Web-Based Acceptance and Commitment Therapy Smoking Cessation Treatment for Smokers With Depressive Symptoms

Abstract

Objective Smokers with depressive symptoms have more difficulty quitting smoking than the general population of smokers. The present study examines a web-based treatment using Acceptance and Commitment Therapy (ACT) for smokers with depressive symptoms. The study aimed to determine participant receptivity to the intervention and its effects on smoking cessation, acceptance of internal cues, and depressive symptoms. Methods Smokers who screened positive for depressive symptoms at baseline (n = 94) were selected from a randomized controlled trial (N = 222) comparing web-based ACT for smoking cessation (Webquit.org) with Smokefree.gov. Forty-five participants (48%) completed the three-month follow-up. Results Compared to Smokefree.gov, WebQuit participants spent significantly more time on site (p = 0.001) and had higher acceptance of physical cravings (p = 0.033). While not significant, WebQuit participants were more engaged and satisfied with their program and were more accepting of internal cues overall. There was preliminary evidence that WebQuit participants had higher quit rates (20% vs. 12%) and lower depressive symptoms at follow-up (45% vs. 56%) than those in Smokefree.gov. Conclusions This was the first study of web-based ACT for smoking cessation among smokers with depressive symptoms, with promising evidence of receptivity, efficacy, impact on a theory-based change process, and possible secondary effects on depression. A fully powered trial of the ACT Webquit.org intervention specifically for depressed smokers is needed. This was part of a clinical trial registered as NCT#01166334, at www.clinicaltrials.gov.

Acceptance and Commitment Therapy and nicotine patch for smokers with bipolar disorder: preliminary evaluation of in‐person and telephone‐delivered treatment

“…The results of the present pilot feasibility study suggest that: (i) it is feasible to recruit and retain smokers with stable bipolar disorder in a smoking cessation study; and (ii) ACT is highly acceptable to smokers with bipolar disorder, shows promising effects on smoking abstinence, and appears to impact its theory‐based mechanism of action for smoking cessation (i.e., acceptance). These findings are consistent with previous work demonstrating ACT's preliminary acceptability and efficacy in broader general population samples of smokers as well as among smokers with current depressive symptoms . The observed increase in acceptance is similar to our prior work, where a 50% increase in AIS scores from baseline to post‐treatment was associated with a 51% increase in the odds of quitting [odds ratios = 1.51, 95% confidence interval: 0.37–6.23; unpublished results from ].…”

Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis

“…All participants were self-selected. Of the participants, 2 RCTs were recruited from a clinical population (pain clinics) [ 49 , 50 ], 2 from an undergraduate student population [ 47 , 48 ] whereas the remainder were recruited from the general population [ 29 , 36 , 45 , 46 , 51 ]. Trials ranged in size from 38 to 236 participants.…”

“…Powers et al [ 24 ] reported a “clear effect and overall advantage of ACT compared to control conditions” but found no evidence to suggest it was more effective than established treatments. Others have also reported ACT to be effective across a range of conditions, including psychiatric disorders [ 25 ], chronic pain [ 26 - 28 ], tinnitus [ 29 ], multiple sclerosis [ 30 ], anxiety disorders [ 31 , 32 ], stress [ 33 - 35 ], and health behavior or lifestyle change together with smoking [ 36 - 39 ] and weight optimization [ 40 ]. Thus whilst there is some uncertainty of the effectiveness of ACT, it appears to be related more to establishing the evidence base rather than ACT being an ineffective intervention.…”

Efficacy of online lifestyle interventions targeting lifestyle behaviour change in depressed populations: A systematic review

“…The studies where the target behaviours were not changed were also unsuccessful in altering depressive symptoms (Geisner et al, 2015;Jones et al, 2015;Schaub et al, 2012). This may be because substance abuse and smoking cessation are more resistant to change in a depressed population (Jones et al, 2015;Schaub et al, 2012), or perhaps, more likely, the lack of change was due to deficits in elements of the intervention design and small sample sizes. In support of this, while no significant results were achieved, Jones et al (2015) reported positive trends in both depressive symptoms and smoking cessation in their analysis.…”

“…In most cases, the implementation techniques are driven by the theoretical framework the intervention is based on, as opposed to the target audience. Jones et al (2015) discussed the theoretical approach used in their intervention and how it might be beneficial for depressed populations in their analysis, but not specific intervention features. In addition, their study was a post hoc analysis of a depressed subset and not an intervention specifically designed for depressed populations.…”