Effect of technology-based acceptance and commitment therapy for smoking cessation: A systematic review and meta-analysis.

BACKGROUND

Tobacco use remains one of the world's greatest public health challenges, contributing substantially to morbidity and mortality. Effective and accessible smoking cessation interventions are essential to reducing tobacco-related health risks. Acceptance and Commitment Therapy (ACT) has demonstrated efficacy in enhancing quit rates. However, the effectiveness of technology-based ACT, a more accessible modality, has not yet been comprehensively studied and synthesized.

OBJECTIVE

To assess the overall and subgroup effectiveness of technology-based ACT interventions for smoking cessation compared with active comparators.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, CENTRAL, CINAHL, Embase, PsycInfo, Ovid and Web of Science from the database inception until March 2025 were searched. Additionally, we searched Clinicaltrials.gov. and the Association of Contextual Behavioral Science Web site which contains a list of ACT randomized controlled trials from 1986 to March 2025. The risk of bias of the studies included was assessed using the revised Cochrane risk-of-bias tool. Random-effects models were selected and statistical analyses were performed using ReviewManager. Subgroup analyses were undertaken by stratifying studies according to delivering methods. Sensitivity analysis using complete case data was conducted. Publication bias was tested by funnel plots. The primary outcomes were quit rates at different time points. The secondary outcomes were number of cigarettes smoked daily and utilization of intervention.

RESULTS

Fifteen randomized controlled trials including 8699 patients were included in the meta-analysis. Technology-based ACT interventions significantly increased smoking cessation rates at ≤3 months follow-up compared with active comparators (RR = 1.42, 95 % CI: 1.07, 1.89). Subgroup analysis found that ACT interventions were more effective than active comparators when delivered via a smartphone application (RR = 1.72, 95%CI: 1.42-2.08). No significant differences were found at 3 to 6 months (RR = 1.23, 95%CI: 0.93-1.62) and 12-month (RR = 1.08, 95%CI: 0.86-1.35) follow-ups, and ACT did not significantly reduce number of cigarettes smoked daily (MD = 0.12, 95%CI: -2.45-2.69). However, technology-based ACT interventions demonstrated a beneficial effect on intervention utilization (SMD = 0.39, 95%CI: 0.27-0.52).

CONCLUSIONS

This review and meta-analysis found that technology-based ACT interventions, particularly those delivered via mobile applications, were significantly more effective in promoting smoking cessation than active comparators at the ≤3-month follow-up. However, no significant differences were observed at the 3 to 6-month and 12-month follow-ups. Given the limited number of included studies, more studies, especially those with long-term follow-ups, are needed before more definitive conclusions can be made.

REGISTRATION: This study was registered in PROSPERO (CRD42022311210).