Smoking kills. We all know it.
The last 50 years have seen an explosion of anti-smoking campaigns as public health officials realize that smoking is a chief cause of cancer, cardiovascular illness and a host of other diseases.
To some extent these campaigns have worked: We are seeing a dramatic reduction in smoking among younger generations. In 2013 the smoking rate among young people (about 19 percent)1 was nearly 25 percent lower than in 20051 and approaching 50 percent lower than in 1995.2 That is great progress, but frankly it isn't enough. Smoking remains the No. 1 cause of preventable disease and death in the United States; 42 million adults in this country are smokers 1 and tobacco use accounts for 1 out of every 5 deaths in the nation. 3
The biggest problem that anti-smoking advocates face is that quitting.
But now there is a new way forward.
An innovative researcher at Fred Hutchinson Cancer Research Center has been testing a set of technologically based forms of an acceptance and mindfulness-based therapy. The studies he's done to date are so exciting that he is a candidate for Geekwire's Geek of the Year Award.
This man happens to be a good friend and colleague of mine. His name is Jonathan Bricker. He is bravely challenging the very foundation of existing smoking-cessation programs and getting dramatically better results while doing it.
A Revolutionary Approach to Smoking Cessation
I first met Jonathan at an Acceptance and Commitment Therapy (ACT) workshop I was giving back in 2004. Elizabeth Gifford had just published an exciting new trial on ACT for smoking 3 and Jonathan saw the enormous possibilities. He was interested in part because it was such a radically different approach to virtually every other program out there.
Most smoking cessation programs -- including the popular government-funded, Internet-based smokefree.gov -- provide motivational counseling to help people quit and encourage them to avoid situations that trigger cravings. When urges do strike, smokers are typically advised to distract themselves from these urges.
If you have followed my work, you know that these kinds of techniques can be inert or even counterproductive. Sometimes they only intensify the thought, feeling or urge. For more details about why, you can check out my other blogs.
Jonathan became interested in applying the psychological flexibility concepts of acceptance, defusion, and values-based living that are inside ACT using more technologically advanced methods of smoking cessation. He saw immediately that if smokers could be taught to accept their urges, mindfully get some psychological distance from them, and to focus instead on their values, a real step forward in public health was possible. But doing this one at a time or even in small groups (as had been done in the Gifford trial) was way too cumbersome and hard to disseminate.
Jonathan is a geek. He thought there was a leap forward that could happen from ACT-based apps, websites, and telephone-based smoking cessation programs.
Jonathan fought against the skeptics who raised their eyebrows. His first break came when Dr. Ross Prentice at Hutch's Public Health Sciences Division took a chance on Bricker's ideas and awarded him a small grant to conduct a pilot study.
The study was a success and not long after Jonathan won a grant from NIH for $3.2 million to create a website to provide ACT-based intervention to smokers. He has since landed several additional major grants to build out the work.
To date, there are seven randomized controlled trials of ACT for smoking with nearly 1000 participants. 3-10 Jonathan is senior author on all of them that are using technologically-based interventions. ACT has been compared to pharmacotherapy, traditional cognitive-behavioral therapy, and the main US government-created phone lines, websites, and apps including smokefree.gov, and QuitGuide. The existing methods had an average quit rate of 14% at the end of follow up, but across those six studies ACT was over twice as effective (odds ratio of 2.2; p <.001). And="" because="" it="" is="" technology="" based="" now="" thanks="" to="" Jonathan,="" ACT="" ready="" be="" deployed="" help="" thousands="" upon="" of="" smokers="" at="" a="" low="" cost.="">
Enormous funded trials are now underway with literally thousands of participants but if these exciting early results continue to hold it will mean that some people will see their grandchildren grow up who otherwise would not; some people will see sunsets that otherwise they would never see; some people will know the love of their partner who otherwise would have passed.
How cool is that?
I just voted for Jonathan for his geek work on smoking. I sincerely hope he will become and believe he deserves to be the Geek of the Year.
To learn more about Bricker's work on smoking cessation using ACT, check out his Tedx Talk.
1 Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults--United States, 2005-2013. Morbidity and Mortality Weekly Report 2014;63(47):1108-12 [accessed 2015 Jan 22].
2 Centers for Disease Control and Prevention. Trends in Current Cigarette Smoking among High School Students and Adults, 1965 - 2011. [accessed 2015 April 25].
3 U.S. Department of Health and Human Services. The Health Consequences of Smoking--50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Jan 22].
4 Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Applying a functional acceptance based model to smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-705. doi: 10.1016/S0005-7894(04)80015-7
5 Bricker, Jonathan B., et al. "Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy." Drug and alcohol dependence 143 (2014): 87-94.
6 Bricker, Jonathan B., et al. "Randomized trial of telephone-delivered acceptance and commitment therapy versus cognitive behavioral therapy for smoking cessation: a pilot study." Nicotine & Tobacco Research (2014): ntu102.
7 Bricker, Jonathan, et al. "Pilot randomized controlled trial of web-based acceptance and commitment therapy for smoking cessation." Nicotine & Tobacco Research (2013): ntt056.
8 Bricker, Jonathan B., et al. "Telephone-delivered acceptance and commitment therapy for adult smoking cessation: A feasibility study." Nicotine & Tobacco Research 12.4 (2010): 454-458.
9 Hernández-López, Mónica, et al. "Acceptance and commitment therapy for smoking cessation: a preliminary study of its effectiveness in comparison with cognitive behavioral therapy." Psychology of Addictive Behaviors 23.4 (2009): 723.
10 Gifford, Elizabeth V., et al. "Does acceptance and relationship focused behavior therapy contribute to bupropion outcomes? A randomized controlled trial of functional analytic psychotherapy and acceptance and commitment therapy for smoking cessation." Behavior Therapy 42.4 (2011): 700-715.
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