Can being accepting and mindful help you stop smoking?

Tobacco remains a public health priority. Dr. Jennifer McClure discusses her new findings comparing ’acceptance and commitment therapy’ to standard care.

Acceptance and commitment therapy encourages committing to actions consistent with your personal values.

Smoking may have been eclipsed in media headlines by the opioid crisis, but tobacco use remains the leading preventable cause of death and illness in the United States. An estimated 36.5 million Americans smoke, and tobacco use kills more than 480,000 people each year. Helping people successfully quit smoking continues to be an important public health priority.

But what’s the best approach to quitting? Most experts recommend using some kind of behavioral support, along with prescription medication that can help you cope with cravings and stress. A recent high-profile study found that using e-cigarettes may be a useful step toward quitting combustible tobacco (the kind you light with a match), but this advice remains controversial for many reasons and requires further research. Either way, smokers generally benefit from some kind of behavior-change therapy. The question is, which kind of therapy is best?

Standard behavioral treatment is ‘avoid, control, and distract’

CBT-based treatments are currently considered “best practice” and they are an effective strategy, particularly when combined with stop-smoking medications. However, CBT does not work for everyone. New treatments are needed. Ideally these new programs will be more effective than CBT, but at the very least, we hope to find treatments that are equally effective and can offer tobacco users more options to choose from. More options mean more people will try to quit smoking and, ultimately, more will succeed.

A new treatment option: Mindfulness-based acceptance and commitment

ACT uses a mindfulness-based approach to teach people to be more accepting of their unwanted thoughts and behavior. People are encouraged to commit to actions that are consistent with their personal values and to remain committed to these actions even in the presence of difficult cravings, thoughts, or emotions. In the context of smoking cessation, smokers are taught to observe, acknowledge, and accept their cravings to smoke, their emotions, and their thoughts — and to allow them to come and go without smoking. People are also encouraged to identify what they value about not smoking and to use this to motivate a value-based decision to quit. Although CBT and ACT both focus on smokers’ thoughts and behaviors, they are conceptually distinct.

The PATH trial compared the two approaches

We found that group-based CBT was more effective at the end of treatment (28% of ACT participants quit smoking vs. 44% of CBT participants). But after one year, there was no difference in abstinence rates (14% ACT vs. 18% CBT). The results were similar to another recent study we conducted, which compared an online ACT-based treatment to the National Cancer Institute’s CBT-based Smokefree.gov program. Both treatments in this study were similarly effective. Other researchers have also found mindfulness-based treatment programs to be similarly effective to CBT.

The take home message

In the meantime, anyone interested in quitting smoking can call the national tobacco quitline at 1–800-QUIT-NOW for help. Members of Kaiser Permanente Washington can also receive CBT-based counseling and stop smoking medications by calling 1–800–462–5327.

By Jennifer McClure, PhD, Senior Investigator and Director of Research, Faculty & Development, Kaiser Permanente Washington Health Research Institute

KP Washington Health Research Institute

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