Smiling Instead of Smoking

SiS, “Smiling Instead of Smoking,” is an app that engages you in daily positive psychology exercises over the course of 7 weeks, and assigns “behavioral challenges” every 2-4 days to coach you through the steps towards smoking cessation. This is an app designed by scientists based on existing evidence and clinical guidelines regarding smoking cessation. The effectiveness of this app will be tested, as funded by a grant from the American Cancer Society. The key innovation of this app is its use of positive psychology, which is a promising new approach to smoking cessation. The happiness exercises used in this app have been fully vetted, and the app provides scientific facts and insights along the way (i.e., “Owl Wisdoms”).  Our goal is to inform and empower, while engaging you in daily practices that enhance and/or maintain your happiness, while you undertake the challenge of quitting smoking.


Click here to download the app

FAQs

HOW WELL DOES IT WORK?

The app you are downloading is Version 3 of this app. It builds on the feedback received from participants in Studies 1 and 2 of this apps, who found the app easy to use and useful, and whose confidence to quit smoking increased, and urge to smoke decreased (click here for results of Study 1). In Study 1, 30% of study participants were biochemically confirmed to be abstinent from smoking 2 weeks after their chosen quit day, and 6 months after the chosen quit day, 55% of study participants reported having been abstinent from smoking for the past 30 days. Stay tuned for the outcomes of Study 2, which are currently under review for publication. 

BY USING THIS APP, YOU SUPPORT SCIENCE

Over the next year, we will gather data and feedback on Version 3 of the app. Based on this information, we will further improve and streamline this app. By using this app, you are providing valuable data to us. As you use the app, and if you permit it, we will log how you use the app (e.g., percent of days on which you completed a happiness exercise, number of behavioral challenges you completed) to give us an idea of how well this app works. You could also simply email us and share your thoughts and feedback – we would love to hear from you! To provide feedback, simply email the study team (sis@mgh.harvard.edu) or the principal investigator for this app directly, Dr. Bettina Hoeppner (bhoeppner@mgh.harvard.edu).

WHY USE A POSITIVE PSYCHOLOGY APPROACH?

Mood plays a pivotal role in smoking, and mood-focused smoking cessation treatments have been developed and found to be effective in randomized controlled trials.2-8 Typically, however, mood-focused interventions have focused on smokers with depression or depressive symptoms and have largely targeted negative affect.  Positive affect (i.e., happiness) is psychometrically distinct from negative affect,9 with different neural underpinnings,10 and differing psychosocial correlates.9 It also plays an important role in smoking cessation.  Reductions in positive affect have been linked to increased temptation to smoke,11 and data from laboratory cue presentations indicate that exposure to positive affect cues reduces craving in both daily and non-daily smokers.12  During smoking cessation, positive affect has been shown to decrease in the weeks leading up to the quit day,13 which is problematic, as decreases in positive affect on the quit day are associated with a greater risk for smoking relapse.14,15  Thus, an intervention that enhances happiness should have a positive effect on smoking cessation – and indeed, a recent study suggests that it can do so successfully. 16  

CAN SIMPLE, BRIEF EXERCISES ACTUALLY ENHANCE HAPPINESS?

Enhancing positive affect with brief, self-administered exercises is entirely feasible.  While positive affect interventions to improve smoking cessation outcomes are largely absent from the smoking cessation literature, an entire sub-discipline of psychology, coined positive psychology,17 is dedicated to understanding and enhancing the frequency and intensity of positive affect states.  This research has led to the creation of positive psychology exercises that are designed to enhance positive states.  A recent meta-analysis, spanning 51 positive psychology interventions and a total sample size of 4,266 participants, found that these positive psychology exercises have consistently led to improvements in overall well-being and reductions in depression.18 

Of note is the fact that these effects were achieved with very brief, self-administered positive activities rather than clinician-administered treatments.18 That means that such exercises could conceivably be delivered via smartphone app.  Thus, we have developed a smartphone app that does just that. 

Additionally, see here for our recently published paper, which provides support for the idea that brief, self-administered happiness exercises can increase momentary happiness in individuals in recovery.19

References

  1. Hoeppner, B. B., Hoeppner, S. S., Kelly, L., Schick, M., & Kelly, J. F. (2017). Smiling Instead of Smoking: Development of a Positive Psychology Smoking Cessation Smartphone App for Non-daily Smokers. International journal of behavioral medicine, 24(5), 683–693. https://doi.org/10.1007/s12529-017-9640-9

  2. Hall, S. M., Muñoz, R. F., Reus, V. I., Sees, K. L., Duncan, C., Humfleet, G. L., & Hartz, D. T. (1996). Mood management and nicotine gum in smoking treatment: a therapeutic contact and placebo-controlled study. Journal of consulting and clinical psychology, 64(5), 1003–1009. https://doi.org/10.1037//0022-006x.64.5.1003

