Improving Smoking Cessation Quitlines: Pilot Study of Acceptance Therapy

描述（由申请人提供）：戒烟电话戒烟热线是美国烟草控制计划的一个组成部分。但是增加他们的成功是非常必要的。即使采用传统认知行为疗法与药物疗法（典型的尼古丁替代疗法；NRT）相结合的标准干预方法，使用戒烟疗法的吸烟者中，平均有86%的人会复吸（即14%的人保持戒烟）。没有新的、被证明有效的咨询方法来提高戒烟线的戒烟成功率。我们通过试点测试一种有前途的方法来解决这一关键需求，这种方法被称为接受与承诺疗法（ACT），作为一种电话传递的戒烟干预措施。我们最近完成了一项小型（n =14）单臂可行性研究，该研究在社区招募的参与者中证明，通过电话提供ACT戒烟是可行的，并且参与者接受干预。在治疗后12个月（93%的保留率），打算治疗的长期戒断率为29%。虽然结果很有希望，但没有对照组，样本量只有14人，参与者不是退出热线来电者，也没有提供NRT。为了建立在这些结果的基础上，现在需要进行一项随机对照试验，包括更大的样本量，从退出热线来电者中招募，并提供NRT，以便为全尺寸R01随机试验的设计提供信息。因此，本提案的目的是进行一项随机试验，比较电话提供的ACT咨询加NRT与电话提供的CBT咨询加NRT，以便：(1)证明ACT的实施结果至少与传统CBT的实施结果一样好；(2)证明ACT与CBT相比，具有更高的戒烟率和相关行为改变率的趋势；(3)证明ACT的戒烟结果，而不是传统的CBT，是由两种心理测量来调节的，这两种心理测量是ACT理论模型的核心：(a)接受吸烟的内部线索（感觉、情绪和思想）和(b)戒烟的承诺。关键的创新是戒烟热线咨询的新概念模式。该研究将这个新模型应用于戒烟这一非常重要的公共卫生问题，并在戒烟线这一广泛传播的背景下对该模型进行了测试。该研究提出了一个研究范式的转变，以增加戒烟咨询内容的创新。该建议显示出提高戒烟成功率、从而降低医疗费用和减少与烟草有关的过早死亡的令人兴奋的希望。

DESCRIPTION (provided by applicant): Smoking cessation telephone quitlines are an integral component in the US tobacco control program. But increasing their success is greatly needed. Even with quitlines' standard intervention of traditional Cognitive Behavioral Therapy combined with pharmacotherapy (typically nicotine replacement therapy; NRT), an average of 86% of smokers using quitlines will relapse to smoking (i.e., 14% stay quit). There are no new, proven-effective counseling approaches to improve the smoking cessation success rates of quitlines. We address this critical need by pilot testing a promising approach, called Acceptance & Commitment Therapy (ACT), as a telephone-delivered smoking cessation intervention. We recently completed a small (n =14) single- arm feasibility study of community-recruited participants which demonstrated that ACT for smoking cessation was feasibly-delivered by telephone and that participants were receptive to the intervention. At 12 months post- treatment (93% retention), the intent-to-treat prolonged abstinence rate was 29%. While results were promising, there was no control group, the sample size was only 14, participants were not quitline callers, and no NRT was provided. To build on these results, a pilot randomized controlled trial that includes a larger sample size, recruitment from quitline callers, and NRT provision is now needed to inform the design of a full- scale R01 randomized trial. Accordingly, the aims of this proposal are to conduct a pilot randomized trial comparing telephone-delivered ACT counseling plus NRT to telephone-delivered CBT counseling plus NRT, in order to: (1) Demonstrate that ACT's implementation outcomes are at least as good as those of traditional CBT; (2) Demonstrate that ACT, as compared to CBT, has a trend toward higher smoking cessation and related behavior change rates; (3) Demonstrate that the smoking cessation outcomes of ACT, but not traditional CBT, are mediated by two psychological measures that are central to the theoretical model underlying ACT: (a) acceptance of internal cues to smoke (sensations, emotions, and thoughts) and (b) commitment to quitting smoking. The key innovation is a new conceptual model for quitline counseling. The study applies this new model to the highly important public health problem of smoking cessation and tests the model in the widely disseminable context of a quitline. The study proposes a research paradigm shift toward increasing innovations in quitline counseling content. The proposal shows exciting promise for improving the success rates of quitlines and thereby lowering healthcare costs and reducing premature tobacco-related deaths. PUBLIC HEALTH RELEVANCE: This two-year R21 randomized trial will pilot test a newly emerging counseling approach, called Acceptance & Commitment Therapy (ACT), as a telephone-delivered smoking cessation intervention. If ACT is later proven effective in a full-scale trial and disseminated to 50% to 100% of US quitlines, it is possible that 31,000 to 61,000 more smokers could quit each year.