Spontaneous but not induced self-affirmation is associated with smoking cessation in a mobile app randomized controlled trial

Background: Most smokers attempt cessation numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. Objectives: This study examined whether self-affirmation was associated with smoking cessation in the context of a cessation app. Two types of self-affirmation were examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publiclyavailable smoking cessation application (Smoke Free - Quit Smoking Now). Additionally, this study explored whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predicted smoking cessation. Methods: All users who met inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to one of four conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully-automated and all data were collected through self-assessments in the application. Self-reported smoking cessation was assessed 1 month and 3 months following study entry. Results: The study enrolled 7,899 participants; 647 completed the 1-month follow up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% of participants (569/7,899) self-reported not smoking in the previous week and 6.4% (503/7,899) selfreported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted greater likelihood of cessation (p<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. Additionally, spontaneous self-affirmation did not moderate the relationship between the selfaffirmation inductions and cessation. Greater baseline sadness was associated with lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation. Conclusions: Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced selfaffirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmations. Trial Registration: This study was intended to replicate our team’s earlier study (Taber et al., 2016) in a different setting.