Positive Psychotherapy for Smoking Cessation Enhanced with Text Messaging: A Randomized Controlled Trial

Introduction Positive Psychology Interventions (PPIs) aim to enhance well-being and have shown promise in improving mental health and augmenting behavioral interventions. Although pilot studies have suggested PPIs may support smoking cessation, no full-scale randomized clinical trials (RCTs) have tested their efficacy in this context. Method In this RCT, 271 adults who smoked > 5 cigarettes per day (55.2% female, mean age = 49.2 (SD = 12.0); average cigarettes per day = 16.9 [SD = 7.0]) were randomized to six sessions of Positive Psychotherapy for Smoking Cessation with text messaging (PPT-S+) or a time-matched standard treatment with text messaging (ST+). All participants received eight weeks of nicotine replacement therapy (transdermal nicotine patch). The primary outcome was biochemically-confirmed 7-day point-prevalence smoking abstinence at 12, 26, and 52 post quit date. Results Seven-day point-prevalence abstinence did not differ significantly by condition: 20.9%, 19.4%, and 19.4% at 12, 26, and 52 weeks in PPT-S+ compared to 19.1%, 20.6%, and 21.4% at 12, 26, and 52 weeks in ST+. Conditions did not differ in self-reported use of positive psychology-consistent strategies for quitting smoking at posttreatment, representing an implementation failure, and these strategies did not significantly predict subsequent smoking outcomes. Those in ST+ rated the text messaging program as significantly more helpful than those in PPT-S+. Conclusions PPT-S+ did not improve smoking cessation outcomes compared to a time-matched control. The completion of positive psychology exercises through text messaging may have reduced the helpfulness of the text-messaging support program received in both conditions.