A Behavioral Activation App to Motivate Smokers to Quit: Feasibility and Pilot Trial (Preprint)

BACKGROUND Behavioral Activation (BA) is an evidence-based treatment for depression that fosters engagement in values based activities (VBA) 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 randomized to either 8 weeks of the BA app (n=27; set two VBAs per week + motivational messages + feedback on changes in smoking, mood and VBA progress) or control group (no app; received resources for quitting smoking & completed weekly online assessments n=29). RESULTS Results support feasibility (86% of those eligible were randomized), satisfaction (80% would recommend to others; moderate-high scores on the Mobile App Rating Scale; 88% rated the app ‘3 stars’ or higher), and high levels of engagement (26/27 planned VBAs, 18/27 planned 7 or more activities; 138 activities were completed), even among those who are at highest risk for continued smoking (low motivation to quit, low confidence to quit, high negative affect; p’s <.05). Greater pleasant activity completion tended to be associated 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 activities planned was associated with lower negative affect (b(SE) = -0.26 (0.15), 95%CI[-0.55, 0.04], p = .09). There were no significant group differences, but there were promising trends in the hypothesized direction, regarding number of cigarettes smoked and motivation and confidence to quit. Four BA participants (of 25) set a quit date vs. one (of 27) control group. CONCLUSIONS This study demonstrates the feasibility of an innovative ‘foot in the door’ approach to help unmotivated smokers to quit, who otherwise may not receive motivational messages to quit smoking.