.09, p = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain.ConclusionsPCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

“I’m a runner not a smoker”: Changes in identity as predictors of smoking cessation and physical activity

This study examined associations of changes in identity with physical activity and smoking within Run to Quit, a national multiple health behaviour change intervention that utilizes group-based learn-to-run clinics to assist participants in quitting smoking. It was hypothesized that the behaviour-change curriculum and running delivered via groups, would not only help participants mitigate physical symptoms of withdrawal but would also facilitate changes in smoking- and running-related identities. Further, changes in these identities (i.e., reduced smoker identity and increased runner identity) were hypothesized to predict smoking cessation and running behaviour. Adult smokers (n = 216) completed 10-week clinics in Running Room locations across Canada. Within the pre-post design, participants completed questionnaires assessing identity, physical activity, running frequency, and smoking status (including carbon monoxide [CO] testing) at weeks 1 and 10, as well as post-program interviews. Consistent with a priori hypotheses, runner identity increased, and smoker identity decreased from beginning to end of program (p’s<.001). Regression analyses indicated that reductions in smoker identity predicted reductions in CO levels (β = 0.302, p < .001) and increases in runner identity predicted increases in running frequency (β = 0.235, p = .001). While change in runner identity was correlated with quit outcomes and change in smoker identity correlated with running frequency (p’s<.001), they were not significant predictors in the other behaviour models, and neither was the interaction between the two identities. Although future experimental research is required, these findings, along with complimentary qualitative data, suggest changes in identity may be one potential avenue through which group-based physical activity assists smoking cessation.     

Exercise is medicine… when you enjoy it: Exercise enjoyment,relapse prevention efficacy,and health outcomes for youth within a drug and alcohol treatment service

ObjectiveEvidence for the effectiveness of exercise as therapy for youth substance use disorder (SUD) is scarce. In this study, we investigated associations between exercise enjoyment and recovery outcomes for youth undergoing residential SUD treatment.MethodUsing ecological momentary assessment, each week participants reported perceptions of exercise enjoyment, relapse prevention efficacy, self-esteem, and physical health, and associations between these variables were assessed at both between- and within-person levels. There were 97 participants (age: M = 17.5, SD = 1.57, range = 14 to 21; 37 female, 60 male), with a final sample of 64 due to participants (n = 33) discontinuing treatment within 2 weeks of commencement. Of the remaining sample, 50% (n = 32) completed 3 or more assessments, 40% (n = 26) completed 5 or more, and 25% (n = 16) completed 7 or more.ResultsRelapse prevention efficacy, self-esteem, and perceived physical health increased over time in the program. Youth who, on average, enjoyed exercise more had higher self-esteem, perceived physical health, and relapse prevention efficacy than those who enjoyed it less. Additionally, on occasions when youth enjoyed exercise more (relative to their own average), they reported higher self-esteem, perceived physical health, and relapse prevention efficacy than on occasions when they reported enjoying it less.ConclusionParticipation in—and importantly, enjoyment of—exercise was linked to key health indices and predictors of relapse for youth during SUD treatment. These findings demonstrate that participation in enjoyable structured exercise may provide an important component of successful SUD treatment.     

Depression vulnerability moderates the effects of cognitive behavior therapy in a randomized controlled trial for smoking cessation

Several clinical trials have tested the hypothesis that smoking cessation treatments with a mood management component derived from cognitive behavior therapy (CBT) for depression would be specifically effective for depression-vulnerable smokers, with mixed results. This trial addressed methodological concerns with some of the previous studies to clarify whether depression vulnerability does in fact moderate CBT smoking cessation outcome. The study compared 8-session group CBT with a time-matched comparison group condition in a sample of 100 cigarette smokers randomized to treatment condition. Each treatment group was led by one of 7 American University clinical psychology graduate students; therapists were crossed with treatment conditions. Outcome (7-day point prevalence abstinence) was evaluated 1 month and 3 months after quit date. Baseline self-reported depression vulnerability (sample median split on the Depression Proneness Inventory) moderated treatment response, such that more depression-prone smokers fared better in CBT whereas less depression-prone smokers fared better in the comparison condition. These results may have implications for determining when to use CBT components in smoking cessation programs.     

