Cited by 100Smoking Behavior and CessationMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

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

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Bricker, J. B., Bush, T., Zbikowski, S. M., Mercer, L. D., Heffner, J. L.·2014·Nicotine & Tobacco Research

Abstract

OBJECTIVE: We conducted a pilot randomized trial of telephone-delivered acceptance and commitment therapy (ACT) versus cognitive behavioral therapy (CBT) for smoking cessation. METHOD: Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers (at least 10 cigarettes/day) and who wanted to quit within the next 30 days. Participants were randomized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy (NRT). RESULTS: ACT participants completed more calls than CBT participants (M = 3.25 in ACT vs. 2.23 in CBT; p = .001). Regarding satisfaction, 100% of ACT participants reported their treatment was useful for quitting smoking (vs. 87% for CBT; p = .03), and 97% of ACT participants would recommend their treatment to a friend (vs. 83% for CBT; p = .06). On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postrandomization, the quit rates were 31% in ACT versus 22% in CBT (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.7-3.4). Among participants depressed at baseline (n = 47), the quit rates were 33% in ACT versus 13% in CBT (OR = 1.2, 95% CI = 1.0-1.6). Consistent with ACT's theory, among participants scoring low on acceptance of cravings at baseline (n = 57), the quit rates were 37% in ACT versus 10% in CBT (OR = 5.3, 95% CI = 1.3-22.0). CONCLUSIONS: ACT is feasible to deliver by phone, is highly acceptable to quitline callers, and shows highly promising quit rates compared with standard CBT quitline counseling. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.

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  • Only three studies have compared ACT with CBT and have shown equivalent effectiveness in the short term.

    “Only three studies have compared ACT with CBT and these have shown equivalent effectiveness in the short-term [149,150,151].”

    From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [150]

    The Cessation Outcomes section confirms that this study compared ACT with CBT at six months and found no statistically significant difference in overall quit rates (31% versus 22%; p = .32). But the Quit Rates Overall section says the pilot comparison was underpowered, so it does not establish equivalent effectiveness. This paper also does not establish that only three studies made the comparison. (LLM, conf=0.88)

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  • In the long term, ACT was more successful than CBT in maintaining abstinence rates.

    “In the long-term, ACT was more successful than CBT in maintaining abstinence rates [150,151].”

    From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [150]

    The Cessation Outcomes section reports higher 30-day abstinence at six months with ACT than CBT (31% versus 22%), but the overall difference was not statistically significant (p = .32). The Limitations section says longer follow-up is needed, so the study does not establish that ACT is more successful at maintaining abstinence in the long term. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • 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 [54]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • ACT increases acceptance of physical cravings and appears to be generalized to other psychopathological problems.

    “ACT increases acceptance of physical cravings [150] and would appear to be generalized to other psychopathological problems [151].”
  • Of the five RCTs of ACT for smoking cessation that Lee et al. analyzed, three were conducted by Bricker et al., who have continued to publish in this area since that time.

    “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].”

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Research works printed but not linked: 2

  1. Bricker, J. B. (2011). Acceptance and Commitment Therapy: A promising approach to smoking cessation. In L. M. McCracken (Ed.), Mindfulness and acceptance in behavio- ral medicine: Current theory and practice (pp. 103-130).
  2. Herbert, J. D., & Forman, E. M. (Ed.). (2011). Acceptance and mindfulness in Cognitive Behavior Therapy. Hoboken, NJ: John Wiley & Sons.

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Authors
Bricker, J. B., Bush, T., Zbikowski, S. M., Mercer, L. D., & Heffner, J. L.
Affiliations
  • University of Washington (US)
  • Alere (United States) (US)
  • Fred Hutch Cancer Center (US)
Venue
Nicotine & Tobacco Research
Published
2014-06-16
Volume
16
Issue
11
Pages
1446-1454
ISSN
  • 1462-2203 (ISSN-L)
  • 1469-994X
OpenAlex
W2012980101
Cited by
100
References
43
Citations by year
2026: 4 · 2025: 8 · 2024: 5 · 2023: 12 · 2022: 13 · 2021: 10 · 2020: 8 · 2019: 9 · 2018: 6 · 2017: 8 · 2016: 8 · 2015: 4 · 2014: 4 · 2013: 1
FWCI
5.32
Type
journal article
Language
en
Open access
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 (R21DA030646, K23DA026517)
  • National Cancer Institute (R01CA151251, R01CA166646)
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, cognitive behavioral therapy, smoking cessation, quitlines, nicotine replacement therapy, depression, treatment acceptability, abstinence rates
MeSH terms
Adolescent, Adult, Feasibility Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Smoking, South Carolina, Telephone, Cognitive Behavioral Therapy, Smoking Cessation, Acceptance and Commitment Therapy

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