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Pilot Randomized Controlled Trial of Web-Based Acceptance and Commitment Therapy for Smoking Cessation
Open accessAbstract
OBJECTIVE: Web-based smoking cessation interventions have high reach, but low effectiveness. To address this problem, we conducted a pilot randomized controlled trial of the first web-based acceptance and commitment therapy (ACT) intervention for smoking cessation. The aims were to determine design feasibility, user receptivity, effect on 30-day point prevalence quit rate at 3 months post-randomization, and mediation by ACT theory-based processes of acceptance. METHODS: Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (N = 222), which compared web-based ACT for smoking cessation (WebQuit.org) with the National Cancer Institute's Smokefree.gov-the U.S. national standard for web-based smoking cessation interventions. RESULTS: We recruited 222 participants in 10 weeks. Participants spent significantly longer on the ACT WebQuit.org site per login (18.98 vs. 10.72 min; p = .001) and were more satisfied with the site (74% vs. 42%; p =.002). Using available follow-up data, more than double the fraction of participants in the ACT WebQuit.org arm had quit smoking at the 3-month follow-up (23% vs. 10%; OR = 3.05; 95% CI = 1.01-9.32; p = .050). Eighty percent of this effect was mediated by ACT theory-based increases in total acceptance of physical, cognitive, and emotional cues to smoke (p < .001). CONCLUSIONS: The trial design was feasible. Compared with Smokefree.gov, ACT had higher user receptivity and short-term cessation, and strong evidence of theory-based mechanisms of change. While results were promising, they were limited by the pilot design (e.g., limited follow-up), and thus a full-scale efficacy trial is now being conducted.
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In the citing paper
“For example, RCTs have found ACT to be effective in a web-based self-help format for depression (e.g., Lappalainen et al., 2014), smoking (e.g., Bricker et al., 2013) and chronic pain (e.g., Trompetter et al., 2015).”
From Web-Based Acceptance and Commitment Therapy for Mental Health Problems in College Students: A Randomized Controlled Trial (2017) · cites this paper as Bricker et al., 2013
In the citing paper
“In addition, there is growing evidence for the efficacy of web-based ACT interventions [6–11].”
From How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms (2016) · cites this paper as [7]
In the citing paper
“For mediators of change, the number of studies doing formal mediational analyses of psychological flexibility and mindfulness in web-based ACT interventions is small [7, 30].”
From How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms (2016) · cites this paper as [7]
In the citing paper
“Also, Bricker et al. [7] found that acceptance processes mediated the effects on smoking cessation through greater acceptance of physical urges, cognitions, and emotions.”
From How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms (2016) · cites this paper as [7]
In the citing paper
“Of the five RCTs of ACT for smoking cessation that Lee et al. [30] analyzed, three were conducted by Bricker et al. [35–37], who have continued to publish in this area since that time [38, 39].”
From A Randomized Feasibility/Acceptability Trial of Acceptance and Commitment Therapy for People with HIV Who Drink at Unhealthy Levels. (2026) · cites this paper as [35]
In the citing paper
“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 [53]
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Cited by
Sorted by citations
Internet-based interventions for smoking cessation
Taylor, G. M. J., Dalili, M. N., Semwal, M., Čivljak, M., Sheikh, A., & Car, J. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007078.pub5 · Cited by 676
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“ACT has been administered successfully in 1-day workshops [45], telehealth coaching calls [52, 55], online and smartphone interventions [53], and 20-min sessions integrated into primary care visits [51], demonstrating the feasibility, acceptability, and preliminary efficacy of brief ACT interventions.”
MethodAn initial meta-analysis of acceptance and commitment therapy for treating substance use disorders
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“Additionally, while not exclusive to ACT, novel delivery methods (e.g., telehealth, computer, and phone applications) of ACT are rapidly being explored and have shown promise (e.g., Bricker et al., 2014b).”
Influential
Metadata
- Authors
- Bricker, J., Wyszynski, C., Comstock, B., & Heffner, J. L.
- Affiliations
- University of Washington (US)
- Fred Hutch Cancer Center (US)
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-05-23
- Volume
- 15
- Issue
- 10
- Pages
- 1756-1764
- ISSN
- 1462-2203 (ISSN-L)
- 1469-994X
- PMC
- PMC3768336
- OpenAlex
- W2000457378
- Cited by
- 170
- References
- 49
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 3 · 2023: 8 · 2022: 14 · 2021: 11 · 2020: 13 · 2019: 12 · 2018: 18 · 2017: 20 · 2016: 16 · 2015: 28 · 2014: 16 · 2013: 2
- FWCI
- 14.39
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute on Drug Abuse (K23DA026517)
- National Cancer Institute (R01CA166646, P30CA015704)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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, online intervention, e-health, quit rates
- MeSH terms
- Double-Blind Method, Female, Humans, Male, Smoking Cessation, Internet
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