An Anxiety Sensitivity Reduction Smoking-Cessation Program for Spanish-Speaking Smokers (Argentina)

The present study evaluated a Spanish-language version of an Anxiety Sensitivity Reduction Program for Smoking Cessation among a sample of daily adult smokers from Argentina (n = 6; M_age = 49.4, SD = 15.43) in an open trial methodological design. To be eligible, each participant expressed a current desire to quit smoking and previous difficulties with anxiety/mood symptoms during past quit attempts (e.g., anxiety, stress, depression, irritability). Participants completed a baseline assessment and received eight 90-minute weekly group sessions. The study involved one doctoral-level and two graduate-level therapists. Follow-up visits were scheduled at 1, 2, 4, 8, and 12 weeks post-quit day. Smoking status was confirmed biochemically and via self-report at quit day and each follow-up assessment. The treatment yielded positive results in terms of attendance, positive smoking cessation outcome (5 out of 6 were abstinent at 12-week follow-up), and significant reductions in anxiety sensitivity. The results suggest potential clinical utility among Spanish-speaking smokers for an anxiety-sensitivity smoking cessation program in regard to cessation outcome.     

Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders

ObjectiveTo assess the relationship between session-by-session putative mediators and treatment outcomes in traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for mixed anxiety disorders.MethodSession-by-session changes in anxiety sensitivity and cognitive defusion were assessed in 67 adult outpatients randomized to CBT (n = 35) or ACT (n = 32) for a DSM-IV anxiety disorder.ResultsMultilevel mediation analyses revealed significant changes in the proposed mediators during both treatments (p < .001, d = .90–1.93), with ACT showing borderline greater improvements than CBT in cognitive defusion (p = .05, d = .82). Anxiety sensitivity and cognitive defusion both significantly mediated post-treatment worry; cognitive defusion more strongly predicted worry reductions in CBT than in ACT. In addition, cognitive defusion significantly mediated quality of life, behavioral avoidance, and (secondary) depression outcomes across both CBT and ACT (p < .05, R² change = .06–.13), whereas anxiety sensitivity did not significantly mediate other outcomes.ConclusionsCognitive defusion represents an important source of therapeutic change across both CBT and ACT. The data offered little evidence for substantially distinct treatment-related mediation pathways.     

Pilot Cases of Combined Cognitive Processing Therapy and Smoking Cessation for Smokers With Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) and smoking are often comorbid, and both problems are in need of improved access to evidence-based treatment. The combined approach could address two high-priority problems and increase patient access to both treatments, but research is needed to determine whether this is feasible and has promise for addressing both PTSD and smoking.We collected data from 15 test cases that received a treatment combining two evidence-based treatments: cognitive processing therapy–cognitive version (CPT-C) for PTSD and integrated care for smoking cessation (ICSC). We explored two combined treatment protocols including a brief (six-session) CPT-C with five follow-up in-person sessions focused on smoking cessation (n = 9) and a full 12-session CPT-C protocol with ICSC (n = 6). The combined interventions were feasible and acceptable to patients with PTSD making a quit attempt. Initial positive benefits of the combined treatments were observed. The six-session dose of CPT-C and smoking cessation resulted in 6-month bioverified smoking abstinence in two of nine participants, with clinically meaningful PTSD symptom reduction in three of nine participants. In the second cohort (full CPT-C and smoking treatment), both smoking and PTSD symptoms were improved, with three of six participants abstinent from smoking and four of six participants reporting clinically meaningful reduction in PTSD symptoms. Results suggested that individuals with PTSD who smoke are willing to engage in concurrent treatment of these problems and that combined treatment is feasible.     

