JMIR Publications

ABSTRACT

Background:

Behavioral Activation (BA) is an evidence-based treatment for depression that fosters engagement in values based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation.

Objective:

This study aims to provide feasibility and preliminary efficacy regarding a mobile app to motivate smokers to quit by using BA and by providing motivational messages to quit smoking, and resources if needed.

Methods:

Adult smokers (N=56, M age =34.5 years) who were not ready to quit smoking within 30 days were recruited from advertisements and a database from a professional recruitment company, and randomized to either 8 weeks of the BA app (set two values-based activities per week + motivational messages + feedback on changes in smoking, mood and values-based activities) or control group (no app; received resources for quitting smoking). All participants completed web-based baseline and end of treatment assessments. Controls were also emailed a link weekly assessments and BA participants answered assessments through the app.

Results:

There were no dropouts and only two people in each condition did not complete the end of treatment questionnaire. Results support feasibility (66 participants were eligible to participate and 57 participants (86%) were randomized; n=27 to BA and n=29 to control), satisfaction (20 out of 25 participants or 80% would recommend to others; moderate-high scores on the Mobile App Rating Scale; 22 out of 25 participants or 88% rated the app ‘3 stars’ or higher), and high levels of engagement (26 out of27 planned activities, 18 out of 27 planned 7 or more activities; 138 activities were completed), even among those who were at highest risk for continued smoking (low motivation to quit, low confidence to quit, high negative affect). Greater pleasant activity completion had a small association with greater positive affect (b(SE) = 0.37 (0.21), 95%CI[-0.05, 0.79], P=.08) and greater positive affect tended to predict fewer cigarettes smoked the next day (b(SE) = -0.19 (0.10), 95%CI[-0.39, 0.01], P=.06). A greater number of activities planned had a small association with lower negative affect (b(SE) = -0.26 (0.15), 95%CI[-0.55, 0.04], P=.09). There were no significant differences between the BA app group and controls, but there were promising trends in the hypothesized direction regarding number of cigarettes smoked and motivation and confidence to quit. Four BA app participants (of 25) set a quit date vs. one (of 27) in the control group.

Conclusions:

These findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects that are important to them, such as mood and stress management. This theory-based intervention has shown some initial support for the underlying theoretical constructs and further efficacy testing is warranted in a fully powered trial.