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.
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Work by Bricker et al. has demonstrated that ACT interventions in various delivery formats (face-to-face, online, smartphone app, telephone) have led to greater smoking cessation rates than gold-standard cognitive behavioral therapy comparison interventions.
“Work by Bricker et al. [53 -56] has demonstrated that ACT interventions in various delivery formats (face-to-face, online, smartphone app, telephone) have led to greater smoking cessation rates than gold-standard cognitive behavioral therapy comparison interventions.”
From Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. (2017) · cites this paper as [56]
The long-term abstinence rates achieved in this study are similar to those reported in previous controlled trials on the effectiveness of behavioral cessation programs.
“The long-term abstinence rates achieved are similar to those also reported in previous controlled trials on the effectiveness of behavioral cessation programs (e.g., Hernandez-Lopez et al., 2009; Wittchen et al., 2011).”
From Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial (2024) · cites this paper as Hernandez-Lopez et al., 2009
In smoking cessation treatment, the effectiveness of ACT as compared to other interventions (e.g., nicotine replacement treatment, functional analytic psychotherapy, and cognitive behavioral therapy) has been demonstrated in a series of RCTs.
“In smoking cessation treatment, the effectiveness of ACT as compared to other interventions (e.g., nicotine replacement treatment, functional analytic psychotherapy, and cognitive behavioral therapy) has been demonstrated in a series of RCTs (e.g., Gifford et al., 2004, 2011; Hernández-López et al., 2009; Bricker et al., 2014, 2017).”
From Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach (2018) · cites this paper as Hernández-López et al., 2009
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“Acceptance and Commitment Therapy (ACT), which includes an emphasis on tolerance and “defusion” of aversive states has also has shown preliminary efficacy for smoking cessation (Gifford et al., 2004; Hernandez-Lopez et al., 2009).”
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“…effectiveness of ACT as compared to other interventions (e.g., nicotine replacement treatment, functional analytic psychotherapy, and cognitive behavioral therapy) has been demonstrated in a series of RCTs (e.g., Gifford et al., 2004, 2011; Hernández-López et al., 2009; Bricker et al., 2014, 2017).”
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“For instance, Hofmann and Asmundson (2008) used Gross’s (2001) theory of emotion regulation in an attempt to explain the differences between characteristic CT and ACT interventions.”
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“P A A uthor M anuscript promising results for smoking cessation (Bricker et al., 2010; Brown et al., 2008, 2011, 2013; Gifford et al., 2004; Hernandez-Lopez et al., 2009), very limited research has examined the use of ACT for the treatment of other substance use disorders such as opioid dependence…”
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Self-citationEffects of Acceptance and Commitment Therapy on Impulsive Decision-Making
Morrison, K. L., Smith, B. M., Ong, C. W., Lee, E. B., Friedel, J. E., Odum, A. L., Madden, G. J., Ledermann, T., Rung, J. M., & Twohig, M. P. (2019) · Behavior Modification · doi:10.1177/0145445519833041 · Cited by 32 · see citing works
A randomized controlled trial of distress tolerance treatment for smoking cessation.
Brown, R. A., Reed, K. M. P., Bloom, E. L., Minami, H., Strong, D. R., Lejuez, C. W., Zvolensky, M. J., & Hayes, S. C. (2018) · Psychology of Addictive Behaviors · doi:10.1037/adb0000372 · Cited by 32 · see citing works
“Gifford and colleagues excluded smokers with psychiatric and/or substance use comorbidities (Gifford et al., 2004, 2011), whereas other studies of ACT-based treatments for smoking cessation did not (Bricker et al., 2010, 2013, 2014; Hernández-López et al., 2009).”
