AN INTEGRATED DIGITAL THERAPEUTIC APPROACH TO SMOKING CESSATION IN ADULT SMOKERS: PRELIMINARY RANDOMIZED CONTROLLED TRIAL
Authors: Pyeon *Arom , Chun Ji-Won , Jo Yeong Seon , Hu Min Kyung , Kim Dai Jin 
Published: February 2025

Abstract

Background
Nicotine dependence is a chronic and recurrent disease that requires long-term and consistent therapeutic management (John et al., 2004). Traditional treatments have included taking prescription medications and face-to-face counseling based on cognitive behavioral therapy (CBT) (Killen et al., 2008). In many cases, however, some patients may not take their medications as described, which can reduce their effectiveness. Face-to-face counseling for smoking cessation frequently necessitates numerous visiting, which is time-consuming and expensive for patients. Therefore, new approaches are needed to help treat addictive smoking behavior.

Aims & Objectives
Digital therapeutics can be an alternative option that can supplement the limitation of existing treatment for smoking cessation, by increasing accessibility and affordability. The purpose of this study was to evaluate the safety and effectiveness of the program for smoking cessation.

Method
For smoking cessation, we developed a treatment program that is a combination of a mobile application and VR. The program was based on cognitive behavioral treatment (CBT) and focuses on the change of the dysfunctional and irrational thoughts, beliefs, and behaviors that are associated with smoking (Tudor-Sfetea et al., 2018). Examples of strategies used in this program include ‘Relaxation techniques’, ‘Re-framing thoughts’, ‘Problem-solving’, and ‘Social support’. In addition, the motivational enhancement therapy (MET) approach was used to help the individual identify their reasons for wanting to quit and to increase their awareness of the benefits of quitting. Adult men and women (N=30) who visited the Seoul St. Mary’ s Hospital to receive smoking cessation treatment were randomly assigned to [digital treatment group (DTG)] or [basic treatment group (BTG)]. DTG used the treatment application for 12 weeks, performed the CBT-based educational content given for each week, and kept daily smoking/cessation records. Additionally, they visited the hospital at 4-week intervals to conduct VR training, consisting of relaxation training, skills to deal with cravings, and problem-solving. BTG was provided with standardized educational materials for smoking cessation for 12 weeks and watched a CBT-based smoking cessation education video every 4 weeks. Both groups received the same level of medications for smoking cessation medication as before for the duration of the study.

Results
The abstinence rate at 12 weeks for DTG showed 55.6%, and BTG showed 38.5%. The average number of cigarettes smoked over the course of seven days at the 12-week mark was 2.2 for DTG and 14.4 for BTG, showing minimal cigarette usage in DTG.

Discussion & Conclusion
The CBT-based treatment application has the potential to increase the effectiveness of smoking cessation treatment by expanding access to ongoing therapeutic intervention and smoking cessation treatment. This study suggests that a new therapeutic intervention called complementary digital therapy for smoking cessation treatment can potentially contribute to reducing smoking problems in light to heavy smokers.

References
1.JOHN, U., MEYER, C., HAPKE, U., RUMPF, H.-J. & SCHUMANN, A. 2004. Nicotine dependence, quit attempts, and quitting among smokers in a regional population sample from a country with a high prevalence of tobacco smoking. Preventive Medicine, 38, 350-358.
2.KILLEN, J. D., FORTMANN, S. P., SCHATZBERG, A. F., ARREDONDO, C., MURPHY, G., HAYWARD, C., CELIO, M., CROMP, D., FONG, D. & PANDURANGI, M. 2008. Extended cognitive behavior therapy for cigarette smoking cessation. Addiction, 103, 1381-90.
3.TUDOR-SFETEA, C., RABEE, R., NAJIM, M., AMIN, N., CHADHA, M., JAIN, M., KARIA, K., KOTHARI, V., PATEL, T., SUSEEHARAN, M., AHMED, M., SHERWANI, Y., SIDDIQUI, S., LIN, Y. & EISINGERICH, A. B. 2018. Evaluation of Two Mobile Health Apps in the Context of Smoking Cessation: Qualitative Study of Cognitive Behavioral Therapy (CBT) Versus Non-CBT-Based Digital Solutions. 6, e98.