Smiling Instead of Smoking

SiS, “Smiling Instead of Smoking,” is an app that engages you in daily positive psychology exercises over the course of 7 weeks, and assigns “behavioral challenges” every 2-4 days to coach you through the steps towards smoking cessation. This is an app designed by scientists based on existing evidence and clinical guidelines regarding smoking cessation. We are currently conducting the large-scale efficacy testing of version 4 of the app. The key innovation of this app is its use of positive psychology, which is a promising new approach to smoking cessation. The happiness exercises used in this app have been fully vetted, and the app provides scientific facts and insights along the way (i.e., “Owl Wisdoms”).  Our goal is to inform and empower, while engaging you in daily practices that enhance and/or maintain your happiness, while you undertake the challenge of quitting smoking.

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iOS

FAQ

How well does it work?

The app you are downloading is version 3 of this app. It builds on the feedback received from participants in Studies 1 and 2 of this apps, who found the app easy to use and useful, and whose confidence to quit smoking increased, and urge to smoke decreased [1,2] In Study 1, 30% of study participants were biochemically confirmed to be abstinent from smoking 2 weeks after their chosen quit day. 6 months after their chosen quit day, 55% of study participants reported having been abstinent from smoking for the past 30 days [1]. In Study 2, 87% of participants reported that the SiS app helped them in their quit attempt, and 82% said it helped them stay positive while quitting. Self-reported abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after their chosen quit day, respectively [2]. In Study 3, a proof-of-concept randomized controlled trial testing version 3 of the app, SiS participants reported higher self-efficacy to quit smoking at the end of treatment, lower craving, and higher positive affect compared to the two control groups [3]. Study 4 (currently ongoing) is the fully powered large-scale trial that is testing if using the SiS app (compared to another smoking cessation app) improves smoking cessation.

Why use a positive psychology approach?

Mood plays a pivotal role in smoking, and mood-focused smoking cessation treatments have been developed and found to be effective in randomized controlled trials [4-10]. Typically, however, mood-focused interventions have focused on smokers with depression or depressive symptoms and have largely targeted negative affect.  Positive affect (i.e., happiness) is psychometrically distinct from negative affect [11], with different neural underpinnings [12], and differing psychosocial correlates [11]. It also plays an important role in smoking cessation.  Reductions in positive affect have been linked to increased temptation to smoke [13], and data from laboratory cue presentations indicate that exposure to positive affect cues reduces craving in both daily and non-daily smokers [14].  During smoking cessation, positive affect has been shown to decrease in the weeks leading up to the quit day [15], which is problematic, as decreases in positive affect on the quit day are associated with a greater risk for smoking relapse [16,17]. Thus, an intervention that enhances happiness should have a positive effect on smoking cessation – and indeed, a recent study suggests that it can do so successfully [18].  

Can simple, brief exercises actually enhance happiness?

Enhancing positive affect with brief, self-administered exercises is entirely feasible.  While positive affect interventions to improve smoking cessation outcomes are largely absent from the smoking cessation literature, an entire sub-discipline of psychology, coined positive psychology [20], is dedicated to understanding and enhancing the frequency and intensity of positive affect states. This research has led to the creation of positive psychology exercises that are designed to enhance positive states. A recent meta-analysis, spanning 51 positive psychology interventions and a total sample size of 4,266 participants, found that these positive psychology exercises have consistently led to improvements in overall well-being and reductions in depression [20].

Of note is the fact that these effects were achieved with very brief, self-administered positive activities rather than clinician-administered treatments [20]. That means that such exercises could conceivably be delivered via smartphone app.  Thus, we have developed a smartphone app that does just that. 

Additionally, see here for our recently published paper, which provides support for the idea that brief, self-administered happiness exercises can increase momentary happiness in individuals in recovery [21].

References

  1. Hoeppner, B., Hoeppner, S., Kelly, L., Schick, M., & Kelly, J. (2017). Smiling Instead of Smoking: Development of a Positive Psychology Smoking Cessation Smartphone App for Non-daily Smokers. International journal of behavioral medicine, 24. https://doi.org/10.1007/s12529-017-9640-9

  2. Hoeppner, B. B., Siegel, K. R., Carlon, H. A., Kahler, C. W., Park, E. R., & Hoeppner, S. S. (2021). A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study [Original Paper]. JMIR Form Res, 5(11), e29760. https://doi.org/10.2196/29760

  3. Hoeppner, B. B., Siegel, K. R., Futter, A. E., Finley-Abboud, D., Williamson, A. C., Kahler, C. W., Park, E. R., & Hoeppner, S. S. (2025). Smoking Cessation Smartphone App for Nondaily Smoking With Telephone Onboarding: Proof-of-Concept Randomized Controlled Trial [Original Paper]. JMIR Mhealth Uhealth, 13, e53971. https://doi.org/10.2196/53971

  4. Hall, S. M., Muñoz, R. F., Reus, V. I., Sees, K. L., Duncan, C., Humfleet, G. L., & Hartz, D. T. (1996). Mood management and nicotine gum in smoking treatment: a therapeutic contact and placebo-controlled study. Journal of consulting and clinical psychology, 64(5), 1003–1009. https://doi.org/10.1037//0022-006x.64.5.1003

