First RCT of Web-Based Acceptance & Commitment Therapy For Smoking Cessation: 3 Month Processes &...
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Transcript of First RCT of Web-Based Acceptance & Commitment Therapy For Smoking Cessation: 3 Month Processes &...
First RCT of Web-Based Acceptance & Commitment Therapy For Smoking
Cessation: 3 Month Processes & Outcomes
Jonathan B. Bricker, PhDFred Hutchinson Cancer Research Center
University of Washington
Reach & Efficacy of Smoking Intervention Modalities
Reach(# of million using modality annually)
1m 2m 3m 4m
Efficacy(% Quit at
12 months)
30%
20%
10%
Individual
Web
Telephone
Group
Why do current interventions have low quit rates?
Interventions don’t focus on basic processes that lead people to smoke
and to relapse!
Basic Processes: Low Acceptance& Commitment
Low Acceptance at age 18 predicted a 2.75 times higher odds (p <.001) of smoking at age 20 (99% data retention; N = 3305; Bricker et al., 2011)
Low Commitment to Quitting predicted a 2.32 times higher odds (p <.01) of relapse 26 weeks after quit date (92% data retention; N = 157; Kahler et al., 2007)
Acceptance & Commitment Therapy (ACT) is a Potential
Solution to the Problem of Low Quit Rates
What is ACT?
Acceptance of our
“baggage”
Committed Action in valued
direction
Pathways to Acceptance
Mindfulness: Present-moment focused attention in the face of challenging circumstances
Defusion: Stepping back and watching the process of thinking
Self-as-Context: The “part” of us that is aware of what we think, feel, and sense
Pathways to Commitment
Values: What deeply matters; want you want your life to be about
Action: Doing what it takes, guided by what deeply matters
Acceptance & Commitment Lead to Life-Embracing Behavior
Change
Mindfulness
Defusion
Self as Context
Acceptance
Values
Commitment
Action
Life-Embracing Behavior Change
Web-Delivered ACT for Smoking Cessation
Phase II Trial of Web ACT vs. Current Standard for Smoking
Cessation (FHCRC Pilot Grant; PI: Bricker)
Aim 1: Show trial design feasibility: recruitment, study arm balance and retention
Aim 2: Assess ACT 3-month cessation process & outcomes compared with Smokefree
Comparison: Smokefree.gov
Current Standard: US Clinical Practice Guidelines and panel of experts
Most visited in US: 1.2 million annual visitors
Highest user satisfaction: Of all non-profit websites (Etter et al, 2006)
Benchmark 7-10% quit rate: consistent with other published website trials (Hutton et al., 2011)
Experimental Design
Aim 1 Results: Recruitment
Enrollment: 621 eligible, 302 consent, 222 randomized (94 per month)
Recruitment sources:
41%: Referring websites (e.g., Google Ads)
35%: Search engine results (e.g., “how to quit smoking”)
24%: Direct entry (e.g., media)
Aim 1 Results: Demographics at Baseline & Retention
BaselineCharacteristic
Smokefree.gov
(n=111)ACT
(n=111)
BaselineCompariso
np=value
3-monthRetention
Comparisonp=value
Age, mean (SD)
45.3 (13.1) 44.8 (13.6)
0.76 0.84
Male 35% 41% 0.36 0.15
Caucasian 90% 95% 0.20 0.32
Hispanic 3% 6% 0.20 0.53
Married 42% 45% 0.95 0.14
Working 60% 62% 0.78 0.67
HS or less educ
24% 19% 0.15 0.56
Aim 1 Results: Smoking & Social Env at Baseline & Retention
BaselineCharacteristic
Smokefree.gov
(n=111)ACT
(n=111)
BaselineCompariso
np=value
3-monthRetentionCompariso
np=value
Smoking Behavior
1st cig within 30 min of waking
82% 75% 0.25 0.58
Smokes more than
half pack per day
80% 76% 0.63 0.30
Smoked for 10 or more years
79% 81% 0.45 0.20
Quit attempts in past 12M, mean (SD)
1.4 (2.1) 1.5 (2.6) 0.61 0.36
Friend & Partner Smoking Close friends who smoke, mean (SD)
1.6 (1.6) 1.7 (1.5) 0.84 0.44
Living with partner
who smokes
26% 22% 0.53 0.33
Aim 2 Results: 3-Month Cessation Processes
ACT Smokefree p-value
Acceptance of physical cues, mean
2.38 1.81 0.001
Acceptance of emotional cues, mean
1.95 1.63 0.022
Acceptance of cognitive cues, mean
1.77 1.48 0.083
Number of quit attempts since randomization, mean
9.21 3.92 0.101
Nicotine dependence 18% 44% 0.036
Aim 2 Results: Quit Rate
3-Month Outcome ACT Smokefreep-
value
30-day quit rate 23% 10% 0.050
Conclusions
Aim 1: Feasible trial design.
Aim 2: Process results comport with ACT theoretical model & show lower nicotine dependence than Smokefree.
ACT’s 23% Quit Rate
Over double 10% Smokefree quit rate.
Over 2-3 times higher than typical website.
Rare evidence of tx website being more effective than comparison tx website.
Achieved without pharmacotherapy.
ResearchStaff