Table 1 Overview of the content of the 11 modules included in the nuumi behavioral therapy
Module | Educational content | Exercises |
|---|---|---|
Fundamentals | Psychoeducational content on the mechanisms of cigarette dependence is provided. Nuumi use guidelines as well as technological and safety aspects of EC use are discussed. Content supporting the transition from cigarettes to the EC is featured e.g. (implementation intentions [83], social support) | - Formulation of if–then plans [83] aiming at using the EC instead of cigarettes - Preparation of physical and social environment for quitting cigarette use (removing cigarettes and physical triggers; informing social environment and asking for support) |
1. Habits and addiction | In-depth information is provided on formation and maintenance of habits and addiction, explaining the role of nicotine and the dopaminergic reward system, supporting individuals in gaining a deeper understanding of their addiction as a basis for learning effective strategies to overcome it | - Reflection of daily habits, including rating them (beneficial, non-beneficial, neutral) - Reflection of personal smoking history - Motivational interview: assessment of participants’ preparedness for quitting, individual motivations for quitting smoking, and the advantages and disadvantages of continuing to smoke versus quitting |
2. The way out of addiction | Participants learn about effective, positive goal setting in health behavior change [60] and are prompted to formulate their individual goal for the nuumi program. Participants learn about the different stages and principles of behavior change and the life-long learning capacity of the human brain (i.e. neuroplasticity) | - Formulation of a positively framed individual goal for the program (e.g. “I want to be a non-smoker.”, “I want to live a dependence-free live”) - Quiz - Reflection of novel and positive experiences in the past days |
3. Stress | Psychoeducation on stress and its role in smoking cessation and relapse is provided. Participants learn what the short-term and long-term consequences of stress can be and how they can recognize stress in themselves | - Assessment of current stress level - Exploration of individual stress warning signals - Guided body scan meditation - Reflection of novel and positive experiences in the past days |
4. Relaxation | Content on the role of relaxation as an antagonist of stress is provided. Participants are taught to differentiate between active and passive methods of relaxation. Information is provided regarding the positive effects of regular relaxation practice on focus, emotion regulation, body awareness, sleep, and self-regulation | - Diaphragmic breathing - Breathing meditation - SBRC technique (stop—breathe—reflect—choose) - Reflection of novel and positive experiences in the past days |
5. Mindfulness | Psychoeducation on mindfulness (formal versus informal) and an introduction to meditation is provided. Participants are prompted to practice guided mindful walking and learn about the benefits of mindfulness for smoking cessation and relapse prevention. Individuals are asked to identify their triggers for smoking/use of EC and learn to practice awareness when encountering relapse triggers in their daily life | - Five senses exercise as a coping strategy to stop rumination in demanding situations during withdrawal or stressful situations - Mindful walking meditation - Quiz - Identification of smoking/EC use triggers - Reflecting on novel and positive experiences in the past days |
6. Thoughts | Information on thoughts, mental distortions and maladaptive coping mechanisms (e.g. smoking) is provided. Exercises target identification of irrational and maladaptive thought patterns about, among other topics, smoking (e.g. “I will never be able to enjoy life anymore without smoking.”) and teach coping strategies like cognitive restructuring, and thought labelling | - Thought labelling - Practice of questioning thoughts critically - Reflection of novel and positive experiences in the past days |
7. Emotions | Psychoeducational content features information on adaptive and maladaptive emotion regulation strategies. Participants develop an understanding about how emotions affect smoking cravings and behavior and learn to employ cognitive restructuring and labelling techniques to cope with negative affect. Participants are educated about self-compassion, are invited to reflect about their own degree of self-compassion, and learn strategies to increase this skill | - Emotion labelling - Urge surfing [57] to cope with negative mood and smoking cravings - Pause button; an exercise to learn taking breaks to mindfully recognize emotions - Reflection of novel and positive experiences in the past days |
8. Nutrition and exercise | Participants are introduced to the concepts of mindful and healthy eating and learn how to manage food cravings. Physical exercise is emphasized as an effective strategy for overcoming cravings and for weight control after quitting smoking. Participants are further educated about the pitfalls of alcohol in smoking cessation and are introduced to coping strategies | - SBRC technique is repeated - Visualization of obstacles for eating healthy and exercising regularly and formulating if–then plans for how to overcome these obstacles - Reflection of novel and positive experiences in the past days |
9. Handling relapse | Relapse prevention content consists of educating participants about the role and effects of negative thought spirals after relapse. Participants are advised to see relapses as temporary setbacks, and are encouraged to avoid blaming themselves. Coping strategies like urge surfing and SBRC technique are repeated. Also, the role of social support in successful relapse prevention is highlighted | - Assessment of participants’ preparedness for quitting using also the EC, and re-assessment of individual motivations for quitting smoking/EC use - Safety net: Participants are asked to identify people in their environment to support them on their relapse prevention journey - Mountain meditation as a tool for remaining calm during stressful situations, e.g. when cravings occur - Reflection of novel and positive experiences in the past days |
10. Your New Me | Participants’ stress levels are re-evaluated, and they are prompted to reflect on their stress warning signals and coping skills, as well as to reflect on potential changes that occurred in the span of the course. Coping strategies such as practicing mindfulness when encountering triggers, urge surfing, SBRC technique, Five Senses, and breathing meditation are repeated, and implementation intentions [83] are recommended to be used to implement the adoption of these coping strategies into daily life | - Visualization exercise to identify future situations which could potentially lead to relapse and learn to prepare for such situations - Reflection of the nuumi program |