The effects of lemon taste on attention,perceived exertion,and affect during a stepping task

ObjectivesTo better understand the effects of taste cues on delaying the attention shift from an external focus (dissociative) towards an internal focus (associative) as exercise intensity increases.DesignA between subjects' experimental design with random assignment to three groups: taste (lemon-flavored mouth guards), placebo (unflavored mouth guards), or control group (no mouth guards) was used. Participants reported perceived exertion, affect (i.e., pleasantness and arousal), and attention allocation before, during, and after performing a weighted stepping task.ResultsPerforming the task resulted in a gradual increase of perceived exertion, F (1.87, 74.89) = 63.05, p < .05, η_p² = .61, along with a shift from dissociative to associative attention, F (2.17, 86.68) = 35.57, p < .05, η_p² = .47 across all conditions. Additionally, participants reported feeling less pleasant and more aroused after task completion in all conditions. The lemon-flavored mouth guard failed to affect attention, F (4.33, 86.68) = 1.41, p = .23, η_p² = .07, perceived exertion, F (3.74, 74.86) = .38, p = .81, η_p² = .02, pleasantness, F (2, 40) = .126, p = .88, η_p² = .01, and arousal, F (2, 40) = 2.40, p = .10, η_p² = .10, differently than the other two conditions.ConclusionsThe study was one of the first to examine the effects of taste during an exertive task. Despite the non-significant effects of using a lemon-taste mouth guard on various cognitive variables (perception of exertion, attention allocation, pleasantness, and arousal), more scientific effort is needed to explore the effects of other tastes (e.g., sweet, bitter) and delivery methods (e.g., sprays, drops).     

Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample

Sleep disturbance and emotion dysregulation have been identified as etiologic and maintaining factors for a range of psychopathology and separate literatures support their relationships to anxiety, depression, PTSD, and alcohol dependence (AD) symptom severity. Previous studies have examined these relationships in isolation, failing to account for the high rates of comorbidity among disorders. It is not yet known whether these processes uniquely predict symptom severity in each of these domains. Participants were 220 patients in residential substance abuse treatment, who had experienced a potentially traumatic event and exceeded screening cutoffs for probable PTSD and problematic alcohol use. Controlling for emotion dysregulation and the interrelationships among the outcome variables, insomnia was uniquely associated with anxiety (B = .27, p < .001), depression (B = .25, p < .001), PTSD (B = .22, p < .001), and AD (B = .17, p = .01) symptom severity. Similarly, controlling for insomnia, emotion dysregulation was uniquely associated with anxiety (B = .40, p < .001), depression (B = .47, p < .001), PTSD (B = .38, p < .001), and AD (B = .26, p < .001) symptom severity. Insomnia and emotion dysregulation appear to be transdiagnostic processes uniquely associated with symptom severity across a number of different domains and might be important treatment targets for individuals with PTSD and AD.     

Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills

BackgroundExercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.MethodsPhysically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.ResultsFrom T1 to T3, the intervention group significantly improved on global symptom severity (d = −0.43, p = .031), depression among a depressed subsample (d = −0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = −0.28, p = .037) and clinically significant changes (ß = −0.24, p = .042).ConclusionsThe exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.     

Everyday tasks impair spatiotemporal variables of gait in older adults with Parkinson's disease