InfluentialKarekla, M., Constantinou, P., Ioannou, M., Gloster, A. T., & Kareklas, I. (2019) · Clinical Psychology in Europe · doi:10.32872/cpe.v1i3.33058 · Cited by 29 · see citing works
Buckner, J. D., Farris, S. G., Zvolensky, M. J., Shah, S. M., Leventhal, A. M., Minnix, J. A., & Schmidt, N. B. (2014) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2014.927472 · Cited by 29 · see citing works
Bonn‐Miller, M. O., Vujanovic, A. A., Twohig, M. P., Medina, J. L., & Huggins, J. L. (2010) · Mindfulness · doi:10.1007/s12671-010-0013-6 · Cited by 29 · see citing works
“This pattern of findings is broadly consistent with prior work highlighting lower levels of acceptance among those with posttraumatic stress (Vujanovic et al. 2009; Walser and Westrup 2007), as well as literature identifying mindfulnessbased interventions as helpful in the treatment of substance use disorders, broadly…”
BackgroundResultKarekla, M., & Savvides, S. N. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz128 · Cited by 25 · see citing works
Hopkins, P. D., Spears, C. A., Hoover, D. S., Li, L., Cambron, C., Potter, L. N., Cinciripini, P. M., Lam, C. Y., & Wetter, D. W. (2021) · Psychology of Addictive Behaviors · doi:10.1037/adb0000734 · Cited by 25 · see citing works
Effects of Experimental Negative Affect Manipulations on Ad Lib Smoking: A Meta-Analysis
Heckman, B., Carpenter, M. J., Correa, J. B., Wray, J., Saladin, M., Froeliger, B., Drobes, D., & Brandon, T. (2015) · Addiction · doi:10.1111/add.12866 · Cited by 23 · see citing works
Minami, H., Bloom, E., Reed, K. M. P., Hayes, S., & Brown, R. A. (2014) · Psychology of Addictive Behaviors · doi:10.1037/adb0000030 · Cited by 23 · see citing works
Responding to tobacco craving: Experimental test of acceptance versus suppression.
Litvin, E. B., Kovacs, M. A., Hayes, P. L., & Brandon, T. H. (2012) · Psychology of Addictive Behaviors · doi:10.1037/a0030351 · Cited by 23 · see citing works
Mak, Y. W., Leung, D. Y. P., & Loke, A. Y. (2020) · BMC Public Health · doi:10.1186/s12889-020-09820-0 · Cited by 24 · see citing works
Mak, Y. W., & Loke, A. Y. (2015) · BMC Public Health · doi:10.1186/s12889-015-1485-z · Cited by 22 · see citing works
“As there has been no study that included a brief ACT for smoking cessation in HK, the sample size estimation was taken reference from available ACT studies for smoking cessation [17-20].”
BackgroundMethodKrotter, A., Diego, G. A., Menéndez, A. G., González‐Roz, A., Secades‐Villa, R., & Pérez, Á. G. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100773 · Cited by 25 · see citing works
The impact of smoking on radical cystectomy complications increases in elderly patients
Haeuser, L., Marchese, M., Schrag, D., Trinh, Q., Chang, S. L., Kibel, A. S., Gore, J. L., Noldus, J., & Mossanen, M. (2020) · Cancer · doi:10.1002/cncr.33308 · Cited by 18 · see citing works
Mujcic, A., Blankers, M., Boon, B. J. F., Engels, R. C. M. E., & van Laar, M. (2018) · BMC Cancer · doi:10.1186/s12885-018-4206-z · Cited by 18 · see citing works
“Unlike traditional CBT, ACT does not teach methods to avoid or control these triggers, but it focuses on changing one’s relationship with them by allowing them to be present without acting on them [42, 49, 54].”
BackgroundLuciano, C., Páez-Blarrina, M., & Valdivia‐Salas, S. (2010) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 17 · see citing works
Mantler, T., Irwin, J. D., & Morrow, D. (2012) · Psychological Reports · doi:10.2466/02.06.13.18.pr0.110.2.445-460 · Cited by 16 · see citing works
Buckner, J. D., Farris, S. G., Schmidt, N. B., & Zvolensky, M. J. (2014) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntt285 · Cited by 16 · see citing works
Brown, R. A., Bloom, E. L., Hecht, J., Moitra, E., Herman, D. S., & Stein, M. D. (2014) · Behavior Modification · doi:10.1177/0145445514538279 · Cited by 16 · see citing works
Bloom, E., Wing, R.-N. R., Kahler, C., Thompson, J. K., Meltzer, S., Hecht, J., Minami, H., Price, L., & Brown, R. A. (2016) · Behavior Modification · doi:10.1177/0145445516683500 · Cited by 12 · see citing works
Kwon, D. M., Santiago-Torres, M., Mull, K. E., Sullivan, B. M., Zvolensky, M. J., & Bricker, J. B. (2022) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2022.101952 · Cited by 16 · see citing works
Self-citationOlinder, A. L., Fischier, J., Fries, J., Alfonsson, S., Elvingson, V., Eriksson, J. W., & Leksell, J. K. (2015) · BMC Nursing · doi:10.1186/s12912-015-0101-y · Cited by 15 · see citing works
“Previous studies have reported good preliminary results for ACT in numerous behavioural medicine areas [13, 28–30].”