  5. Hall, S. M., Lightwood, J. M., Humfleet, G. L., Bostrom, A., Reus, V. I., & Muñoz, R. (2005). Cost-effectiveness of bupropion, nortriptyline, and psychological intervention in smoking cessation. The journal of behavioral health services & research, 32(4), 381–392. https://doi.org/10.1007/BF02384199

  6. Hall, S. M., Humfleet, G. L., Reus, V. I., Muñoz, R. F., & Cullen, J. (2004). Extended nortriptyline and psychological treatment for cigarette smoking. The American journal of psychiatry, 161(11), 2100–2107. https://doi.org/10.1176/appi.ajp.161.11.2100

  7. Hall, S. M., Humfleet, G. L., Reus, V. I., Muñoz, R. F., Hartz, D. T., & Maude-Griffin, R. (2002). Psychological intervention and antidepressant treatment in smoking cessation. Archives of general psychiatry, 59(10), 930–936. https://doi.org/10.1001/archpsyc.59.10.930

  8. Hall, S. M., Reus, V. I., Muñoz, R. F., Sees, K. L., Humfleet, G., Hartz, D. T., Frederick, S., & Triffleman, E. (1998). Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Archives of general psychiatry, 55(8), 683–690. https://doi.org/10.1001/archpsyc.55.8.683

  9. van der Meer, R. M., Willemsen, M. C., Smit, F., Cuijpers, P., & Schippers, G. M. (2010). Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: a pragmatic randomized controlled trial. Addiction (Abingdon, England), 105(11), 1991–1999. https://doi.org/10.1111/j.1360-0443.2010.03057.x

  10. MacPherson, L., Tull, M. T., Matusiewicz, A. K., Rodman, S., Strong, D. R., Kahler, C. W., Hopko, D. R., Zvolensky, M. J., Brown, R. A., & Lejuez, C. W. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. Journal of consulting and clinical psychology, 78(1), 55–61. https://doi.org/10.1037/a0017939

  11. Watson, D., & Clark, L. A. (1997). Measurement and mismeasurement of mood: recurrent and emergent issues. Journal of personality assessment, 68(2), 267–296. https://doi.org/10.1207/s15327752jpa6802_4

  12. Davidson, R. J., Ekman, P., Saron, C. D., Senulis, J. A., & Friesen, W. V. (1990). Approach-withdrawal and cerebral asymmetry: emotional expression and brain physiology. I. Journal of personality and social psychology, 58(2), 330–341. https://pubmed.ncbi.nlm.nih.gov/2319445/

  13. Rabois, D., & Haaga, D. A. (2003). The influence of cognitive coping and mood on smokers' self-efficacy and temptation. Addictive behaviors, 28(3), 561–573. https://doi.org/10.1016/s0306-4603(01)00249-0

  14. Shiffman, S., Dunbar, M. S., Kirchner, T. R., Li, X., Tindle, H. A., Anderson, S. J., Scholl, S. M., & Ferguson, S. G. (2013). Cue reactivity in non-daily smokers: effects on craving and on smoking behavior. Psychopharmacology, 226(2), 321–333. https://doi.org/10.1007/s00213-012-2909-4

  15. Strong, D. R., Kahler, C. W., Leventhal, A. M., Abrantes, A. M., Lloyd-Richardson, E., Niaura, R., & Brown, R. A. (2009). Impact of bupropion and cognitive-behavioral treatment for depression on positive affect, negative affect, and urges to smoke during cessation treatment. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 11(10), 1142–1153. https://doi.org/10.1093/ntr/ntp111

  16. Strong, D. R., Leventhal, A. M., Evatt, D. P., Haber, S., Greenberg, B. D., Abrams, D., & Niaura, R. (2011). Positive reactions to tobacco predict relapse after cessation. Journal of abnormal psychology, 120(4), 999–1005. https://doi.org/10.1037/a0023666

  17. Cook, J. W., Spring, B., McChargue, D., & Hedeker, D. (2004). Hedonic capacity, cigarette craving, and diminished positive mood. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 6(1), 39–47. https://doi.org/10.1080/14622200310001656849

  18. Kahler, C. W., Spillane, N. S., Day, A. M., Cioe, P. A., Parks, A., Leventhal, A. M., & Brown, R. A. (2015). Positive Psychotherapy for Smoking Cessation: A Pilot Randomized Controlled Trial. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 17(11), 1385–1392. https://doi.org/10.1093/ntr/ntv011

  19. Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology. An introduction. The American psychologist, 55(1), 5–14. https://doi.org/10.1037//0003-066x.55.1.5

  20. Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. Journal of clinical psychology, 65(5), 467–487. https://doi.org/10.1002/jclp.20593

  21. Hoeppner, B. B., Schick, M. R., Carlon, H., & Hoeppner, S. S. (2019). Do self-administered positive psychology exercises work in persons in recovery from problematic substance use? An online randomized survey. Journal of substance abuse treatment, 99, 16–23. https://doi.org/10.1016/j.jsat.2019.01.006