IntroductionAlthough it is known that individuals with Parkinson's disease (PD) have difficulties performing dual-task activities, most of the studies have verified the effect of dual tasks on gait using tasks that are uncommon to perform while walking. However, the realization of tasks involving gait that really represents the daily activities carried out by the participants, allow us to detect real fall risk situations of individuals with PD during their gait.ObjectiveOur aim was to verify the influence of daily-life dual-tasks on gait spatiotemporal variables of the older adults with PD.Methods20 older adults without PD and 20 older adults with PD participated in the study. Gait kinematic was analyzed under three different conditions: walking without dual task, walking carrying bags with weight, and walking talking on the cell phone.ResultsOlder adults with PD presented lower speed (p = .001), cadence (p = .039), and shorter step length (p = .028) than older adults without PD during walking without dual tasks. When walking while carrying bags with weight, older adults with PD had a lower speed (p < .001), cadence (p = .015), shorter step length (p = .008), and greater double support time (p = .021) compared with older adults without PD. During walking while talking on the cell phone, older adults with PD walked with lower speed (p < .001), cadence (p = .013), shorter step length (p = .001) and swing time (p = .013), and increased double support time (p = .008) and support time (p = .014) in relation to older adults without PD.ConclusionDaily-life dual tasks impair the spatiotemporal variables of gait in the older adults with PD, which was most evident during walking talking on the cell phone.     

Psychological need satisfaction and thwarting: A test of Basic Psychological Needs Theory in physical activity contexts

ObjectivesTo test Basic Psychological Needs Theory (BPNT; Deci & Ryan, 2002) to determine if psychological need thwarting experienced when physically active contributes to the understanding of well-being and ill-being.Design/methodParticipants (N = 155, 67.70% female, M_age = 37.46 years; SD_age = 19.89 years) completed assessments of psychological need satisfaction and thwarting, subjective vitality and positive/negative affect during separate testing sessions separated by 6 months.ResultsScores from the modified version of the Psychological Need Thwarting Scale (PNTS-PA; Bartholomew, Ntoumanis, Ryan, & Thøgersen-Ntoumani, 2011) demonstrated discriminant evidence of validity, evidence of internal structure and minimal error variance. Changes in psychological need satisfaction positively predicted positive affect (R² = .16, p < .05), subjective vitality (R² = .13, p < .05) and negatively predicted negative affect (R² = .12, p < .05). Additional regression analyses revealed that changes in psychological need thwarting predicted negative affect (ΔR² = .11, p < .05), but not positive affect (ΔR² = .01, p > .05) or subjective vitality (ΔR² = .04, p > .05) beyond contributions made by psychological need satisfaction.ConclusionsOverall, these results extend the potential utility of the PNTS-PA as an instrument for use with BPNT beyond sport and support Deci and Ryan's (2002) contentions regarding the critical role of psychological need thwarting.     

Assessment of tobacco craving by means of the affective image visualization paradigm

Smoking cues that increase craving are subjectively described by smokers as pleasant rather than unpleasant. However, it remains controversial whether the motivational nature of these smoking cues is consistent with an appetitive or aversion-relief model of tobacco craving. In the two studies presented here, the Bioinformational model of emotion proposed by Lang was used to address this issue. In study I, 40 smokers (10 males) assessed a set of tobacco-related pictures and a subset of standard pleasant, neutral, and unpleasant pictures in order to examine how craving relates to the three general dimensions of emotion: valence, arousal, and dominance. Results showed that the tobacco-related images were all assessed as appetitive, and craving was correlated positively with valence (r = .863, p < .0001) and arousal (r = .923, p < .0001) and negatively with dominance (r = −.504, p < .002). In study II, 24 female abstinent smokers were examined using Lang’s startle modulation paradigm in order to assess whether tobacco-related pictures, compared to standard pleasant and unpleasant ones, inhibited the startle response, consistent with an appetitive model of tobacco craving. Contrary to expectations, the startle response during visualization of tobacco-related pictures was more similar in magnitude to the response to unpleasant than to pleasant images, a finding inconsistent with an appetitive model of tobacco craving.     

