Smoking Cessation Clinical Trial
Official title:
Individual, Acceptance and Commitment Therapy (ACT) in Smoking Cessation for People With Schizophrenia: a Randomized Controlled Trial
The purpose of this study is to evaluate the efficacy of using Acceptance and commitment therapy for smoking cessation for schizophrenic patients.
Background: Amongst people with mental disorders, the prevalence of smoking has been reported
to be the highest among people with schizophrenia, ranging from 54%-90%. It is more than two
to three times (20%-30%) of the general population. The co-occurrence of schizophrenia and
smoking will lead to a higher chance of smoking-related diseases such as cardiovascular
disease, liver diseases and reduced life expectancy. Currently, there is a large gap in
knowledge regarding smoking cessation in people with schizophrenia; there has been few
studies examining non-pharmacological interventions in smoking cessation on people with
schizophrenia. Acceptance and commitment therapy (ACT) for mental health disorders has found
that it has in general positive outcomes for the clients; improvements were consistently
found in a number of studies. ACT is more encouraging compared to traditional methods of
smoking cessation, where the individual is seen to be at fault for the habit. To date, no
randomized trial has been conducted to compare the effects of ACT in smoking cessation among
people with schizophrenia.
Objective: To evaluate the efficacy of Acceptance and Commitment Therapy (ACT) in enhancing
smoking cessation among people with schizophrenia living in the community.
Design: This is a randomised controlled trial. Individual, face to face, assessor-blinded
with assessments will be conducted before intervention, after intervention, and at the 6th
and 12th month after the initial session of ACT intervention.
Participants and setting: 160 individuals aged 18 years or older, currently smoking but not
undergoing any smoking cessation or similar programme, who were diagnosed with schizophrenia
and were referred to 4 community-based mental health rehabilitation settings by medical
doctors will be included in this trial.
Using the Six Core Processes in Intervention (Flaxman, Blackledge & Bond, 2010) Acceptance By
acceptance, ACT does not mean by the traditional sense of "letting go", "admitting faith
passively", or "do something after acknowledging the facts". Since psychological avoidance
toward distress, which can be unfavorable thoughts, emotions, will inevitably push individual
to evade such experiences, ACT attacks the problem by accepting the psychological distress as
it is, without distorting, interpreting or re-interpreting it through verbal constructs.
Defusion Patients frequently, if not inevitably, fall into the trap of fusing their thoughts
and appraisals with their self-concept. They are often so identified with the internal
dialogues that whenever a thought of judging themselves arise, they treat them as a valid
statement of evaluation on themselves. Cognitive defusion aims at creating a space between
the thought and its relation with the individual, with the effect that the words, thoughts,
and emotions are down-valued as a reference rather than a valid description of who we are.
Self as context Our sense of self is often derived from our experienced thoughts, emotions,
memories and physical sensations. This is called the self-as-content and is a readily
accessible self-concept most of us would refer to. By addressing the above experience,
especially the more frequent ones, we draw the conclusion that we are the person defined by
them. On the contrary, ACT adopts the notion of self-as-context and defines the self as that
stable, ever-present part of you that notices the transient thoughts, emotions, memories and
sensations that enter in and out of awareness. When the self-as-context is embraced, the self
is no longer defined as the various thoughts, feelings, and sensations, but as the person who
is having or noticing those experiences. Although ACT makes no attempt to discern which one
is a better representation of the self, it does appreciate self-as-context as a way to
examine the distance between those internal experiences and the self.
Contact with the Present Moment Making a closer contact with the present moment is the key to
seeing how effectively or ineffectively what we are behaving in the moment, and that places
us in a better position to change our behaviors as well as a higher motivation to do so.
However, thoughts are always pulling us away from the present moment and we are either in the
past or future. In fact, thoughts are about anything and everything except now.
Values Values are perhaps the most powerful reinforcers in driving us to our goal and at the
same time a valuable asset for individuals who are trying to live what they expect from life.
Instead of swamping oneself in numerous problems, issues, regrets, and longings, values
provide a powerful drive for patients to act according to what they want to become.
Therapist, on the other hand, have a consistent measure as to the way the patients have to
live up to their own expectations. Still more, therapist and patients are to endeavor
collaboratively in working out the qualities in realizing patients' values.
Committed Action If value is the train, commitment is the fuel that drives the person
forward. Value, together with commitment, is a non-binding guideline that points to the way
an individual can act. Therapist, on the other hand, is supposed to reinforce and encourage
behaviors that are consistent with the values. Any behaviors inconsistent with the values are
to be accepted as they are in a non-judgmental attitude, and the patient is encouraged to
choose again in accordance to his values. Commitment is not only viewed as a promise but also
actions that realize what one believes and upholds.
Competency of therapist:
The following are extracted from the core competencies self rating form posted at the website
of Association for Contextual Behavioral Science (Luoma, n.d.).
Basic competency in ACT The therapist is able to take heed of the patient's schizophrenic
background and introduce the concepts and skills of ACT in a simple language that is
compatible with the level of cognition and intelligence of the patient.
The therapist helps the patient to realize his beliefs, thoughts, desires, fears and worries
with smoking cessation.
The therapist assists the patient in addressing in-depth his/her motivations and values
regarding smoking cessation.
The therapist is capable of leading the patient to apprehend the futility of the attempts to
control the cravings and accept the urges as it is without necessarily yielding to them.
By guiding the patient to see the hopelessness of controlling craving, the therapist is able
to guide the patient to the ultimate solution-doing nothing, i.e., the mindfulness strategy
of observing the cravings without the need to do anything.
The therapist assists the patient to bring about actions in executing his/her values in a
practical manner amidst even the most unfavorable circumstances as perceived by the patient.
The therapist is able to master the six core processes of ACT and uses them flexibly by the
flow of the therapy and the need of the patient.
;
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