Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial

Background Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. Results There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462

Exploring Mechanisms of Mental Illness Stigma Reduction in Asian Canadian Men: Exploration Des Mécanismes de la Réduction des Stigmates de la Maladie Mentale Chez les Hommes Canadiens d’origine Asiatique

Objective: Although there is evidence of effective stigma reduction by various psychological and educational interventions, the mechanisms of change remain unclear. In this article, we examine hypothesized processes that might have mediated reductions in stigma observed among Asian men who had received in mental health promotion interventions in Greater Toronto Area, Canada. Method: Our sample consisted of 495 Asian men, who received either acceptance and commitment therapy (ACT; n = 133), contact-based empowerment education (CEE; n = 149), combination of ACT and CEE ( n = 152), or psychoeducation ( n = 61). Group differences on intervention outcomes, including stigmatizing attitudes (Community Attitudes toward the Mentally Ill), internalized stigma (Internalized Stigma of Mental Illness), valued living (Valued Living Questionnaire), and attitudes to engage in social change (Social Justice Scale) were hypothesized to be due to the impact of the different interventions and mediated by changes in specific underlying psychological processes. These process-related changes were modelled using measures of mindfulness (Freiburg Mindfulness Inventory), psychological flexibility (Acceptance and Action Questionnaire version II), and empowerment (Empowerment Scale [ES]). Their pre- and post changes were analyzed with repeated measures analysis of variance, and mediational analyses were performed. Results: Findings from mediational analyses suggest that empowerment (ES) mediated a significant portion of the effects observed in reduction in stigmatizing attitudes and internalized stigma across intervention groups ( t = 3.67 to 3.78 for CEE groups, and t = 4.32 to 4.56 for ACT groups). For the ACT groups, reduction in internalized stigma might also have been partly mediated by psychological flexibility, an intervention-specific psychological process. Conclusions: Results from the current study suggest that different stigma reduction interventions may be mediated by increased empowerment as a common mechanism of change, while intervention-specific mechanism of change, improved psychological flexibility through ACT, may also contribute to improvement in internalized stigma.

Experiential Avoidance and Meaning in Life as Predictors of Valued Living: A Daily Diary Study

Values-based interventions encourage engagement in valued living as a means to promote psychological well-being. Valued living is best operationalized as ongoing, reinforcing behavioral patterns consistent with idiographic values that facilitate psychological well-being and improved mental health. Cross-sectional research illustrates positive associations between valued living and well-being and negative associations between valued living and psychopathology. However, it is important to have an understanding of different daily-level factors that predict fluctuations in valued living. Consistent with cognitive and behavioral models, meaning may positively relate to engagement in valued living, while experiential avoidance negatively relates to valued living. To address these relationships at the daily level, we systematically examined valued living, meaning, and experiential avoidance using ecological momentary assessment across 14 days with 73 college students. Multilevel modeling supported a positive relationship between meaning (i.e., at both the within- and between-person level) and daily valued living, above and beyond the within-person effects of experiential avoidance. The results elucidate a daily link between valued living and aspects of well-being. Further, these results show that constructs commonly assessed cross-sectionally fluctuate at the daily level, which sets the stage for future research programs that examine factors promoting and inhibiting fluctuations in meaning, experiential avoidance, and valued living. These results have important implications for prevention of mental health problems and promotion of psychological well-being.

Above and beyond emotional suffering: the unique contribution of compassionate and uncompassionate self-responding in chronic pain

ObjectivesStudies have shown that self-compassion plays a protective role against depression in women with chronic pain (CP). However, the majority of studies in CP have used the total score of the self-compassion scale (SCS), which have raised concerns due to potential overlap, not only between the uncompassionate self-responding factors and psychopathology, but also between self-compassion as a whole and other well-known psychological processes (e.g., mindfulness, acceptance, psychological flexibility). This calls for a more nuanced understanding of which components of (un)compassionate self-responding adds to better mental health in CP.MethodsThis study explores the unique contribution of compassionate and uncompassionate self-responding to depressive symptoms in women with CP undergoing pain consultation (n = 49).ResultsCorrelation analyses suggest that compassionate self-responding only significantly correlates with progress in valued living, while the uncompassionate self-responding significantly correlates with pain fusion, pain avoidance, obstructions to valued living and depression. Multiple regression analysis showed that self-compassion contributes to depressive symptoms (R2 = 8%) above and beyond pain intensity and disability (R2 = 12%) and psychological (in) flexibility processes (R2 = 31%), and uncompassionate (but not compassionate) self-responding uniquely contributes to depressive symptoms (sr2 = 18%).ConclusionsFindings suggest that uncompassionate self-responding is a stronger contributor to depression in CP than compassionate self-responding. Clinical implications are further discussed.

Examining Daily-Level Associations Between Nightly Alcohol Use and Next-Day Valued Behavior in College Students

Objective: Adverse consequences of binge drinking episodes are well-established, but fewer studies have investigated how incremental changes in daily alcohol use relate to well-being. We examined within- and between-person associations in alcohol use and next-day valued living to enhance our understanding of the impact of alcohol use on following-day outcomes in college students.Participants. During November 2018, 73 undergraduate participants (65.7% female) completed surveys through Qualtrics.Method: Using daily diary methodology, participants completed nightly surveys (N = 784) on their cellular devices over a two-week period.Results: Within-participant variations in evening alcohol use demonstrated a negative linear association with next-day valued living, controlling for relevant variables.Conclusions: Findings supplement other studies demonstrating the impact of individual variability in alcohol use on engagement in valued behaviors. Knowledge of the hazards of alcohol use within the context of valued living has the potential to inform alcohol use prevention and intervention programs.