  3. Hall, S. M., Lightwood, J. M., Humfleet, G. L., Bostrom, A., Reus, V. I., & Muñoz, R. (2005). Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation. The journal of behavioral health services & research, 32(4), 381–392. https://doi.org/10.1007/BF02384199

  4. Hall, S. M., Humfleet, G. L., Reus, V. I., Muñoz, R. F., & Cullen, J. (2004). Extended nortriptyline and psychological treatment for cigarette smoking. The American journal of psychiatry, 161(11), 2100–2107. https://doi.org/10.1176/appi.ajp.161.11.2100

  5. Hall, S. M., Humfleet, G. L., Reus, V. I., Muñoz, R. F., Hartz, D. T., & Maude-Griffin, R. (2002). Psychological intervention and antidepressant treatment in smoking cessation. Archives of general psychiatry, 59(10), 930–936. https://doi.org/10.1001/archpsyc.59.10.930

  6. Hall, S. M., Reus, V. I., Muñoz, R. F., Sees, K. L., Humfleet, G., Hartz, D. T., Frederick, S., & Triffleman, E. (1998). Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Archives of general psychiatry, 55(8), 683–690. https://doi.org/10.1001/archpsyc.55.8.683

  7. van der Meer, R. M., Willemsen, M. C., Smit, F., Cuijpers, P., & Schippers, G. M. (2010). Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: a pragmatic randomized controlled trial. Addiction (Abingdon, England), 105(11), 1991–1999. https://doi.org/10.1111/j.1360-0443.2010.03057.x

  8. MacPherson, L., Tull, M. T., Matusiewicz, A. K., Rodman, S., Strong, D. R., Kahler, C. W., Hopko, D. R., Zvolensky, M. J., Brown, R. A., & Lejuez, C. W. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. Journal of consulting and clinical psychology, 78(1), 55–61. https://doi.org/10.1037/a0017939

  9. Watson, D., & Clark, L. A. (1997). Measurement and mismeasurement of mood: recurrent and emergent issues. Journal of personality assessment, 68(2), 267–296. https://doi.org/10.1207/s15327752jpa6802_4

  10. Davidson, R. J., Ekman, P., Saron, C. D., Senulis, J. A., & Friesen, W. V. (1990). Approach-withdrawal and cerebral asymmetry: emotional expression and brain physiology. I. Journal of personality and social psychology, 58(2), 330–341. https://pubmed.ncbi.nlm.nih.gov/2319445/

  11. Rabois, D., & Haaga, D. A. (2003). The influence of cognitive coping and mood on smokers' self-efficacy and temptation. Addictive behaviors, 28(3), 561–573. https://doi.org/10.1016/s0306-4603(01)00249-0

  12. Shiffman, S., Dunbar, M. S., Kirchner, T. R., Li, X., Tindle, H. A., Anderson, S. J., Scholl, S. M., & Ferguson, S. G. (2013). Cue reactivity in non-daily smokers: effects on craving and on smoking behavior. Psychopharmacology, 226(2), 321–333. https://doi.org/10.1007/s00213-012-2909-4

  13. Strong, D. R., Kahler, C. W., Leventhal, A. M., Abrantes, A. M., Lloyd-Richardson, E., Niaura, R., & Brown, R. A. (2009). Impact of bupropion and cognitive-behavioral treatment for depression on positive affect, negative affect, and urges to smoke during cessation treatment. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 11(10), 1142–1153. https://doi.org/10.1093/ntr/ntp111

  14. Strong, D. R., Leventhal, A. M., Evatt, D. P., Haber, S., Greenberg, B. D., Abrams, D., & Niaura, R. (2011). Positive reactions to tobacco predict relapse after cessation. Journal of abnormal psychology, 120(4), 999–1005. https://doi.org/10.1037/a0023666

  15. Cook, J. W., Spring, B., McChargue, D., & Hedeker, D. (2004). Hedonic capacity, cigarette craving, and diminished positive mood. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 6(1), 39–47. https://doi.org/10.1080/14622200310001656849

  16. Kahler, C. W., Spillane, N. S., Day, A. M., Cioe, P. A., Parks, A., Leventhal, A. M., & Brown, R. A. (2015). Positive Psychotherapy for Smoking Cessation: A Pilot Randomized Controlled Trial. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 17(11), 1385–1392. https://doi.org/10.1093/ntr/ntv011

  17. Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology. An introduction. The American psychologist, 55(1), 5–14. https://doi.org/10.1037//0003-066x.55.1.5

  18. Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. Journal of clinical psychology, 65(5), 467–487. https://doi.org/10.1002/jclp.20593

  19. Hoeppner, B. B., Schick, M. R., Carlon, H., & Hoeppner, S. S. (2019). Do self-administered positive psychology exercises work in persons in recovery from problematic substance use? An online randomized survey. Journal of substance abuse treatment, 99, 16–23. https://doi.org/10.1016/j.jsat.2019.01.006