ResultSmith, B. P., Coe, E., & Meyer, E. C. (2021) · Clinical Case Studies · doi:10.1177/1534650120963183 · Cited by 15 · see citing works
“Recent meta-analyses demonstrate the effectiveness of ACT in reducing symptoms of depression (Bai et al., 2020), as well as substance use disorders (Lee et al., 2015) and smoking cessation (Hernández-López et al., 2009).”
Testing the relationship between health values consistent living and health-related behavior
Stapleton, A., O’Connor, M., Feerick, E., Kerr, J., & McHugh, L. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.05.002 · Cited by 14 · see citing works
Bricker, J. B., Sullivan, B. M., Mull, K. E., Torres, A. J., & Carpenter, K. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac052 · Cited by 13 · see citing works
Self-citationSingh, S., Starkey, N. J., & Sargisson, R. J. (2017) · DIGITAL HEALTH · doi:10.1177/2055207617729535 · Cited by 12 · see citing works
“Participants in an ACT condition experienced similar treatment effects but a five times higher abstinence rate compared to participants in a CBT condition, who experienced higher relapse rates.(14) ACT smoking cessation treatment also produces better long-term outcomes compared to Nicotine Replacement Therapy.”
BackgroundMethodResultInfluentialHeffner, J. L., Kelly, M. M., Reilly, E. D., Reece, S. G., Claudio, T., Serfozo, E., Baker, K. K., Watson, N. L., & Karekla, M. (2023) · JMIR Formative Research · doi:10.2196/44503 · Cited by 11 · see citing works
Can Acceptance & Commitment Therapy be delivered with fidelity as a brief telephone-intervention?
Schimmel‐Bristow, A., Bricker, J. B., & Comstock, B. A. (2011) · Addictive Behaviors · doi:10.1016/j.addbeh.2011.11.015 · Cited by 11 · see citing works
“The ‘ACT Now’ telephone-delivered intervention, adapted from prior ACT for smoking cessation protocols (Gifford et al., 2004; Hernández-López et al., 2009) provided up to five scheduled counseling sessions (average of 30 min for the first call and average of 15 min for all following calls) with a…”
InfluentialSelf-citationKelly, M. M., Latta, R. E., & Gimmestad, K. D. (2012) · Journal of Dual Diagnosis · doi:10.1080/15504263.2012.670846 · Cited by 11 · see citing works
“The results of this study showed significantly better long-term (12 month) outcomes for Acceptance and Commitment Therapy versus cognitive behavioral therapy for tobacco cessation (Hernández-López et al., 2009).”
BackgroundThe role of negative affect management in postpartum relapse to smoking
Psaros, C., Pajolek, H., & Park, E. R. (2011) · Archives of Women s Mental Health · doi:10.1007/s00737-011-0250-2 · Cited by 10 · see citing works
“make health-related behavior change, including smoking (Hernandez-Lopez et al. 2009).”
Farris, S. G., DiBello, A. M., Heggeness, L. F., Reitzel, L. R., Vidrine, D. J., Schmidt, N. B., & Zvolensky, M. J. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.12.003 · Cited by 10 · see citing works
Hooper, N., Dack, C., Karekla, M., Niyazi, A., & McHugh, L. (2018) · Addiction Research & Theory · doi:10.1080/16066359.2018.1434156 · Cited by 12 · see citing works
“Hernandez-Lopez et al. (2009) later extended this study with the inclusion of a Cognitive Behavior Therapy (CBT) comparison.”
BackgroundResultImpact of Acceptance-Based Nursing Intervention on Postsurgical Recovery: Preliminary Findings
Fernández, M. D., Luciano, C., & Valdivia‐Salas, S. (2012) · The Spanish Journal of Psychology · doi:10.5209/rev_sjop.2012.v15.n3.39421 · Cited by 9 · see citing works
Mindfulness and smoking frequency: An investigation with Australian students
Chan, E. Y. (2021) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2021.100342 · Cited by 8 · see citing works
Rostami, M., Moheban, F., Davoudi, M., Heshmati, K., & Taheri, A. A. (2022) · Addiction and Health · doi:10.34172/ahj.2022.1225 · Cited by 8 · see citing works
“31,37 Exposure would increase the probability of withdrawal.”
