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Jonathan B. Bricker, PhD Fred Hutchinson Cancer Research Center University of Washington

First RCT of Web-Based Acceptance & Commitment Therapy For Smoking Cessation: 3 Month Processes & Outcomes. Jonathan B. Bricker, PhD Fred Hutchinson Cancer Research Center University of Washington. Reach & Efficacy of Smoking Intervention Modalities. 30% 20% 10%. Individual.

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Jonathan B. Bricker, PhD Fred Hutchinson Cancer Research Center University of Washington

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  1. First RCT of Web-Based Acceptance & Commitment Therapy For Smoking Cessation: 3 Month Processes & Outcomes Jonathan B. Bricker, PhD Fred Hutchinson Cancer Research Center University of Washington

  2. Reach & Efficacy of Smoking Intervention Modalities 30% 20% 10% Individual Efficacy(% Quit at 12 months) 1m 2m 3m 4m Reach(# of million using modality annually) Group Telephone Web

  3. Why do current interventions have low quit rates? Interventions don’t focus on basic processes that lead people to smoke and to relapse!

  4. 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 Quittingpredicted a 2.32 times higher odds (p <.01) of relapse 26 weeks after quit date (92% data retention; N = 157; Kahler et al., 2007)

  5. Acceptance & Commitment Therapy (ACT) is a Potential Solution to the Problem of Low Quit Rates

  6. What is ACT?

  7. Acceptance of our “baggage” Committed Action in valued direction

  8. 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

  9. 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

  10. Acceptance & Commitment Lead to Life-Embracing Behavior Change Mindfulness Values Commitment Acceptance Defusion Self as Context Action Life-Embracing Behavior Change

  11. Web-Delivered ACT for Smoking Cessation

  12. 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

  13. 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)

  14. Experimental Design

  15. 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)

  16. Aim 1 Results: Demographics at Baseline & Retention

  17. Aim 1 Results: Smoking & Social Env at Baseline & Retention

  18. Aim 2 Results: 3-Month Cessation Processes

  19. Aim 2 Results: Quit Rate

  20. Conclusions Aim 1: Feasible trial design. Aim 2: Process results comport with ACT theoretical model & show lower nicotine dependence than Smokefree.

  21. 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.

  22. ResearchStaff

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