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Smoking cessation is a pressing public health concern. Behavioral therapy has been widely promoted as a means to aid smoking cessation. Acceptance and commitment therapy (ACT), based on the principles of cognitive behavioral therapy, can help participants accept, rather than suppress, the physical and emotional experiences and thoughts associated with not smoking, identify experiential avoidance behaviors, strengthen the determination to quit, and ultimately commit to adaptive behavioral changes guided by smoking-cessation-related values, thereby achieving the goal of quitting smoking.
To assess the effects of ACT compared with other smoking cessation interventions by examining three key outcomes: cessation rates, smoking behaviors, and psychological outcomes.
We searched 8 databases and 2 registration platforms, covering the period from inception to March 26, 2025. We included only randomized controlled trials that recruited adult smokers and implemented ACT for smoking cessation, with the comparison group receiving either active treatment, no treatment, or any other intervention.
A total of 23 studies involving 8951 participants were included. The findings indicated that, compared with all types of control interventions, ACT significantly increased smoking cessation rates both immediately postintervention (RR = 1.48, 95% CI [1.03, 2.14], p = 0.04, I 2 = 81%) and at short-term follow-up (RR = 1.63, 95% CI = 1.31 to 2.01, p < 0.01, I 2 = 0%). Subgroup analyses showed that ACT significantly improved short-term cessation rates compared with behavioral support (RR = 1.60, 95% CI [1.27, 2.02], p < 0.01, I 2 = 0%), while, compared with the blank control, ACT significantly increased smoking cessation rates across three different time points (postintervention: RR = 3.11, 95% CI [2.13, 4.54], p < 0.01, I 2 = 0%; medium-term follow-up: RR = 2.55, 95% CI [1.32, 4.93], p < 0.01; long-term follow-up: RR = 3.33, 95% CI [1.66, 6.68], p < 0.01). Narrative synthesis suggested that compared with behavioral therapy, ACT may confer benefits in improving psychological outcomes, while compared with the blank control, it may also reduce daily cigarette consumption and nicotine dependence, and enhance psychological outcomes.
Acceptance and commitment therapy may be a beneficial approach for improving cessation rates, enhancing smoking cessation behaviors, and promoting psychological well-being among adult smokers. However, the quality of the included evidence was limited, thereby weakening the strength of these findings. Future rigorously designed trials with larger sample sizes, particularly those comparing ACT against other smoking cessation interventions, are warranted to further confirm its effects.
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