Full-scale Randomized Trial Comparing Acceptance and Commitment Therapy (ACT) Telephone-delivered Co

Bricker JB, Sullivan BM, Mull KE, Torres AJ, Carpenter KM.
Full-scale Randomized Trial Comparing Acceptance and Commitment Therapy (ACT) Telephone-delivered Coaching with Standard Telephone-delivered Coaching among Medicare/uninsured Quitline Callers.
Nicotine Tob Res. 2022 Feb 23:ntac052. doi: 10.1093/ntr/ntac052. Epub ahead of print. PMID: 35196381.

Introduction. The aim of this study was to compare Acceptance and Commitment Therapy (ACT) telephone-delivered coaching with standard quitline (QL) telephone-delivered coaching.

Methods. Medicare/uninsured adults (analyzable sample N = 1170) who smoked at least 10 cigarettes per day were recruited from Optum®, a major US provider of quitline services, in a two-arm stratified double-blind randomized trial with main outcome of self-reported missing=smoking 30-day point prevalence abstinence (PPA) at the 12-month follow-up. Participants were mean (SD) age 47.4 (12.7), 61% female, and 72% white race. Five-sessions of telephone-delivered ACT or QL interventions were offered. Both arms included combined nicotine patch (4 weeks) and gum or lozenge (2 weeks).

Results. The 12-month follow-up data retention rate was 67.8%. ACT participants reported their treatment was more useful for quitting smoking (92.0% for ACT vs. 82.3% for QL; OR = 2.48; 95% CI: 1.53, 4.00). Both arms had similar 12-month cessation outcomes (missing=smoking 30-day PPA: 24.6% for ACT vs. 28.8% for QL; OR = .81; 95% CI: .62, 1.05) and the ACT arm trended toward greater reductions in number cigarettes smoked per day (-5.6 for ACT vs. -1.7 QL, among smokers; p = .075).

Conclusions. ACT telephone-delivered coaching was more satisfying, engaging, and was as effective as standard quitline telephone-delivered coaching. ACT may help those who fail to quit after standard coaching or who choose not to use nicotine replacement therapy.

Implications. In a sample of Medicare and uninsured quitline callers, a large randomized trial with long term follow-up showed that Acceptance and Commitment Therapy (ACT) telephone-delivered coaching was more satisfying, engaging, and was as effective as standard quitline telephone-delivered coaching-which has followed the same behaviour change approach since the 1990s. This newer model of coaching might be a welcome addition to quitline services.