Acceptance and commitment therapy for smoking cessation: A preliminary study of its effectiveness in comparison with cognitive behavioral therapy.

Abstract

This controlled preliminary trial determined the feasibility and initial effectiveness of a promising behavioral intervention for smoking: Acceptance and Commitment Therapy (ACT). In a quasi-experimental design, the ACT intervention condition used metaphors and experiential exercises focused on personal values to motivate quitting smoking and enhancing the willingness to experience internal cues to smoke (e.g., urges) and abstinence-related internal distress. The comparison condition was cognitive behavioral therapy (CBT)--the current standard in behavioral intervention for smoking cessation. Each treatment was delivered in seven weekly 90-min sessions in a group format to 81 (43 in ACT; 38 in CBT) adult smokers. Results show that the ACT treatment was as feasible as the CBT treatment. They also demonstrate promising evidence of ACT's effectiveness: 30.2% intent-to-treat biochemically-supported 30-day point prevalence at twelve month follow-up, compared with 13.2% in the CBT condition (odds ratio = 5.13; p = .02). Replication in a well-powered, randomized, controlled trial is now needed.

Randomized Trial of Telephone-Delivered Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Smoking Cessation: A Pilot Study

“…Second, the results comport with the ACT theoretical model of acceptance as it applies to smoking cessation, namely that acceptance of cravings is an underlying process of smoking cessation. Finally, the results are highly consistent with our first trial of telephone-delivered ACT (Bricker et al, 2010) and all three face-to-face studies of ACT for smoking cessation (Gifford et al, 2004(Gifford et al, , 2011Hernandez-Lopez et al, 2009). …”

“…While high for both arms, participant satisfaction in the ACT arm was generally higher than that of the CBT arm. The high level of satisfaction for ACT is very similar to that reported in our first ACT telephone study (Bricker et al, 2010) and all three face-to-face studies of ACT for smoking cessation (Gifford et al, 2004(Gifford et al, , 2011Hernandez-Lopez et al, 2009). This is an important finding because ACT asks smokers to do something counterintuitive-namely, to accept their cravings.…”

“…The 31% observed quit rate for ACT was similar to the 29% we obtained in our first trial of telephone-delivered ACT (Bricker et al, 2010) and the 30%-35% quit rates observed in all three face-to-face trials of ACT for smoking cessation (Gifford et al, 2004(Gifford et al, , 2011Hernandez-Lopez et al, 2009). While each study had different designs and their own set of methodological limitations, the similarity of ACT quit rates across studies is noteworthy.…”

“…Promising evidence from three studies, albeit with methodological limitations (e.g., nonbehavioral comparison group, small Ns), suggests that face-to-face ACT for smoking cessation has 30%-35% quit rates at 12 months follow-up (Gifford et al, 2004(Gifford et al, , 2011Hernandez-Lopez et al, 2009). For example, in a randomized trial of 302 smokers, Gifford and colleagues (2011) compared individual plus group therapy ACT with bupropion to bupropion only.…”

“…In intent-to-treat 12-month follow-up analysis, the ACT intervention arm had a quit rate of 32% versus 18% in the comparison arm (p < .05). We compared group therapy ACT to CBT (both with no pharmacotherapy) for adult smoking cessation in a small (N = 81) nonrandomized trial (Hernandez-Lopez et al, 2009). The intent-to-treat 12-month 30-day point prevalence quit rate was 30% in the ACT group versus 13% in the CBT group (odds ratio [OR] = 2.86; p = .05).…”