Self-compassion and women athletes' responses to emotionally difficult sport situations: An evaluation of a brief induction

ObjectivesTo examine self-compassion as a way to promote healthy responses in women athletes when faced with emotionally difficult sport-specific situations.DesignPhase I, cross-sectional; Phase II, experimental.MethodsIn Phase I, participants (N = 101; M_age = 20.0, SD = 2.8 years) completed measures of self-compassion, self-esteem, and narcissism, as well as reactions, thoughts, and emotions in response to hypothetical (i.e., responsible for a team loss) and recalled scenarios. Participants returning for Phase II were randomly assigned to a brief self-compassion induction (n = 21), self-esteem induction (n = 20), or writing control (n = 18) group. Following the induction, they responded to the same hypothetical scenario as in Phase I.Phase I resultsAfter partialling out self-esteem and narcissism, self-compassion was related (p < .01) to negative affect (r = −.40), catastrophizing thoughts (r = −.30), personalizing thoughts (r = −.32), and behavioral equanimity (r = .28) for the hypothetical scenario. A similar pattern was found for the recalled scenario.Phase II resultsA MANOVA with Phase I self-compassion, self-esteem, and narcissism as covariates resulted in a non-significant group by time interaction, Wilks' Lambda = .75, F(12,96) = 1.27, p = .25. Follow-up hierarchical regression analysis showed Phase I levels of self-compassion as the only significant predictor for negative affect, personalizing thoughts, and behavioral equanimity.ConclusionsWomen athletes with higher self-compassion levels generally responded in healthier ways to emotionally difficult hypothetical and recalled situations in sport than their less self-compassionate counterparts. However, future research needs continued focus on evaluating self-compassion inductions and interventions for use in sport.     

Technology‐based contingency management and e‐cigarettes during the initial weeks of a smoking quit attempt

Contingency management (CM) interventions are among the most effective behavioral interventions for smoking. This study assessed the effects of CM and electronic cigarettes (ECs) on smoking reductions and abstinence for durations of 30‐36 days. Twelve participants were exposed to Baseline, EC alone, and EC + CM conditions. An internet‐based platform was used to monitor smoking via breath carbon monoxide (CO) and deliver CM for smoking abstinence (CO ≤4 ppm). A Bluetooth‐enabled EC monitored daily EC puffs. Abstinence rates were equivalent between EC (34.4%) and EC + CM (30.4%) conditions. Both conditions promoted smoking reductions. We observed an inverse correlation between smoking and EC puffs (r = ‐.62, p < .05). Results suggest the use of electronic cigarettes can promote smoking reductions and abstinence, and CM did not improve these outcomes. Larger magnitude consequences or tailoring EC characteristics (e.g., flavor) may have improved outcomes. Technology‐based methods to collect intensive, longitudinal measures of smoking and electronic cigarette use may be useful to characterize their environmental determinants.     

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Alcohol dependent smokers (N=118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-min counseling session with 5 min of follow-up. Intensive intervention consisted of three 1-hr counseling sessions plus 8 weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath carbon monoxide, was significantly higher for the intensive treatment group (27.5%) versus the rate for the brief treatment group (6.6%) at 1 month after the quit date but not at 6 months, when abstinence rates fell to 9.1% for the intensive treatment group and 2.1% for the brief treatment group. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short-term tobacco abstinence, other, perhaps more intensive, smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers.     

VOUCHER‐BASED CONTINGENT REINFORCEMENT OF SMOKING ABSTINENCE AMONG METHADONE‐MAINTAINED PATIENTS: A PILOT STUDY

This study evaluated the efficacy of a contingency management (CM) intervention to promote smoking cessation in methadone‐maintained patients. Twenty participants, randomized into contingent (n = 10) or noncontingent (n = 10) experimental conditions, completed the 14‐day study. Abstinence was determined using breath carbon monoxide and urine cotinine levels. Contingent participants received voucher‐based incentives for biochemical evidence of smoking abstinence. Noncontingent participants earned vouchers independent of smoking status. Contingent participants achieved significantly more smoking abstinence and longer durations of continuous smoking abstinence than did noncontingent participants. These results support the potential efficacy of using voucher‐based CM to promote smoking cessation among methadone‐maintained patients.