BackgroundBatra, A., Eck, S., Riegel, B., Friedrich, S., Fuhr, K., Torchalla, I., & Tönnies, S. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1330362 · Cited by 6 · see citing works
Behaviour counselling and psychosocial interventions. The role of patient involvement
Martínez, C., Schoretsaniti, S., Bobak, A., & Fletcher, M. J. (2021) · European Respiratory Society eBooks · doi:10.1183/2312508x.10013220 · Cited by 6 · see citing works
The acute effect of mindfulness-based regulation on neural indices of cue-induced craving in smokers
Zheng, M., Hong, T., Zhou, H., Garland, E. L., & Hu, Y. (2024) · Addictive Behaviors · doi:10.1016/j.addbeh.2024.108134 · Cited by 6 · see citing works
Examining replicability in addictions research: How to assess and ways forward.
Pearson, M. R., Schwebel, F. J., Richards, D. K., & Witkiewitz, K. A. (2021) · Psychology of Addictive Behaviors · doi:10.1037/adb0000730 · Cited by 6 · see citing works
Behavior and Substance Addictions in Children
Belisle, J., & Dixon, M. R. (2020) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2020.02.013 · Cited by 5 · see citing works
Addressing Smoking in Musculoskeletal Specialty Care
Thayer, L. S., Tiffany, E. M., & Carreira, D. S. (2021) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.21.00108 · Cited by 4 · see citing works
Sigarayı Bırakma Tedavisinde Bilişsel Davranışçı Terapinin Etkililiği: Sistematik Bir Gözden Geçirme
ÇELİK, Z. H., & Sevi, O. M. (2019) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.534638 · Cited by 4 · see citing works
Blarrina, M. B. P., & Montesinos, F. (2019) · Análisis y Modificación de Conducta · doi:10.33776/amc.v45i171-2.3682 · Cited by 4 · see citing works
Self-citationNot Just a Pill: Toward a Tailored Antismoking Intervention for Respiratory Diseases
Masiero, M. A., Renzi, C., Mazzocco, K., & Pravettoni, G. (2019) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000276 · Cited by 4 · see citing works
Farris, S. G., Zvolensky, M. J., Robles, Z., & Schmidt, N. B. (2014) · Psychology Health & Medicine · doi:10.1080/13548506.2014.963129 · Cited by 4 · see citing works
Flexibilidad psicológica y autoabandono del tabaco
Roales-Nieto, J. G., Moreno, E., García, R. C., Romero, B. M., López, F. R. J., Luciano, A. G., Arranz, A. S., Lao, I. F., Gámez, G. G., & Hernández-López, M. (2016) · Dialnet (Universidad de la Rioja) · Cited by 4 · see citing works
Self-citationKent, W., Hulbert-Williams, N., & Hochard, K. D. (2020) · Health Psychology Report · doi:10.5114/hpr.2020.100787 · Cited by 3 · see citing works
“…for psychopathology (Powers et al., 2009; Ruiz, 2010), interventions for health behaviour change (Forman et al., 2009; Hef-fner et al., 2003; Hernández-López et al., 2009; Lil-lis et al., 2009) and, specific to this review, for stress in the workplace setting (Dahl et al., 2004; Flaxman &…”
BackgroundKabul ve Kararlılık Terapisiyle Sigara Bırakma: Olgu Sunumu
Bal, U., Çakmak, S., Yılmaz, E., Tamam, L., & Karaytuğ, M. O. (2015) · Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi) · doi:10.17826/cutf.46727 · Cited by 3 · see citing works
- Authors
- Hernández-López, M., Luciano, M. C., Bricker, J. B., Roales-Nieto, J. G., & Montesinos, F.
- Affiliations
- University of Almería (ES)
- Fred Hutch Cancer Center (US)
- Asociación Española Contra el Cáncer (ES)
- Venue
- Psychology of Addictive Behaviors
- Published
- 2009
- Volume
- 23
- Issue
- 4
- Pages
- 723-730
- ISSN
- 0893-164X (ISSN-L)
- 1939-1501
- OpenAlex
- W1965322486
- Cited by
- 137
- References
- 39
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 7 · 2020: 13 · 2019: 8 · 2018: 9 · 2017: 6 · 2016: 7 · 2015: 12 · 2014: 22 · 2013: 11 · 2012: 8
- FWCI
- 4.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychology of Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Junta de Andalucia
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- acceptance and commitment therapy, smoking cessation, cognitive behavioral therapy, group intervention, smoking urges, personal values, treatment feasibility, abstinence, nicotine dependence
- MeSH terms
- Adult, Aged, Behavior Therapy, Female, Humans, Male, Middle Aged, Motivation, Pilot Projects, Surveys and Questionnaires, Regression Analysis, Chi-Square Distribution, Odds Ratio, Smoking Cessation, Treatment Outcome, Patient Selection
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